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Trial record 2 of 7 for:    Hepatitis C | Heart Transplant

Zepatier For Treatment Of Hepatitis C-Negative Patients Who Receive Heart Transplants From Hepatitis C-Positive Donors (HCV) (USHER)

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT03146741
Recruitment Status : Recruiting
First Posted : May 10, 2017
Last Update Posted : August 26, 2019
Merck Sharp & Dohme Corp.
Information provided by (Responsible Party):
University of Pennsylvania

Tracking Information
First Submitted Date  ICMJE April 27, 2017
First Posted Date  ICMJE May 10, 2017
Last Update Posted Date August 26, 2019
Actual Study Start Date  ICMJE May 16, 2017
Estimated Primary Completion Date December 2019   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: May 8, 2017)
  • Post-treatment sustained virologic response (SVR) [ Time Frame: baseline to 24 weeks ]
    The primary analysis will be based on a calculation of SVR rates (number of subjects with SVR); negative HCV RNA after completing Zepatier therapy) / (number of subjects treated with Zepatier post-heart transplantation)
  • Major adverse events attributable to HCV therapy in post-heart transplant patients post-heart transplant patients. [ Time Frame: baseline to 52 weeks ]
Original Primary Outcome Measures  ICMJE Same as current
Change History Complete list of historical versions of study NCT03146741 on Archive Site
Current Secondary Outcome Measures  ICMJE Not Provided
Original Secondary Outcome Measures  ICMJE Not Provided
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
Descriptive Information
Brief Title  ICMJE Zepatier For Treatment Of Hepatitis C-Negative Patients Who Receive Heart Transplants From Hepatitis C-Positive Donors (HCV)
Official Title  ICMJE Open-Labeled Trial Of Zepatier For Treatment Of Hepatitis C-Negative Patients Who Receive Heart Transplants From Hepatitis C-Positive Donors
Brief Summary This study is being conducted to determine safety and effectiveness of transplanting hearts from Hepatitis C-positive donors into Hepatitis C-negative patients on the heart transplant waitlist, who will then be treated with Zepatier after transplantation.
Detailed Description Open-labelled pilot clinical trial of Zepatier (MK-5172 and MK-8742/Grazoprevir + Elbasvir) in up to 20 HCV-negative subjects receiving a heart transplant from a HCV-positive donor. Eligible subjects will receive a heart transplant from a deceased-donor with genotype 1 or 4 HCV, and then will receive 12 weeks of Zepatier after heart transplantation when infection with HCV is confirmed in these heart transplant recipients. Treatment will be complete after 12 weeks.
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 1
Phase 2
Study Design  ICMJE Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE Heart Failure
Intervention  ICMJE Drug: Zepatier
Zepatier (grazoprevir 100mg and elbasvir 50 mg once daily) is taken by mouth for 12 weeks unless a genetic variation is detected. In this case treatment with Zepatier will be extended to 16 weeks. Study subjects with treatment failure will be provided open-label Zepatier + sofosbuvir (sovaldi) 400mg + Ribavirin (generic), renally dosed based on creatinine clearance per the manufacturer guidelines.
Study Arms  ICMJE Experimental: Zepatier (grazoprevir 100mg and elbasvir 50 mg) o
Intervention: Drug: Zepatier
Publications *

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
Recruitment Information
Recruitment Status  ICMJE Recruiting
Estimated Enrollment  ICMJE
 (submitted: March 12, 2019)
Original Estimated Enrollment  ICMJE
 (submitted: May 8, 2017)
Estimated Study Completion Date  ICMJE December 2020
Estimated Primary Completion Date December 2019   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • New York Heart Association (NYHA) Class III or IV CHF refractory to maximal medical therapy (ACE inhibitor, B-blocker, digoxin and diuretics, resynchronization therapy or Implantable Cardioverter Defibrillator when applicable) and/or conventional surgery.
  • Inoperable coronary artery disease with intractable anginal symptoms
  • Malignant ventricular arrhythmias unresponsive to medical or surgical therapy
  • 18-65 years of age
  • Obtained agreement for participation from the transplant cardiology team
  • No evident contraindication to liver transplantation other than the underlying cardiac disorder
  • Able to travel to the University of Pennsylvania for routine post-transplant visits and study visits for a minimum of 6 months after transplantation
  • No active illicit substance abuse
  • Women must agree to use birth control in accordance with Mycophenolate Risk Evaluation and Mitigation Strategy (REMS) following transplant due to the increased risk of birth defects and/or miscarriage
  • Both men and women must agree to use at least one barrier method of birth control or remain abstinent following transplant due to risk of HCV transmission
  • Inclusion criteria for treatment (not for entry as study patient) will include any detectable HCV RNA by week 4 post-heart transplantation
  • Able to provide informed consent

Exclusion Criteria:

