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Boceprevir/Peginterferon/Ribavirin for Chronic Hepatitis C: Erythropoietin Use Versus Ribavirin Dose Reduction for Anemia (P06086 AM2)

Primary Purpose

Hepatitis C, Chronic

Status
Completed
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Boceprevir
Peginterferon alfa-2b (PEG2b)
Ribavirin (RBV)
Erythropoietin
Sponsored by
Merck Sharp & Dohme LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatitis C, Chronic

Eligibility Criteria

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

Inclusion Criteria:

  • Participant must have previously documented Chronic Hepatitis C (CHC) genotype 1 infection.
  • Hemoglobin concentration at Screening must be ≤15 g/dL for both females and males.
  • Participant must have a liver biopsy with histology consistent with CHC and no other etiology.
  • Participant with bridging fibrosis (F3) or cirrhosis (F4) must have an ultrasound within 6 months of the Screening Visit (or between Screening and Day 1) with no findings suspicious for hepatocellular carcinoma.
  • Participant's weight must be ≥40 kg and ≤125 kg.
  • Participant and participant's partner(s) must each agree to use acceptable methods of contraception for at least 2 weeks prior to Day 1 and continue until at least 6 months after last dose of study medication, or longer if dictated by local regulations.
  • Participant must be willing to give written informed consent.
  • Participant must be willing to attend frequent site visits for the duration of the trial.
  • Participant must not have any contraindications for the use of erythropoietin.

Exclusion Criteria:

  • Participants known to be coinfected with the human immunodeficiency virus (HIV) or hepatitis B virus.
  • Participants who received prior treatment for hepatitis C.
  • Treatment with any investigational drug within 30 days of the screening visit in this trial.
  • Participants receiving any of the following medication(s) within 2 weeks prior to the Day 1 visit: alfuzosin, antiarrhythmics (amiodarone, bepridil, flecainide, propafenone, and quinidine), ergot derivatives, cisapride, lovastatin, simvastatin, pimozide, triazolam, and orally administered midazolam.
  • Participation in any other clinical trial within 30 days of the screening visit in this trial or intention to participate in another clinical trial during participation in this trial.
  • Evidence of decompensated liver disease.
  • Diabetic and/or hypertensive participants with clinically significant ocular examination findings.
  • Pre-existing psychiatric condition(s).
  • Clinical diagnosis of substance abuse of specified drugs within specified timeframes.
  • Any known pre-existing medical condition that could interfere with the participant's participation in and completion of the trial.
  • Evidence of active or suspected malignancy, or a history of malignancy, within the last 5 years (except adequately treated carcinoma in situ and basal cell carcinoma of the skin).
  • Participants who are pregnant or nursing. Participants who intend to become pregnant during the trial period. Male participants with partners who are, or intend to become, pregnant during the trial period.
  • Any other condition which, in the opinion of a physician, would make the participant unsuitable for enrollment or could interfere with the participant participating in and completing the trial.
  • Participant who had a life-threatening serious adverse event during the screening period.
  • A participant must not be a member or a family member of the personnel of the investigational or sponsor staff directly involved with this trial.
  • Protocol-specified hematologic, biochemical, and serologic criteria (growth factors may not be used to achieve trial entry requirements).
  • Serum albumin below the lower limit of normal (LLN) of laboratory reference range.
  • Thyroid-stimulating hormone (TSH) >1.2 x Upper Limit of Normal (ULN) or <0.8 x LLN of laboratory reference.
  • Serum creatinine >ULN of the laboratory reference.
  • Protocol-specified serum glucose concentrations.
  • Prothrombin time/partial thromboplastin time (PT/PTT) values >10% above laboratory reference range.
  • Protocol-specified alpha fetoprotein concentrations.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Experimental

    Experimental

    Experimental

    Arm Label

    Treated/Not Randomized

    Ribavirin Dose Reduction

    Erythropoietin Use

    Arm Description

    Participants received 4 weeks of PEG2b/RBV followed by 24 or 44 weeks of boceprevir plus PEG2b/RBV depending on Hepatitis C Virus RNA (HCV-RNA) levels. Participants continued with this treatment if their serum hemoglobin remained >10 g/dL throughout the 28- or 48-week treatment period.

    After the initiation of treatment with 4 weeks with PEG2b/RBV followed by 24 or 44 weeks of boceprevir, participants who became anemic (serum hemoglobin = ≤10 g/dL) within the 28- or 48-week treatment period and who were randomized to the Ribavirin (RBV) Dose Reduction Arm received reduced doses of RBV for management of the anemia in combination with PEG2b and boceprevir therapies.

    After the initiation of treatment with 4 weeks with PEG2b/RBV followed by 24 or 44 weeks of boceprevir, participants who became anemic (serum hemoglobin = ≤10 g/dL) within the 28- or 48-week treatment period and who were randomized to the Erythropoietin Use Arm received erythropoietin for management of the anemia in addition to PEG2b/RBV and boceprevir therapies.

