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A Phase II Trial of Sofosbuvir (SOF) and GS-5816 for People With Chronic Hepatitis C Virus Infection and Recent Injection Drug Use (SIMPLIFY)

Primary Purpose

Hepatitis C

Status
Completed
Phase
Phase 2
Locations
Australia
Study Type
Interventional
Intervention
Sofosbuvir (SOF)/GS-5816
Sponsored by
Kirby Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatitis C

Eligibility Criteria

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

Inclusion Criteria:

  1. Participants have voluntarily signed the informed consent form.
  2. 18 years of age or older.
  3. Chronic HCV infection as defined by anti-HCV antibody or HCV RNA detection for greater than 6 months.
  4. HCV RNA plasma ≥ 1000 IU/ml at Screening.
  5. HCV genotypes 1-6.
  6. Recent injecting drug use (previous 6 months).
  7. Compensated liver disease.
  8. Participants with Fibroscan >12 KPa or AFP >50 ng/mL must have an abdominal ultrasound or CT scan without evidence of hepatocellular carcinoma within 2 months prior to screening.
  9. Negative pregnancy test at baseline (females of childbearing potential only).
  10. All fertile males and females must be using effective contraception during treatment and during the 30 days after treatment end.

Exclusion Criteria:

  1. History of any of the following:

    1. Clinically significant illness (other than HCV) or any other major medical disorder that may interfere with the participant treatment, assessment or compliance with the protocol; participants currently under evaluation for a potentially clinically significant illness (other than HCV) are also excluded.
    2. Clinical hepatic decompensation (i.e. ascites, encephalopathy or variceal haemorrhage)
    3. Solid organ transplant
    4. Malignancy within 5 years prior to screening, with exception of specific cancers that may have been cured by surgical resection (basal cell skin cancer, etc.). Subjects under evaluation for possible malignancy are also excluded.
    5. Significant drug allergy (such as anaphylaxis or hepatotoxicity).
  2. Screening ECG with clinically significant abnormalities
  3. Any of the following lab parameters at screening:

    1. ALT > 10 x ULN
    2. AST > 10 x ULN
    3. Direct bilirubin > 1.5 x ULN
    4. Platelets < 50,0000/μL
    5. HbA1c > 8.5%
    6. Creatinine clearance (CLcr) < 60 mL/min
    7. Haemoglobin < 11 g/dL for females ; < 12 g/dL for males
    8. Albumin < 30g/L
    9. INR > 1.5 ULN unless subject has known haemophilia or is stable on an anticoagulant regimen affecting INR
  4. Pregnant or nursing female.
  5. HIV infection or HBV infection (HBcAb and HBsAg positive)
  6. Use of prohibited concomitant medications as described in section 5.2
  7. Chronic use of systemically administered immunosuppressive agents (e.g. prednisone equivalent > 10 mg/day)
  8. Known hypersensitivity to GS-5816, sofosbuvir (SOF) or formulation excipients.
  9. Therapy with any anti-neoplastic or immunomodulatory treatment (including supraphysiologic doses of steroids and radiation) ≤6 months prior to the first dose of study drug.
  10. Any investigational drug ≤6 weeks prior to the first dose of study drug.
  11. Previous therapy with sofosbuvir (SOF) or an NS5A inhibitor prior to the first dose of study drug.
  12. Ongoing severe psychiatric disease as judged by the treating physician.
  13. Frequent injecting drug use that is judged by the treating physician to compromise treatment safety.
  14. Inability or unwillingness to provide informed consent or abide by the requirements of the study.

Sites / Locations

  • The Kirby Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Sofosbuvir (SOF)/GS-5816

Arm Description

12 weeks of Sofosbuvir (SOF)/GS-5816 (400mg/100mg) in an oral once-daily fixed dose combination

Outcomes

Primary Outcome Measures

Sustained Virological Response (SVR12)
To evaluate the proportion of patients with undetectable HCV RNA at 12 weeks post end of treatment (SVR12) following sofosbuvir (SOF)/GS-5816 therapy for 12 weeks in people with chronic HCV infection and recent injection drug use.

