1. ODYSSEY clinical trial design: a randomised global study to evaluate the efficacy and safety of dolutegravir-based antiretroviral therapy in HIV-positive children, with nested pharmacokinetic sub-studies to evaluate pragmatic WHO-weight-band based dolutegravir dosing
- Author
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Moore, C.L., Turkova, A., Mujuru, H., Kekitiinwa, A., Lugemwa, A., Kityo, C.M., Barlow-Mosha, L.N., Cressey, T.R., Violari, A., Variava, E., Cotton, M.F., Archary, M., Compagnucci, A., Puthanakit, T., Behuhuma, O., Saϊdi, Y., Hakim, J., Amuge, P., Atwine, L., Musiime, V., Burger, D.M., Shakeshaft, C., Giaquinto, C., Rojo, P., Gibb, D.M., Ford, D., Moore, C.L., Turkova, A., Mujuru, H., Kekitiinwa, A., Lugemwa, A., Kityo, C.M., Barlow-Mosha, L.N., Cressey, T.R., Violari, A., Variava, E., Cotton, M.F., Archary, M., Compagnucci, A., Puthanakit, T., Behuhuma, O., Saϊdi, Y., Hakim, J., Amuge, P., Atwine, L., Musiime, V., Burger, D.M., Shakeshaft, C., Giaquinto, C., Rojo, P., Gibb, D.M., and Ford, D.
- Abstract
Contains fulltext : 232479.pdf (Publisher’s version ) (Open Access), BACKGROUND: Dolutegravir (DTG)-based antiretroviral therapy (ART) is highly effective and well-tolerated in adults and is rapidly being adopted globally. We describe the design of the ODYSSEY trial which evaluates the efficacy and safety of DTG-based ART compared with standard-of-care in children and adolescents. The ODYSSEY trial includes nested pharmacokinetic (PK) sub-studies which evaluated pragmatic World Health Organization (WHO) weight-band-based DTG dosing and opened recruitment to children < 14 kg while dosing was in development. METHODS: ODYSSEY (Once-daily DTG based ART in Young people vS. Standard thErapY) is an open-label, randomised, non-inferiority, basket trial comparing the efficacy and safety of DTG + 2 nucleos(t) ides (NRTIs) versus standard-of-care (SOC) in HIV-infected children < 18 years starting first-line ART (ODYSSEY A) or switching to second-line ART (ODYSSEY B). The primary endpoint is clinical or virological failure by 96 weeks. RESULTS: Between September 2016 and June 2018, 707 children weighing ≥14 kg were enrolled; including 311 ART-naïve children and 396 children starting second-line. 47% of children were enrolled in Uganda, 21% Zimbabwe, 20% South Africa, 9% Thailand, 4% Europe. 362 (51%) participants were male; median age [range] at enrolment was 12.2 years [2.9-18.0]. 82 (12%) children weighed 14 to < 20 kg, 135 (19%) 20 to < 25 kg, 206 (29%) 25 to < 35 kg, 284 (40%) ≥35 kg. 128 (18%) had WHO stage 3 and 60 (8%) WHO stage 4 disease. Challenges encountered include: (i) running the trial across high- to low-income countries with differing frequencies of standard-of-care viral load monitoring; (ii) evaluating pragmatic DTG dosing in PK sub-studies alongside FDA- and EMA-approved dosing and subsequently transitioning participants to new recommended doses; (iii) delays in dosing information for children weighing 3 to < 14 kg and rapid recruitment of ART-naïve older/heavier children, which led to capping recruitment of participants weigh
- Published
- 2021