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DAA Based Therapy for Recently Acquired Hepatitis C (DARE-C) (DARE-C)

Primary Purpose

Hepatitis C, Chronic

Status
Completed
Phase
Phase 4
Locations
Australia
Study Type
Interventional
Intervention
TPV/PEG-IFN/RBV
Sponsored by
Kirby Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatitis C, Chronic focused on measuring Hepatitis C, Individualised therapy, Response-guided therapy, Telaprevir, PEG-IFN, Ribavirin, Hepatitis

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Provision of written, informed consent.
  2. HCV genotype 1 infection
  3. Quantifiable HCV RNA at screening and baseline (>10,000 IU/ml)
  4. Recent hepatitis C infection with an estimated duration of Infection >6 months and ≤ 18 months defined as A) i) First anti-HCV antibody or HCV RNA positive within the previous 6 months and ii) Documented anti-HCV antibody negative or HCV RNA negative within the 24 months prior to anti-HCV antibody positive result OR B) i) First anti-HCV antibody or HCV RNA positive within the previous 6 months and ii) acute clinical hepatitis (jaundice or ALT> 10 X ULN) within the 12 months prior to first positive HCV antibody or HCV RNA with no other cause of acute hepatitis identifiable
  5. Compensated liver disease (Child-Pugh A)
  6. Negative pregnancy test at screening and 24 hours prior to the first dose of study drugs.
  7. If heterosexually active, a female subject of childbearing potential and a nonvasectomized male subject who has a female partner of childbearing potential must agree to use 2 effective contraceptives from screening onwards until 6 months (female subject) or 7 months (male subject) after RBV therapy has ended. Note: Hormonal contraceptives may be continued but may not be reliable during telaprevir dosing and for 2 months following cessation of telaprevir. Therefore, subjects should agree to use 2 effective non-hormonal methods of contraception during telaprevir combination therapy and for 2 months after the last intake of telaprevir. As of two months after completion of telaprevir hormonal contraceptives can again be used as one of the two required effective methods of birth control.
  8. Subject is judged to be medically stable on the basis of physical examination, medical history and vital signs.
  9. Adequate English to provide written, informed consent and to provide reliable responses to the study interview

Additional inclusion criteria for HIV positive individuals

  • Confirmed HIV infection > 6 months duration
  • CD4 > 200 cells/mm3 and HIV < 50 c/ml on stable antiretroviral therapy (ART) at least 3 months prior to treatment
  • Or
  • CD4 >= 500 cells/mm3 and HIV viral load (VL) < 100,000 not on ART
  • If on ART must be taking a regimen containing an accepted* combination of the following drugs: tenofovir ( TDF), lamivudine ( 3TC), emtricitabine (FTC), efavirenz (EFV), abacavir (ABC), raltegravir (RAL), etravirine (ETV), rilpivirine (RIL), ritonavir boosted atazanavir (r/ATZ) * Combination must be supported by current HIV treatment guidelines

Exclusion Criteria:

  • Individuals considered by the study investigators to be unlikely to participate in intensive follow-up and/or unwilling to provide extra blood samples
  • Current injecting drug use (any injecting within previous 4 weeks)
  • Standard exclusions to Pegylated-interferon (PEG-IFN), Ribavirin (RBV) and Telaprevir (TPV) therapy

Sites / Locations

  • St Vincent's Hospital
  • Royal Adelaide Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Group A - 8 weeks total therapy

Group B - 12 weeks total therapy

Group C - 24 weeks total therapy

Arm Description

8 weeks total therapy of TPV/PEG-IFN/RBV if undetectable HCV RNA after 2 weeks of therapy

12 weeks total therapy of TPV/PEG-IFN/RBV if undetectable HCV RNA after 4 weeks of therapy

24 weeks total therapy - TPV/PEG-IFN/RBV for 12 weeks + PEG-IFN/RBV for 12 weeks if undetectable HCV RNA after 8 weeks of therapy

