Ignite Creation Date:
2024-05-05 @ 9:01 PM
Last Modification Date:
2024-10-26 @ 9:57 AM
Study NCT ID:
NCT00792324
Status:
COMPLETED
Last Update Posted:
2009-11-18
First Post:
2008-11-14
Brief Title:
Pilot Study Switching Individuals Receiving EFV With Continuing Central Nervous System Toxicity to TMC125
Sponsor:
St Stephens Aids Trust
Organization:
St Stephens Aids Trust
Study Overview
Official Title:
A Phase III Double Blind Mulit-centre Randomised Placebo Controlled Pilot Study to Assess the Feasibility of Switching Individuals Receiving Efavirez With Continuing Central Nervous System CNS Toxicity to TMC125
Status:
COMPLETED
Status Verified Date:
2009-11
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The purpose of the study is to examine the effect of switching from an antiretroviral combination that includes efavirenz Susitiva in individuals experiencing efavirenz-related side effects and replacing this with an investigational HIV medication called Etravirine TMC125
The study will primarily investigate the effect of change in medication on your viral load the levels of the HIV virus in your blood on immunological parameters CD4 count on other safety parameters such as cholesterol your side effects and also on your quality of life
The study will primarily investigate the effect of change in medication on your viral load the levels of the HIV virus in your blood on immunological parameters CD4 count on other safety parameters such as cholesterol your side effects and also on your quality of life
Detailed Description:
The majority of individuals who commence treatment for HIV in the UK start with a regimen that includes EFV in combination with other antiretrovirals These regimens are convenient once daily dosing and highly efficacious However EFV has several potential drawbacks including continued CNS toxicity the potential for teratogenesis and a low barrier to the development of virological resistance In the past the only alternative NNRTI available was nevirapine which appears to have a lower rate of virological success and is associated with potentially life threatening toxicities including hepatotoxicity and cutaneous toxicity including the Stevens-Johnson syndrome
Clinically controlled trials frequently reported undesirable nervous system side effects in patients receiving 600 mg EFV with other antiretroviral agents including dizzinessinsomnia somnolence impaired concentration and abnormal dreaming CNS symptoms of moderate to severe intensity were experienced by 194 of patients compared to 90 of patients receiving control regimens These symptoms were severe in 20 of patients receiving EFV 600 mg daily and in 13 of patients receiving control regimens In clinical studies 21 of patients treated with 600 mg of EFV discontinued therapy because of nervous system symptoms
Nervous system symptoms usually begin during the first one or two days of therapy and often resolve after the first 2 -4 weeks However in a significant proportion of individuals it continues with an adverse effect on quality of life CNS toxicity may also worsen drug compliance In a study of uninfected volunteers a representative nervous system symptom had a median time to onset of 1 hour post dose and a median duration of 3 hours
Nervous system symptoms may occur more frequently when EFV is taken concomitantly with meals possibly due to increased EFV plasma Dosing at bedtime seems to improve the tolerability of these symptoms and can be recommended during the first weeks of therapy and in patients who continue to experience symptoms although this is not always successful and may be associated with vivid or disturbing dreams Dose reduction or splitting the daily dose has not been shown to provide benefit
Other adverse events associated with efavirenz include rash 5-26 usually minorincreased cholesterol 20-40 and triglycerides 6-11 diarrhea 3-14 nausea and hyperglycemia 2-5 Serious psychiatric adverse events such as precipitation of psychosis seizure suicidal ideation paranoia mania and aggression have also been associated with use These are seen in 1 taking EFV and are thought to be more likely in those with a history of mental illnessdrug abuse or predisposition to psychological reactions
TMC125 is a diarylpyrimidine derivative that has proven efficacy against HIV-1 including activity in viral isolates with existing NNRTI signature mutations Resistance to TMC125 also appears to develop less readily than to EFV and NVP This has been attributed to its molecular structure TMC125 has demonstrated safety and efficacy in short term studies in both treatment-naïve and NNRTI-resistant HIV-1 infected patients
Recently published results from phase 3 trials give further support to these findings with efficacy in reduction of HIV-1-RNA levels seen in patients with substantial NNRTI and PI resistance when treated with TMC125 plus an optimized background
