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Study for the Treatment of Significant Steatosis With Xenical Followed by Treatment of Hepatitis C With Pegasys/Copegus (HCVNASH)

This study has been completed.
Sponsor:
Collaborators:
Hoffmann-La Roche
The Geneva Foundation
Information provided by (Responsible Party):
Stephen A Harrison, Brooke Army Medical Center
ClinicalTrials.gov Identifier:
NCT00207311
First received: September 13, 2005
Last updated: February 13, 2012
Last verified: February 2012
  Purpose

This is a prospective, multi-center, randomized, placebo-controlled trial in subjects with histological evidence of > 33% hepatic steatosis or nonalcoholic steatohepatitis (NASH) and chronic hepatitis C. Patients who have not been previously treated for hepatitis C (treatment naive) will be enrolled.


Condition Intervention Phase
Fatty Liver
Hepatitis C
Drug: Xenical, Pegasys, Copegus
Behavioral: Xenicare Program
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
Official Title: A Multi-Centered, Prospective, Randomized, Placebo-Controlled Clinical Trial for the Treatment of Significant Steatosis or NASH With Xenical Followed by Treatment of Hepatitis C (HCV) With PEG-Interferon Alpha-2a/Copegus

Resource links provided by NLM:


Further study details as provided by Brooke Army Medical Center:

Primary Outcome Measures:
  • Sustained virological response (SVR) defined as the percentage of participants with undetectable HCV-RNA as measured by the Roche AMPLICORTM HCV Test, v 2.0 (detection limit 50 IU/mL) at 24 weeks post completion of the treatment period [ Time Frame: 110 weeks ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Hepatic steatosis, necroinflammatory activity and fibrosis improvement at week 36 as determined by Dr. Elizabeth Brunt at Saint Louis University [ Time Frame: 36 weeks ] [ Designated as safety issue: No ]

Enrollment: 30
Study Start Date: August 2005
Study Completion Date: May 2009
Primary Completion Date: May 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: Xenical placebo
Xenical placebo PO three times daily with meals plus enrollment into the Xenicare program for 36 weeks followed by 48 weeks of therapy with Pegasys (180mcg/ml) plus weight based ribavirin for HCV genotype 1 or 4 and 24 weeks of therapy with Pegasys (180mcg/ml) plus 800mg ribavirin for HCV genotypes 2 and 3.
Behavioral: Xenicare Program
Xenicare program for 36 weeks.
Other Names:
  • Xenical placebo
  • Pegasys (Peg interferon alpha-2a)
Active Comparator: Xenical (orlistat)
Xenical (orlistat) 120mg PO three times daily with meals plus enrollment into the Xenicare program for 36 weeks followed by 48 weeks of therapy with Pegasys (180mcg/ml) plus weight based ribavirin for HCV genotype 1 or 4 and 24 weeks of therapy with Pegasys (180mcg/ml) plus 800mg ribavirin for HCV genotypes 2 and 3.
Drug: Xenical, Pegasys, Copegus
Xenical 120mg three times daily for 36 weeks or xenical placebo (Arm 1). Pegasys 180 mcg weekly for 48 weeks. Ribavirin daily for 48 weeks.
Other Names:
  • Xenical (orlistat)
  • Pegasys (PEG-Interferon alpha-2a)

Detailed Description:

Recent evidence suggests that patients with concomitant chronic HCV infection and NASH or significant hepatic steatosis (>33%) respond less well to standard antiviral therapy. As previously noted, up to 10% of patients with chronic HCV infection will have concomitant NASH and an even greater percentage will have associated hepatic steatosis. No prospective studies to date have evaluated the sustained viral response rates to standard antiviral therapy in this group of patients who were previously treated with a medication to eliminate or improve the underlying NASH and/or hepatic steatosis.

Primary Outcome: To determine if decreasing the amount of NASH or hepatic steatosis in overweight (BMI >27 kg/m2) HCV patients results in improved overall SVR to PEGASYS and Copegus.

Secondary Outcome: 1.To determine the amount of steatosis, necroinflammatory activity, and fibrosis change in a group of participants with chronic hepatitis C and NASH or significant steatosis treated with Xenical vs. placebo for 36 weeks. 2. To assess for a difference in insulin resistance, as measured by the QUICKI score, before and after treatment with Xenical or Xenical placebo and diet and exercise.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Participants must be willing to give written informed consent and be able to adhere to dose and visit schedules.
  • HCV-Ab or HCV-RNA by PCR Positive for at least 6 months
  • Serum positive for HCV-RNA by PCR assay
  • Treatment naïve participants who have hepatitis C with genotype 1, 2, 3, or 4
  • Body mass index >27
  • Liver biopsy within 12 months with a pathology report confirming the histological diagnosis consistent with CHCand NASH or hepatic steatosis of >33%
  • Compensated liver disease with minimum hematological, biochemical, and serologic criteria at the Enrollment Visit (WNL = within normal limits):

    • Hemoglobin values of <12 gm/dL for females and <13 gm/dL for males
    • WBC <3,000/ mm3
    • Neutrophil count < 1,500/mm3
    • Platelets <65,000/ mm3
    • Direct bilirubin within 20% of ULN
    • Indirect bilirubin WNL
    • Albumin > 3 gm/dL
    • creatinine < 20% of ULN
    • TSH WNL
    • Alpha fetoprotein value < 100 ng/mL
  • Reconfirmation and documentation that sexually active female subjects of childbearing potential are practicing adequate contraception method, or monogamous relationship with a male partner who has had a vasectomy or is using a condom + spermicide) during the treatment period and for six months following the last dose of study medication
  • Reconfirmation that sexually active male subjects are practicing two acceptable methods of contraception

Exclusion Criteria:

  • Women who are pregnant or breast-feeding
  • Males whose female partner is pregnant
  • No other Thiazolidinedione after liver biopsy and/or during the entire study
  • Hepatitis C of non-genotype 1,2,3 or 4
  • Previous anti-viral therapy for treatment of Hepatitis C
  • Suspected hypersensitivity to interferon, PEG-interferon, ribavirin, Xenical
  • Any other cause for liver disease other than chronic hepatitis C and NASH or steatosis, including but not limited to:

    • Hemochromatosis
    • Alpha-1 antitrypsin deficiency
    • Co-infection with HBV
    • Wilson's disease
    • Autoimmune hepatitis
    • Alcoholic liver disease
    • Drug-related liver disease
  • Any condition that would prevent the subject from having a liver biopsy
  • Hemoglobinopathies (e.g., Beta Thalassemia)
  • Evidence of advanced liver disease
  • Patients with organ transplants other than cornea and hair transplant
  • Any known preexisting medical condition that could interfere with the subject's participation in and completion of the protocol such as:

    • Preexisting psychiatric condition, especially severe depression, or a history of severe psychiatric disorder, such as major psychoses, suicidal ideation and/or suicidal attempt are excluded
    • CNS trauma or preexisting/active seizure disorders uncontrolled with medication
    • Significant cardiovascular dysfunction within the past 12 months
    • Poorly controlled diabetes mellitus
    • Chronic pulmonary disease with documented pulmonary hypertension
    • Immunologically mediated disease (Crohn's disease, ulcerative colitis), rheumatoid arthritis, idiopathic thrombocytopenia purpura, systemic lupus erythematosus, autoimmune hemolytic anemia, scleroderma, severe psoriasis, clinical cryoglobulinemia with vasculitis
  • Any medical condition requiring, or likely to require chronic systemic administration of steroids
  • Evidence of an active or suspected cancer or a history of malignancy where the risk of reoccurrence is ≥ 20% within 2 years
  • Active clinical gout
  • Substance abuse
  • Participants not willing to be counseled/abstain from alcohol
  • Participants with clinically severe retinal abnormalities
  • Any other condition that in the opinion of the investigator would make the patient unsuitable for enrollment, or could interfere with the patient participating in and completing the protocol
  • Known positive HIV
  • Inability/unwillingness to provide informed consent or abide by the requirements of the study
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00207311

Locations
United States, Texas
Brooke Army Medical Center
Ft. Sam Houston, Texas, United States, 78234
Sponsors and Collaborators
Brooke Army Medical Center
Hoffmann-La Roche
The Geneva Foundation
Investigators
Principal Investigator: Stephen A Harrison, MD Brooke Army Medical Center
  More Information

No publications provided

Responsible Party: Stephen A Harrison, Principal Investigator, Brooke Army Medical Center
ClinicalTrials.gov Identifier: NCT00207311     History of Changes
Other Study ID Numbers: C.2004.140
Study First Received: September 13, 2005
Last Updated: February 13, 2012
Health Authority: United States: Federal Government

Keywords provided by Brooke Army Medical Center:
Hepatitis C
Fatty Liver
NASH
Steatohepatitis

Additional relevant MeSH terms:
Fatty Liver
Hepatitis
Hepatitis A
Hepatitis C
Digestive System Diseases
Enterovirus Infections
Flaviviridae Infections
Hepatitis, Viral, Human
Liver Diseases
Picornaviridae Infections
RNA Virus Infections
Virus Diseases
Interferon-alpha
Interferons
Orlistat
Peginterferon alfa-2a
Ribavirin
Anti-Infective Agents
Anti-Obesity Agents
Antimetabolites
Antineoplastic Agents
Antiviral Agents
Central Nervous System Agents
Enzyme Inhibitors
Immunologic Factors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs
Therapeutic Uses

ClinicalTrials.gov processed this record on November 25, 2014