Outcomes

Primary Outcome Measures

SVR12 (Sustain Virological Response, HCV RNA Undetectable 12 Weeks Post-treatment)
Proportion of subjects achieving SVR 12 (negative qualitative HCV RNA 12 weeks after therapy completion)

Secondary Outcome Measures

SVR24
To evaluate the proportion of patients with undetectable HCV RNA 24 weeks after therapy completion (SVR24)
Undetectable HCV RNA (ETR)
To evaluate the proportion of patients with undetectable HCV RNA at end of treatment (ETR)
Undetectable HCV RNA (Week 1)
To evaluate the proportion of patients with undetectable HCV RNA at week 1 of therapy.
Undectectable HCV RNA (Week 2)
To evaluate the proportion of patients with undetectable HCV RNA at week 1 of therapy.
Undetectable HCV RNA (Week 3)
To evaluate the proportion of patients with undetectable HCV RNA at week 3 of therapy.
Undetectable HCV RNA (Week 4)
To evaluate the proportion of patients with undetectable HCV RNA at week 4 of therapy.
Decrease in Absolute Neutrophil Count (ANC) ≤0.75
Decrease in Platelets <50
Change in Hemoglobin at End of Treatment
To evaluate indicators of toxicity during telaprevir based therapy
Resistance-associated Variants
To examine the emergence of resistance-associated variants during telaprevir based therapy for early chronic infection
Baseline Resistance-associated Variants
To correlate the presence and frequency of baseline resistance-associated variants (RAVs) with the response of Telaprevir based therapy for early chronic HCV infection.
Plasma Ribavirin Levels
To correlate plasma ribavirin levels with treatment outcome and changes in haemoglobin during therapy
CD4 and HIV RNA
In HIV positive participants to evaluate changes in CD4 counts and HIV RNA during telaprevir based therapy
Gene IL28B Polymorphism
To examine treatment outcome by IL28B polymorphism

Full Information

First Posted
November 28, 2012
Last Updated
February 28, 2017
Sponsor
Kirby Institute
Collaborators
Janssen-Cilag Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT01743521
Brief Title
DAA Based Therapy for Recently Acquired Hepatitis C (DARE-C)
Acronym
DARE-C
Official Title
Direct Acting Antiviral (DAA) Based Therapy for Recently Acquired Hepatitis C
Study Type
Interventional

2. Study Status

Record Verification Date
February 2017
Overall Recruitment Status
Completed
Study Start Date
January 2013 (undefined)
Primary Completion Date
November 2015 (Actual)
Study Completion Date
January 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Kirby Institute
Collaborators
Janssen-Cilag Ltd.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To examine the safety and efficacy of response guided triple therapy (PEG-IFN, Ribavirin, Telaprevir) for the treatment of early chronic Hepatitis C Virus (HCV) infection.
Detailed Description
DARE-C is a prospective open label multi-centre pilot study examining the safety and efficacy of response guided triple therapy (PEG-IFN, Ribavirin and Telaprevir) for the treatment of early chronic HCV genotype 1 infection in individuals with and without HIV infection.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatitis C, Chronic
Keywords
Hepatitis C, Individualised therapy, Response-guided therapy, Telaprevir, PEG-IFN, Ribavirin, Hepatitis

