VERxVE Study on Efficacy and Safety of Nevirapine XR in Comparison to Nevirapine IR With Truvada in Naive HIV+ Patients

Study Overview
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Brief Summary
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The primary objective of this study is to evaluate the efficacy of 400 mg QD nevirapine extended release (NVP XR) formulation versus 200 mg BID nevirapine immediate release (NVP IR) in ARV therapy naïve HIV-1 infected patients after 48 weeks of treatment. Secondary objectives are to evaluate safety and pharmacokinetics of NVP XR and NVP IR.

Official Title
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A Randomised, Double Blind, Double Dummy, Parallel Group, Active Controlled Trial to Evaluate the Antiviral Efficacy of 400 mg QD neVirapine Extended Release Formulation in Comparison to 200 mg BID neVirapinE Immediate Release in Combination With Truvada® in Antiretroviral Therapy naïve HIV-1 Infected Patients (VERxVE)

Conditions
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HIV Infections

Intervention / Treatment
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* Drug: nevirapine IR
* Drug: nevirapine XR


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Signed informed consent in accordance with Good Clinical Practice and local regulatory requirements prior to trial participation HIV-1 infected males or females >= 18 years of age with positive serology (ELISA) confirmed by Western blot No previous antiretroviral treatment Males with CD4+ counts >50 - <400 cells/ml or females with CD4+ counts >50-<250 cells/ml Adequate renal function defined as a calculated creatinine clearance (CLCr) greater than or equal to 50 mL/min according to the Cockcroft-Gault formula as follows: Male: (140 - age in years) x (weight in kg) divided by 72 x (serum creatinine in mg/dl) = CLCr (mL/min). Female: (140 - age in years) x (weight in kg) divided by 72 x (serum creatinine in mg/dl) x 0.85 = CLCr (mL/min). Karnofsky score >70 (see Appendix 10.4) An HIV-1 viral load of 1,000 copies/mL Willingness to initiate CD4+ cell count-guided chemoprophylaxis to prevent important opportunistic infections as defined in Appendix 10.2 Willingness to abstain from ingesting substances which may alter plasma study drug levels by interaction with the cytochrome P450 system (listed in Appendix 10.3) during the study. For centers participating in the PK substudy only: Written informed consent in accordance with GCP and local legislation for participation in the PK substudy. Refusal to participate in the PK substudy is not an exclusion criterion for participation in the trial. Only study centers with previous experience and equipped in handling PK samples are eligible for participation in the substudy. Exclusion criteria: Active drug abuse or chronic alcoholism at the investigator's discretion Active hepatitis B or C disease, defined as HBsAg-positive and HBV-DNA-positive or HCV-RNA-positive Female patients of child-bearing potential who: are pregnant at screening; are breast feeding; are planning to become pregnant; are not willing to use a barrier method of contraception, or; are not willing to use methods of contraception other than ethinyl estradiol containing oral contraceptives Note: During participation in this study, females and males have to use barrier methods of contraception in addition or instead of ethinyl estradiol containing oral contraceptives. Laboratory parameters >DAIDS Grade 2 ALT/AST > DAIDS Grade 1 Hypersensitivity to any ingredients of the test products Previous use of Viramune® (nevirapine) or any other antiretroviral agents (does not include use of single dose NVP for the prevention of mother to child transmission) Resistance to NNRTIs or either one of the components of Truvada® (emtricitabine or tenofovir disoproxil fumarate) or lamivudine (3TC) based on HIV-1 genotypic resistance testing report obtained at screening Patients who are receiving other concomitant treatments which are not permitted, as described in the prescribing information Use of investigational medications (any experimental agent other than the study regimen) within 30 days before study entry or during the trial Use of immunomodulatory drugs within 30 days before study entry or during the trial (e.g., interferon, cyclosporin, hydroxyurea, interleukin 2) Patients who have been diagnosed with malignant disease Patients who in the opinion of the investigator are not candidates for inclusion in the study Patient with Progressive Multifocal Leukoencephalopathy (PML), Visceral Kaposi's Sarcoma (KS), and/or any lymphoma Any AIDS defining illness that is unresolved, symptomatic or not stable on treatment for at least 12 weeks at screening visit

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: nevirapine XR<br>400 mg QD | Drug: nevirapine XR<br>* 400 mg QD<br>|
| Active Comparator: nevirapine IR<br>200 mg BID | Drug: nevirapine IR<br>* 200 mg BID<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of Proportion of Virologic Response at Week 48 Using Lower Limit of Quantification (LLOQ) = 50 Copies/mL, Full Analysis Set Population | Primary endpoint was the number of patients with a sustained virologic response through week 48 using LLOQ = 50 copies/mL | week 48 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Kaplan-Meier Estimates of the Proportions of Patients Without Loss of Virologic Response Using Lower Limit of Quantification (LLOQ) = 50 Copies/mL, Full Analysis Set Population |  | week 0 to 144 | 
| Proportion of Sustained Virologic Response at Week 144 Using Lower Limit of Quantification (LLOQ) = 50 Copies/mL, Full Analysis Set Population | Endpoint was the number of patients with a sustained virologic response through week 144 using LLOQ = 50 copies/mL | week 144 | 
| Kaplan-Meier Estimates for Time to New AIDS or AIDS-related Progression Event or Death, Full Analysis Set Population |  | week 0 to 144 | 
| Comparison of HIV-1 Viral Load (log10 Copies/mL) Change From Baseline at Week 144, Full Analysis Set Population |  | baseline, week 144 | 
| Comparison of CD4+ Cell Count (Cells/Cubic Millimeter) Change From Baseline at Week 144, Full Analysis Set Population |  | baseline, week 144 | 
| Occurrence of Rashes | Frequency of patients with drug related rash events by functional grouping | until last patient completed 144 weeks (up to 193 weeks) | 
| Occurrence of Elevations in Laboratory Measurement by DAIDS Grade |  | until last patient completed 144 weeks (up to 193 weeks) | 
| Kaplan -Meier Estimate of Cumulative Probability of Permanent Discontinuation of Study Medication |  | week 0 to 144 | 
| Kaplan -Meier Estimate of Cumulative Probability of Grade 3 or 4 ALT/AST Abnormalities |  | week 0 to 72 | 
| Kaplan -Meier Estimate of Cumulative Probability of Grade 3 or 4 Asymptotic Transaminases Abnormalities |  | week 0 to 72 | 
| Kaplan -Meier Estimate of Cumulative Probability of Clinical Hepatic Events |  | week 0 to 72 | 
| Kaplan -Meier Estimate of Cumulative Probability of Group III or IV Drug-related Rash |  | week 0 to 72 | 
| Relative Bioavailability Trough C_pre,ss,1 | Relative bioavailability measured of trough concentrations. Analysis based on adjusted by-treatment geometric means, the adjusted geometric mean ratio of NVP XR : NVP IR and it's 90% confidence interval with p-value and the inter-individual geometric coefficient of variation. | week 132 | 
| Occurrence of Hepatic Events | Frequency of patients with hepatitis symptoms | until last patient completed 144 weeks (up to 193 weeks) |