TMC-125 is generally well tolerated and in particular has lower reported rates of CNS toxicity than EFV Animal studies have shown a low risk of teratogenesis The major toxicity of TMC125 has been skin rash which is usually self-limiting In the repeated dose trials the adverse events AEs reported in more than 10 of all subjects were headache somnolence diarrhea flatulence nausea and vomiting fatigue fever rashand pruritus Overall AEs were mild to moderate in intensity with no apparent doseresponse relationship No consistent or clinically relevant changes in electrocardiogram ECG or vital signs were observed with single and repeated TMC125 dosing
TMC125 is a new NNRTI with proven efficacy against HIV-1 with several potential advantages over EFV including no CNS toxicity and a high barrier to the development of resistance This study aims to investigate whether substitution of EFV with TMC125 leads to improvement of CNS toxicity with continued virological suppression and immunological reconstitution and whether this is associated with an improvement in quality of life
Clinically controlled trials frequently reported undesirable nervous system side effects in patients receiving 600 mg EFV with other antiretroviral agents including dizzinessinsomnia somnolence impaired concentration and abnormal dreaming CNS symptoms of moderate to severe intensity were experienced by 194 of patients compared to 90 of patients receiving control regimens These symptoms were severe in 20 of patients receiving EFV 600 mg daily and in 13 of patients receiving control regimens In clinical studies 21 of patients treated with 600 mg of EFV discontinued therapy because of nervous system symptoms
Nervous system symptoms usually begin during the first one or two days of therapy and often resolve after the first 2 -4 weeks However in a significant proportion of individuals it continues with an adverse effect on quality of life CNS toxicity may also worsen drug compliance In a study of uninfected volunteers a representative nervous system symptom had a median time to onset of 1 hour post dose and a median duration of 3 hours
Nervous system symptoms may occur more frequently when EFV is taken concomitantly with meals possibly due to increased EFV plasma Dosing at bedtime seems to improve the tolerability of these symptoms and can be recommended during the first weeks of therapy and in patients who continue to experience symptoms although this is not always successful and may be associated with vivid or disturbing dreams Dose reduction or splitting the daily dose has not been shown to provide benefit
Other adverse events associated with efavirenz include rash 5-26 usually minorincreased cholesterol 20-40 and triglycerides 6-11 diarrhea 3-14 nausea and hyperglycemia 2-5 Serious psychiatric adverse events such as precipitation of psychosis seizure suicidal ideation paranoia mania and aggression have also been associated with use These are seen in 1 taking EFV and are thought to be more likely in those with a history of mental illnessdrug abuse or predisposition to psychological reactions
TMC125 is a diarylpyrimidine derivative that has proven efficacy against HIV-1 including activity in viral isolates with existing NNRTI signature mutations Resistance to TMC125 also appears to develop less readily than to EFV and NVP This has been attributed to its molecular structure TMC125 has demonstrated safety and efficacy in short term studies in both treatment-naïve and NNRTI-resistant HIV-1 infected patients
Recently published results from phase 3 trials give further support to these findings with efficacy in reduction of HIV-1-RNA levels seen in patients with substantial NNRTI and PI resistance when treated with TMC125 plus an optimized background
TMC-125 is generally well tolerated and in particular has lower reported rates of CNS toxicity than EFV Animal studies have shown a low risk of teratogenesis The major toxicity of TMC125 has been skin rash which is usually self-limiting In the repeated dose trials the adverse events AEs reported in more than 10 of all subjects were headache somnolence diarrhea flatulence nausea and vomiting fatigue fever rashand pruritus Overall AEs were mild to moderate in intensity with no apparent doseresponse relationship No consistent or clinically relevant changes in electrocardiogram ECG or vital signs were observed with single and repeated TMC125 dosing
TMC125 is a new NNRTI with proven efficacy against HIV-1 with several potential advantages over EFV including no CNS toxicity and a high barrier to the development of resistance This study aims to investigate whether substitution of EFV with TMC125 leads to improvement of CNS toxicity with continued virological suppression and immunological reconstitution and whether this is associated with an improvement in quality of life
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None