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DART II Once Daily Regimen for Treatment-naïve HIV+ Patients with Stavudine XR + Lamivudine + Efavirenz 24 Week Interim Efficacy and Safety Results D aily A nti R etroviral T herapy II D. Jayaweera 1, S. Becker 2, F. Felizarta 3, M. Sands 4, L. Slater 5 S. Gothelf 6, J. Maa 6, C. Dezii 6, S. Hodder 6, J. Tudor 6 1 University of Miami, Miami, FL, USA. 2 Pacific Horizon Medical Group, San Francisco, CA, USA. 3 34th Street Community Health Center, Bakersfield, CA, USA. 4 University of Florida, Jacksonville, FL, USA. 5 University of Oklahoma, Oklahoma City, OK, USA. 6 Bristol-Myers Squibb, Plainsboro, NJ, USA.
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DART II AI455-096 and -099 Study Outlines ARV-naive patients Randomized d4T XR 100mg QD d4T IR 40mg BID Patients <60 kg: d4T XR 75 mg QD; d4T IR 30 mg BID NFV substitution permitted if EFV-intolerant Adapted from: Brett-Smith H et al. 43rd ICAAC, September, 2003. Poster H-843 Study 096n=74n=76 Study 099n=392 (d4T IR placebo BID) 3TC 150mg BID EFV 600mg QD (d4T XR placebo QD) 3TC 150mg BID EFV 600mg QD
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DART II Selected Adverse Events of Interest for Patients on Therapy for 2 Years Any Lipoatrophy (Any Grade) 64 (14%)36 (8%) Any Lipodystrophy (Any Grade) 73 (16%)52 (11%) 0.004 0.05 Lactic Acidosis Syndrome Pancreatitis Peripheral Neurologic Symptoms (Grades 2-4) 1 (<1%) 4 (1%) 38 (8%) 1 (<1%) 17 (4%) Symptomatic Hyperlactatemia 5 (<1%)2 (<1%) d4T XR arm n=466 d4T IR arm n= 468 Study 096/099/110 * P-Value 0.005 Adapted from: Brett-Smith H et al. 43rd ICAAC, September, 2003. Poster H-843 * Median follow up is 116 weeks XR and 114 weeks for IR
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DART II d4T XR 100 mg Once Daily Comparable Drug Exposure to d4T IR 40 mg BID TIME [h] 1 10 100 1000 PLASMA CONCENTRATION [ng/mL] 04 8 12162024 d4T IR d4T XR Peak (C max ) for d4T XR is ~50% of the IR formulation d4T XR formulation has 2-3 times higher trough plasma levels than d4T IR * Parallel groups for XR and IR formulations in HIV patients
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DART II Prospective, once-daily, open-label, ARV-Naïve patients, VL > 1000 c/mL, CD4 > 100 Planned N= 70 Patients <60 kg: d4T XR 75 mg QD DART II: Study Design d4T XR 100 mg QD 3TC 300 mg QD EFV 600 mg QD + + Epivir ® (lamivudine, 3TC) is a registered trademark and manufactured by GlaxoSmithKline
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DART II DART II: OBJECTIVES Efficacy of once daily d4T XR + 3TC + EFV as determined by proportion of patients with plasma HIV-RNA <400 copies/mL at 48-weeks Primary Objective: Secondary Objective: Proportion of patients with plasma HIV-RNA <400 and <50 copies/mL at Weeks 24, 48, 72, and 96 Patient adherence using pill counts and Antiviral Medication Adherence Form (AMAF) Safety and tolerability
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DART II Baseline Characteristics d4T XR QD 3TC QD + EFV QD (N=64) Median Age, (years) Male White Black Other 83% 42% 45% 13% Median HIV RNA (log 10 copies/mL)4.7 100,000 copies/mL 30% Median CD4 Counts (cells/ L) 315 Demography Clinical 37
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DART II Patient Disposition at Week 24 Evaluable Total Discontinuations, n (%) Reasons for Discontinuation Adverse Event Serious Adverse Event Death 10 (16%) 3 (5%) 0 0 Withdrew Consent4 (6%) 64 Lost to Follow-up2 (3%) Virologic Failure1 (2%) d4T XR QD 3TC QD + EFV QD
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DART II Virologic Response HIV RNA <400 copies/mL : Baseline to Week 24 2048121620 24 Weeks Percent of Patients 94.3% 78.1% As Treated (n=54) ITT (NC=F) (n=64)
