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A Pilot Study of Boceprevir for the Treatment of Genotype 6 HCV (HCV-6)

Primary Purpose

Chronic Hepatitis C

Status
Unknown status
Phase
Phase 2
Locations
Australia
Study Type
Interventional
Intervention
Victrelis® (boceprevir) 800mg by mouth, TID (200 mg tablets)
Peg-Intron® (peginterferon-α-2b), 1.5ug/kg sc injection
Rebetol® (ribavirin), 1000/1200mg by mouth daily
Sponsored by
St Vincent's Hospital Melbourne
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Hepatitis C

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female, at least 18 years of age
  • Asian background
  • HCV treatment-naïve.
  • Chronic HCV infection is defined as one of the following:
  • Positive for anti-HCV antibody (Ab) or HCV RNA at least 6 months before Screening, and positive for HCV RNA and anti-HCVAb at the time of Screening; or
  • Positive for anti-HCV Ab and HCV RNA at the time of Screening with a liver biopsy consistent with chronic HCV infection (or a liver biopsy performed prior to enrollment with evidence of chronic hepatitis C disease).
  • Screening laboratory result indicating HCV genotype 6-infection (HCV-6).
  • Plasma HCV RNA level > 10,000 IU/mL at Screening.
  • IL28B C/C genotype (rs12979860)
  • Per local standard practice, documented results of one of the following:
  • A liver biopsy within 24 months prior to or during screening demonstrating the absence of cirrhosis, e.g., a METAVIR Score of 3 or less, Ishak score of 4 or less; or
  • A screening FibroTest score of ≤ 0.72 and Aspartate Aminotransferase to Platelet Ratio Index (APRI) ≤ 2; or
  • A screening FibroScan result of < 9.6 kPa.
  • Subjects with a non-qualifying Fibrotest/APRI or Fibroscan result may only be enrolled if they have a qualifying liver biopsy preformed within 24 months prior to or during screening.
  • Candidate for PEG/RBV therapy
  • Body mass index (BMI) between 18 and 36 kg/m2
  • Agree to use two highly effective methods of avoiding contraception for the duration of the study and for 7 months after the last dose study medication. Females of childbearing potential must have negative pregnancy test at Screening and Baseline
  • Provide written informed consent to participate in the study.
  • Subjects must have the following laboratory parameters at Screening:
  • ALT ≤ 10 × the upper limit of normal (ULN)
  • AST ≤ 10 × ULN
  • Hemoglobin ≥ 12 g/dL
  • White blood cell count ≥ 2,500 cells/μL
  • Absolute neutrophil count (ANC) ≥ 1,500 cells/mm3
  • Platelets ≥ 90,000/mm3
  • Prothrombin time ≤ 1.5 × ULN
  • Albumin > 3 g/dL
  • Direct (conjugated) bilirubin < ULN
  • Thyroid stimulating hormone (TSH) ≤ ULN
  • Creatinine clearance (CLcr) ≥ 50 mL/min, as calculated by the Cockcroft-Gault equation

Exclusion Criteria:

  • Non-genotype 6 HCV infection, or evidence of mixed genotype HCV infection
  • IL28B C/T or T/T polymorphism (rs12979860)
  • Any current or past clinical evidence of cirrhosis such as ascites or esophageal varices, or prior biopsy showing cirrhosis, e.g., a Metavir Score of >3 or Ishak score of > 4.
  • Exceed defined thresholds for key laboratory parameters at Screening.
  • Females who are pregnant or plan to become pregnant, or breastfeeding, or males whose partners are pregnant or planning to become pregnant within 7 months (or per local RBV label) after their last dose of study drug.
  • Positive test result for Hepatitis B surface antigen (HBsAg) or anti-Human immunodeficiency virus antibody (HIV Ab).
  • Diagnosis of autoimmune disease, decompensated liver, disease, poorly controlled diabetes mellitus, significant psychiatric illness, severe chronic obstructive pulmonary disease (COPD), hepatocellular carcinoma or other malignancy (with exception of certain skin cancers), hemoglobinopathy, retinal disease, or are immunosuppressed
  • Subjects with current use of amphetamines, cocaine, opiates (e.g., morphine, heroin), or ongoing alcohol abuse are excluded. Subjects on stable methadone maintenance treatment for at least 6 months prior to Screening may be included into the study.
  • Use of prohibited concomitant medications two weeks prior to baseline through the end of treatment, as defined by the product label.

