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Evaluating the Safety of Two Medications to Treat Hepatitis C in People With Thalassemia (The HepC Study) (HepC)

Primary Purpose

Hepatitis C, Thalassemia

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Peginterferon Alfa-2a and Ribavirin
Ribavirin
Sponsored by
Carelon Research
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatitis C

Eligibility Criteria

18 Years - 44 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosis of thalassemia
  • Serum positive for hepatitis C virus RNA by polymerase chain reaction (PCR) test (using the Roche COBAS Amplicor hepatitis C virus test)
  • Hepatitis B surface antigen (HBsAg) negative and HIV negative within the 12 months prior to study entry
  • Liver biopsy showing histologic evidence of active hepatitis (i.e., at least grade 1 inflammation)
  • Willing to use acceptable forms of contraception throughout the study

Exclusion Criteria:

  • Baseline liver iron concentration greater than 40.00 mg/g dry weight (iron may be chelated and the individual re-screened). All people with liver iron levels greater than 20.00 mg/g dry weight will be permitted to enroll only if their ejection fraction is 55 or greater by echocardiography (ECHO).
  • Currently participating in other interventional clinical studies
  • Received interferon-alfa therapy within the 6 months prior to study entry
  • Liver dysfunction, defined as international normalized ratio (INR) greater than 1.3, albumin less than or equal to 3.5g/dL, or serum bilirubin greater than 4.0 mg/dL that, in the opinion of the investigator, is not due to Gilbert's syndrome or thalassemia-related hemolysis
  • Other causes of liver disease (e.g., hereditary hemochromatosis, presumed drug-associated liver disease, Wilson's disease, obesity [body mass index (BMI) greater than 30])
  • Major psychiatric illness
  • Neutrophil count less than or equal to 1500/mm3
  • Platelet count less than or equal to 80,000/mm3
  • Active alcohol abuse within the 12 months prior to study entry
  • Use of illicit drugs (e.g., heroin, cocaine, angel dust) within the 2 years prior to study entry
  • Alpha-fetoprotein level greater than 200 ng/mL or evidence of a liver mass lesion by either ultrasound, CT scan, or MRI scan that is suspicious for hepatocellular cancer
  • Kidney insufficiency, as defined by a clinically significant abnormal serum creatinine test and confirmed by a creatinine clearance rate of less than 50 mL/min based on 24-hour urine collection. People with an elevated serum creatinine level must undergo a creatinine clearance test.
  • Diabetes that, in the opinion of the investigator, is not controlled by diet, an oral hypoglycemic agent, and/or insulin
  • Received an organ, limb, or bone marrow transplant
  • Requires the use of certain long-term medications such as immunosuppressive medications (e.g., corticosteroids, methotrexate, azathioprine)
  • Active systemic autoimmune disorder (e.g., rheumatoid arthritis, systemic lupus)
  • Diagnosis or treatment of cancer within the 5 years prior to study entry, except for localized squamous or basal cell cancers treated by local excision
  • Any of the following pre-existing conditions that, in the opinion of the investigator, would prevent treatment with interferon and/or ribavirin:

    1. unstable heart disease that is not controlled by medication
    2. serious cerebrovascular disease
    3. serious lung disease
  • History of a seizure disorder that has not been well-controlled by anti-seizure medications within the 2 years prior to study entry
  • Pregnant or breastfeeding
  • Male partners of women who are pregnant
  • Any other condition that, in the opinion of the investigator, would prevent study participation
  • Known hypersensitivity to any study drug or their components
  • Past history of multiple sclerosis, transverse myelitis, optic neuritis, papilledema, chorioretinitis, uveitis, or increased ocular pressure/glaucoma
  • Currently taking hematopoietic growth factors
  • Currently taking ribavirin

Sites / Locations

  • Children's Hospital and Research Center at Oakland
  • Weill Medical College of Cornell University
  • Children's Hospital Philadelphia
  • Toronto General Hospital, Universty Health Network
  • University College London

Outcomes

Primary Outcome Measures

Safety of peginterferon alfa-2a and ribavirin in individuals with thalassemia (measured by changes in liver iron stores and development of iron overload-related complications)

Secondary Outcome Measures

Mean change in hepatic iron concentration from baseline biopsy to follow-up biopsy; relationship of change to baseline level
Transfusion frequency and volume required to maintain trough Hb 9.0-10.5 g/dL during treatment, as compared to that required in the 6 months prior to hepatitis C treatment
Cumulate change in deferoxamine dose; evidence for deferoxamine toxicity during hepatitis C treatment
Response rate (undetectable hepatitis C virus RNA)
Sustained virologic response rate (undetectable hepatitis C virus RNA 24 weeks after the end of treatment) and its association with baseline hepatic iron concentration
Rate of viral clearance from serum in the first 4 weeks of treatment, rate of early virologic response at week 12, and each rate's association with sustained virologic response
Change in liver inflammation and fibrosis scores from baseline to 48 weeks
Adverse events
Cardiac adverse events, defined as either symptomatic left ventricular dysfunction requiring medication or pathologic arrhythmia requiring medication
Quality of life

Full Information

First Posted
July 16, 2007
Last Updated
March 3, 2014
Sponsor
Carelon Research
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
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1. Study Identification

Unique Protocol Identification Number
NCT00502788
Brief Title
Evaluating the Safety of Two Medications to Treat Hepatitis C in People With Thalassemia (The HepC Study)
Acronym
HepC
Official Title
Thalassemia Clinical Research Network - Hepatitis C Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
March 2014
Overall Recruitment Status
Completed
Study Start Date
May 2003 (undefined)
Primary Completion Date
June 2006 (Actual)
Study Completion Date
August 2006 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Carelon Research
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Hepatitis C is one of the most common causes of long-term liver disease in the United States. Ribavirin and peginterferon alfa-2a are two medications that are used to treat hepatitis C infection. The purpose of this study is to evaluate the safety of these two medications in adults with hepatitis C and thalassemia, a type of blood disorder.
Detailed Description
Hepatitis C is an inflammation of the liver that is caused by infection with the hepatitis C virus. Over time, people may develop liver failure, liver cancer, or cirrhosis, a condition in which the liver may become permanently scarred. Ribavirin and peginterferon alfa-2a are two medications that are used to treat hepatitis C. Ribavirin stops the hepatitis C virus from spreading inside the body, and peginterferon alfa-2a decreases the amount of hepatitis C virus in the body. Individuals with thalassemia, an inherited blood disorder that can cause anemia, often receive regular blood transfusions as part of their treatment. These individuals may have an increased risk of developing hepatitis C as a result of blood transfusions received before routine hepatitis C blood screening was available. Treating thalassemia patients with standard hepatitis C therapy can be difficult because ribavirin can worsen anemia. However, omitting ribavirin then increases the risk of hepatitis C relapse following treatment. The purpose of this study is to evaluate the safety of ribavirin and peginterferon alfa-2a for treating hepatitis C in adults with thalassemia. This study will enroll adults with thalassemia and long-term hepatitis C. Participants will attend study visits weekly for 4 weeks, every 2 weeks until Week 24, every 4 weeks until Week 48, and then every 6 weeks until Week 72. All participants will receive a peginterferon alfa-2a injection once a week and ribavirin daily. Participants with the hepatitis C genotype 1 will receive 48 weeks of treatment; participants with all other genotypes of the disease will receive 24 weeks of treatment. A liver biopsy will occur at baseline and Week 48. The following will occur at selected study visits: physical exam, blood and urine collection, hearing and vision screening, chest x-ray, heart rate monitoring, and questionnaires to assess hepatitis C symptoms, quality of life, and depression. Participants with liver iron levels greater than 20 mg/g will undergo an echocardiogram ultrasound test every 3 months to monitor the heart.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
21 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Peginterferon Alfa-2a and Ribavirin
Other Intervention Name(s)
Human recombinant E. Coli, Hoffmann-la Roche
Intervention Description
Patients will be treated with alfa-2a and ribavirin as follows: Peginterferon alfa-2a will be started as a dose of 180 ug subcutaneously once weekly.
Intervention Type
Drug
Intervention Name(s)
Ribavirin
Intervention Description
Ribavirin will be started at a dose of 800mg daily for those weighing less than or equal to 50 kg, 1000 mg daily for those with body weight 51 to 75 kg and 1200 mg daily for those with body weight > 75 kg. Ribavirin will be given orally in two divided doses. The lower dose has been included because potentially-eligible patients in the TCRN registry have a mean weight of 57 kg.
Primary Outcome Measure Information:
Title
Safety of peginterferon alfa-2a and ribavirin in individuals with thalassemia (measured by changes in liver iron stores and development of iron overload-related complications)
Time Frame
Measured at Week 72
Secondary Outcome Measure Information:
Title
Mean change in hepatic iron concentration from baseline biopsy to follow-up biopsy; relationship of change to baseline level
Time Frame
Measured at Week 48
Title
Transfusion frequency and volume required to maintain trough Hb 9.0-10.5 g/dL during treatment, as compared to that required in the 6 months prior to hepatitis C treatment
Time Frame
Measured at Week 72
Title
Cumulate change in deferoxamine dose; evidence for deferoxamine toxicity during hepatitis C treatment
Time Frame
Measured at Week 72
Title
Response rate (undetectable hepatitis C virus RNA)
Time Frame
Measured at Week 24 or 48
Title
Sustained virologic response rate (undetectable hepatitis C virus RNA 24 weeks after the end of treatment) and its association with baseline hepatic iron concentration
Time Frame
Measured at Week 72
Title
Rate of viral clearance from serum in the first 4 weeks of treatment, rate of early virologic response at week 12, and each rate's association with sustained virologic response
Time Frame
Measured at Week 72
Title
Change in liver inflammation and fibrosis scores from baseline to 48 weeks
Time Frame
Measured at Week 48
Title
Adverse events
Time Frame
Measured at Week 72
Title
Cardiac adverse events, defined as either symptomatic left ventricular dysfunction requiring medication or pathologic arrhythmia requiring medication
Time Frame
Measured at Week 72
Title
Quality of life
Time Frame
Measured at Week 72

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
44 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of thalassemia Serum positive for hepatitis C virus RNA by polymerase chain reaction (PCR) test (using the Roche COBAS Amplicor hepatitis C virus test) Hepatitis B surface antigen (HBsAg) negative and HIV negative within the 12 months prior to study entry Liver biopsy showing histologic evidence of active hepatitis (i.e., at least grade 1 inflammation) Willing to use acceptable forms of contraception throughout the study Exclusion Criteria: Baseline liver iron concentration greater than 40.00 mg/g dry weight (iron may be chelated and the individual re-screened). All people with liver iron levels greater than 20.00 mg/g dry weight will be permitted to enroll only if their ejection fraction is 55 or greater by echocardiography (ECHO). Currently participating in other interventional clinical studies Received interferon-alfa therapy within the 6 months prior to study entry Liver dysfunction, defined as international normalized ratio (INR) greater than 1.3, albumin less than or equal to 3.5g/dL, or serum bilirubin greater than 4.0 mg/dL that, in the opinion of the investigator, is not due to Gilbert's syndrome or thalassemia-related hemolysis Other causes of liver disease (e.g., hereditary hemochromatosis, presumed drug-associated liver disease, Wilson's disease, obesity [body mass index (BMI) greater than 30]) Major psychiatric illness Neutrophil count less than or equal to 1500/mm3 Platelet count less than or equal to 80,000/mm3 Active alcohol abuse within the 12 months prior to study entry Use of illicit drugs (e.g., heroin, cocaine, angel dust) within the 2 years prior to study entry Alpha-fetoprotein level greater than 200 ng/mL or evidence of a liver mass lesion by either ultrasound, CT scan, or MRI scan that is suspicious for hepatocellular cancer Kidney insufficiency, as defined by a clinically significant abnormal serum creatinine test and confirmed by a creatinine clearance rate of less than 50 mL/min based on 24-hour urine collection. People with an elevated serum creatinine level must undergo a creatinine clearance test. Diabetes that, in the opinion of the investigator, is not controlled by diet, an oral hypoglycemic agent, and/or insulin Received an organ, limb, or bone marrow transplant Requires the use of certain long-term medications such as immunosuppressive medications (e.g., corticosteroids, methotrexate, azathioprine) Active systemic autoimmune disorder (e.g., rheumatoid arthritis, systemic lupus) Diagnosis or treatment of cancer within the 5 years prior to study entry, except for localized squamous or basal cell cancers treated by local excision Any of the following pre-existing conditions that, in the opinion of the investigator, would prevent treatment with interferon and/or ribavirin: unstable heart disease that is not controlled by medication serious cerebrovascular disease serious lung disease History of a seizure disorder that has not been well-controlled by anti-seizure medications within the 2 years prior to study entry Pregnant or breastfeeding Male partners of women who are pregnant Any other condition that, in the opinion of the investigator, would prevent study participation Known hypersensitivity to any study drug or their components Past history of multiple sclerosis, transverse myelitis, optic neuritis, papilledema, chorioretinitis, uveitis, or increased ocular pressure/glaucoma Currently taking hematopoietic growth factors Currently taking ribavirin
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Maureen Jonas, MD
Organizational Affiliation
Boston Children's Hospital
Official's Role
Study Chair
Facility Information:
Facility Name
Children's Hospital and Research Center at Oakland
City
Oakland
State/Province
California
ZIP/Postal Code
94609
Country
United States
Facility Name
Weill Medical College of Cornell University
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States
Facility Name
Children's Hospital Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
Toronto General Hospital, Universty Health Network
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2C4
Country
Canada
Facility Name
University College London
City
London
ZIP/Postal Code
WC1E 6HX
Country
United Kingdom

12. IPD Sharing Statement

Learn more about this trial

Evaluating the Safety of Two Medications to Treat Hepatitis C in People With Thalassemia (The HepC Study)

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