    Outcomes

    Primary Outcome Measures

    Percentage of Participants With Sustained Virologic Response (SVR)
    SVR was defined as undetectable plasma Hepatitis C Virus ribonucleic acid (HCV-RNA) at Follow-up Week 24

    Secondary Outcome Measures

    Percentage of Participants Who Discontinued Treatment
    Cumulative discontinuation was defined as the sum of discontinuations due to adverse events, viral breakthrough/resistance, detectable HCV-RNA and futility rules (<2-log10 decline in HCV-RNA at Treatment Week 12, ≥ Lower Limit of Quantification [LLQ] HCV-RNA at Treatment Week 24), and other (noncompliance, withdrawal of consent, lost to follow-up).

    Full Information

    First Posted
    November 24, 2009
    Last Updated
    January 15, 2021
    Sponsor
    Merck Sharp & Dohme LLC
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    1. Study Identification

    Unique Protocol Identification Number
    NCT01023035
    Brief Title
    Boceprevir/Peginterferon/Ribavirin for Chronic Hepatitis C: Erythropoietin Use Versus Ribavirin Dose Reduction for Anemia (P06086 AM2)
    Official Title
    Boceprevir and Peginterferon/Ribavirin for the Treatment of Chronic Hepatitis C in Treatment-Naive Subjects: A Comparison of Erythropoietin Use Versus Ribavirin Dose Reduction for the Management of Anemia
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    January 2021
    Overall Recruitment Status
    Completed
    Study Start Date
    December 7, 2009 (Actual)
    Primary Completion Date
    October 26, 2011 (Actual)
    Study Completion Date
    October 26, 2011 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Merck Sharp & Dohme LLC

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    The current trial is designed to prospectively explore the safety of erythropoietin use for the treatment of anemia during boceprevir plus peginterferon alfa-2b/Ribavirin (PEG2b/RBV) therapy and to assess its relationship to efficacy. All participants in this trial will be treated with the triple combination of boceprevir plus PEG2b/RBV. If a participant becomes anemic during treatment, the participant will be randomized to one of two therapeutic strategies for management of anemia (erythropoietin use versus RBV dose reduction).

    6. Conditions and Keywords

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

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    687 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Treated/Not Randomized
    Arm Type
    Experimental
    Arm Description
    Participants received 4 weeks of PEG2b/RBV followed by 24 or 44 weeks of boceprevir plus PEG2b/RBV depending on Hepatitis C Virus RNA (HCV-RNA) levels. Participants continued with this treatment if their serum hemoglobin remained >10 g/dL throughout the 28- or 48-week treatment period.
    Arm Title
    Ribavirin Dose Reduction
    Arm Type
    Experimental
    Arm Description
    After the initiation of treatment with 4 weeks with PEG2b/RBV followed by 24 or 44 weeks of boceprevir, participants who became anemic (serum hemoglobin = ≤10 g/dL) within the 28- or 48-week treatment period and who were randomized to the Ribavirin (RBV) Dose Reduction Arm received reduced doses of RBV for management of the anemia in combination with PEG2b and boceprevir therapies.
    Arm Title
    Erythropoietin Use
    Arm Type
    Experimental
    Arm Description
    After the initiation of treatment with 4 weeks with PEG2b/RBV followed by 24 or 44 weeks of boceprevir, participants who became anemic (serum hemoglobin = ≤10 g/dL) within the 28- or 48-week treatment period and who were randomized to the Erythropoietin Use Arm received erythropoietin for management of the anemia in addition to PEG2b/RBV and boceprevir therapies.
    Intervention Type
    Drug
    Intervention Name(s)
    Boceprevir
    Other Intervention Name(s)
    SCH 503034
    Intervention Description
    800 mg given three times a day (TID), orally (PO)
    Intervention Type
    Drug
    Intervention Name(s)
    Peginterferon alfa-2b (PEG2b)
    Other Intervention Name(s)
    SCH 054031
    Intervention Description
    1.5 µg/kg/week given subcutaneously (SC)
    Intervention Type
    Drug
    Intervention Name(s)
    Ribavirin (RBV)
    Other Intervention Name(s)
    SCH 018908, Rebetol
    Intervention Description
    Ribavirin weight-based dosing (WBD), 600 to 1400 mg/day given twice daily (BID), orally (PO)
    Intervention Type
    Drug
    Intervention Name(s)
    Erythropoietin
    Other Intervention Name(s)
    Procrit, Eprex
    Intervention Description
    Initial dose of 40,000 Units given subcutaneously (SC) once weekly (QW), with dose adjustment as necessary to achieve and maintain serum hemoglobin levels of 10-12 g/dL
    Primary Outcome Measure Information:
    Title
    Percentage of Participants With Sustained Virologic Response (SVR)
    Description
    SVR was defined as undetectable plasma Hepatitis C Virus ribonucleic acid (HCV-RNA) at Follow-up Week 24
    Time Frame
    At Follow-up Week 24
    Secondary Outcome Measure Information:
    Title
    Percentage of Participants Who Discontinued Treatment
    Description
    Cumulative discontinuation was defined as the sum of discontinuations due to adverse events, viral breakthrough/resistance, detectable HCV-RNA and futility rules (<2-log10 decline in HCV-RNA at Treatment Week 12, ≥ Lower Limit of Quantification [LLQ] HCV-RNA at Treatment Week 24), and other (noncompliance, withdrawal of consent, lost to follow-up).
    Time Frame
    From Study Day 1 up to Study Treatment Week 48

