Chronic Hepatitis C Treatment by Pegylated Interferon and Ribavirin in Naive Egyptian Patients (ANRS 1211)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00158496
Recruitment Status : Completed
First Posted : September 12, 2005
Last Update Posted : April 24, 2007
Hoffmann-La Roche
Information provided by:
French National Agency for Research on AIDS and Viral Hepatitis

Brief Summary:
Chronic hepatitis C is a liver disease related to a virus: hepatitis C virus (HCV). The type of HCV present in Egypt (genotype 4), has the reputation to respond poorly to Interferon treatment at the chronic stage. Pegylated Interferon is a new form of Interferon that stays in the body for longer time and allows the patient to take less injection per week. It has proved to be more effective than standard Interferon. The combination of two drugs, Interferon and Ribavirin, is considered to be the best treatment available for chronic hepatitis C.

Condition or disease Intervention/treatment Phase
Chronic Hepatitis C Drug: pegylated interferon alpha2a Drug: ribavirin Phase 3

Detailed Description:

Egypt is the country with the highest HCV prevalence worldwide, and the number of infected Egyptians is estimated around 8 million. The HCV genotype circulating in Egypt is genotype 4. This genotype has the reputation, based on the few available data, to respond poorly to treatment. This study will estimate the safety and efficacy of the combination of peg-IFNα-2a plus Ribavirin, in Egyptian patients with chronic hepatitis C. This treatment has been chosen based on its better expected efficacy compared to pegylated interferon alone.

The primary objective of the study is to assess the efficacy and tolerance of the combination of pegylated interferon (peg-IFNα-2a) plus ribavirin in Egyptian patients with chronic hepatitis C and with no prior treatment for HCV.

Methods: Open trial. Follow-up duration: 72 weeks. Enrolment duration: 18 months. Total trial duration: 3 years and a half, including trial analysis (carried out in the 6 months following the follow-up completion of the last patient). Total number of patients: 100. Precision around the expected efficacy rate (40% in intention-to-treat analysis): 9.6%.

Treatment strategy: Peg-IFNα-2a 180microg/week for 48 weeks, Ribavirin at least 11 mg/kg/day for 48 weeks Main inclusion criteria: HCV RNA positive by PCR; METAVIR score : >A2 and >= F1 or >= A1 and > F2; ALAT over 1.5*N; no prior treatment with IFNalpha, PEG-IFNalpha and ribavirin Main exclusion criteria : Liver disease other than hepatitis C; advanced liver disease; negative HCV RNA.

Patient from a cohort follow-up conducted in a village in rural Egypt with High HCV prevalence (Menoufia governorate) will be proposed to participate in the trial. Pre-enrolment investigations, liver biopsy, and patients follow-up will be carried out at a local hospital. Blood test analyses will be carried out under the responsibility of Hepatitis Virology Reference Laboratory at the National Hepatology and Tropical Medicine Institute, Cairo; trial monitoring will be carried out by the Department of Community Medicine of Ain Shams; methodological assistance from the “Unite des Maladies Emergentes” at Pasteur Institute and INSERM U444, Paris.

Treatment for patients with HCV RNA by qualitative PCR still positive after 24 weeks of the combination Peg-IFNα-2a with ribavirin, will be stopped.

Study Type : Interventional  (Clinical Trial)
Enrollment : 100 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Clinical Trial of the Efficacy of the Combination of Pegylated Interferon (PEG-IFNα-2a) Plus Ribavirin in Egyptian Patients With Untreated Chronic Hepatitis C
Study Start Date : August 2002
Actual Study Completion Date : January 2005

Resource links provided by the National Library of Medicine

Primary Outcome Measures :
  1. - Disappearance of HCV RNA by qualitative PCR 24 weeks after the end of treatment

Secondary Outcome Measures :
  1. Evaluation of HCV RNA at 12 and 24 weeks
  2. changes in HCV RNA load during treatment
  3. Normalization of ALT during treatment and 24 weeks after the end of treatment
  4. Study of side effects
  5. Histological changes 24 weeks after the end of treatment (decrease by at least 1 point of the Metavir score)

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • HCV antibodies using a third generation test
  • HCV RNA positive by PCR
  • Liver biopsy in the past 18 months with METAVIR score over A2 and over or equal to F1, or over or equal A1 and over F2
  • ALT over 1.5 time the normal range in the 24 weeks prior to inclusion (Week-28; W-2);
  • Patients never treated with ribavirin, IFNalpha or PEG-IFNalpha
  • Normal albumin
  • Prothrombin time over or equal to 60 percent
  • Normal bilirubin
  • Alpha-foeto-protein under or equal to 3 times the normal range for the laboratory
  • HBs antigen negative
  • Two negative Kato test (for S.mansoni) three days apart
  • Hemoglobin over or equal 11g/dl,
  • Leucocytes over or equal 3000/mm3
  • Neutrophils over or equal 1500/mm3
  • Platelets over or equal 100 000/mm3
  • Blood creatinin over or equal 150 micromol/l
  • Normal TSH
  • Anti-nuclear antibodies under 1/160
  • Fasting blood sugar between 70-115mg/dl (if glucose intolerance or diabetes: HbA1C <= 8,5%)
  • Normal ophthalmologic examination in patients with history of blood pressure and/or diabetes
  • Effective contraception during the treatment period
  • No breastfeeding during the study period.
  • Signed informed consent

Exclusion Criteria:

  • Co-infection with hepatitis B (positive HBs antigen)
  • Hemochromatosis
  • Alpha-1 anti-trypsin deficiency
  • Wilson disease
  • Alcoholism-related liver disease
  • Gilbert disease
  • Alcohol intake over 50g/day for males and 40 g/day for females
  • Ongoing intravenous drug use
  • Aggravated liver cirrhosis (history or presence of ascitis, oesophageal varicosis, liver encephalopathy)
  • Hepatocellular carcinoma
  • Psychiatric disease: history of severe nervous breakdown or severe psychiatric diseases such as major psychosis, suicidal ideas, suicide attempts…
  • Epilepsy
  • Auto-immune disease
  • Heart disease in the six months preceding enrolment – patients with significant changes at EKG
  • Uncontrolled diabetes
  • Chronic respiratory insufficiency with hypoxemia <10 kPa
  • Medical or surgical condition, non-stabilised, with life expectancy lower than two years.
  • Pregnancy or breastfeeding

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00158496

Ismail Sallam hospital
Zawiat Razin, Menoufia, Egypt
National Hepatology and Tropical Medicine Research Institute
Cairo, Egypt
Sponsors and Collaborators
French National Agency for Research on AIDS and Viral Hepatitis
Hoffmann-La Roche
Study Chair: Arnaud Fontanet Institut Pasteur de Paris
Principal Investigator: Mostafa K Mohamed National Hepatology and Tropical Medicine Research Institute

Additional Information:
Publications: Identifier: NCT00158496     History of Changes
Other Study ID Numbers: ANRS 1211
First Posted: September 12, 2005    Key Record Dates
Last Update Posted: April 24, 2007
Last Verified: April 2007

Keywords provided by French National Agency for Research on AIDS and Viral Hepatitis:
Chronic Hepatitis C
Genotype 4
Pegylated Interferon

Additional relevant MeSH terms:
Hepatitis A
Hepatitis C
Hepatitis, Chronic
Hepatitis C, Chronic
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Virus Diseases
Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
Flaviviridae Infections
Peginterferon alfa-2a
Antineoplastic Agents
Antiviral Agents
Anti-Infective Agents
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Physiological Effects of Drugs