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Group A - 8 weeks total therapy
Arm Type
Experimental
Arm Description
8 weeks total therapy of TPV/PEG-IFN/RBV if undetectable HCV RNA after 2 weeks of therapy
Arm Title
Group B - 12 weeks total therapy
Arm Type
Experimental
Arm Description
12 weeks total therapy of TPV/PEG-IFN/RBV if undetectable HCV RNA after 4 weeks of therapy
Arm Title
Group C - 24 weeks total therapy
Arm Type
Experimental
Arm Description
24 weeks total therapy - TPV/PEG-IFN/RBV for 12 weeks + PEG-IFN/RBV for 12 weeks if undetectable HCV RNA after 8 weeks of therapy
Intervention Type
Drug
Intervention Name(s)
TPV/PEG-IFN/RBV
Other Intervention Name(s)
Telaprevir brand name: INCIVO, Ribavirin brand name: COPEGUS, PEG-IFN brand name: PEGASYS
Intervention Description
Drug Telaprevir (TPV): dosed 1125mg twice daily (given as three 375 mg film-coated tablets) orally, except in the situation where a patient is on efavirenz in which case the dose of telaprevir will be 1125mg three times daily. Drug Ribavirin (RBV): 1000mg or 1200mg p.o daily in split doses (1000mg for patients weighing <75kg and 1200mg for patients weighing ≥ 75kg). Drug PEG-IFN (other name: Pegasys): 180mcg in 0.5ml (pre-filled syringes) administered subcutaneously once weekly.
Primary Outcome Measure Information:
Title
SVR12 (Sustain Virological Response, HCV RNA Undetectable 12 Weeks Post-treatment)
Description
Proportion of subjects achieving SVR 12 (negative qualitative HCV RNA 12 weeks after therapy completion)
Time Frame
12 weeks post-treatment
Secondary Outcome Measure Information:
Title
SVR24
Description
To evaluate the proportion of patients with undetectable HCV RNA 24 weeks after therapy completion (SVR24)
Time Frame
24 weeks post-treatment
Title
Undetectable HCV RNA (ETR)
Description
To evaluate the proportion of patients with undetectable HCV RNA at end of treatment (ETR)
Time Frame
Wk 8 (Group A), Wk 12 (Group B), Wk 24 (Group C)
Title
Undetectable HCV RNA (Week 1)
Description
To evaluate the proportion of patients with undetectable HCV RNA at week 1 of therapy.
Time Frame
Week 1 of therapy
Title
Undectectable HCV RNA (Week 2)
Description
To evaluate the proportion of patients with undetectable HCV RNA at week 1 of therapy.
Time Frame
Week 2 of therapy
Title
Undetectable HCV RNA (Week 3)
Description
To evaluate the proportion of patients with undetectable HCV RNA at week 3 of therapy.
Time Frame
Week 3 of therapy
Title
Undetectable HCV RNA (Week 4)
Description
To evaluate the proportion of patients with undetectable HCV RNA at week 4 of therapy.
Time Frame
Week 4 of therapy
Title
Decrease in Absolute Neutrophil Count (ANC) ≤0.75
Time Frame
Baseline, Wk 8 (Group A), Wk 12 (Group B), Wk 24 (Group C)
Title
Decrease in Platelets <50
Time Frame
Baseline, Wk 8 (Group A), Wk 12 (Group B), Wk 24 (Group C)
Title
Change in Hemoglobin at End of Treatment
Description
To evaluate indicators of toxicity during telaprevir based therapy
Time Frame
Baseline, Wk 8 (Group A), Wk 12 (Group B), Wk 24 (Group C)
Title
Resistance-associated Variants
Description
To examine the emergence of resistance-associated variants during telaprevir based therapy for early chronic infection
Time Frame
Baseline, Wk 8 (Group A), Wk 12 (Group B), Wk 24 (Group C)
Title
Baseline Resistance-associated Variants
Description
To correlate the presence and frequency of baseline resistance-associated variants (RAVs) with the response of Telaprevir based therapy for early chronic HCV infection.
Time Frame
Baseline, Wk 8 (Group A), Wk 12 (Group B), Wk 24 (Group C)
Title
Plasma Ribavirin Levels
Description
To correlate plasma ribavirin levels with treatment outcome and changes in haemoglobin during therapy
Time Frame
Baseline, Wk 8 (Group A), Wk 12 (Group B), Wk 24 (Group C)
Title
CD4 and HIV RNA
Description
In HIV positive participants to evaluate changes in CD4 counts and HIV RNA during telaprevir based therapy
Time Frame
Baseline, Wk 8 (Group A), Wk 12 (Group B), Wk 24 (Group C)
Title
Gene IL28B Polymorphism