Secondary Outcome Measures

Treatment adherence
To evaluate the proportion of patients adherent to therapy (both on-treatment adherence and treatment discontinuation)
Impact of adherence on therapy (association between adherence and response to treatment )
To evaluate the association between adherence and response to treatment [including an evaluation of the impact of early (0-3 weeks), mid (4-7 weeks) and late (8-11 weeks) missed doses on response to therapy]; Adehernce will be measure via a self report quesitonanire and pill counts via return of the weeekly blister packs. The impact of the number and timing of missed pills will be evaluated.
Factors associated with on-treatment adherence
To evaluate factors associated with on-treatment adherence >90% and treatment discontinuation. Demographic and behavioural factors will be examined.
End of Treatment Response (ETR) (proportion of participants with undetectable HCV RNA at the end of treatment (ETR)
To evaluate the proportion of participants with undetectable HCV RNA at the end of treatment (ETR)
Safety and tolerability (number and type of adverse events and serious adverse events)
To evaluate the number and type of adverse events and serious adverse events on treament and for 12 weeks post end of treatment
Change in drug use
To evaluate the change in drug use during treatment
Change in mental health
To evaluate the change in mental health during treatment
Change in health related quality of life
To evaluate the change in health-related quality of life during treatment
Impact of mixed infection on treatment response
To evaluate the rate of mixed HCV infection at baseline and among those with treatment non-response
Reinfection Rate
To evaluate the rate of HCV reinfection during and up to two years following treatment
Immunovirological factors associated with treatment clearance
To evaluate immunovirological factors associated with treatment clearance. We will evaluate cytokines and chemokines (e.g. interferon inducible protein 10), T-cell responses, viral evolution and genetic markers (e.g. inteferon lambda 4) that are potentially associated with treatment induced clearance
Utility of Dried Blood Spot (DBS) (method for monitoring HCV including treatment response)
To evaluate the utility of dried blood spot (DBS) as a simple method for monitoring HCV including treatment response. HCV RNA will be measured from DBS samples and then compared to HCV RNA levels measured using standard methods (EDTA Plasma samples and Roche Taqman)

Full Information

First Posted
January 4, 2015
Last Updated
February 26, 2019
Sponsor
Kirby Institute
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1. Study Identification

Unique Protocol Identification Number
NCT02336139
Brief Title
A Phase II Trial of Sofosbuvir (SOF) and GS-5816 for People With Chronic Hepatitis C Virus Infection and Recent Injection Drug Use
Acronym
SIMPLIFY
Official Title
A Phase II, Open-label, Single Arm, Multicentre, International Trial of Sofosbuvir (SOF) and GS-5816 for People With Chronic Hepatitis C Virus Infection and Recent Injection Drug Use
Study Type
Interventional

2. Study Status

Record Verification Date
February 2019
Overall Recruitment Status
Completed
Study Start Date
March 16, 2016 (Actual)
Primary Completion Date
April 17, 2017 (Actual)
Study Completion Date
November 28, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Kirby Institute

