A Randomized, Phase II, Placebo Controlled Trial of Abacavir (ABC, 1592U89) in Combination With Open-Label Indinavir Sulfate (IDV) and Efavirenz (EFV, DMP-266) in HIV-Infected Subjects With Nucleoside Analog Experience: A Rollover Study for ACTG 320
Therapeutically, there is a need to explore potent alternative therapy for patients who have
received, or are currently receiving, a double nucleoside analog combination including
lamivudine (3TC), a regimen that was proven to be clinically inferior to indinavir (IDV)
when combined with zidovudine/3TC in study ACTG 320. In order to produce and maintain a
maximal antiviral response, all patients in this study will receive 2 or 3 potent, new
agents; ABC, a nucleoside analog, EFV, a non-nucleoside reverse transcriptase inhibitor
(NNRTI), and IDV, a protease inhibitor. Virologically, the major question this protocol
seeks to answer is how prior 3TC exposure in a dual nucleoside regimen influences the
response to subsequent treatment. It is unclear whether it is best to add a protease
inhibitor either 1) an NNRTI at 1 of 2 doses, or 2) an NNRTI at 1 of 2 doses plus a new
nucleoside analog to achieve plasma HIV RNA levels that are below the limits of detection.
Prior to randomization, patients are stratified by CD4 cell count (cells/mm3): less than or
equal to 50 versus greater than 50 and by ACTG 320 participation: enrolled versus not
enrolled. Patients with greater than 50 CD4 cells/mm3 are randomized to 1 of 4 treatment
arms (Arms I, II, III, or IV) and patients with less than or equal to 50 CD4 cells/mm3 are
randomized to 1 of 2 treatment arms (Arms I and II). All patients will be followed for 48
weeks beyond the enrollment of the last patient. The regimens for the treatment arms are as
follows: Arm I - indinavir (IDV) plus EFV plus ABC placebo bid, Arm II - IDV (higher dose)
plus EFV (lower dose) plus ABC, Arm III - IDV plus EFV plus ABC placebo, and Arm IV - IDV
(higher dose) plus EFV (lower dose) plus ABC. If 15 week data indicates this is a reasonable
dosing regimen, the sample size in Arms III and IV will be expanded to include additional
patients with a CD4 count greater than 50 cells/mm3 and allow for equal enrollment across
all 4 treatment arms. Those patients who roll over from ACTG 320 will be assigned to receive
open-label treatment on Arm II and evaluated independently of the 4 treatment arms listed
above.
[AS PER AMENDMENT 8/27/97: Patients with 2 consecutive HIV RNA measurements at least 500
copies/ml at week 16 or anytime thereafter are given the option to receive open-label
treatment with IDV plus EFV plus ABC, or to seek the best available therapy outside of the
study. NOTE: Patients who choose the open-label combination may take other prescribed
nucleoside analogs provided outside the study.] [AS PER AMENDMENT 12/17/97: It is strongly
recommended that patients who reach a confirmed endpoint and elect to receive open-label
therapy consider adding additional approved (and novel, if possible) antiretroviral agents
to their open-label regimen.] [AS PER AMENDMENT 1/12/98: Patients who choose the open-label
combination may receive other approved antiretrovirals obtained outside the study provided
the ACTG 368 team approves the combination.] [AS PER AMENDMENT 8/7/98: Subjects will take
study medications for a maximum of 96 weeks, depending on their time of study enrollment.]
[AS PER AMENDMENT 3/10/99: A 24-week extension, which will end July 30, 1999, has been added
to the study. The extension applies to subjects currently on blinded Step 1 treatment, on
open-labeled Step 2, or on study but off treatment. Subjects are to be unblinded in their
study treatment and followed for the remainder of the extension. Subjects continue on their
current study drug schedule. Subjects on blinded IDV plus EFV who, upon unblinding (not
failure) decide to add prescription ABC to their regimen, will be considered off study
treatment and will be followed for the duration of the extension; those already registered
on Step 2 will continue their Step 2 therapy. Any subject who does not wish to continue on
the study extension will be unblinded to their original randomized regimen. Subjects who
experience virologic failure during the extension should seek best available treatment
following current recommendations to use as many approved, novel antiretroviral agents as
possible. The new drug regimen may incorporate any or all of the study drugs.]