  • Hepatocellular carcinoma
  • HIV positive
  • HCV antibody positive and/or RNA positive
  • Hepatitis B surface antigen, core antibody, and/or DNA positive
  • Any other chronic liver disease (excluding non-alcoholic fatty liver disease (NAFLD) with abnormal liver enzymes
  • Persistently elevated liver transaminases
  • Congenital heart disease
  • Fibrosis by liver biopsy or total bilirubin > 2.5 with associated evidence of synthetic dysfunction.
  • Pregnant or nursing (lactating) women
  • Known allergy or intolerance to tacrolimus that would require post-transplant administration of cyclosporine, rather than tacrolimus given the drug-drug interaction between cyclosporine and ZEPATIER
  • Waitlisted for a multi-organ transplant
  • Evidence of end organ damage due to diabetes (e.g. retinopathy, nephropathy, ulcerations) and /or brittle diabetes mellitus (e.g. history of diabetic ketoacidosis) and/or uncontrolled diabetes as evidence by a HgbA1C of 7.5-8.5.
  • Chronic bronchitis, chronic obstructive pulmonary disease, inability to stop smoking.
  • Hematologic: Significant coagulation abnormalities, bleeding diatheses.
  • Psychosocial: Profound neurocognitive impairment with absence of social support.
  • Active mental illness or psychosocial instability
  • Inadequate insurance or financial support for post-transplant care.
  • Evidence of drug, tobacco or alcohol abuse within the past six months and completion of recommended therapy/services or meets satisfied parameters as indicated by social work staff and/or consult team.
  • History of chronic non-compliance.
  • Amyloidosis (restricted to cardiac only, without evidence of extra cardiac involvement)
  • BMI ≥38
  • Active peptic ulcer disease.
  • Severe malnutrition.
  • Major chronic disabling illness (e.g. lupus, severe arthritis, neurologic diseases, previous stroke with profound residual).
  • Pulmonary infarction within the past 6 weeks
  • Severe pulmonary hypertension as evidenced by a fixed pulmonary vascular resistance of greater than 4 Wood units on appropriate medical therapy.
  • Patient refusal to receive blood products or transfusions during heart transplant surgery.
  • Severe chronic obstructive pulmonary disease
  • Current clinical sepsis.
  • Symptomatic or severe vascular disease.
  • Chronic Kidney Disease Stage IV, Glomerular Filtration Rate < 30
  • History of Mantle radiation.
  • Asymptomatic renal cell carcinoma <1 year from curative treatment.
  • Symptomatic renal cell carcinoma <5 years from curative treatment.
  • Prostate cancer <2 years from curative treatment.
  • Uterine or cervical cancer <2 years from curative treatment.
  • Any other cancer other than the above including malignant melanoma, < 5 years from treatment apart from other skin malignancies.

Donor Organ Selection Criteria:

General criteria (although there can be exceptions on a case-by-case basis)

  • Detectable HCV RNA
  • Genotype 1 or 4 HCV
  • Age <=55 years
  • No history of coronary artery disease
  • No congenital heart disease except a repaired atrial septal defect (ASD) provided the patient has normal right ventricular function
  • No history of arrhythmia (atrial fibrilation, atrial flutter or VT) except during resuscitation from fatal event.
  • No evidence of cirrhosis

Echocardiographic criteria:

  • Left ventricular ejection fraction (LVEF) >=50%
  • Normal right ventricular function
  • No left ventricular hypertrophy (LVH) - septal wall thickness <1 cm
  • No left ventricular hypertrophy (LVH)- posterior wall thickness <1 cm
  • No significant valvular heart disease - more than mild tricuspid regurgitation, more than mild mitral regurgitation, more than trace aortic regurgitation. No mitral or aortic stenosis.
  • No congenital heart disease - transposition of the great vessels, ventricular septal defect (VSD), ASD, and/or single ventricle (Fontan)

Right heart catheterization criteria:

  • Right atrial pressure <=10mmHg
  • Pulmonary capillary wedge pressure <=18mmHg
  • CI >=2.1 l/min/m2
  • Pulmonary hypertension is allowed if the patient has normal right ventricular function and a normal tricuspid valve
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 65 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Stacey Prenner, MD (307) 22-THINK
Contact: Rhondalyn Forde-Mclean, MD, MHSE (307) 22-THINK
Listed Location Countries  ICMJE United States
Removed Location Countries  
Administrative Information
NCT Number  ICMJE NCT03146741
Other Study ID Numbers  ICMJE 826708
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes
IPD Sharing Statement  ICMJE
Plan to Share IPD: Undecided
Responsible Party University of Pennsylvania
Study Sponsor  ICMJE University of Pennsylvania
Collaborators  ICMJE Merck Sharp & Dohme Corp.
Investigators  ICMJE
Principal Investigator: Peter Reese, MD, MSCE Perelman School of Medicine at the University of Pennsylvania
PRS Account University of Pennsylvania
Verification Date August 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP