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Therapy With Asunaprevir, Daclatasvir, Ribavirin and Pegylated Interferon Alpha-2a in HCV Genotype 4-infected Patients Who Have Failed to a Previous Therapy With Peg-Interferon/Ribavirin (ANRS HC32 QUATTRO)

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ClinicalTrials.gov Identifier: NCT02107365
Recruitment Status : Completed
First Posted : April 8, 2014
Last Update Posted : January 24, 2017
Sponsor:
Collaborator:
Bristol-Myers Squibb
Information provided by (Responsible Party):
French National Institute for Health and Medical Research-French National Agency for Research on AIDS and Viral Hepatitis (Inserm-ANRS)

Brief Summary:

Success rates, after retreatment with Peg-Interferon/Ribavirin bitherapy, in patients infected with HCV (hepatitis C virus) genotype 4 and non-responders to a first standard treatment, are disappointing. The association of Asunaprevir and Daclatasvir in combination with the standard-of-care bitherapy has been shown to increase the efficacy of the treatment in non-responders genotype 1-infected patients.

Given the absence of current solutions and urgent therapeutic needs for HCV genotype 4-infected patients previously treated with pegylated Interferon/Ribavirin, this pilot study aims to evaluate the efficacy and safety of a quadritherapy associating Asunaprevir, Daclatasvir, pegylated Interferon alpha-2a and Ribavirin, in this very difficult to treat population.

60 subjects will be enrolled.

The primary endpoint will be the rate of sustained virological response (SVR), defined by an undetectable HCV RNA, at Week 36 (12 weeks after the end of a 24 weeks quadritherapy).


Condition or disease Intervention/treatment Phase
Hepatitis C Virus Genotype 4 Infection Drug: Asunaprevir Drug: Daclatasvir Drug: Ribavirin Drug: Pegylated Interferon alpha-2a Phase 2

Detailed Description:

The population studied presents the maximum of factors of non-response to the retreatment of hepatitis C: non-response to well followed prior treatment with pegylated Interferon and Ribavirin, infection with HCV genotype 4, and the presence of cirrhosis (in less than 50% of the included patients) that could diminish the chances of SVR to a standard bitherapy.

The likelihood of SVR with standard bitherapy in this study population is thus considered low, around 15%.

The principal objective of this multicentric, national, single-arm, open-labeled, non-randomized phase II pilot study in 60 patients, is to assess the rate of SVR 12 weeks after 24 weeks of quadritherapy and to determine whether this rate is significantly greater than 20%.

The proportion of patients presenting with cirrhosis (defined by a METAVIR F4 score on liver biopsy or with hepatic impulse elastometry ≥ 15 kPa) will be limited to 50% of all patients included.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 60 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Pilot Study to Assess Efficacy and Safety of a Quadruple Therapy With Asunaprevir, Daclatasvir, Ribavirin and Pegylated Interferon Alpha-2a in HCV Genotype 4-infected Patients Non-responders to Pegylated Interferon-Ribavirin Regimen
Study Start Date : November 2013
Actual Primary Completion Date : February 2015
Actual Study Completion Date : April 2015


Arm Intervention/treatment
Experimental: Asunaprevir, Daclatasvir, Ribavirin, Peg-Interferon alpha-2a
Quadritherapy from Day 0 to Week 24
Drug: Asunaprevir
Asunaprevir 100 mg, 1 capsule twice a day from Day 0 to Week 24

Drug: Daclatasvir
Daclatasvir 60 mg, 1 tablet once a day from Day 0 to Week 24

Drug: Ribavirin
Ribavirin tablets or capsules 200 mg, weight-based daily dose ( <75 kg : 1000 mg ; ≥ 75 kg : 1200 mg), from Day 0 to Week 24

Drug: Pegylated Interferon alpha-2a
Pegylated Interferon alpha-2a, by subcutaneous injection 180µg / week, from Day 0 to Week 24




Primary Outcome Measures :
  1. SVR12 Rate [ Time Frame: Week 36 ]
    HCV RNA measured 12 weeks after the end of the HCV treatment (Week 36)


Secondary Outcome Measures :
  1. Number of patients with adverse events [ Time Frame: Up to Week 48 ]
  2. Treatment discontinuations [ Time Frame: Up to Week 24 ]
    Number and causes of treatment discontinuations

