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Hepatitis C in a Cohort of Patients With Maintenance Therapy for Opiate Dependence - Prevalence, Severity and Outcome of Antiviral Therapy

Primary Purpose

Hepatitis C

Status
Completed
Phase
Phase 4
Locations
Sweden
Study Type
Interventional
Intervention
Pegylated interferon-alfa-2b and ribavirin
Sponsored by
Region Skane
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatitis C focused on measuring Hepatitis C patients, Hepacivirus

Eligibility Criteria

undefined - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients that meet all of the following inclusion criteria are eligible for part I of the study:

    1. Registered in a clinic providing maintenance therapy for opiate dependence at the date of study initiation.
    2. Written informed consent for part I of the study.
  • Patients that meet all of the following inclusion criteria are eligible for part II of the study:

    1. Fulfilled part I
    2. Registered in a clinic providing maintenance therapy for opiate dependence at the date of study initiation.
    3. HCV-PCR positive.
    4. Written informed consent for part II of the study.
  • Patients that meet all of the following inclusion criteria are eligible for part III of the study:

    1. Fulfilled part II
    2. Registered in a clinic providing maintenance therapy for opiate dependence at the date of study initiation.
    3. HCV-PCR positive.
    4. Written informed consent for part III of the study and able to adhere to dosing and visiting schedules.
    5. At least 6 months of uninterrupted maintenance therapy for opiate dependence.
    6. Treatment indication with at least one of the following:

      • Fibrosis/cirrhosis
      • Other HCV related disease/symptoms
      • Psychological indication
    7. For patients with cirrhosis, an ultrasound investigation should be performed within six months before study initiation, part III, (not showing signs of HCC).
    8. Use of adequate contraception during the treatment period and for six months after the completion of therapy (for all participants regardless of gender).

Exclusion Criteria:

  • The presence of any of the following criteria will exclude the patient from participating in part III of the study:

    1. Pregnant women, women who plan to become pregnant, male patients whose partner wants to become pregnant, and breastfeeding women.
    2. Previous treatment for chronic hepatitis C with an antiviral or immunomodulating agent or with an interferon or ribavirin product, whether alone or in combination.
    3. Participation in another clinical drug trial.
    4. Coinfection with HBV or HIV
    5. Hemoglobin <120 g/L for females and <130 g/L for males.
    6. LPK <3,0 x 109/L
    7. Platelets <80 x 109/L
    8. Creatinin clearance <50mL/min
    9. Any of the following diseases considered to be a dominant cause of the patients chronic liver disease:

      • Hemochromatosis
      • Alpha-1 antitrypsin deficiency
      • Wilson's disease
      • Autoimmune hepatitis
      • Alcoholic liver disease
      • Non-alcoholic steatohepatitis (NASH)
      • Drug-related liver disease
    10. Active malignant disease or suspicion or history of malignant disease within five previous years (except for adequately treated basal cell carcinoma).
    11. Patients with organ transplants, except for corneal or hair transplant.
    12. Poorly controlled diabetes mellitus.
    13. Evidence of severe retinopathy or clinically relevant ophthalmological disorder in patients with diabetes mellitus or hypertension.
    14. Poorly controlled epilepsy.
    15. Thyroid dysfunction not adequately controlled
    16. Decompensated cirrhosis (Child-Pugh B-C).
    17. Treatment with immunomodulatory drugs (chronic systemic corticosteroids (equivalent to >10 mg prednisone/day), immunosuppressive drugs, chemotherapy) and/or treatment with herbal drugs for chronic hepatitis.
    18. Any other condition which in the opinion of the investigator would make the patient unsuitable for enrollment, or could interfere with the patient participating in and completing the study.

Sites / Locations

  • Skåne university hospital

Outcomes

Primary Outcome Measures

To determine the completion rates of HCV treatment with pegylated interferon-alfa-2b and ribavirin in patients who are under opiate maintenance treatment and eligible for HCV therapy.

Secondary Outcome Measures

Prevalence of chronic HCV infection in the patient population eligible for part I in the study.
Clinical and histological characteristics of chronic hepatitis C.
Prevalence of hepatic decompensation and cirrhosis/advanced liver disease.
Risk factors for advanced liver disease.
Proportion of sustained virological responders, defined as a plasma HVC RNA level below Lower Level of Quantification at 24 week post-treatment.
Rates of relapse in opiate drug abuse.
Prevalence of depressive symptoms and assessment of quality of life before, under and after HCV treatment.
Potential pharmacokinetic interactions between ribavirin and methadone or buprenorphine.

Full Information

First Posted
September 11, 2009
Last Updated
October 1, 2013
Sponsor
Region Skane
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1. Study Identification

Unique Protocol Identification Number
NCT01045278
Brief Title
Hepatitis C in a Cohort of Patients With Maintenance Therapy for Opiate Dependence - Prevalence, Severity and Outcome of Antiviral Therapy
Official Title
Hepatitis C in a Cohort of Patients With Maintenance Therapy for Opiate Dependence - Prevalence, Severity and Outcome of Antiviral Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
October 2013
Overall Recruitment Status
Completed
Study Start Date
April 2008 (undefined)
Primary Completion Date
September 2013 (Actual)
Study Completion Date
September 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Region Skane