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To evaluate the proportion of patients with undetectable HCV RNA at 12 weeks post end of treatment (SVR12) following sofosbuvir/GS-5816 therapy for 12 weeks in people with chronic HCV infection and recent injection drug use.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
103 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Sofosbuvir (SOF)/GS-5816
Arm Type
Experimental
Arm Description
12 weeks of Sofosbuvir (SOF)/GS-5816 (400mg/100mg) in an oral once-daily fixed dose combination
Intervention Type
Drug
Intervention Name(s)
Sofosbuvir (SOF)/GS-5816
Other Intervention Name(s)
SOF/GS-5816
Intervention Description
12 weeks of Sofosbuvir (SOF)/GS-5816 (400mg/100mg) in an oral once-daily fixed dose
Primary Outcome Measure Information:
Title
Sustained Virological Response (SVR12)
Description
To evaluate the proportion of patients with undetectable HCV RNA at 12 weeks post end of treatment (SVR12) following sofosbuvir (SOF)/GS-5816 therapy for 12 weeks in people with chronic HCV infection and recent injection drug use.
Time Frame
Week 24
Secondary Outcome Measure Information:
Title
Treatment adherence
Description
To evaluate the proportion of patients adherent to therapy (both on-treatment adherence and treatment discontinuation)
Time Frame
Baseline to Week 12
Title
Impact of adherence on therapy (association between adherence and response to treatment )
Description
To evaluate the association between adherence and response to treatment [including an evaluation of the impact of early (0-3 weeks), mid (4-7 weeks) and late (8-11 weeks) missed doses on response to therapy]; Adehernce will be measure via a self report quesitonanire and pill counts via return of the weeekly blister packs. The impact of the number and timing of missed pills will be evaluated.
Time Frame
early (0-3 weeks), mid (4-7 weeks) and late (8-11 weeks) during therapy
Title
Factors associated with on-treatment adherence
Description
To evaluate factors associated with on-treatment adherence >90% and treatment discontinuation. Demographic and behavioural factors will be examined.
Time Frame
Baseline to Week 12
Title
End of Treatment Response (ETR) (proportion of participants with undetectable HCV RNA at the end of treatment (ETR)
Description
To evaluate the proportion of participants with undetectable HCV RNA at the end of treatment (ETR)
Time Frame
Week 12
Title
Safety and tolerability (number and type of adverse events and serious adverse events)
Description
To evaluate the number and type of adverse events and serious adverse events on treament and for 12 weeks post end of treatment
Time Frame
Baseline to Week 24
Title
Change in drug use
Description
To evaluate the change in drug use during treatment
Time Frame
Baseline to Week 12
Title
Change in mental health
Description
To evaluate the change in mental health during treatment
Time Frame
Basleine to Week 12
Title
Change in health related quality of life
Description
To evaluate the change in health-related quality of life during treatment
Time Frame
Baseline to Week 12
Title
Impact of mixed infection on treatment response
Description
To evaluate the rate of mixed HCV infection at baseline and among those with treatment non-response
Time Frame
Baseline to Week 24
Title
Reinfection Rate
Description
To evaluate the rate of HCV reinfection during and up to two years following treatment
Time Frame
Week 108
Title
Immunovirological factors associated with treatment clearance
Description
To evaluate immunovirological factors associated with treatment clearance. We will evaluate cytokines and chemokines (e.g. interferon inducible protein 10), T-cell responses, viral evolution and genetic markers (e.g. inteferon lambda 4) that are potentially associated with treatment induced clearance
Time Frame
Week 24
Title
Utility of Dried Blood Spot (DBS) (method for monitoring HCV including treatment response)
Description
To evaluate the utility of dried blood spot (DBS) as a simple method for monitoring HCV including treatment response. HCV RNA will be measured from DBS samples and then compared to HCV RNA levels measured using standard methods (EDTA Plasma samples and Roche Taqman)
Time Frame
Week 108

