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Phase 3 Completed N=516 Randomized Treatment

Regimen Switch to Dolutegravir + Rilpivirine From Current Antiretroviral Regimen in Human Immunodeficiency Virus Type 1 Infected and Virologically Suppressed Adults (SWORD-2)

Source: ClinicalTrials.gov NCT02422797 ↗
Enrolled (actual)
516
Serious AEs
7.8%
Results posted
Oct 2017
Primary outcomePrimary: Percentage of Participants With Plasma HIV-1 RNA <50 c/mL at Week 48 Using Snapshot Algorithm — 94; 94 Percentage of participants
◆ Published Evidence
Highly cited
358citations · ~45 / year
Efficacy, safety, and tolerability of dolutegravir-rilpivirine for the maintenance of virological suppression in adults with HIV-1: phase 3, randomised, non-inferiority SWORD-1 and SWORD-2 studies.
Lancet (London, England) · 2018 · Likely link

Summary

The aim of this study was to determine if virologically suppressed, human immunodeficiency virus type 1 (HIV-1) infected adults on an antiretroviral regimen (including 2 nucleoside reverse transcriptase inhibitors [NRTIs] plus a third agent) remain suppressed upon switching to a two-drug regimen with dolutegravir (DTG) + rilpivirine (RPV). The study primarily assessed the non-inferiority antiviral activity of switching to DTG + RPV once daily compared to the continuation of current antiretroviral regimen (CAR) up to Week 48 with a switch visit for eligible subjects in the CAR group to initiate DTG + RPV therapy at Week 52. CAR included 2 NRTIs plus 1 HIV-1 integrase inhibitor (INI), or 1 non-nucleoside reverse transcriptase inhibitor (NNRTI), or 1 protease inhibitor (PI). The study included a 148-week open-label treatment phase, comprising of an Early Switch Phase (Day 1 to Week 52) and a Late Switch Phase (Week 52 to Week 148). The participants fulfilling the study eligibility criteria participated in the Early Switch Phase where they either switched from their CAR to DTG + RPV, or continued taking their CAR, until Week 52. At the end of Early Switch Phase, eligible participants proceeded to the Late Switch Phase where all participants in both DTG + RPV and CAR treatment groups received DTG + RPV therapy until Week 148. After Week 148, subjects could have been eligible to continue to receive DTG +RPV in the Continuation Phase.

Linked Publications (3)

  • Efficacy, safety, and tolerability of dolutegravir-rilpivirine for the maintenance of virological suppression in adults with HIV-1: phase 3, randomised, non-inferiority SWORD-1 and SWORD-2 studies.
    Lancet (London, England) · 2018 · 358 citations · Likely link
  • Efficacy and safety of dolutegravir-rilpivirine for maintenance of virological suppression in adults with HIV-1: 100-week data from the randomised, open-label, phase 3 SWORD-1 and SWORD-2 studies.
    The lancet. HIV · 2019 · 121 citations · Likely link
  • Switch from tenofovir disoproxil fumarate combination to dolutegravir with rilpivirine improves parameters of bone health.
    AIDS (London, England) · 2018 · 55 citations · Open access · Likely link