Sites / Locations

  • Box Hill Hospital
  • Monash Medical Centre
  • St Vincent's Hospital
  • Western Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

Active Comparator

Arm Label

Boceprevir triple therapy with 5-day lead in

Boceprevir triple therapy

Standard of Care

Arm Description

Victrelis® (boceprevir) 800mg by mouth, TID (200 mg tablets) for 5 days, followed by boceprevir plus • Peg-Intron® (peginterferon-α-2b), 1.5ug/kg sc injection plus • Rebetol® (ribavirin), 1000/1200mg, by mouth daily for 24 weeks. In patients who achieve an undetectable plasma HCV RNA level at week 4 of triple therapy (week 5 from baseline), and maintain an undetectable plasma HCV RNA at week 20 of triple therapy (week 21 from baseline), treatment will stop at week 25. Patients who have a detectable plasma HCV RNA at week 4 of triple therapy, but an undetectable plasma HCV RNA at week 20, will continue a with follow-on peginterferon-α-2b plus ribavirin for a further 23 weeks (stopping at week 48).

Victrelis® (boceprevir) 800mg by mouth, TID (200 mg tablets) plus Peg-Intron® (peginterferon-α-2b), 1.5ug/kg sc injection and Rebetol® (ribavirin), 1000/1200mg, by mouth daily for 24 weeks. In patients who achieve an undetectable plasma HCV RNA level at week 4 of triple therapy, and maintain an undetectable plasma HCV RNA at week 20 of triple therapy, treatment will stop at week 24. Patients who have a detectable plasma HCV RNA at week 4 of triple therapy, but an undetectable plasma HCV RNA at week 20, will continue a with follow-on peginterferon-α-2b plus ribavirin for a further 24 weeks (stopping at week 48).

48 weeks of Peg-Intron® (peginterferon-α-2b), 1.5ug/kg sc injection and Rebetol® (ribavirin), 1000/1200mg by mouth daily (200mg tablets)

Outcomes

Primary Outcome Measures

Early viral kinetics
Determined by plasma HCV RNA quantification at frequent time points - baseline, day 1, 2, 3, 4 and 5

Secondary Outcome Measures

Rates of virological response
Percentage of patients with undetectable plasma HCV RNA) at different time-points
Number of patients eligible for Response Guided Therapy
Patients in Arm A and B randomised to received boceprevir-based triple therapy who achieve an undetectable HCV PCR at week 4 and week 20 are eligible for 24 weeks of therapy, vs. 48 weeks of therapy
Rates of virological breakthrough
Defined by an increase in HCV RNA > 1 log10 IU/mL from nadir, or HCV RNA increase to > 100 IU/mL in patients who had previously reached an undetectable HCV RNA, and confirmed by 2 consecutive samples < 4 weeks apart.
Rates of SVR12 and relapse
SVR 12 - Number of patients who achieve an undetectable HCV PCR 12-weeks post treatment Relapse - Number of patients who have an undetectable HCV PCR at the end of treatment but detectable HCV PCR 12-weeks post treatment
Rates of anaemia on treatment

Full Information

First Posted
September 4, 2013
Last Updated
September 19, 2013
Sponsor
St Vincent's Hospital Melbourne
Collaborators
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT01949168
Brief Title
A Pilot Study of Boceprevir for the Treatment of Genotype 6 HCV
Acronym
HCV-6
Official Title
Phase 2a Study of Boceprevir for the Treatment of Genotype 6 Hepatitis C
Study Type
Interventional

2. Study Status

Record Verification Date
September 2013
Overall Recruitment Status
Unknown status
Study Start Date
September 2013 (undefined)
Primary Completion Date
September 2015 (Anticipated)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
St Vincent's Hospital Melbourne
Collaborators
Merck Sharp & Dohme LLC

