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Antiviral Activity and Safety of 3 Different Doses of Mifepristone in Hepatitis C Infected Patients

Primary Purpose

Hepatitis C Virus Infection

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
VGX-410 (Mifepristone)
Placebo
Sponsored by
VGX Pharmaceuticals, LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatitis C Virus Infection focused on measuring Hepatitis C

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: Hepatitis C infection for ≥ 1 year. Viral load at entry will be measured by the Amplicor Hepatitis C Virus Test Version 2.0 (Roche Molecular Systems; Plesasanton, CA) and genotyped by Trugene HCV 5'NC Genotyping kit (Visible Genetics; Toronto, Canada) performed within 90 days prior to study entry by a lab(s) certified for the assays. Male or female ages 18-65 years, inclusive. Plasma hepatitis C RNA of >105 copies/mL (or equivalent international units) Laboratory values: stable hepatic, renal, and hematological indices obtained within 30 days prior to study entry, as follows: Absolute neutrophil count (ANC) >= 750/mm³ Hemoglobin >= 10.0 g/dL Platelet count >= 100,000/mm3 Creatinine <= 2 x ULN AST (SGOT), ALT (SGPT), and alkaline phosphatase <= 3 x ULN Total bilirubin <= 3 x ULN Albumin >= 3 g/dL Normal PT and PTT Serum lipase <= 1.5 x ULN TSH within normal limits (0.5-6.0 mIU/L) Morning plasma cortisol >= 20 µg/dL Normal fasting glucose Urinalysis free of clinically significant abnormalities NOTE: Fasting is defined as no oral intake except water for at least 8 hours prior to the study visit. Female subjects of reproductive potential (girls who have reached menarche or women who have not been post-menopausal for at least 24 consecutive months, i.e., who have had menses within the preceding 24 months or have not undergone surgical sterilization [e.g., hysterectomy, bilateral oophorectomy, or salpingotomy]) must have a negative spot urine pregnancy test result (with a sensitivity of at least 50 mIU/mL) performed at entry, before initiating study medication. All subjects must agree not to participate in a conception process (e.g., active attempt to become pregnant or to impregnate, donate sperm, or in vitro fertilization). If participating in sexual activity that could lead to pregnancy, the subject/partner must agree to use two reliable methods of contraception simultaneously (condoms with a spermicidal agent; or a diaphragm or cervical cap with spermicide) while on study drug and for 30 days after stopping the medication. Female subjects, who are not of reproductive potential, are eligible without requiring the use of contraception. Male subjects must use a condom with every sexual act that could lead to pregnancy. NOTE: Acceptable documentation of sterilization is either written or oral documentation communicated by clinician or clinician's staff of one of the following: physician report/letter: operative report or other source documentation in the patient record (a laboratory report of azoospermia is required to document successful vasectomy); discharge summary; laboratory report of azoospermia; or FSH measurement elevated into the menopausal range as established by the reporting laboratory. Karnofsky performance score >= 80 within 30 days prior to study entry. Ability and willingness of subject to give written informed consent. Willingness to return for a follow-up visit on day 56. Subjects taking any precautionary concomitant medications (see section 5.2.2) must be on stable doses for >8 weeks prior to study entry and have no plans to change medications or doses for the duration of the study. Exclusion Criteria: Receipt of anti-hepatitis C therapy within the 4 weeks prior to study entry or intent to initiate ant-hepatitis C therapy within 60 days after entry. Clinical evidence of cirrhosis or decompensated liver failure. Chronic or acute adrenal failure, history of active hepatitis B, HIV-1 infection, porphyrias, known moderate to severe cirrhosis, hemorrhagic disorders, concurrent anticoagulant therapy, any prior pituitary tumor, surgery, radiation treatment, or pituitary failure. Diabetes requiring treatment with oral hypoglycemics or insulin therapy. Pregnancy within 90 days prior to study entry. Breast-feeding. Dysfunctional uterine bleeding within the 12 months prior to study entry. Any current hormonal contraception or IUD use. Use of drugs that are inhibitors or inducers of metabolism by the CYP 3A4 within 7 days of study entry. Use of systemic corticosteroids or hormonal agents within 90 days prior to study entry. Use of any cytotoxic chemotherapy, immunomodulators or investigational therapy within 90 days prior to study entry. Any vaccination within 30 days prior to study entry. Allergy to mifepristone or its formulation. Active drug or alcohol use or dependence that, in the opinion of the investigator, would interfere with adherence to study requirement. Weight < 40 kg. Any other condition thought by the investigator that may interfere with the patient's ability to comply with the study protocol.