Outcome Measures

OutcomeResultp-value
PRIMARY
Percentage of Participants With Plasma HIV-1 RNA <50 c/mL at Week 48 Using Snapshot Algorithm
94; 94 —
SECONDARY
Changes From Baseline in Cluster Designation (CD)4+ Lymphocyte Count at Weeks 24 and 48
42.0; 42.4; 28.0; 18.4 —
SECONDARY
Percentage of Participants With Plasma HIV 1 RNA <50 c/mL at Week 24 Using Snapshot Algorithm
97; 98 —
SECONDARY
Number of Participants With Common Non-serious Adverse Event (AE), Any Serious AE (SAE), AE of Maximum Toxicity Grade 1, 2, 3 or 4 and AE Leading to Discontinuation (AELD)
166; 132; 50; 32; 78; 85 —
SECONDARY
Number of Participants With Maximum Post-baseline Emergent Chemistry Toxicities Over 48 Weeks
92; 80; 72; 79; 11; 16 —
SECONDARY
Number of Participants With Maximum Post-baseline Emergent Hematology Toxicities Over 48 Weeks
11; 11; 2; 2; 3; 0 —
SECONDARY
Mean Change From Baseline in High-sensitivity C-reactive Protein (Hs-CRP) at Week 48
0.10; 0.80 —
SECONDARY
Mean Change From Baseline in Cystatin C at Week 48
-0.02; -0.01 —
SECONDARY
Mean Change From Baseline in D-Dimer at Week 48
0.01; -0.13 —
SECONDARY
Mean Change From Baseline in Fatty Acid Binding Protein 2 (FABP) and Soluble CD14 at Week 48
-1.50; -0.99; 456.69; 802.26 —
SECONDARY
Mean Change From Baseline in Soluble CD163 and Oxidized Low Density Lipoprotein (LDL) at Week 48
65.38; 53.94; 60.87; 13.92 —
SECONDARY
Mean Change From Baseline in Retinol Binding Protein (RBP), Serum Creatinine and Glucose at Week 48
-0.13; 0.00; 0.100; -0.003; 0.187; 3.220 —
SECONDARY
Mean Change From Baseline in Urine Phosphate at Week 48
1.335; -0.798 —
SECONDARY
Mean Change From Baseline in Beta-2-microglobulin (B2M) (Blood and Urine), Urine RBP and 25 Hydroxy-vitamin D (Blood) at Week 48
-16.8800; -4.7501; -13.9; -9.2; -173.2820; 62.3209 0.007 sig
SECONDARY
Mean Change From Baseline in Urine Albumin/Creatinine Ratio and Urine Protein/Creatinine Ratio at Week 48
-0.78; -0.64; -2.73; 1.23 —
SECONDARY
Mean Change From Baseline in Bone-specific Alkaline Phosphatase, Procollagen 1 N-terminal Propeptide, Osteocalcin, Type 1 Collagen C-telopeptides and Soluble Vascular Cell Adhesion Molecule (sVCAM) at Week 48
-3.18; 0.92; -5.8; 0.3; -5.11; -1.14 0.001 sig
SECONDARY
Mean Change From Baseline in Interleukin 6 (IL-6) at Week 48
-0.08; -0.07 —
SECONDARY
Mean Change From Baseline in Insulin Resistance Based on Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) at Week 48
0.50; 0.80 —
SECONDARY
Mean Change From Baseline in Fasting Lipids at Weeks 24 and 48
-0.015; 0.020; -0.079; -0.038; 0.085; 0.055 —
SECONDARY
Number of Participants With Genotypic Resistance-Early Switch Phase
1; 0; 0; 0; 0; 0 —
SECONDARY
Number of Participants With Genotypic Resistance-DTG+RPV Arm Through Early and Late Switch Phase
2; 0; 0; 0; 0; 2 —
SECONDARY
Number of Participants With Genotypic Resistance-CAR Arm Through Late Switch Phase
1; 0; 0; 0; 0; 1 —
SECONDARY
Number of Participants With Phenotypic Resistance-Early Switch Phase
0; 1; 0; 0; 1; 0 —
SECONDARY
Number of Participants With Phenotypic Resistance-DTG+RPV Group Through Early and Late Switch Phase
0; 0; 1; 0; 0; 1 —
SECONDARY
Number of Participants With Phenotypic Resistance-CAR Group Through Late Switch Phase
1; 0; 0; 1; 0; 0 —
SECONDARY
Pre-dose Concentrations of DTG and RPV in Participants Switching to DTG + RPV - DTG+RPV Group Through Early and Late Switch Phase
1578.88; 79.50; 1447.23; 90.21; 1384.36; 91.41 —
SECONDARY
Pre-dose Concentrations of DTG and RPV in Participants Switching to DTG + RPV - CAR Group Through Late Switch Phase
1544.75; 77.27; 1806.77; 91.46; 1881.97; 90.89 —
SECONDARY
Pre-dose Concentrations of DTG and RPV in the First 20 Participants Who Switch From Efavirenz (EFV) or Nevirapine (NVP) to DTG + RPV
834.58; 57.342; 1218.23; 78.338; 1472.50; 79.652 —
SECONDARY