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to evaluate the antiviral efficacy of Boceprevir-based therapy for the treatment of genotype 6 chronic hepatitis C infection. Boceprevir has recently been approved for the treatment of genotype 1 chronic hepatitis C infection. Recent in vitro studies suggest similar efficacy against genotype 6 chronic hepatitis C infection. The investigators therefore hypothesise that: i) Boceprevir is a potent inhibitor of genotype 6 hepatitis C replication in vivo. ii) Boceprevir in combination with pegylated interferon-alpha and ribavirin for 24 weeks will cure a high proportion of patients chronically infected with genotype 6 chronic hepatitis C infection.
Detailed Description
Genotype 6 HCV (HCV-6) is common in parts of South-East Asia, in particular Vietnam. There is a small but growing population of immigrant patients with chronic HCV-6 in Australia. The current standard-of-care treatment (SOC) for chronic HCV-6 infection is peg-interferon-α (PEG-IFN) and ribavirin (RBV) therapy for 48 weeks. The available data evaluating treatment outcome suggests that SVR rates are intermediate between those of HCV-1 and HCV-2/3. There is a medical need for novel therapies that might increase SVR rates and/or allow shortened treatment duration. Boceprevir is a novel HCV NS3 protease inhibitor, and boceprevir-based triple therapy has recently been approved for the treatment of HCV-1. Boceprevir also appears to have some antiviral effect against HCV-2 and HCV-3 in vivo. Boceprevir has not been used to treat patients with chronic HCV-6 infection. Recent in vitro data have demonstrated that boceprevir has an antiviral effect against HCV-6. The investigators are therefore undertaking an investigator-initiated proof-of-concept pilot study of boceprevir-based therapy for the treatment of patients chronically infected with HCV-6. The study population will consist of a representative group of 30 adult patients who are chronically infected with genotype 6 HCV. All patients will be of Asian background, will be non-cirrhotic, and will carry a "good response" IL28B genotype (C/C for rs12979860). The patients will be recruited from the outpatient clinics of 4 Hepatology units in Melbourne, Australia, represented by the principal and associate investigators.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Boceprevir triple therapy with 5-day lead in
Arm Type
Active Comparator
Arm Description
Victrelis® (boceprevir) 800mg by mouth, TID (200 mg tablets) for 5 days, followed by boceprevir plus • Peg-Intron® (peginterferon-α-2b), 1.5ug/kg sc injection plus • Rebetol® (ribavirin), 1000/1200mg, by mouth daily for 24 weeks. In patients who achieve an undetectable plasma HCV RNA level at week 4 of triple therapy (week 5 from baseline), and maintain an undetectable plasma HCV RNA at week 20 of triple therapy (week 21 from baseline), treatment will stop at week 25. Patients who have a detectable plasma HCV RNA at week 4 of triple therapy, but an undetectable plasma HCV RNA at week 20, will continue a with follow-on peginterferon-α-2b plus ribavirin for a further 23 weeks (stopping at week 48).
Arm Title
Boceprevir triple therapy
Arm Type
Active Comparator
Arm Description
Victrelis® (boceprevir) 800mg by mouth, TID (200 mg tablets) plus Peg-Intron® (peginterferon-α-2b), 1.5ug/kg sc injection and Rebetol® (ribavirin), 1000/1200mg, by mouth daily for 24 weeks. In patients who achieve an undetectable plasma HCV RNA level at week 4 of triple therapy, and maintain an undetectable plasma HCV RNA at week 20 of triple therapy, treatment will stop at week 24. Patients who have a detectable plasma HCV RNA at week 4 of triple therapy, but an undetectable plasma HCV RNA at week 20, will continue a with follow-on peginterferon-α-2b plus ribavirin for a further 24 weeks (stopping at week 48).
Arm Title
Standard of Care
Arm Type
Active Comparator
Arm Description
48 weeks of Peg-Intron® (peginterferon-α-2b), 1.5ug/kg sc injection and Rebetol® (ribavirin), 1000/1200mg by mouth daily (200mg tablets)
Intervention Type
Drug
Intervention Name(s)
Victrelis® (boceprevir) 800mg by mouth, TID (200 mg tablets)
Intervention Type
Drug
Intervention Name(s)
Peg-Intron® (peginterferon-α-2b), 1.5ug/kg sc injection
Intervention Type
Drug
Intervention Name(s)
Rebetol® (ribavirin), 1000/1200mg by mouth daily
Primary Outcome Measure Information:
Title
Early viral kinetics
Description
Determined by plasma HCV RNA quantification at frequent time points - baseline, day 1, 2, 3, 4 and 5
Time Frame
Day 5
Secondary Outcome Measure Information:
Title
Rates of virological response
Description
Percentage of patients with undetectable plasma HCV RNA) at different time-points
Time Frame
Day 3, 5, week 2, week 4, week 12 and end of treatment (week 24 or week 48)
Title
Number of patients eligible for Response Guided Therapy
Description
Patients in Arm A and B randomised to received boceprevir-based triple therapy who achieve an undetectable HCV PCR at week 4 and week 20 are eligible for 24 weeks of therapy, vs. 48 weeks of therapy
Time Frame
Week 4 and week 20
Title
Rates of virological breakthrough
Description
Defined by an increase in HCV RNA > 1 log10 IU/mL from nadir, or HCV RNA increase to > 100 IU/mL in patients who had previously reached an undetectable HCV RNA, and confirmed by 2 consecutive samples < 4 weeks apart.
Time Frame
Week 4, week 20, week 24, week 48, week 60
Title
Rates of SVR12 and relapse
Description