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants have voluntarily signed the informed consent form. 18 years of age or older. Chronic HCV infection as defined by anti-HCV antibody or HCV RNA detection for greater than 6 months. HCV RNA plasma ≥ 1000 IU/ml at Screening. HCV genotypes 1-6. Recent injecting drug use (previous 6 months). Compensated liver disease. Participants with Fibroscan >12 KPa or AFP >50 ng/mL must have an abdominal ultrasound or CT scan without evidence of hepatocellular carcinoma within 2 months prior to screening. Negative pregnancy test at baseline (females of childbearing potential only). All fertile males and females must be using effective contraception during treatment and during the 30 days after treatment end. Exclusion Criteria: History of any of the following: Clinically significant illness (other than HCV) or any other major medical disorder that may interfere with the participant treatment, assessment or compliance with the protocol; participants currently under evaluation for a potentially clinically significant illness (other than HCV) are also excluded. Clinical hepatic decompensation (i.e. ascites, encephalopathy or variceal haemorrhage) Solid organ transplant Malignancy within 5 years prior to screening, with exception of specific cancers that may have been cured by surgical resection (basal cell skin cancer, etc.). Subjects under evaluation for possible malignancy are also excluded. Significant drug allergy (such as anaphylaxis or hepatotoxicity). Screening ECG with clinically significant abnormalities Any of the following lab parameters at screening: ALT > 10 x ULN AST > 10 x ULN Direct bilirubin > 1.5 x ULN Platelets < 50,0000/μL HbA1c > 8.5% Creatinine clearance (CLcr) < 60 mL/min Haemoglobin < 11 g/dL for females ; < 12 g/dL for males Albumin < 30g/L INR > 1.5 ULN unless subject has known haemophilia or is stable on an anticoagulant regimen affecting INR Pregnant or nursing female. HIV infection or HBV infection (HBcAb and HBsAg positive) Use of prohibited concomitant medications as described in section 5.2 Chronic use of systemically administered immunosuppressive agents (e.g. prednisone equivalent > 10 mg/day) Known hypersensitivity to GS-5816, sofosbuvir (SOF) or formulation excipients. Therapy with any anti-neoplastic or immunomodulatory treatment (including supraphysiologic doses of steroids and radiation) ≤6 months prior to the first dose of study drug. Any investigational drug ≤6 weeks prior to the first dose of study drug. Previous therapy with sofosbuvir (SOF) or an NS5A inhibitor prior to the first dose of study drug. Ongoing severe psychiatric disease as judged by the treating physician. Frequent injecting drug use that is judged by the treating physician to compromise treatment safety. Inability or unwillingness to provide informed consent or abide by the requirements of the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Greg Dore, MBBS PhD
Organizational Affiliation
Kirby Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Kirby Institute
City
Sydney
State/Province
New South Wales
ZIP/Postal Code
2052
Country
Australia

12. IPD Sharing Statement

Citations:
PubMed Identifier
32166305
Citation
Cunningham EB, Hajarizadeh B, Amin J, Hellard M, Bruneau J, Feld JJ, Cooper C, Powis J, Litwin AH, Marks P, Dalgard O, Conway B, Moriggia A, Stedman C, Read P, Bruggmann P, Lacombe K, Dunlop A, Applegate TL, Matthews GV, Fraser C, Dore GJ, Grebely J. Reinfection Following Successful Direct-acting Antiviral Therapy for Hepatitis C Virus Infection Among People Who Inject Drugs. Clin Infect Dis. 2021 Apr 26;72(8):1392-1400. doi: 10.1093/cid/ciaa253.
Results Reference
derived
PubMed Identifier
31300820
Citation
Artenie AA, Cunningham EB, Dore GJ, Conway B, Dalgard O, Powis J, Bruggmann P, Hellard M, Cooper C, Read P, Feld JJ, Hajarizadeh B, Amin J, Lacombe K, Stedman C, Litwin AH, Marks P, Matthews GV, Quiene S, Erratt A, Bruneau J, Grebely J. Patterns of Drug and Alcohol Use and Injection Equipment Sharing Among People With Recent Injecting Drug Use or Receiving Opioid Agonist Treatment During and Following Hepatitis C Virus Treatment With Direct-acting Antiviral Therapies: An International Study. Clin Infect Dis. 2020 May 23;70(11):2369-2376. doi: 10.1093/cid/ciz633.
Results Reference
derived
PubMed Identifier
29310928
Citation
Grebely J, Dalgard O, Conway B, Cunningham EB, Bruggmann P, Hajarizadeh B, Amin J, Bruneau J, Hellard M, Litwin AH, Marks P, Quiene S, Siriragavan S, Applegate TL, Swan T, Byrne J, Lacalamita M, Dunlop A, Matthews GV, Powis J, Shaw D, Thurnheer MC, Weltman M, Kronborg I, Cooper C, Feld JJ, Fraser C, Dillon JF, Read P, Gane E, Dore GJ; SIMPLIFY Study Group. Sofosbuvir and velpatasvir for hepatitis C virus infection in people with recent injection drug use (SIMPLIFY): an open-label, single-arm, phase 4, multicentre trial. Lancet Gastroenterol Hepatol. 2018 Mar;3(3):153-161. doi: 10.1016/S2468-1253(17)30404-1. Epub 2018 Jan 6.
Results Reference
derived

Learn more about this trial

A Phase II Trial of Sofosbuvir (SOF) and GS-5816 for People With Chronic Hepatitis C Virus Infection and Recent Injection Drug Use

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