Percentage of Participants With Plasma HIV 1 RNA <50 c/mL at Week 48 Using Snapshot Algorithm by Baseline Third Agent Treatment Class
97; 93; 92; 94; 91; 97 0.179
SECONDARY
Changes From Baseline in CD4+ Lymphocyte Count at Week 48 by Baseline Third Agent Treatment Class
49.7; 24.3; -11.2; 10.3; 10.5; 12.2 —
SECONDARY
Number of Participants With Any AE, AELD or AE With Grade 1, 2, 3 or 4 Toxicity Over 48 Weeks by Baseline Third Agent Treatment Class
106; 96; 47; 36; 42; 42 —
SECONDARY
Number of Participants With Maximum Post-baseline Emergent Chemistry Toxicities Over 48 Weeks by Baseline Third Agent Treatment Class
51; 52; 31; 40; 7; 4 —
SECONDARY
Number of Participants With Maximum Post-baseline Emergent Hematology Toxicities Over 48 Weeks by Baseline Third Agent Treatment Class
7; 6; 1; 2; 1; 0 —
SECONDARY
Number of Participants With Observed Genotypic Resistance for Participants Meeting Virologic Withdrawal Criteria by Baseline Third Agent Treatment Class
— —
SECONDARY
Number of Participants With Observed Phenotypic Resistance for Participants Meeting Virologic Withdrawal Criteria by Baseline Third Agent Treatment Class
— —
SECONDARY
Change From Baseline in Fasting Lipids at Weeks 24 and 48 by Baseline Third Agent Treatment Class
1.015; 1.300; -0.165; 0.194; 1.238; 0.281 —
SECONDARY
Change From Baseline in Pre-specified Treatment Symptoms Using the Symptom Distress Module at Weeks 4, 24 and 48-Early Switch Phase
-1.1; -0.8; -0.7; -0.8; -0.5; -0.4 0.430
SECONDARY
Change From Baseline in Pre-specified Treatment Symptoms Using the Symptom Distress Module at Weeks 56, 76, 100 and 148-DTG+RPV Group Through Early and Late Switch Phase
-0.8; -0.6; -0.5; -0.7; -1.8; -1.6 —
SECONDARY
Change From LS Baseline in Pre-specified Treatment Symptoms Using the Symptom Distress Module at Weeks 56, 76, 100 and 148-CAR Group Through Late Switch Phase
-0.9; -0.7; -0.4; -0.6; -2.1; -1.0 —
SECONDARY
Change From Baseline Treatment Satisfaction Using the HIV Treatment Satisfaction Questionnaire (HIV TSQ) at Weeks 4, 24 and 48-Early Switch Phase
0.0; 0.0; 0.0; 0.0; 0.0; 0.0 0.037 sig
SECONDARY
Change From Baseline Treatment Satisfaction Using the HIV TSQ at Weeks 56, 76, 100 and 148-DTG+RPV Group Through Early and Late Switch Phase
0.0; 1.0; 0.0; 1.0; 0.0; 0.0 —
SECONDARY
Change From LS Baseline Treatment Satisfaction Using the HIV TSQ at Weeks 56, 76, 100 and 148-CAR Group Through Late Switch Phase
0.0; 0.0; 0.0; 0.0; 0.0; 0.0 —
SECONDARY
Number of Participants With Observed Genotypic Resistance for Participants Meeting Virologic Withdrawal Criteria by Baseline Third Agent Treatment Class-DTG+RPV Group Through Continuation Phase
2; 0; 0; 0; 0; 2 —
SECONDARY
Number of Participants With Observed Phenotypic Resistance for Participants Meeting Virologic Withdrawal Criteria by Baseline Third Agent Treatment Class-DTG+RPV Group Through Continuation Phase
0; 0; 1; 0; 0; 1 —
SECONDARY
Number of Participants With Observed Genotypic Resistance for Participants Meeting Virologic Withdrawal Criteria by Baseline Third Agent Treatment Class CAR Group Through Continuation Phase
1; 0; 0; 0; 0; 1 —
SECONDARY
Number of Participants With Observed Phenotypic Resistance for Participants Meeting Virologic Withdrawal Criteria by Baseline Third Agent Treatment Class- CAR Group Through Continuation Phase
1; 0; 0; 1; 0; 0 —
SECONDARY
Number of Participants With Genotypic Resistance-DTG+RPV Group Through Continuation Phase
2; 0; 0; 0; 0; 2 —
SECONDARY
Number of Participants With Phenotypic Resistance-DTG+RPV Group Through Continuation Phase
0; 0; 1; 0; 0; 1 —
SECONDARY
Number of Participants With Genotypic Resistance-CAR Group Through Continuation Phase
1; 0; 0; 0; 0; 1 —
SECONDARY
Number of Participants With Phenotypic Resistance- CAR Group Through Continuation Phase
1; 0; 0; 1; 0; 0 —