Interventional
Endpoint Classification: Safety Study, Masking: Open Label, Primary Purpose: Treatment
Squires KE
Study Chair
United States: Federal Government
ACTG 368
NCT00001086
September 1999
Name | Location |
---|---|
San Francisco Gen Hosp | San Francisco, California 941102859 |
Bellevue Hosp / New York Univ Med Ctr | New York, New York 10016 |
Univ of Rochester Medical Center | Rochester, New York 14642 |
Julio Arroyo | West Columbia, South Carolina 29169 |
UCLA CARE Ctr | Los Angeles, California 90095 |
Stanford at Kaiser / Kaiser Permanente Med Ctr | San Francisco, California 94115 |
Univ of Colorado Health Sciences Ctr | Denver, Colorado 80262 |
Univ of Miami School of Medicine | Miami, Florida 331361013 |
Rush Presbyterian - Saint Luke's Med Ctr | Chicago, Illinois 60612 |
Northwestern Univ Med School | Chicago, Illinois 60611 |
Indiana Univ Hosp | Indianapolis, Indiana 462025250 |
Tulane Univ School of Medicine | New Orleans, Louisiana 70112 |
Harvard (Massachusetts Gen Hosp) | Boston, Massachusetts 02114 |
Beth Israel Deaconess Med Ctr | Boston, Massachusetts 02215 |
Beth Israel Deaconess - West Campus | Boston, Massachusetts 02215 |
Boston Med Ctr | Boston, Massachusetts 02118 |
Univ of Minnesota | Minneapolis, Minnesota 55455 |
SUNY / Erie County Med Ctr at Buffalo | Buffalo, New York 14215 |
Cornell Univ Med Ctr | New York, New York 10021 |
Mount Sinai Med Ctr | New York, New York 10029 |
Univ of North Carolina | Chapel Hill, North Carolina 275997215 |
Duke Univ Med Ctr | Durham, North Carolina 27710 |
Ohio State Univ Hosp Clinic | Columbus, Ohio 432101228 |
Milton S Hershey Med Ctr | Hershey, Pennsylvania 170330850 |
Univ of Tennessee / E Tennessee Comprehensive Hemophilia Ctr | Knoxville, Tennessee 37920 |
Univ of Washington | Seattle, Washington 98105 |
Great Lakes Hemophilia Foundation | Milwaukee, Wisconsin 53233 |
Johns Hopkins Hosp | Baltimore, Maryland 21287 |
Charity Hosp / Tulane Univ Med School | New Orleans, Louisiana 70112 |
St Louis Regional Hosp / St Louis Regional Med Ctr | St Louis, Missouri 63112 |
Univ of Southern California / LA County USC Med Ctr | Los Angeles, California 900331079 |
Univ of Iowa Hosp and Clinic | Iowa City, Iowa 52242 |
Hennepin County Med Clinic | Minneapolis, Minnesota 55415 |
St Paul Ramsey Med Ctr | St Paul, Minnesota 55101 |
Univ of Nebraska Med Ctr | Omaha, Nebraska 681985130 |
Beth Israel Med Ctr | New York, New York 10003 |
Saint Clare's Hosp and Health Ctr | New York, New York 10019 |
Moses H Cone Memorial Hosp | Greensboro, North Carolina 27401 |
Univ of Cincinnati | Cincinnati, Ohio 452670405 |
Univ of Pennsylvania at Philadelphia | Philadelphia, Pennsylvania 19104 |
Stanford Univ Med Ctr | Stanford, California 943055107 |
Howard Univ | Washington, District of Columbia 20059 |
Univ of Hawaii | Honolulu, Hawaii 96816 |
Louis A Weiss Memorial Hosp | Chicago, Illinois 60640 |
Univ of Kentucky Lexington | Cincinnati, Ohio 45267 |
Case Western Reserve Univ | Cleveland, Ohio 44106 |
Univ of Texas Galveston | Galveston, Texas 775550435 |
Queens Med Ctr | Honolulu, Hawaii 96816 |
Georgetown Univ Hosp | Washington, District of Columbia 20037 |
Division of Inf Diseases/ Indiana Univ Hosp | Indianapolis, Indiana 46202 |
Tulane Med Ctr Hosp | New Orleans, Louisiana 70112 |
State of MD Div of Corrections / Johns Hopkins Univ Hosp | Baltimore, Maryland 212052196 |
St Vincent's Hosp / Mem Sloan-Kettering Cancer Ctr | New York, New York 10021 |
Central Prison/Women's Prison in Raleigh / NC | Raleigh, North Carolina 276260540 |
Vanderbilt Univ Med Ctr | Nashville, Tennessee 37203 |