SVR 12 - Number of patients who achieve an undetectable HCV PCR 12-weeks post treatment Relapse - Number of patients who have an undetectable HCV PCR at the end of treatment but detectable HCV PCR 12-weeks post treatment
Time Frame
Week 48 and Week 60
Title
Rates of anaemia on treatment
Time Frame
Day 0, 1, 2, 3, 4, 5, then monthly up to week 48 of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female, at least 18 years of age Asian background HCV treatment-naïve. Chronic HCV infection is defined as one of the following: Positive for anti-HCV antibody (Ab) or HCV RNA at least 6 months before Screening, and positive for HCV RNA and anti-HCVAb at the time of Screening; or Positive for anti-HCV Ab and HCV RNA at the time of Screening with a liver biopsy consistent with chronic HCV infection (or a liver biopsy performed prior to enrollment with evidence of chronic hepatitis C disease). Screening laboratory result indicating HCV genotype 6-infection (HCV-6). Plasma HCV RNA level > 10,000 IU/mL at Screening. IL28B C/C genotype (rs12979860) Per local standard practice, documented results of one of the following: A liver biopsy within 24 months prior to or during screening demonstrating the absence of cirrhosis, e.g., a METAVIR Score of 3 or less, Ishak score of 4 or less; or A screening FibroTest score of ≤ 0.72 and Aspartate Aminotransferase to Platelet Ratio Index (APRI) ≤ 2; or A screening FibroScan result of < 9.6 kPa. Subjects with a non-qualifying Fibrotest/APRI or Fibroscan result may only be enrolled if they have a qualifying liver biopsy preformed within 24 months prior to or during screening. Candidate for PEG/RBV therapy Body mass index (BMI) between 18 and 36 kg/m2 Agree to use two highly effective methods of avoiding contraception for the duration of the study and for 7 months after the last dose study medication. Females of childbearing potential must have negative pregnancy test at Screening and Baseline Provide written informed consent to participate in the study. Subjects must have the following laboratory parameters at Screening: ALT ≤ 10 × the upper limit of normal (ULN) AST ≤ 10 × ULN Hemoglobin ≥ 12 g/dL White blood cell count ≥ 2,500 cells/μL Absolute neutrophil count (ANC) ≥ 1,500 cells/mm3 Platelets ≥ 90,000/mm3 Prothrombin time ≤ 1.5 × ULN Albumin > 3 g/dL Direct (conjugated) bilirubin < ULN Thyroid stimulating hormone (TSH) ≤ ULN Creatinine clearance (CLcr) ≥ 50 mL/min, as calculated by the Cockcroft-Gault equation Exclusion Criteria: Non-genotype 6 HCV infection, or evidence of mixed genotype HCV infection IL28B C/T or T/T polymorphism (rs12979860) Any current or past clinical evidence of cirrhosis such as ascites or esophageal varices, or prior biopsy showing cirrhosis, e.g., a Metavir Score of >3 or Ishak score of > 4. Exceed defined thresholds for key laboratory parameters at Screening. Females who are pregnant or plan to become pregnant, or breastfeeding, or males whose partners are pregnant or planning to become pregnant within 7 months (or per local RBV label) after their last dose of study drug. Positive test result for Hepatitis B surface antigen (HBsAg) or anti-Human immunodeficiency virus antibody (HIV Ab). Diagnosis of autoimmune disease, decompensated liver, disease, poorly controlled diabetes mellitus, significant psychiatric illness, severe chronic obstructive pulmonary disease (COPD), hepatocellular carcinoma or other malignancy (with exception of certain skin cancers), hemoglobinopathy, retinal disease, or are immunosuppressed Subjects with current use of amphetamines, cocaine, opiates (e.g., morphine, heroin), or ongoing alcohol abuse are excluded. Subjects on stable methadone maintenance treatment for at least 6 months prior to Screening may be included into the study. Use of prohibited concomitant medications two weeks prior to baseline through the end of treatment, as defined by the product label.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alexander Thompson, MBBS
Organizational Affiliation
St Vincent's Hospital Melbourne
Official's Role
Principal Investigator
Facility Information:
Facility Name
Box Hill Hospital
City
Box Hill
State/Province
Victoria
ZIP/Postal Code
3128
Country
Australia
Facility Contact:
First Name & Middle Initial & Last Name & Degree
John Lubel, MBBS
Phone
61-3 9094 9548
First Name & Middle Initial & Last Name & Degree
John Lubel, MBBS
Facility Name
Monash Medical Centre
City
Clayton
State/Province
Victoria
ZIP/Postal Code
3168
Country
Australia
Facility Contact:
First Name & Middle Initial & Last Name & Degree
William Sievert, MBBS
Phone
613 9594 3177
Email
william.sievert@monash.edu
First Name & Middle Initial & Last Name & Degree
William Sievert, MBBS
Facility Name
St Vincent's Hospital
City
Fitzroy
State/Province
Victoria
ZIP/Postal Code
3065
Country
Australia
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Swee Lin G Chen Yi Mei, MBBS
Phone
61 3 9288 3580
Email
sweelin.chenyimei@svhm.org.au
First Name & Middle Initial & Last Name & Degree
Alexander Thompson, MBBS
Phone
61 3 9288 3580
Email
alexander.thompson@svhm.org.au
First Name & Middle Initial & Last Name & Degree
Alexander Thompson, MBBS
First Name & Middle Initial & Last Name & Degree
Swee Lin G Chen Yi Mei, MBBS
Facility Name
Western Hospital
City
Footscray
State/Province
Victoria
ZIP/Postal Code
3011
Country
Australia
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Niranjan JS Arachchi, MBBS
Phone
61-3 83457266
First Name & Middle Initial & Last Name & Degree
Niranjan JS Arachchi, MBBS

