Trial of Simplified Treatment Monitoring for 8 Weeks Glecaprevir/Pibrentasvir in Chronic Hepatitis C Patients

Hepatitis C, Chronic Clinical Trial

— SMART-C  

Official title:

A Phase IIIb, Open-label, Multicentre, International Randomised Controlled Trial of Simplified Treatment Monitoring for 8 Weeks Glecaprevir (300mg)/Pibrentasvir (120mg) in Chronic HCV Treatment naïve Patients Without Cirrhosis

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03117569
• Other study ID #: VHCRP1701
• Status: Completed
• Phase: Phase 3
• Start date: August 21, 2017
• Est. completion date: December 19, 2018

Study information

• Verified date: December 2019
• Source: Kirby Institute
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The aim of this study is to determine if treatment monitoring schedule for chronic HCV patients treated with glecaprevir (300mg)/pibrentasvir (120mg) can be simplified.

Data has shown that direct acting antiviral (DAA) regimen of glecaprevir (300mg)/pibrentasvir (120mg), a protease inhibitor and NS5A inhibitor respectively , provides key features for HCV treatment simplification.

Eligible participants (naïve pre-cirrhosis chronic HCV patients) will be randomized (1:2) to the standard or simplified monitoring arm and will receive treatment for 8 weeks.

One post treatment visit will be conducted 12 weeks after the final dose of study medication to evaluate the proportion of patients with undetectable HCV RNA at this timepoint (SVR12).

Description:

The capacity to scale-up interferon-free DAA therapy would be enhanced by simplified treatment monitoring strategies. The "next generation" DAA regimen of glecaprevir (300mg)/pibrentasvir (120mg), a protease inhibitor and NS5A inhibitor, provides key features for HCV treatment simplification, including on-treatment monitoring: 1) pangenotypic activity with extremely high efficacy (SVR>95%); 2) no relationship between time to undetectable HCV RNA and SVR; 3) minimal drug-related toxicity; 4) ease of dosing (three pills once daily); and short duration (8 weeks in non-cirrhosis and 12 weeks in cirrhosis for treatment naïve patients). In phase II and III clinical trials in participants without cirrhosis, 8 weeks of glecaprevir (300mg)/pibrentasvir (120mg) has provided intention-to-treat SVR rates of 99.1%, 98%, 97%, and 93.1% in genotype 1, 2, 3, and 4-6 populations, respectively.

Current standard on-treatment monitoring in clinical trials involves clinic-based visits every 4 weeks. In the DAA era where treatments are highly tolerable, effective and short duration, this intensive monitoring strategy may no longer be required. A simplified on-treatment monitoring strategy is hypothesised to be non-inferior to the standard clinical trial on treatment monitoring strategy. If successful, a simplified on-treatment monitoring strategy is likely to be highly attractive to patients, clinicians and health care payers. It has the potential to improve the rapid scale up of treatment providing population level benefits in the reduction of global hepatitis C disease burden.

This study will be conducted as a Phase IIIb, randomised, controlled, multicentre, international trial.

There will be a maximum screening period of 6 weeks prior to Baseline. Eligible patients will be randomised into one of two on-treatment monitoring strategies; standard clinical trial monitoring (4-weekly on-treatment visits) vs simplified monitoring (no on-treatment visits). Randomisation will be 1:2 (standard vs simplified) and all participants will receive treatment with glecaprevir (300mg)/pibrentasvir (120mg) for 8 weeks.

All participants will attend the clinic for screening and baseline visit. Randomisation will occur at the baseline visit.

The two on-treatment monitoring strategies will differ as follows:

• Standard monitoring arm participants will have on-treatment clinic visits at weeks 4 and 8 (EoT).

• Simplified monitoring arm participants will have no on-treatment clinic visits.

Study nurse phone contact will also be made to participants in BOTH arms 1-2 days prior Week 4 and EoT (Week 8) visits to provide standardized reporting of adverse events, concomitant medication and adherence. One post treatment clinic visit will be conducted at SVR12 (week 20) for all participants.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 380
• Est. completion date: December 19, 2018
• Est. primary completion date: December 19, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Have voluntarily signed the informed consent form.