Sites / Locations

  • University of Connecticut
  • Orlando Clinical Research Center
  • Saint Louis University
  • University of Pennsylvania

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Placebo Comparator

Active Comparator

Active Comparator

Active Comparator

Arm Label

Placebo

150 mg daily

300mg daily

300mg twice daily

Arm Description

Outcomes

Primary Outcome Measures

Mean Log Change in Viral Load From Baseline (Day 1) to Day 28
Mean log change in HCV RNA viral load (significant reduction is considered >0.5 log 10) from baseline (Day 1) following once or twice daily dosing for 28 days at the 28 day timepoint

Secondary Outcome Measures

Full Information

First Posted
November 15, 2005
Last Updated
October 30, 2009
Sponsor
VGX Pharmaceuticals, LLC
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1. Study Identification

Unique Protocol Identification Number
NCT00255177
Brief Title
Antiviral Activity and Safety of 3 Different Doses of Mifepristone in Hepatitis C Infected Patients
Official Title
A Randomized, Open-label Phase II Trial of the Anti-HCV Activity and Safety of VGX-410 (Mifepristone) at 3 Dose Levels in HCV Infected Patients
Study Type
Interventional

2. Study Status

Record Verification Date
October 2009
Overall Recruitment Status
Completed
Study Start Date
November 2005 (undefined)
Primary Completion Date
September 2007 (Actual)
Study Completion Date
January 2008 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
VGX Pharmaceuticals, LLC

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Hepatitis C virus (HCV) infects approximately 170 million people worldwide. The current standard- of- care therapy of chronic HCV infection is a regimen of subcutaneously administered (pegylated)-interferon-α and ribavirin for 24 weeks (for genotypes 2 and 3) to 48 weeks (for genotype 1). The sustained viral response rates (SVR) in patients infected with genotypes 2 and 3 are ~80% but remain <50% in patients infected with genotype 1. The treatment is quite toxic with approximately 30% of patients experiencing adverse events (i.e. depression, fever, anemia, fatigue) requiring dose reduction or discontinuation of therapy. This regimen is contraindicated in women who are pregnant and in patients with decompensated liver disease. The absence of acceptable therapies for many patients with HCV infections makes new therapies desirable for this disease.
Detailed Description
The 341-nucleotide 5' non-translated region is the most conserved part of the hepatitis C virus (HCV) genome. It contains a highly structured internal ribosomal entry site (IRES) that mediates cap-independent initiation of translation of the viral polyprotein by a mechanism that is unprecedented in eukaryotes. The first step in translation initiation is assembly of eukaryotic initiation factor (eIF) 3, eIF2, GTP, initiator tRNA and a 40S ribosomal subunit into a 43S preinitiation complex (1, 2). The IRES contains sites that bind independently with the eIF3 and 40S ribosomal subunit components of 43S complexes, and structural determinants that ensure the correct spatial orientation of these binding sites so that the 48S complex assembles precisely at the initiation codon. Since inhibiting this early translation of viral protein should block HCV replication downstream, this early critical step in replication is of great interest as a drug target. All genotypes of HCV use the same pathway; this drug target should be effective for all HCV genotypes. VGX-410 represents the first drug in a novel class of HCV IRES inhibitors under development. VGX-410 is an orally active and bioavailable, small-molecule, organic drug. Because a related formulation of mifepristone has been previously approved by the FDA for another indication (medical abortion), there are pre-existing data from animal toxicity tests showing the safety of this compound at very high doses (5 mg/kg for 6 months in rats and macaques). In addition, chronic administration (up to 200 mg/day) of this compound for the experimental treatment of a variety of malignant and non-malignant conditions has been well tolerated in non-HCV-infected subjects for up to 1 year (3-6). In cell culture tests, VGX-410 has been shown to be effective in inhibiting HCV replication with the 50% and 90% effective antiviral concentrations (EC50 and EC90) of 2 and 10 μM, respectively. Furthermore, VGX-410 was shown to act synergistically with interferon-a (IFN-a), the most widely-used drug treatment option available today. When used in combination with a low dose IFN-a at 1 IU/ml, EC90 of VGX-410 was reduced to 3 µM. Moreover, since VGX-410 inhibits viral replication by blocking the cellular protein complex for HCV IRES, there is reduced potential for viral mutation and resistance to this drug. From these in vitro data, we would expect to observe 50 to 90% anti-HCV effects in humans at serum drug concentrations of 2 to 10 μM, respectively. Moreover, we compiled the drug concentration results from several previously-reported clinical data on the level of steady-state concentrations in patients who took repeat daily doses of mifepristone (>4 days). For instance, repeated oral administration of 100 and 200-mg mifepristone daily for 4 days achieved maximum plasma levels of 4.5 and 5.4 μM, respectively (9).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatitis C Virus Infection
Keywords
Hepatitis C