Description
To examine treatment outcome by IL28B polymorphism
Time Frame
Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Provision of written, informed consent. HCV genotype 1 infection Quantifiable HCV RNA at screening and baseline (>10,000 IU/ml) Recent hepatitis C infection with an estimated duration of Infection >6 months and ≤ 18 months defined as A) i) First anti-HCV antibody or HCV RNA positive within the previous 6 months and ii) Documented anti-HCV antibody negative or HCV RNA negative within the 24 months prior to anti-HCV antibody positive result OR B) i) First anti-HCV antibody or HCV RNA positive within the previous 6 months and ii) acute clinical hepatitis (jaundice or ALT> 10 X ULN) within the 12 months prior to first positive HCV antibody or HCV RNA with no other cause of acute hepatitis identifiable Compensated liver disease (Child-Pugh A) Negative pregnancy test at screening and 24 hours prior to the first dose of study drugs. If heterosexually active, a female subject of childbearing potential and a nonvasectomized male subject who has a female partner of childbearing potential must agree to use 2 effective contraceptives from screening onwards until 6 months (female subject) or 7 months (male subject) after RBV therapy has ended. Note: Hormonal contraceptives may be continued but may not be reliable during telaprevir dosing and for 2 months following cessation of telaprevir. Therefore, subjects should agree to use 2 effective non-hormonal methods of contraception during telaprevir combination therapy and for 2 months after the last intake of telaprevir. As of two months after completion of telaprevir hormonal contraceptives can again be used as one of the two required effective methods of birth control. Subject is judged to be medically stable on the basis of physical examination, medical history and vital signs. Adequate English to provide written, informed consent and to provide reliable responses to the study interview Additional inclusion criteria for HIV positive individuals Confirmed HIV infection > 6 months duration CD4 > 200 cells/mm3 and HIV < 50 c/ml on stable antiretroviral therapy (ART) at least 3 months prior to treatment Or CD4 >= 500 cells/mm3 and HIV viral load (VL) < 100,000 not on ART If on ART must be taking a regimen containing an accepted* combination of the following drugs: tenofovir ( TDF), lamivudine ( 3TC), emtricitabine (FTC), efavirenz (EFV), abacavir (ABC), raltegravir (RAL), etravirine (ETV), rilpivirine (RIL), ritonavir boosted atazanavir (r/ATZ) * Combination must be supported by current HIV treatment guidelines Exclusion Criteria: Individuals considered by the study investigators to be unlikely to participate in intensive follow-up and/or unwilling to provide extra blood samples Current injecting drug use (any injecting within previous 4 weeks) Standard exclusions to Pegylated-interferon (PEG-IFN), Ribavirin (RBV) and Telaprevir (TPV) therapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gail Matthews, MbChB, PhD
Organizational Affiliation
Kirby Institute
Official's Role
Study Chair
Facility Information:
Facility Name
St Vincent's Hospital
City
Sydney
State/Province
New South Wales
ZIP/Postal Code
2010
Country
Australia
Facility Name
Royal Adelaide Hospital
City
Adelaide
State/Province
South Australia
ZIP/Postal Code
5000
Country
Australia

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
26867206
Citation
Martinello M, Hellard M, Shaw D, Petoumenos K, Applegate T, Grebely J, Yeung B, Maire L, Iser D, Lloyd A, Thompson A, Sasadeusz J, Haber P, Dore GJ, Matthews GV. Short duration response-guided treatment is effective for most individuals with recent hepatitis C infection: the ATAHC II and DARE-C I studies. Antivir Ther. 2016;21(5):425-34. doi: 10.3851/IMP3035. Epub 2016 Feb 11.
Results Reference
derived

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DAA Based Therapy for Recently Acquired Hepatitis C (DARE-C)

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