2. 18 years of age or older.

3. Chronic HCV infection as defined by anti-HCV antibody or HCV RNA detection for greater than 6 months.

4. HCV RNA plasma = 10,000 IU/ml at screening.

5. HCV genotype 1-6.

6. HCV treatment naïve (no prior treatment with an approved or investigation anti-HCV medication).

7. Stage F0-3, based on: hepatic elastography <12.5 kPa on Fibroscan® or APRI <1.0.

8. If co-infection with HIV is documented, the subject must meet the following criteria:

• ART naïve with CD4 T cell count >500 cells/mm3; OR

• On a stable ART regimen (containing only permissible ART - see protocol section 3.2) for >8 weeks prior to screening visit, with CD4 T cell count >200 cells/mm3 and a plasma HIV RNA level below the limit of detection.

9. Negative pregnancy test at screening and baseline (females of childbearing potential only).

10. All fertile females must be using effective contraception during treatment and during the 30 days after treatment end.

Exclusion Criteria:

1. History of any of the following:

1. Clinically significant illness (other than HCV) or any other major medical disorder that may interfere with the participant treatment, assessment or compliance with the protocol; participants currently under evaluation for a potentially clinically significant illness (other than HCV) are also excluded.

2. Clinical hepatic decompensation (i.e. ascites, encephalopathy or variceal haemorrhage).

3. Solid organ transplant.

4. History of severe, life-threatening or other significant sensitivity to any excipients of the study drugs.

2. Any of the following lab parameters at screening:

1. ALT > 10 x ULN

2. AST > 10 x ULN

3. Direct bilirubin > ULN

4. Platelets < 90,000/µL (cells/mm3) if Fibroscan® <12.5 kPa OR < 150,000/µL (cells/mm3) if Fibroscan® is unavailable and patient is included with APRI <1

5. Creatinine clearance (CLcr) < 50 mL/min

6. Haemoglobin < 12g/dL for males; <11g/dL for females

7. Albumin < LLN

8. INR > 1.5 ULN unless subject has known haemophilia or is stable on an anticoagulant regimen affecting INR

3. Pregnant or breastfeeding female.

4. HBV infection (HBsAg positive).

5. Use of prohibited concomitant medications as described in protocol section 5.2.

6. Chronic use of systemically administered immunosuppressive agents (e.g. prednisone equivalent > 10 mg/day for >2 weeks).

7. Therapy with any anti-neoplastic or immunomodulatory treatment (including supraphysiologic doses of steroids and radiation) =6 months prior to the first dose of study drug.

8. Any investigational drug =6 weeks prior to the first dose of study drug.

9. Ongoing severe psychiatric disease as judged by the treating physician.

10. Positive result of a urine drug screen at the Screening Visit for opiates, barbiturates, amphetamines, cocaine, benzodiazepines, phencyclidine, propoxyphene, or alcohol, with the exception of a positive result (including methadone) associated with documented short-term use or chronic stable use of a prescribed medication in that class.

11. Injecting drug use within the previous six months.

12. Inability or unwillingness to provide informed consent or abide by the requirements of the study.

Related Conditions & MeSH terms

• Hepatitis
• Hepatitis C
• Hepatitis C, Chronic

Intervention

Drug:
• glecaprevir (300mg)/pibrentasvir (120mg)
glecaprevir (300mg)/pibrentasvir (120mg) for 8 weeks