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
44 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Title
150 mg daily
Arm Type
Active Comparator
Arm Title
300mg daily
Arm Type
Active Comparator
Arm Title
300mg twice daily
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
VGX-410 (Mifepristone)
Other Intervention Name(s)
Mifepristone
Intervention Description
VGX-410 tablets taken daily or twice daily for 28 days
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo for VGX-410 tablets taken daily or twice daily for 28 days
Primary Outcome Measure Information:
Title
Mean Log Change in Viral Load From Baseline (Day 1) to Day 28
Description
Mean log change in HCV RNA viral load (significant reduction is considered >0.5 log 10) from baseline (Day 1) following once or twice daily dosing for 28 days at the 28 day timepoint
Time Frame
Baseline (Day 1) to Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Hepatitis C infection for ≥ 1 year. Viral load at entry will be measured by the Amplicor Hepatitis C Virus Test Version 2.0 (Roche Molecular Systems; Plesasanton, CA) and genotyped by Trugene HCV 5'NC Genotyping kit (Visible Genetics; Toronto, Canada) performed within 90 days prior to study entry by a lab(s) certified for the assays. Male or female ages 18-65 years, inclusive. Plasma hepatitis C RNA of >105 copies/mL (or equivalent international units) Laboratory values: stable hepatic, renal, and hematological indices obtained within 30 days prior to study entry, as follows: Absolute neutrophil count (ANC) >= 750/mm³ Hemoglobin >= 10.0 g/dL Platelet count >= 100,000/mm3 Creatinine <= 2 x ULN AST (SGOT), ALT (SGPT), and alkaline phosphatase <= 3 x ULN Total bilirubin <= 3 x ULN Albumin >= 3 g/dL Normal PT and PTT Serum lipase <= 1.5 x ULN TSH within normal limits (0.5-6.0 mIU/L) Morning plasma cortisol >= 20 µg/dL Normal fasting glucose Urinalysis free of clinically significant abnormalities NOTE: Fasting is defined as no oral intake except water for at least 8 hours prior to the study visit. Female subjects of reproductive potential (girls who have reached menarche or women who have not been post-menopausal for at least 24 consecutive months, i.e., who have had menses within the preceding 24 months or have not undergone surgical sterilization [e.g., hysterectomy, bilateral oophorectomy, or salpingotomy]) must have a negative spot urine pregnancy test result (with a sensitivity of at least 50 mIU/mL) performed at entry, before initiating study medication. All subjects must agree not to participate in a conception process (e.g., active attempt to become pregnant or to impregnate, donate sperm, or in vitro fertilization). If participating in sexual activity that could lead to pregnancy, the subject/partner must agree to use two reliable methods of contraception simultaneously (condoms with a spermicidal agent; or a diaphragm or cervical cap with spermicide) while on study drug and for 30 days after stopping the medication. Female subjects, who are not of reproductive potential, are eligible without requiring the use of contraception. Male subjects must use a condom with every sexual act that could lead to pregnancy. NOTE: Acceptable documentation of sterilization is either written or oral documentation communicated by clinician or clinician's staff of one of the following: physician report/letter: operative report or other source documentation in the patient record (a laboratory report of azoospermia is required to document successful vasectomy); discharge summary; laboratory report of azoospermia; or FSH measurement elevated into the menopausal range as established by the reporting laboratory. Karnofsky performance score >= 80 within 30 days prior to study entry. Ability and willingness of subject to give written informed consent. Willingness to return for a follow-up visit on day 56. Subjects taking any precautionary concomitant medications (see section 5.2.2) must be on stable doses for >8 weeks prior to study entry and have no plans to change medications or doses for the duration of the study. Exclusion Criteria: Receipt of anti-hepatitis C therapy within the 4 weeks prior to study entry or intent to initiate ant-hepatitis C therapy within 60 days after entry. Clinical evidence of cirrhosis or decompensated liver failure. Chronic or acute adrenal failure, history of active hepatitis B, HIV-1 infection, porphyrias, known moderate to severe cirrhosis, hemorrhagic disorders, concurrent anticoagulant therapy, any prior pituitary tumor, surgery, radiation treatment, or pituitary failure. Diabetes requiring treatment with oral hypoglycemics or insulin therapy. Pregnancy within 90 days prior to study entry. Breast-feeding. Dysfunctional uterine bleeding within the 12 months prior to study entry. Any current hormonal contraception or IUD use. Use of drugs that are inhibitors or inducers of metabolism by the CYP 3A4 within 7 days of study entry. Use of systemic corticosteroids or hormonal agents within 90 days prior to study entry. Use of any cytotoxic chemotherapy, immunomodulators or investigational therapy within 90 days prior to study entry. Any vaccination within 30 days prior to study entry. Allergy to mifepristone or its formulation. Active drug or alcohol use or dependence that, in the opinion of the investigator, would interfere with adherence to study requirement. Weight < 40 kg. Any other condition thought by the investigator that may interfere with the patient's ability to comply with the study protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bruce Bacon, M.D.
Organizational Affiliation
St. Louis University
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Pablo Tebas, M.D.
Organizational Affiliation
University of Pennsylvania
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
George Wu, MD
Organizational Affiliation
University of Connecticut
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Thomas Marbury, MD
Organizational Affiliation
Orlando Clinical Research Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Connecticut
City
Farmington
State/Province
Connecticut
ZIP/Postal Code
06030
Country
United States
Facility Name
Orlando Clinical Research Center
City
Orlando
State/Province
Florida
ZIP/Postal Code
32809
Country
United States
Facility Name
Saint Louis University
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63104
Country
United States
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
11233977
Citation
Kieft JS, Zhou K, Jubin R, Doudna JA. Mechanism of ribosome recruitment by hepatitis C IRES RNA. RNA. 2001 Feb;7(2):194-206. doi: 10.1017/s1355838201001790.
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Antiviral Activity and Safety of 3 Different Doses of Mifepristone in Hepatitis C Infected Patients

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