12. IPD Sharing Statement

Citations:
PubMed Identifier
21651703
Citation
Sievert W, Altraif I, Razavi HA, Abdo A, Ahmed EA, Alomair A, Amarapurkar D, Chen CH, Dou X, El Khayat H, Elshazly M, Esmat G, Guan R, Han KH, Koike K, Largen A, McCaughan G, Mogawer S, Monis A, Nawaz A, Piratvisuth T, Sanai FM, Sharara AI, Sibbel S, Sood A, Suh DJ, Wallace C, Young K, Negro F. A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver Int. 2011 Jul;31 Suppl 2:61-80. doi: 10.1111/j.1478-3231.2011.02540.x.
Results Reference
background
PubMed Identifier
12395338
Citation
Dev AT, McCaw R, Sundararajan V, Bowden S, Sievert W. Southeast Asian patients with chronic hepatitis C: the impact of novel genotypes and race on treatment outcome. Hepatology. 2002 Nov;36(5):1259-65. doi: 10.1053/jhep.2002.36781.
Results Reference
background
PubMed Identifier
19330875
Citation
Ghany MG, Strader DB, Thomas DL, Seeff LB; American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009 Apr;49(4):1335-74. doi: 10.1002/hep.22759. No abstract available.
Results Reference
background
PubMed Identifier
21449783
Citation
Poordad F, McCone J Jr, Bacon BR, Bruno S, Manns MP, Sulkowski MS, Jacobson IM, Reddy KR, Goodman ZD, Boparai N, DiNubile MJ, Sniukiene V, Brass CA, Albrecht JK, Bronowicki JP; SPRINT-2 Investigators. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011 Mar 31;364(13):1195-206. doi: 10.1056/NEJMoa1010494.
Results Reference
background
PubMed Identifier
21677916
Citation
Bathgate A. Boceprevir for previously treated chronic hepatitis C virus genotype 1 infection. J R Coll Physicians Edinb. 2011 Jun;41(2):122-3. doi: 10.4997/JRCPE.2011.222. No abstract available.
Results Reference
background
PubMed Identifier
23454058
Citation
Silva MO, Treitel M, Graham DJ, Curry S, Frontera MJ, McMonagle P, Gupta S, Hughes E, Chase R, Lahser F, Barnard RJ, Howe AY, Howe JA. Antiviral activity of boceprevir monotherapy in treatment-naive subjects with chronic hepatitis C genotype 2/3. J Hepatol. 2013 Jul;59(1):31-7. doi: 10.1016/j.jhep.2013.02.018. Epub 2013 Feb 27.
Results Reference
background
PubMed Identifier
19684573
Citation
Ge D, Fellay J, Thompson AJ, Simon JS, Shianna KV, Urban TJ, Heinzen EL, Qiu P, Bertelsen AH, Muir AJ, Sulkowski M, McHutchison JG, Goldstein DB. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature. 2009 Sep 17;461(7262):399-401. doi: 10.1038/nature08309. Epub 2009 Aug 16.
Results Reference
background

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A Pilot Study of Boceprevir for the Treatment of Genotype 6 HCV

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