search
Back to results

People With CHC Who Achieved a Sustained Virological Response Following Therapy With Direct Acting Antiviral Agents

Primary Purpose

Diabetes Mellitus, Hepatitis C, Chronic, Cardiovascular Diseases

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Epclusa
Sponsored by
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus focused on measuring Natural History, Hepatitis C Virus, Hepatocellular Carcinoma, Fibrosis, Immune Response

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:

Phase I Treatment

  • Male or female >= 18 years of age
  • Either treatment naive or experienced defined as failure of a prior course of interferon-based and ribavirin, DAA plus interferon and DAA only
  • Confirmation of chronic HCV infection documented by:

    • A positive HCV RNA or positive HCV genotyping test at least 6-months prior to the Baseline/Day 1 visit
    • A liver biopsy performed prior to screening visit showing evidence of chronic hepatitis.
  • Subjects must have the following laboratory parameters at screening:

    • ALT <= 10 x the upper limit of normal (ULN)
    • AST <= 10 x ULN
    • Total bilirubin <2.5 mg/dL, Direct bilirubin <= 1.5 ULN
    • Platelets >= 50,000 K/mm3
    • HbA1c <= 8.5%
    • Hemoglobin >= 10g/dL
    • Albumin >= 3g/dL
    • INR <= 1.5 unless subject has known hemophilia or is stable on an anticoagulant regimen affecting INR.
    • HCV RNA positive at screening.
  • Subjects must be of generally good health, with the exception of chronic HCV infection, as determined by the Investigator.

Phase II Follow-up

  • Male or female >= 18 years of age.
  • SVR24 following therapy with a direct acting antiviral agent regimen and available liver biopsy performed prior to treatment.
  • Subject must be of generally good health as determined by the Investigator.

EXCLUSION CRITERIA:

An individual who meets any of the following criteria will be excluded from participation in this study:

Phase I Treatment

  • Pregnancy or lactation
  • Inability to practice one form of adequate contraction for females of childbearing potential
  • Prior treatment with a NS5a agent
  • Current or prior history of any of the following:

    • Clinically significant illness (other than HCV) or any other major medical disorder that may interfere with subject treatment, assessment, or compliance with the protocol; subjects currently under evaluation for a potentially clinically significant illness (other than HCV) are also excluded
    • Gastrointestinal disorder or post-operative condition that could interfere with the absorption of the study drug
    • Decompensated liver disease as defined by serum bilirubin >= 2.5 mg/dL (with direct bilirubin >= 1.5 mg/dL), INR >1.5 a serum albumin of less than 3 g/dL, or a history of ascites, hepatorenal syndrome, variceal bleeding, or hepatic encephalopathy
    • Solid organ transplantation
    • Significant pulmonary disease, significant cardiac disease
  • History of malignancy or treatment for a malignancy within the past 3 years that is associated with a life expectancy <5 years (except adequately treated carcinoma in situ or basal cell carcinoma of the skin).
  • Chronic liver disease of a non-HCV etiology with the exception of steatosis (e.g., chronic hepatitis B, hemochromatosis, Wilson s disease, alfa-1 antitrypsin deficiency, cholangitis).
  • Evidence of harmful or hazardous drinking as defined as a score >= 8 on the AUDIT questionnaire.
  • Co-infection with HIV defined as the presence of anti-HIV in serum.
  • Clinically relevant drug abuse based on patient history within 12 months of screening.
  • Use of medications contraindicated with use of sofosbuvir/velpatasvir within 21 days of the Baseline/Day 1 visit; this washout period does not apply to proton pump inhibitors, which can be taken up to 7 days before baseline Day 1 for the following:

    • Acid reducing Agents
    • Antiarrhythmics
    • Anticancer
    • Antimycobacterial
    • HIV antivirals
    • Herbal supplements
    • HMG-CoA Reductase Inhibitors
  • Use of antiviral medications within the last 30 days.
  • Chronic use of systemically administered immunosuppressive agents (e.g., prednisone equivalent >= 10 mg/day).
  • Known hypersensitivity to sofosbuvir and velpatasvir, or formulation excipients.
  • Hepatocellular carcinoma, or the presence of a mass on imaging studies of the liver that is suggestive of hepatocellular carcinoma, or an alpha-fetoprotein level of greater than 500 mg/mL
  • Active psychiatric problems such as major depression, schizophrenia, bipolar illness, obsessive-compulsive disorder, severe anxiety, or personality disorder that, in the investigator s opinion, might interfere with participation in the study.
  • Presence of conditions that, in the opinion of the investigators, would not allow the subject to n the current study for at least 1 year.