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Hepatitis C is the leading cause of chronic liver disease in industrialized countries, and is the most common indication for liver transplantation. In the Western world, the absolute majority of cases of Hepatitis C Virus (HCV) infection are related to the use of injectable narcotic drugs. Most injecting drug users contract HCV infection within the first years after starting injecting drug use. The aim of this study is to study hepatitis C in a cohort of patients registered in clinics providing maintenance therapy for opiate dependence in three metropolitan areas of Sweden. The cohort is defined as all patients registered in these three clinics at the date of study initiation. The study contains four parts: Part I: the first part of the study aims to evaluate the prevalence of HCV exposure in the cohort and the proportion of anti-HCV positive participants with chronic infection. Part II: Patients with chronic HCV infection will be offered further investigation of chronic liver disease, including liver biopsy, for selection of candidates for antiviral therapy and identification of risk factors for development of severe liver disease. Part III: Based on the results of these investigations, patients will be considered for antiviral therapy. Indications for such therapy will mainly be clinical and/or histological signs of chronic liver disease with fibrosis. All patients will receive weight-based doses of pegylated interferon-alfa-2b and ribavirin. Part IV: Study of pharmacokinetic interactions between ribavirin and opiate substitution molecule (methadone or buprenorphine) in patients receiving antiviral therapy according to part III.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
277 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Pegylated interferon-alfa-2b and ribavirin
Intervention Description
Pegylated interferon-alfa-2b 1.5 microg/kg subcutaneously once weekly plus weight based ribavirin 800-1200 mg PO for a variable period depending on their HCV genotype and response to treatment.
Primary Outcome Measure Information:
Title
To determine the completion rates of HCV treatment with pegylated interferon-alfa-2b and ribavirin in patients who are under opiate maintenance treatment and eligible for HCV therapy.
Time Frame
14-72 weeks
Secondary Outcome Measure Information:
Title
Prevalence of chronic HCV infection in the patient population eligible for part I in the study.
Time Frame
Screening visit (first visit of the study).
Title
Clinical and histological characteristics of chronic hepatitis C.
Time Frame
Liver investigation visit (second visit of the study). No time frame specified in the protocol.
Title
Prevalence of hepatic decompensation and cirrhosis/advanced liver disease.
Time Frame
Liver investigation visit (second visit of the study). No time frame specified in the protocol.
Title
Risk factors for advanced liver disease.
Time Frame
Liver investigation visit (second visit of the study). No time frame specified in the protocol.
Title
Proportion of sustained virological responders, defined as a plasma HVC RNA level below Lower Level of Quantification at 24 week post-treatment.
Time Frame
24 weeks post-treatment.
Title
Rates of relapse in opiate drug abuse.
Time Frame
Treatment period (14-72 weeks) and up till 24 weeks post-treatment.
Title
Prevalence of depressive symptoms and assessment of quality of life before, under and after HCV treatment.
Time Frame
Treatment period (14-72 weeks) and up to 24 weeks post-treatment.
Title
Potential pharmacokinetic interactions between ribavirin and methadone or buprenorphine.
Time Frame
Measured after 4 weeks treatment.

10. Eligibility

Sex
All
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients that meet all of the following inclusion criteria are eligible for part I of the study: Registered in a clinic providing maintenance therapy for opiate dependence at the date of study initiation. Written informed consent for part I of the study. Patients that meet all of the following inclusion criteria are eligible for part II of the study: Fulfilled part I Registered in a clinic providing maintenance therapy for opiate dependence at the date of study initiation. HCV-PCR positive. Written informed consent for part II of the study. Patients that meet all of the following inclusion criteria are eligible for part III of the study: Fulfilled part II Registered in a clinic providing maintenance therapy for opiate dependence at the date of study initiation. HCV-PCR positive. Written informed consent for part III of the study and able to adhere to dosing and visiting schedules. At least 6 months of uninterrupted maintenance therapy for opiate dependence. Treatment indication with at least one of the following: Fibrosis/cirrhosis Other HCV related disease/symptoms Psychological indication For patients with cirrhosis, an ultrasound investigation should be performed within six months before study initiation, part III, (not showing signs of HCC). Use of adequate contraception during the treatment period and for six months after the completion of therapy (for all participants regardless of gender). Exclusion Criteria: The presence of any of the following criteria will exclude the patient from participating in part III of the study: Pregnant women, women who plan to become pregnant, male patients whose partner wants to become pregnant, and breastfeeding women. Previous treatment for chronic hepatitis C with an antiviral or immunomodulating agent or with an interferon or ribavirin product, whether alone or in combination. Participation in another clinical drug trial. Coinfection with HBV or HIV Hemoglobin <120 g/L for females and <130 g/L for males. LPK <3,0 x 109/L Platelets <80 x 109/L Creatinin clearance <50mL/min Any of the following diseases considered to be a dominant cause of the patients chronic liver disease: Hemochromatosis Alpha-1 antitrypsin deficiency Wilson's disease Autoimmune hepatitis Alcoholic liver disease Non-alcoholic steatohepatitis (NASH) Drug-related liver disease Active malignant disease or suspicion or history of malignant disease within five previous years (except for adequately treated basal cell carcinoma). Patients with organ transplants, except for corneal or hair transplant. Poorly controlled diabetes mellitus. Evidence of severe retinopathy or clinically relevant ophthalmological disorder in patients with diabetes mellitus or hypertension. Poorly controlled epilepsy. Thyroid dysfunction not adequately controlled Decompensated cirrhosis (Child-Pugh B-C). Treatment with immunomodulatory drugs (chronic systemic corticosteroids (equivalent to >10 mg prednisone/day), immunosuppressive drugs, chemotherapy) and/or treatment with herbal drugs for chronic hepatitis. Any other condition which in the opinion of the investigator would make the patient unsuitable for enrollment, or could interfere with the patient participating in and completing the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Anna Jerkeman, MD
Organizational Affiliation
Skane University Hospital
Official's Role
Study Director
Facility Information:
Facility Name
Skåne university hospital
City
Malmö
Country
Sweden

12. IPD Sharing Statement

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Hepatitis C in a Cohort of Patients With Maintenance Therapy for Opiate Dependence - Prevalence, Severity and Outcome of Antiviral Therapy

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