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DART II Virologic Response HIV RNA <50 copies/mL: Baseline to Week 24 2048121620 24 Weeks Percent of Patients 94.3% 78.1% As Treated (n=54) ITT (NC=F) (n=64)
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DART II Mean Change in HIV RNA Level: Baseline to Week 24 HIV RNA Change (log 10 copies/mL) Weeks - 2.7 -3 -2.5 -2 -1.5 -0.5 0 2048121620 24
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DART II CD4 Cell Mean Change: Baseline to Week 24 CD4 Mean Change (cells/mm 3 ) Weeks 0 20 40 60 80 100 120 140 160 CD4 cell count Baseline: 354 Week 24: 488 2048121620 24
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DART II Grade 2 - 4 Treatment Related Adverse Events (>2%) d4T XR + 3TC + EFV n=64 Vomiting2 (3.1%) Nausea Diarrhea Somnolence 4 (6.3%) 2 (3.1%) Grade 2-4 Hypoaesthesia3 (4.7%) Peripheral Neuropathy2 (3.1%)
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DART II Treatment Related Adverse Events of Interest d4T XR + 3TC + EFV n=64 Pancreatitis0 Peripheral Neuropathy Lipodystrophy Symptomatic Hyperlactatemia Lactic Acidosis Syndrome 2 (3.1%) 0 0 0 All Grades
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DART II Grade 3-4 New Onset Laboratory Abnormalities d4T XR + 3TC + EFV n=64 Lipase Creatine Kinase ALT ANC 3 (4.7%) 2 (3.1%) 1 (1.6%) Grade 3-4 * No report of Grade 3-4 triglyceride levels
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DART II Fasting Lipid Values Median Change from Baseline Baseline Total Cholesterol (mg/dL) 162 Median Change (%) + 27.5 (17%) LDL Cholesterol (mg/dL) 102+ 11.5 (11%) Triglycerides (mg/dL) 114- 1.0 (-0.9%) HDL Cholesterol (mg/dL) 38+ 9.5 ( 25%) P-value 0.001 0.003 0.419 0.0001 TC:HDL Ratio 4.76- 0.39 (- 8%) 0.006 Median Values (N=32) Overall Results
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DART II Summary of Adherence and Compliance at 24 Weeks d4T XR + 3TC +EFV Did not miss any dose during the past 4 days. 82.3% (51/62) Any time took fewer pills per dose 5.6% (3/54) Follow specific schedule 80.8% (42/52) d4T XR n=53 80% Compliance at Week 24 89% 3TC n=53 91% EFV n=53 89% Adherence (by AMAF * questionnaire) Compliance (by pill count) 90% Compliance at Week 24 70% 72% * Antiviral Medication Adherence Form
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DART II Conclusions: 24 Weeks Demonstrated a significant reduction in viral load and excellent efficacy: 78.1% of patients achieved viral loads <400 copies/mL and <50 copies/mL (ITT: NC=F) 94.3% of patients achieved viral loads <400 copies/mL and <50 copies/mL (As Treated analysis) Is well tolerated Minimal discontinuations due to adverse events (n=3) Increase in HDL cholesterol, and decrease in TC:HDL ratio, with minimal effects on triglyceride levels In this treatment-naive population, d4T XR + 3TC + EFV administered once daily:
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DART II TO ALL THE PATIENTS AND STUDY CENTER PARTICIPANTS Acknowledgments Stephen Becker, MD. San Francisco, CA Coordinator: Sunita Lundy Nicholaos Bellos, MD. Dallas, TX Coordinators: Christopher Hayes Dawn Chaney Paul Cook, MD. Greenville, NC Coordinator: Grace Wilkins, RN Franco Felizarta, MD. Bakersfield, CA Coordinator: Jennifer Kuhach Dushyantha Jayaweera, MD. Miami, FL Coordinator: Rose Lalanne, RN Gary Richmond, MD. Ft. Lauderdale, FL Coordinator: Vernon Appleby, RN Michael Sands, MD. Jacksonville, FL Coordinator: Debbie Aragon, RN Kunthavi Sathasivam, MD. Washington, DC Coordinator: Takada Harris Leonard Slater, MD. Oklahoma City, OK Coordinator: Brenda Verel, LPN
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