Phase II Follow-up

  • Pregnancy
  • Current or prior history of any of the following:

    • Clinically significant illness (other than resolved HCV) or any other major medical disorder that may interfere with subject treatment, assessment, or compliance with the protocol; subjects currently under evaluation for a potentially clinically significant illness

(other than HCV) are also excluded

--Decompensated liver disease as defined by serum bilirubin >= 2.5 mg/dL (with direct

bilirubin >= 1.5 mg/dL), INR >1.5 a serum albumin of less than 3 g/dL, or a history of ascites, hepatorenal syndrome, variceal bleeding, or hepatic encephalopathy.

  • Solid organ transplantation
  • Significant pulmonary disease, significant cardiac disease

    • History of malignancy or treatment for a malignancy within the past 3 years that is associated with a life expectancy <5 years (except adequately treated carcinoma in situ or basal cell carcinoma of the skin)
    • Chronic liver disease with the exception of steatosis (e.g., chronic hepatitis B, hemochromatosis, Wilson s disease, alfa-1 antitrypsin deficiency, cholangitis)
    • Evidence of harmful or hazardous drinking as defined as a score >= 8 on the AUDIT questionnaire
    • Co-infection with HIV defined as the presence of anti-HIV in serum
    • Clinically relevant drug abuse based on patient history within 12 months of screening
    • Chronic use of systemically administered immunosuppressive agents (e.g., prednisone equivalent >= 10 mg/day)
    • Hepatocellular carcinoma, or the presence of a mass on imaging studies of the liver that is suggestive of hepatocellular carcinoma, or an alpha-fetoprotein level of greater than 500 mg/mL
    • Active psychiatric problems such as major depression, schizophrenia, bipolar illness, obsessive-compulsive disorder, severe anxiety, or personality disorder that, in the investigator s opinion, might interfere with participation in the study
    • Presence of conditions that, in the opinion of the investigators, would not allow the patient to be followed in the current study for at least 1 year.

Sites / Locations

  • National Institutes of Health Clinical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

No Intervention

No Intervention

Arm Label

Phase I

Phase II after Phase I

Phase II without Phase I

Arm Description

Phase I treatment

Participants who achieved SVR12 in Phase I

Participants who achieved SVR 24 previously

Outcomes

Primary Outcome Measures

Phase II: Liver-related clinical outcome, HCC, or liver-related mortality
Composite of ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, variceal hemorrhage, hepatocellular carcinoma, liver-related mortality
Phase I - SVR 12
SVR at 12 weeks after completion of 12 weeks of treatment

Secondary Outcome Measures

Phase II: All-cause mortality
Phase II: Change in Fibroscan
Phase II: Assess Regression in Portal Hypertension
Phase II: HCC
Phase II: Change in Ishak fibrosis score

Full Information

First Posted
May 9, 2018
Last Updated
October 19, 2023
Sponsor
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
search

1. Study Identification

Unique Protocol Identification Number
NCT03520660
Brief Title
People With CHC Who Achieved a Sustained Virological Response Following Therapy With Direct Acting Antiviral Agents
Official Title
Long-Term Follow-Up Of Subjects With CHC Who Achieved A Sustained Virological Response Following Therapy With Direct Acting Antiviral Agents
Study Type
Interventional

2. Study Status

Record Verification Date
September 6, 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 19, 2018 (Actual)
Primary Completion Date
December 31, 2032 (Anticipated)
Study Completion Date
December 31, 2032 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Background: Chronic hepatitis C infects the liver. It may scar the liver. This is called cirrhosis and may lead to liver cancer or death. Current chronic hepatitis C treatments cure most people. But some keep getting complications even after it is cured. Researchers want to study why. Objective: To study the course and complications of liver disease after cure of hepatitis C infection. Eligibility: Adults 18 years and older infected with chronic hepatitis C virus who were never treated or were treated and not cured and those who were cured Design: Participants will be screened with: Blood and urine tests Questionnaires Liver ultrasound Fibroscan. A probe vibrates the liver, testing stiffness. In Phase 1, people with chronic hepatitis C will: Have a 3-day hospital admission to repeat some screening tests and have a liver biopsy. A small piece of liver is removed by needle passed through the skin. Take 1 tablet containing 2 hepatitis C drugs once a day for 12 weeks. Repeat some blood tests at 3 visits in those 12 weeks while on treatment, then 4 additional visits in the next 24 weeks with more blood work collected. Phase 1 participants who test negative for hepatitis C and all other eligible participants will enter Phase 2. Phase 2 participants will have a visit every 24 weeks for 10 years. These may include: Repeats of screening tests Questionnaires Scans Stool tests Chest x-ray Heart function test Endoscopy. A tube guides a camera into the upper digestive system. At about 5 years, participants will have another liver biopsy. Some participants will give separate consent for genetic testing and a special blood procedure....
Detailed Description
Study Description:<TAB> We intend to enroll up to 350 subjects with chronic hepatitis C virus (HCV) infection. Subjects will be recruited from two sources: Phase I: treatment na(SqrRoot) ve or experienced who have failed a prior treatment (including DAA-experienced) who are willing to undergo a pre-treatment liver biopsy. Subjects yet to achieve an SVR will receive 12 weeks of therapy with sofosbuvir/velapatasvir (Epclusa(R)) fixed dose combination Subjects yet to achieve SVR with evidence of clinical cirrhosis will undergo a transjugular liver biopsy with hepatic venous portal gradient (HVPG) pressure measurements in lieu of the percutaneous liver biopsy Phase II: subjects who have already achieved sustained virologic response (SVR) with oral direct-acting antiviral agent (DAA) only regimen and who have undergone a liver biopsy prior to therapy and no history of hepatic decompensation or hepatocellular carcinoma. Subjects who have attained an SVR prior to enrollment (or upon achieving an SVR12 and SVR24 in Phase I) will undergo a thorough medical evaluation: laboratory testing Fibroscan(R) hepatic ultrasound Thereafter, subjects will be followed prospectively every 24 weeks for liver decompensation (ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, variceal hemorrhage), hepatocellular carcinoma, liver-related mortality, and all-cause mortality. During each study visit, subjects will be questioned on the development of these adverse outcomes. In addition, blood will be drawn for the assessment of routine blood tests, quantitative viral biomarker levels, serological response markers and immune cell functional status. Blood, urine, and stool will be collected and stored for exploratory biomarker development. Fibroscan(R) will be performed annually in all subjects. For subjects with cirrhosis, esophagogastroduodenoscopy (EGD) will be performed annually and imaging every 24 weeks. At the end of 240 weeks, all subjects will be admitted for a liver biopsy to assess the stage of liver fibrosis. In subjects with cirrhosis at study entry, the liver biopsy will be performed by the transjugular route with hepatic venous portal gradient (HVPG) pressure measurements. The primary goal of the study will be to describe the outcome of viral eradication following treatment with direct acting antiviral agents, to identify predictors of adverse outcomes after sustained viral eradication and regression of fibrosis/cirrhosis. Objectives: Primary Objective: Phase 1: SVR12 and SVR24 Phase II: The rate of clinical outcomes (ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, variceal hemorrhage), hepatocellular carcinoma, liver-related mortality, and all-cause mortality Secondary Objectives: Phase II: The proportion and rates of fibrosis regression in subjects Phase II: The agreement between Fibroscan and Ishak fibrosis score Phase II: The comparison of change in Fibroscan and change in Ishak fibrosis as predictors of the primary outcome. Phase II: To assess regression of portal hypertension in subjects with pre-existing portal hypertension either confirmed by direct portal pressure measurement, indirectly by hepatic venous pressure gradient or clinical evidence of portal hypertension such as presence of esophageal or gastric varices of portal hypertensive gastropathy and all-cause mortality. Exploratory Objective: To develop novel biomarkers and genetic predictors of liver related complications including hepatocellular carcinoma. To assess outcome of HCV-related immune dysfunction following sustained eradication of HCV. To assess changes in antibody titer and breadth, B cell activation, and T cell memory after sustained HCV eradication. To prospectively assess the rate of non-hepatic outcomes (diabetes, cardiovascular and renal disease, malignancy including lymphoma, and health related quality of life) following SVR with DAA agents. To characterize the changes in serum lipids and lipoproteins during and after therapy with direct acting antiviral agents and assess cardiovascular risk following eradication of HCV based on serum/plasma LDL particle number. Endpoints: Primary Endpoint: SVR at 12 weeks after completion of 12 weeks of treatment. Composite of ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, variceal hemorrhage, hepatocellular carcinoma, liver-related mortality, and all-cause mortality at 480 weeks. Secondary Endpoints: Improvement in semi-quantitative Ishak fibrosis score after HCV clearance. Correlation between Fibroscan (transient elastography) with Ishak fibrosis score after HCV clearance. Does change improvement in Fibroscan and change in Ishak fibrosis correlate with clinical outcome. Change in portal pressure after SVR12.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Hepatitis C, Chronic, Cardiovascular Diseases
Keywords
Natural History, Hepatitis C Virus, Hepatocellular Carcinoma, Fibrosis, Immune Response

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
350 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Phase I
Arm Type
Experimental
Arm Description
Phase I treatment
Arm Title
Phase II after Phase I
Arm Type
No Intervention
Arm Description
Participants who achieved SVR12 in Phase I
Arm Title
Phase II without Phase I
Arm Type
No Intervention
Arm Description
Participants who achieved SVR 24 previously
Intervention Type
Drug
Intervention Name(s)
Epclusa
Intervention Description
sofosbuvir/velapatasvir combination (Epclusa)
Primary Outcome Measure Information:
Title
Phase II: Liver-related clinical outcome, HCC, or liver-related mortality
Description
Composite of ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, variceal hemorrhage, hepatocellular carcinoma, liver-related mortality
Time Frame
480 Weeks
Title
Phase I - SVR 12
Description
SVR at 12 weeks after completion of 12 weeks of treatment
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Phase II: All-cause mortality
Time Frame
480 weeks
Title
Phase II: Change in Fibroscan
Time Frame
480 weeks
Title
Phase II: Assess Regression in Portal Hypertension
Time Frame
480 weeks
Title
Phase II: HCC
Time Frame
480 weeks
Title
Phase II: Change in Ishak fibrosis score
Time Frame
480 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Phase I Treatment Male or female >= 18 years of age Either treatment naive or experienced defined as failure of a prior course of interferon-based and ribavirin, DAA plus interferon and DAA only Confirmation of chronic HCV infection documented by: A positive HCV RNA or positive HCV genotyping test at least 6-months prior to the Baseline/Day 1 visit A liver biopsy performed prior to screening visit showing evidence of chronic hepatitis. Subjects must have the following laboratory parameters at screening: ALT <= 10 x the upper limit of normal (ULN) AST <= 10 x ULN Total bilirubin <2.5 mg/dL, Direct bilirubin <= 1.5 ULN Platelets >= 50,000 K/mm3 HbA1c <= 8.5% Hemoglobin >= 10g/dL Albumin >= 3g/dL INR <= 1.5 unless subject has known hemophilia or is stable on an anticoagulant regimen affecting INR. HCV RNA positive at screening. Subjects must be of generally good health, with the exception of chronic HCV infection, as determined by the Investigator. Phase II Follow-up Male or female >= 18 years of age. SVR24 following therapy with a direct acting antiviral agent regimen and available liver biopsy performed prior to treatment. Subject must be of generally good health as determined by the Investigator. EXCLUSION CRITERIA: An individual who meets any of the following criteria will be excluded from participation in this study: Phase I Treatment Pregnancy or lactation Inability to practice one form of adequate contraction for females of childbearing potential Prior treatment with a NS5a agent Current or prior history of any of the following: Clinically significant illness (other than HCV) or any other major medical disorder that may interfere with subject treatment, assessment, or compliance with the protocol; subjects currently under evaluation for a potentially clinically significant illness (other than HCV) are also excluded Gastrointestinal disorder or post-operative condition that could interfere with the absorption of the study drug Decompensated liver disease as defined by serum bilirubin >= 2.5 mg/dL (with direct bilirubin >= 1.5 mg/dL), INR >1.5 a serum albumin of less than 3 g/dL, or a history of ascites, hepatorenal syndrome, variceal bleeding, or hepatic encephalopathy Solid organ transplantation Significant pulmonary disease, significant cardiac disease History of malignancy or treatment for a malignancy within the past 3 years that is associated with a life expectancy <5 years (except adequately treated carcinoma in situ or basal cell carcinoma of the skin). Chronic liver disease of a non-HCV etiology with the exception of steatosis (e.g., chronic hepatitis B, hemochromatosis, Wilson s disease, alfa-1 antitrypsin deficiency, cholangitis). Evidence of harmful or hazardous drinking as defined as a score >= 8 on the AUDIT questionnaire. Co-infection with HIV defined as the presence of anti-HIV in serum. Clinically relevant drug abuse based on patient history within 12 months of screening. Use of medications contraindicated with use of sofosbuvir/velpatasvir within 21 days of the Baseline/Day 1 visit; this washout period does not apply to proton pump inhibitors, which can be taken up to 7 days before baseline Day 1 for the following: Acid reducing Agents Antiarrhythmics Anticancer Antimycobacterial HIV antivirals Herbal supplements HMG-CoA Reductase Inhibitors Use of antiviral medications within the last 30 days. Chronic use of systemically administered immunosuppressive agents (e.g., prednisone equivalent >= 10 mg/day). Known hypersensitivity to sofosbuvir and velpatasvir, or formulation excipients. Hepatocellular carcinoma, or the presence of a mass on imaging studies of the liver that is suggestive of hepatocellular carcinoma, or an alpha-fetoprotein level of greater than 500 mg/mL Active psychiatric problems such as major depression, schizophrenia, bipolar illness, obsessive-compulsive disorder, severe anxiety, or personality disorder that, in the investigator s opinion, might interfere with participation in the study. Presence of conditions that, in the opinion of the investigators, would not allow the subject to n the current study for at least 1 year. Phase II Follow-up Pregnancy Current or prior history of any of the following: Clinically significant illness (other than resolved HCV) or any other major medical disorder that may interfere with subject treatment, assessment, or compliance with the protocol; subjects currently under evaluation for a potentially clinically significant illness (other than HCV) are also excluded --Decompensated liver disease as defined by serum bilirubin >= 2.5 mg/dL (with direct bilirubin >= 1.5 mg/dL), INR >1.5 a serum albumin of less than 3 g/dL, or a history of ascites, hepatorenal syndrome, variceal bleeding, or hepatic encephalopathy. Solid organ transplantation Significant pulmonary disease, significant cardiac disease History of malignancy or treatment for a malignancy within the past 3 years that is associated with a life expectancy <5 years (except adequately treated carcinoma in situ or basal cell carcinoma of the skin) Chronic liver disease with the exception of steatosis (e.g., chronic hepatitis B, hemochromatosis, Wilson s disease, alfa-1 antitrypsin deficiency, cholangitis) Evidence of harmful or hazardous drinking as defined as a score >= 8 on the AUDIT questionnaire Co-infection with HIV defined as the presence of anti-HIV in serum Clinically relevant drug abuse based on patient history within 12 months of screening Chronic use of systemically administered immunosuppressive agents (e.g., prednisone equivalent >= 10 mg/day) Hepatocellular carcinoma, or the presence of a mass on imaging studies of the liver that is suggestive of hepatocellular carcinoma, or an alpha-fetoprotein level of greater than 500 mg/mL Active psychiatric problems such as major depression, schizophrenia, bipolar illness, obsessive-compulsive disorder, severe anxiety, or personality disorder that, in the investigator s opinion, might interfere with participation in the study Presence of conditions that, in the opinion of the investigators, would not allow the patient to be followed in the current study for at least 1 year.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Alaina Magnani
Phone
(301) 451-6984
Email
alaina.magnani@nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Marc G Ghany, M.D.
Phone
(301) 402-5115
Email
mg228m@nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marc G Ghany, M.D.
Organizational Affiliation
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR)
Phone
800-411-1222
Ext
TTY8664111010
Email
prpl@cc.nih.gov

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?A_2018-DK-0091.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

People With CHC Who Achieved a Sustained Virological Response Following Therapy With Direct Acting Antiviral Agents

We'll reach out to this number within 24 hrs