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Participant must have previously documented Chronic Hepatitis C (CHC) genotype 1 infection. Hemoglobin concentration at Screening must be ≤15 g/dL for both females and males. Participant must have a liver biopsy with histology consistent with CHC and no other etiology. Participant with bridging fibrosis (F3) or cirrhosis (F4) must have an ultrasound within 6 months of the Screening Visit (or between Screening and Day 1) with no findings suspicious for hepatocellular carcinoma. Participant's weight must be ≥40 kg and ≤125 kg. Participant and participant's partner(s) must each agree to use acceptable methods of contraception for at least 2 weeks prior to Day 1 and continue until at least 6 months after last dose of study medication, or longer if dictated by local regulations. Participant must be willing to give written informed consent. Participant must be willing to attend frequent site visits for the duration of the trial. Participant must not have any contraindications for the use of erythropoietin. Exclusion Criteria: Participants known to be coinfected with the human immunodeficiency virus (HIV) or hepatitis B virus. Participants who received prior treatment for hepatitis C. Treatment with any investigational drug within 30 days of the screening visit in this trial. Participants receiving any of the following medication(s) within 2 weeks prior to the Day 1 visit: alfuzosin, antiarrhythmics (amiodarone, bepridil, flecainide, propafenone, and quinidine), ergot derivatives, cisapride, lovastatin, simvastatin, pimozide, triazolam, and orally administered midazolam. Participation in any other clinical trial within 30 days of the screening visit in this trial or intention to participate in another clinical trial during participation in this trial. Evidence of decompensated liver disease. Diabetic and/or hypertensive participants with clinically significant ocular examination findings. Pre-existing psychiatric condition(s). Clinical diagnosis of substance abuse of specified drugs within specified timeframes. Any known pre-existing medical condition that could interfere with the participant's participation in and completion of the trial. Evidence of active or suspected malignancy, or a history of malignancy, within the last 5 years (except adequately treated carcinoma in situ and basal cell carcinoma of the skin). Participants who are pregnant or nursing. Participants who intend to become pregnant during the trial period. Male participants with partners who are, or intend to become, pregnant during the trial period. Any other condition which, in the opinion of a physician, would make the participant unsuitable for enrollment or could interfere with the participant participating in and completing the trial. Participant who had a life-threatening serious adverse event during the screening period. A participant must not be a member or a family member of the personnel of the investigational or sponsor staff directly involved with this trial. Protocol-specified hematologic, biochemical, and serologic criteria (growth factors may not be used to achieve trial entry requirements). Serum albumin below the lower limit of normal (LLN) of laboratory reference range. Thyroid-stimulating hormone (TSH) >1.2 x Upper Limit of Normal (ULN) or <0.8 x LLN of laboratory reference. Serum creatinine >ULN of the laboratory reference. Protocol-specified serum glucose concentrations. Prothrombin time/partial thromboplastin time (PT/PTT) values >10% above laboratory reference range. Protocol-specified alpha fetoprotein concentrations.

    12. IPD Sharing Statement

    Plan to Share IPD
    Yes
    IPD Sharing Plan Description
    http://engagezone.msd.com/doc/ProcedureAccessClinicalTrialData.pdf
    IPD Sharing URL
    http://engagezone.msd.com/ds_documentation.php
    Citations:
    PubMed Identifier
    23924660
    Citation
    Poordad F, Lawitz E, Reddy KR, Afdhal NH, Hezode C, Zeuzem S, Lee SS, Calleja JL, Brown RS Jr, Craxi A, Wedemeyer H, Nyberg L, Nelson DR, Rossaro L, Balart L, Morgan TR, Bacon BR, Flamm SL, Kowdley KV, Deng W, Koury KJ, Pedicone LD, Dutko FJ, Burroughs MH, Alves K, Wahl J, Brass CA, Albrecht JK, Sulkowski MS; Protocol 6086 Investigators. Effects of ribavirin dose reduction vs erythropoietin for boceprevir-related anemia in patients with chronic hepatitis C virus genotype 1 infection--a randomized trial. Gastroenterology. 2013 Nov;145(5):1035-1044.e5. doi: 10.1053/j.gastro.2013.07.051. Epub 2013 Aug 4.
    Results Reference
    derived

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    Boceprevir/Peginterferon/Ribavirin for Chronic Hepatitis C: Erythropoietin Use Versus Ribavirin Dose Reduction for Anemia (P06086 AM2)

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