Locations

Country	Name	City	State
Australia	Royal Adelaide Hospital	Adelaide	South Australia
Australia	St Vincent's Hospital Melbourne	Melbourne	Victoria
Australia	The Alfred Hospital	Melbourne	Victoria
Australia	East Sydney Doctors	Sydney	New South Wales
Australia	Holdsworth House Medical Practice	Sydney	New South Wales
Australia	St Vincent's Hospital Sydney	Sydney	New South Wales
Canada	William Osler Health System	Brampton	Ontario
Canada	St Joseph's Healthcare Hamilton	Hamilton	Ontario
Canada	McGill University Health Centre (MUHC)	Montréal	Quebec
Canada	CHU de Québec-Université Laval	Québec	Quebec
Canada	Toronto General Hospital	Toronto	Ontario
Canada	(G.I.R.I.) GI Research Institute	Vancouver	British Columbia
Canada	Lair Centre	Vancouver	British Columbia
France	Hopital Henri Mondor	Créteil
France	Hopital Saint Joseph	Marseille
France	Hopital Saint Antoine	Paris
Germany	zibp - Zentrum für Infektiologie Berlin Prenzlauer Berg GmbH	Berlin
Germany	Center for HIV and Hepatogastroenterology	Düsseldorf
Germany	Hannover Medical School	Hanover
Germany	CIM-Centrum fuer Interdisziplinaere Medizin GmbH	Münster
New Zealand	Auckland City Hospital	Auckland
New Zealand	Calder Center	Auckland
New Zealand	Christchurch Hospital	Christchurch
New Zealand	Dunedin Hospital	Dunedin
Switzerland	Inselspital - Universitaetsspital Bern	Bern
Switzerland	University Hospital Zurich	Zürich
United Kingdom	Barts Health	London
United Kingdom	Imperial College Healthcare NHS Trust (St Mary's Hospital)	London
United Kingdom	King's College Hospital	London
United States	Beth Israel Deaconess Medical Center	Boston	Massachusetts
United States	Duke University Medical Center	Durham	North Carolina
United States	SSM Health Dean Medical Group	Madison	Wisconsin
United States	New York University Langone Medical Center	New York	New York

Sponsors (1)

Lead Sponsor	Collaborator
Kirby Institute

Countries where clinical trial is conducted

United States,  Australia,  Canada,  France,  Germany,  New Zealand,  Switzerland,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Common Adverse Events (Safety Outcome)	Proportion of patients with common adverse events (reported in greater than 5%).	12 weeks post end of treatment (SVR12)
Other	Severe/Life Threatening Adverse Events (Safety Outcome)	Proportion of patients with at least one severe or potentially life threatening (grade 3 or 4) adverse event.	12 weeks post end of treatment (SVR12)
Other	Provider Acceptability of Simplified Monitoring Strategy (Exploratory Outcome)	Provider acceptability of simplified monitoring strategy measured by study specific questionnaire completed by each site Principal Investigator and the primary Research Nurse.	12 weeks post end of treatment (SVR12)
Primary	Undetectable HCV RNA (ITT Population)	Number of participants with undetectable HCV RNA based on ITT population.	12 weeks post end of treatment (SVR12)
Secondary	Undetectable HCV RNA (mITT Population)	Number of participants with undetectable HCV RNA based on mITT population.	12 weeks post end of treatment (SVR12)
Secondary	Treatment and Study Visits Adherence	Number adherent to treatment and study visits (on-treatment adherence and early treatment discontinuation).	12 weeks post end of treatment (SVR12)
Secondary	Health-related Quality of Life	Change in health-related quality of life score pre and post-treatment (measured by EQ-5D-3L). The EQ visual analogue scale records the patient's self-rated health on a vertical visual analogue scale where the endpoints are labelled 'Best imaginable health state' (value of 100) and 'Worst imaginable health state' (value of 0). The VAS can be used as a quantitative measure of health outcome that reflects the patient's own judgement. Higher scores indicate better outcomes.	Screening and 12 weeks post end of treatment (SVR12)
Secondary	Number of Virological Failure Participants With NS3 and NS5A Polymorphisms at Baseline and Post-treatment Week 12	Distribution of baseline resistance associated substitutions (RAS) in participants with virological failures. Baseline polymorphisms were detected by Sanger sequencing at the following amino acid positions: NS3: 36, 56, 80, 155, 156, 166, 168 NS5A: 24, 28, 30, 31, 58, 93	Baseline and 12 weeks post-treatment
Secondary	Patient Treatment Satisfaction	Patient was satisfied with their treatment follow-up plan.	12 weeks post end of treatment (SVR12)