  3. Self-reported symptoms [ Time Frame: Day 0, Week 12, Week 36 ]
    ANRS AC24 perceived symptoms scale

  4. Patients' adherence [ Time Frame: Week 4, Week 12, Week 24 ]
    ANRS questionnaire

  5. SVR 24 rate [ Time Frame: Week 48 ]
    Undetectable HCV RNA 24 weeks after the end of the HCV treatment

  6. HCV viral load [ Time Frame: Day 0, Weeks 1, 2, 4, 8, 12, 16, 20, 24, 28, 36, 48 ]
  7. Number of patients with virological failure under treatment [ Time Frame: Up to Week 24 ]
    Patients with detectable HCV viral load at Week 8, or Patients with HCV breakthrough : a) undetectable HCV viral load at Week 8 and detectable at any visit after Week 8 or b) undetectable HCV viral load at any time point before Week 8 and who presents a new confirmed detectable viral load before Week 8

  8. HCV subtypic distribution [ Time Frame: Baseline ]
  9. Proportion of patients with resistance mutations to Asunaprevir and/or Daclatasvir in case of virological failure [ Time Frame: Up to Week 48 ]
  10. Cirrhosis evaluation [ Time Frame: Baseline, Week 12, Week 24, Week 36, Week 48 ]
    For cirrhotic patients : Child-Pugh and MELD scores ; cirrhosis decompensation evaluation on clinical examination

  11. Insulin resistance : HOMA-IR score [ Time Frame: Day 0, Week 36 ]
  12. Metabolic syndrome parameters [ Time Frame: Day 0, Week 36 ]
    Waist circumference, blood pressure, fasting glucose, triglycerides, HDL cholesterol (composite measure)

  13. Liver fibrosis [ Time Frame: Between baseline and Week 48 ]
    Evolution of liver fibrosis on biological parameters (Fibrotest®) and imaging (Fibroscan®)

  14. Polymorphism of the gene of IL28B [ Time Frame: Day 0 ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Adult ≥18 years
  • Infection with HCV genotype 4, confirmed by detectable HCV RNA ≥ 1000 IU/ml at pre-inclusion
  • Non-responders to a prior treatment with pegylated Interferon and Ribavirin, with non-response being defined as follows:

    • Null-response: reduction of less than 2 log10 IU/ml of HCV viral load between D0 of the treatment and week 12
    • Partial response: reduction of at least 2 log10 IU/ml of HCV viral load between D0 of the treatment and week 12 but detectable HCV RNA at week 12 and week 24 and without an undetectable viral load by the end of treatment
  • Anti-HCV treatment discontinued for at least the last 3 months
  • Fibrosis at any stage, with documentation of the presence or absence of cirrhosis at the pre-inclusion visit:

    • history of liver biopsy showing cirrhosis lesions (METAVIR F4), at any time in the patient's history, and/or
    • good quality (length ≥ 15 mm and ≥ 6 portal spaces) liver puncture biopsy from less than 18 months to establish the METAVIR, and/or
    • hepatic impulse elastometry (Fibroscan®) from less than 6 months and of good quality (at least 10 measurements on an incidence with an IQR of less than 30% of the mean elastometry measured and a success rate of 60%)
  • Body weight ≥ 40 kg and ≤125 kg
  • Men and women of child-bearing age and their heterosexual partners must use two adequate contraceptions from 1 month before initiation of treatment up to 7 months after the end of treatment for men and up to 4 months after treatment for women.
  • Written informed consents (2) signed by the patient and the investigator (on the day of the pre-inclusion at the latest and before any examination required by the study)
  • Patients with Health insurance (Sécurité Sociale or Couverture Médicale Universelle)

Exclusion Criteria:

  • CHILD B or C cirrhosis or a history of decompensated cirrhosis. If Child A cirrhosis, presence of varices presenting an hemorrhagic risk (grade II with red spots or grade III) on a fibroscopy dating from less than 3 years
  • Previous HCV therapy including HCV NS3 protease inhibitor, and/or HCV NS5A replication complex inhibitor and/or HCV NS5B polymerase inhibitor
  • Positive HBs Antigen
  • Confirmed HIV-1 or HIV-2 infection
  • Pregnant or breast-feeding women
  • Severe heart or lung disease
  • Transplant recipient
  • Uncontrolled dysthyroidism
  • Uncontrolled diabetes
  • Any evolutive ongoing malignant disease, including hepatocellular carcinoma, which will be specifically screened for before inclusion
  • Consumption of alcohol which, in the opinion of the investigator, will be an obstacle to participation of the patient and to his remaining in the study
  • Drug addiction which, in the the investigator's opinion, will be an obstacle to the patient's participation and to his or her remaining in the study. Patients included in a programme of substitution with methadone or buprenorphine could be included. The opinion of a consultant in addictology is recommended for patients presenting with current drug use or drug use in the past year.
  • Patients taking part in another clinical trial during the 30 days preceding inclusion.
  • Patient under guardianship, trusteeship or judicial protection
  • Hb < 110 g/L
  • Platelets < 80 000/mm3
  • Polynuclear neutrophils < 1000 /mm3 (for European patients) and < 750 /mm3 (for African patients)
  • Kidney failure defined by creatinine clearance < 50mL/mn (MDRD formula)
  • Contra-indication for treatment with Ribavirin including a history of hypersensitivity to Ribavirin or to one of the excipients
  • Contra-indication for treatment with Daclatasvir or Asunaprevir including a history of hypersensitivity to one of the excipients
  • Contra-indication to treatment with Interferon including psychiatric contra-indications. A psychiatrist's opinion is compulsory in the following situations :

