TAILoR - (TelmisArtan and InsuLin Resistance in HIV): A dose-ranging phase II randomised open-labelled trial of telmisartan as a strategy for the reduction of insulin resistance in HIV-positive individuals on combination antiretroviral therapy (cART)

ISRCTN ISRCTN51069819
DOI https://doi.org/10.1186/ISRCTN51069819
EudraCT/CTIS number 2012-000935-18
Secondary identifying numbers 12578
Submission date
29/06/2012
Registration date
29/06/2012
Last edited
21/08/2019
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Infections and Infestations
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Not provided at time of registration

Contact information

Dr Sudeep Pushpakom
Scientific

Molecular and Clinical Pharmacology
1-3 Brownlow Street
Liverpool
L69 3GL
United Kingdom

Phone +44 151 795 5404
Email sudeepp@liverpool.ac.uk

Study information

Study designRandomised; Interventional; Design type: Not specified, Treatment
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Scientific titleTAILoR - (TelmisArtan and InsuLin Resistance in HIV): A dose-ranging phase II randomised open-labelled trial of telmisartan as a strategy for the reduction of insulin resistance in HIV-positive individuals on combination antiretroviral therapy (cART)
Study acronymTAILoR
Study objectivesTAILoR is a phase II multi-centre, randomised, open labelled, dose ranging trial of telmisartan in HIV-positive individuals on combination antiretroviral therapy (cART) to investigate whether telmisartan can reduce insulin resistance observed in this patient population.

Patients with HIV treated by cART are at risk of developing certain serious side effects such as reduced response to insulin (insulin resistance), abnormal body fat distribution (HIV lipodystrophy) and high cholesterol levels leading to diabetes, and importantly, an increase in the risk of cardiovascular disease. A key abnormality seems to be insulin resistance which will develop in almost all patients during the course of anti-HIV therapy. There is a need to find new strategies to reduce insulin resistance in HIV-positive individuals treated with cART, which ultimately will reduce the associated cardiovascular risk.

Telmisartan, a widely used anti hypertensive drug, has been shown to reduce insulin resistance and improve various indicators (biomarkers) of cardiovascular health in non-HIV population. However, whether telmisartan is effective for insulin resistance and other metabolic side effects in HIV patients treated by cART is not known. We also need to identify the most appropriate dose of telmisartan that is effective in reducing the metabolic side effects in HIV patients.

TAILoR will use a novel adaptive trial design to compare three different doses of telmisartan with the control group (those who do not take telmisartan) to determine the effect on insulin resistance over a period of 48 weeks. We will recruit 370 HIV-positive patients from multiple specialist centres across the UK and patients will be randomised to one of the four arms. If telmisartan shows a significant beneficial effect on insulin resistance, a larger phase III study to assess its effect on cardiovascular morbidity will be conducted in HIV-positive individuals treated with cART.
Ethics approval(s)12/NW/0214; First MREC approval date 02/04/2012
Health condition(s) or problem(s) studiedTopic: Infection; Subtopic: Infection (all Subtopics); Disease: Infectious diseases and microbiology
InterventionThere are four groups in the study:
1. A control non-intervention group
2. 20mg telmisartan (intervention)
3. 40mg telmisartan
4. 80mg telmisartan
Intervention typeOther
Primary outcome measureReduction in insulin resistance [as measured by homeostasis model assessment-estimated insulin resistance (HOMA-IR)] at 24 weeks
Secondary outcome measures1. Change in body fat distribution at 24 weeks
2. Change in insulin resistance at 48 weeks
3. Change in lipid profile at 12, 24 and 48 weeks
4. Change in plasma concentrations of biomarkers at 12, 24 and 48 weeks
5. Difference in expected and unexpected adverse drug reactions (ADRs) between treatment arms and control arm at 24, 48 weeks
Overall study start date01/08/2012
Completion date08/06/2017

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participantsPlanned Sample Size: 370; UK Sample Size: 370
Total final enrolment377
Key inclusion criteria1. Adult, male and female (age 18 or above) HIV-positive individuals receiving antiretroviral therapy containing a boosted protease inhibitor (lopinavir/ritonavir, atazanavir/ritonavir, darunavir/ritonavir, fosamprenavir/ritonavir, saquinavir/ritonavir) and/or efavirenz, for at least 6 months. The backbone can be based on N(t)RTI, raltegravir or maraviroc.
Patients on protease inhibitor monotherapy will be included if they meet other criteria.
2. Ability to give informed consent
3. Willingness to comply with all study requirements
Key exclusion criteria1. Pre-existing diagnosis of type 1 or 2 diabetes (Fasting glucose > 7.2mmol/L or HbA1c = 6.5% [48 mmol/ml] or abnormal OGTT or random plasma glucose = 11mmol/l)
2. Patients known to have consistently low blood pressure (pre-existing hypotension; below a threshold of 100/60 mm Hg)
3. Patients with renal disease Estimated Glomerular Filtration Rate(eGFR) <60 in the 6 months preceding randomisation)
4. Patients with known untreated renal artery stenosis
5. Patients with prior diagnosis of Hepatitis C [a positive polymerase chain reaction (PCR) result in the 6 months preceding randomisation]
6. Patients who are on unboosted atazanavir
7. Patients who are on/ have been on hormone therapy (eg. growth hormone), anabolics (eg. testosterone) and insulin sensitisers (eg. Metformin) within 6 months preceding randomisation. Patients who are on hormonal contraception are eligible
8. Patients who are already on/ have been on other angiotensin receptor blockers (ARBs) and/or angiotensin-converting-enzyme inhibitor (ACE) inhibitors within 4 weeks preceding randomisation
9. Those with suspected poor compliance
10. Pregnant or lactating women
11. Women of childbearing age unless using non hormonal contraception
12. Co-enrolment in other drug trials
13. Patients who have participated in a trial of an investigative medicinal product (IMP) likely to influence insulin sensitivity, plasma insulin, glucose levels or plasma lipid levels within 6 months preceding randomisation
14. For the sub-cohort of patients undergoing MRI/MRS, normal MR exclusion criteria will apply
Date of first enrolment19/03/2013
Date of final enrolment20/07/2015

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

Molecular and Clinical Pharmacology
Liverpool
L69 3GL
United Kingdom

Sponsor information

University of Liverpool (UK)
University/education

Wolfson Centre for Personalised Medicine
Department of Pharmacology
Block A: Waterhouse Buildings 1-5 Brownlow Street
Liverpool
L69 3GL
England
United Kingdom

ROR logo "ROR" https://ror.org/04xs57h96

Funders

Funder type

Government

NIHR Efficacy and Mechanism Evaluation (UK)

No information available

Results and Publications

Intention to publish date31/12/2017
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 15/10/2015 Yes No
Results article results 06/05/2020 21/08/2019 Yes No
HRA research summary 28/06/2023 No No

Editorial Notes

21/08/2019: The following changes were made to the trial record:
1. Publication reference added.
2. The total final enrolment was added.
30/08/2017: Overall trial end date changed from 30/09/2014 to 08/06/2017, recruitment start date from 01/08/2012 to 19/03/2013, recruitment end date from 30/09/2014 to 20/07/2015. Intended publictaion date
19/10/2015: Publication reference added.