Eligibility Criteria

Inclusion Criteria

  • Participants must have been able to understand and comply with protocol requirements, instructions, and restrictions.
  • Participants must have been likely to complete the study as planned.
  • Participants must have been considered appropriate candidates for participation in an investigative clinical trial with oral medication (e.g., no active substance abuse, acute major organ disease, or planned long-term work assignments out of the country, etc.).
  • HIV-1 infected men or women of greater than or equal to (>=)18 years of age.
  • Must have been on uninterrupted current regimen (either the initial or second combination antiretroviral therapy [cART] regimen) for at least 6 months prior to screening; Any prior switch, defined as a change of a single drug or multiple drugs simultaneously, must have occurred due to tolerability and/or safety concerns or access to medications, or convenience/simplification. Acceptable stable cART regimens prior to screening include 2 NRTIs plus INI (either the initial or second cART regimen), or an NNRTI (either the initial or second cART regimen), or a Boosted PI (or atazanavir unboosted) (either the initial or second PI-based cART regimen).
  • Documented evidence of at least two plasma HIV-1 RNA measurements =45 years of age) or physically incapable of becoming pregnant with documented tubal ligation, hysterectomy or bilateral oophorectomy or, Child-bearing potential with a negative pregnancy test at both Screening and Day 1 and agrees to use one of the following methods of contraception to avoid pregnancy: Complete abstinence from intercourse from 2 weeks prior to administration of study drug, throughout the study, and for at least 2 weeks after discontinuation of all study medications and completion of the Follow-up visit; Any intrauterine device (IUD) with published data showing that the expected failure rate is =50 c/mL.
  • Within the 6 to 12 month window prior to screening and after confirmed suppression to 200 c/mL.
  • Within the 6 to 12 month window prior to screening and after confirmed suppression to =50 c/mL.
  • Any drug holiday during the window between initiating first HIV ART and 6 months prior to screening, except for brief periods (less than 1 month) where all ART was stopped due to tolerability and/or safety concerns.
  • Any switch to a second line regimen, defined as change of a single drug or multiple drugs simultaneously, due to virologic failure to therapy (defined as a confirmed plasma HIV 1 RNA measurement >=400 c/mL after initial suppression to =5 × upper limit of normal (ULN), or ALT >=3 × ULN and bilirubin >=1.5 × ULN (with greater than [>] 35% direct bilirubin).
  • Corrected QT interval (QTc [Bazett]) >450 milliseconds or QTc (Bazett) >480 milliseconds for participants with bundle branch block. The QTc was the QT interval corrected for heart rate according to Bazett's formula (QTcB).
View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT02422797) and the linked publication. Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication. Informational only — not medical advice.

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