Phase 3
Completed N=508
Regimen Switch to Dolutegravir + Rilpivirine From Current Antiretroviral Regimen in Human Immunodeficiency Virus Type 1 Infected and Virologically Suppressed Adults (SWORD-1)
Source: ClinicalTrials.gov NCT02429791 ↗Enrolled (actual)
508
Serious AEs
6.9%
Results posted
Dec 2017
Primary outcomePrimary: Percentage of Participants With Plasma HIV-1 RNA <50 c/mL at Week 48 Using Snapshot Algorithm — 95; 96 Percentage of participants
◆ Published Evidence
Highly cited
346citations · ~43 / 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.
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 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, eligible subjects were given the opportunity to continue receiving DTG +RPV, in the Continuation Phase.
Linked Publications (3)
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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.
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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.
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Switch from tenofovir disoproxil fumarate combination to dolutegravir with rilpivirine improves parameters of bone health.
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Percentage of Participants With Plasma HIV-1 RNA <50 c/mL at Week 48 Using Snapshot Algorithm |
95; 96 | — |
| SECONDARY Changes From Baseline in Cluster Designation (CD)4+ Lymphocyte Count at Weeks 24 and 48 |
16.2; 47.4; 32.3; 41.8 | — |
| SECONDARY Percentage of Participants With Plasma HIV 1 RNA <50 c/mL at Week 24 Using Snapshot Algorithm |
98; 96 | — |
| 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) |
158; 126; 37; 30; 82; 73 | — |
| SECONDARY Number of Participants With Maximum Post-baseline Emergent Chemistry Toxicities Over 48 Weeks |
95; 78; 61; 86; 22; 23 | — |
| SECONDARY Number of Participants With Maximum Post-Baseline Emergent Hematology Toxicities Over 48 Weeks |
11; 11; 3; 2; 3; 1 | — |
| SECONDARY Mean Change From Baseline in High-sensitivity C-reactive Protein (Hs-CRP) at Week 48 |
0.11; 0.15 | — |
| SECONDARY Mean Change From Baseline in Cystatin C at Week 48 |
0.00; -0.01 | — |
| SECONDARY Mean Change From Baseline in D-Dimer at Week 48 |
-0.02; 0.02 | — |
| SECONDARY Mean Change From Baseline in Fatty Acid Binding Protein 2 (FABP) and Soluble Cluster Designation (CD)14 at Week 48 |
-2.79; -1.93; 379.72; 754.54 | — |
| SECONDARY Mean Change From Baseline in Soluble CD163 and Oxidized Low Density Lipoprotein (LDL) at Week 48 |
50.18; 54.26; 9.49; -41.30 | — |
| SECONDARY Mean Change From Baseline in Retinol Binding Protein (RBP), Serum Creatinine and Glucose at Week 48 |
-0.13; 0.03; 0.087; 0.011; 0.762; 2.492 | — |
| SECONDARY Mean Change From Baseline in Urine Phosphate at Week 48 |
-1.079; -1.511 | — |
| SECONDARY Mean Change From Baseline in Beta-2-microglobulin (B2M) (Blood and Urine), Urine RBP and 25 Hydroxy-vitamin D (Blood) at Week 48 |
-15.1452; -4.5995; -13.9; -8.2; -128.2045; 39.8394 | 0.007 sig |
| SECONDARY Mean Change From Baseline in Urine Albumin/Creatinine Ratio and Urine Protein/Creatinine Ratio at Week 48 |
-1.19; -2.59; -5.63; -1.43 | — |
| SECONDARY Mean Change From Baseline in Bone-specific Alkaline Phosphatase, Procollagen 1 N-terminal Propeptide, Osteocalcin, Type I Collagen C-Telopeptides and Soluble Vascular Cell Adhesion Molecule (sVCAM) at Week 48 |
-2.89; 0.90; -9.1; -1.4; -4.40; -0.68 | 0.001 sig |
| SECONDARY Mean Change From Baseline in Interleukin 6 (IL-6) at Week 48 |
0.17; -0.18 | — |
| SECONDARY Mean Change From Baseline in Insulin Resistance Based on Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) at Week 48 |