    • history of psychiatric disorders requiring hospitalisation of the patient or a consultation with a specialist
    • treatment with mood stabilizers or antipsychotics during the previous year
    • history of psychiatric disorders during prior treatment with Interferon alpha
    • evidence of depression episodes, a risk of suicide, bipolar disorder and/or current behavioral disorders. These patients can only be included after a psychiatric evaluation that specifically authorizes the use of Interferon.
  • History of previous HCV treatment premature cessation (in the first 6 months) for toxicity. Premature cessation for anemia or neutropenia will be authorized in the absence of the use of erythropoietin or polynuclear neutrophil growth factor, respectively.
  • Patients with a non-compliance history, who will be at risk of not complying with the study follow-up timetable
  • Associated treatment likely to interfere with the study drugs

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 ClinicalTrials.gov identifier (NCT number): NCT02107365


Locations
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France
Hôpital AVICENNE
Bobigny, France, 93009
Hôpital Jean Verdier
Bondy, France, 93140
Hôpital de Haut Lévêque
Bordeaux Pessac, France, 33601
Hôpital Beaujon
Clichy, France, 92110
Centre Hospitalier Intercommunal
Créteil, France, 94010
Hôpital Henri Mondor
Créteil, France, 94010
Hôpital Albert Michallon
Grenoble, France, 38043
Hôpital Claude Huriez
Lille, France, 59037
Hôpital Dupuytren
Limoges, France, 87042
Hôpital de la Croix Rousse
Lyon, France, 69317
Fondation Hôpital Saint Joseph
Marseille, France, 13285
Hôpital Saint Eloi
Montpellier, France, 34295
Hôpital de Brabois
Nancy, France, 54511
Hôpital de l'Hôtel Dieu
Nantes, France, 44093
Hôpital de l'Archet
Nice, France, 06202
Hôpital de La Source
Orléans, France
Hôpital Saint Antoine
Paris, France, 75571
Hôpital Pitié Salpêtrière
Paris, France, 75651
Hôpital Cochin
Paris, France, 75679
Hôpital Tenon
Paris, France, 75970
Hôpital Pontchaillou
Rennes, France, 35000
Hôpital Charles Nicolle
Rouen, France, 76031
Institut Arnault Tzank
Saint Laurent du Var, France, 06721
Hôpital Purpan
Toulouse, France, 31059
Hôpital Paul Brousse
Villejuif, France, 94804
Sponsors and Collaborators
French National Institute for Health and Medical Research-French National Agency for Research on AIDS and Viral Hepatitis (Inserm-ANRS)
Bristol-Myers Squibb
Investigators
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Principal Investigator: Dominique ROULOT, MD, PhD Bobigny University Hospital
Study Chair: Eric BELLISSANT, MD, PhD Rennes University Hospital

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Responsible Party: French National Institute for Health and Medical Research-French National Agency for Research on AIDS and Viral Hepatitis (Inserm-ANRS)
ClinicalTrials.gov Identifier: NCT02107365     History of Changes
Other Study ID Numbers: ANRS HC32 QUATTRO
First Posted: April 8, 2014    Key Record Dates
Last Update Posted: January 24, 2017
Last Verified: January 2017
Keywords provided by French National Institute for Health and Medical Research-French National Agency for Research on AIDS and Viral Hepatitis (Inserm-ANRS):
Hepatitis C
HCV infection
HCV genotype 4
Non-responders HCV infected patients
Asunaprevir
Daclatasvir
Pegylated Interferon
Ribavirin
Additional relevant MeSH terms:
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Hepatitis C
Hepatitis
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Virus Diseases
RNA Virus Infections
Flaviviridae Infections
Interferons
Ribavirin
Interferon-alpha
Interferon alpha-2
Peginterferon alfa-2a
Asunaprevir
Antineoplastic Agents
Antiviral Agents
Anti-Infective Agents
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Physiological Effects of Drugs
Protease Inhibitors
Enzyme Inhibitors