-0.30; 0.51 | — |
| SECONDARY Mean Change From Baseline in Fasting Lipids at Weeks 24 and 48 |
0.076; 0.061; 0.089; 0.064; 0.165; 0.103 | — |
| SECONDARY Number of Participants With Genotypic Resistance- Early Switch Phase |
1; NA; 0; NA; 0; NA | — |
| SECONDARY Number of Participants With Genotypic Resistance-DTG+RPV Group Through Early and Late Switch Phase |
5; 0; 0; 0; 0; 4 | — |
| SECONDARY Number of Participants With Genotypic Resistance-CAR Group Through Late Switch Phase |
1; 0; 0; 0; 0; 1 | — |
| SECONDARY Number of Participants With Phenotypic Resistance-Early Switch Phase |
0; 0; 0; 0; 1; 1 | — |
| SECONDARY Number of Participants With Phenotypic Resistance-DTG+RPV Group Through Early and Late Switch Phase |
0; 0; 5; 0; 0; 5 | — |
| 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 at Weeks 4, 24, 48, 56, 76 and 100 in Participants Switching to DTG + RPV-DTG+RPV Group Through Early and Late Switch Phase |
1581.06; 92.05; 1835.68; 87.88; 1915.11; 95.18 | — |
| SECONDARY Pre-dose Concentrations of DTG and RPV at Weeks 56, 76 and 100 in Participants Switching to DTG+RPV-CAR Group Through Late Switch Phase |
1738.55; 84.14; 1800.39; 97.79; 1907.20; 101.93 | — |
| SECONDARY Pre-dose Concentrations of DTG and RPV at Weeks 2, 4 and 8 in the First 20 Participants Who Switch From Efavirenz (EFV) or Nevirapine (NVP) to DTG + RPV |
821.25; 65.360; 994.00; 67.374; 1561.34; 77.416 | — |
| SECONDARY Percentage of Participants With Plasma HIV 1 RNA <50 c/mL at Week 48 Using Snapshot Algorithm by Baseline Third Agent Treatment Class |
95; 98; 98; 96; 95; 92 | 0.317 |
| SECONDARY Changes From Baseline in Cluster Designation (CD)4+ Lymphocyte Count at Week 48 by Baseline Third Agent Treatment Class |
47.9; 25.0; 19.9; 39.9; 12.5; 74.7 | — |
| 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 |
102; 98; 38; 34; 60; 58 | — |
| SECONDARY Number of Participants With Maximum Post-baseline Emergent Chemistry Toxicities Over 48 Weeks by Baseline Third Agent Treatment Class |
47; 42; 32; 48; 13; 13 | — |
| SECONDARY Number of Participants With Maximum Post-Baseline Emergent Hematology Toxicities Over 48 Weeks by Baseline Third Agent Treatment Class |
5; 3; 1; 1; 1; 1 | — |
| 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 |
3.239; 2.375; 3.596; 2.472; 3.383; 4.099 | — |
| SECONDARY Change From Baseline in Pre-specified Treatment Symptoms Using the Symptom Distress Module at Weeks 4, 24 and 48-Early Switch Phase |
-1.6; 0.2; -0.8; -0.2; -0.4; 0.0 | 0.940 |
| 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 |
-0.9; -0.2; -0.4; -0.6; -1.6; -0.9 | — |
| 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 |
-0.7; 0.1; 0.0; 0.4; -2.0; -0.4 | — |
| 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; 1.0; 0.0; 0.5; 0.0 | 0.002 sig |
| SECONDARY Change From Baseline Treatment Satisfaction Using HIV TSQ at Weeks 56, 76, 100 and 148 - DTG+RPV Group Through Early and Late Switch Phase |
0.0; 0.5; 0.0; 1.0; 0.0; 0.0 | — |
| SECONDARY Change From LS Baseline Treatment Satisfaction Using 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 |
3; 0; 0; 0; 0; 3 | — |
| 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; 2; 0; 0; 2 | — |
| 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 |
6; 0; 0; 0; 0; 5 | — |
| SECONDARY Number of Participants With Phenotypic Resistance-DTG+RPV Group Through Continuation Phase |
0; 0; 5; 0; 0; 5 | — |
| 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).
Data sourced from ClinicalTrials.gov (NCT02429791) 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.