Monitoring SOF/VEL in Treatment Naïve, HCV Participants With Active Infection

Phase 4

Completed

Conditions: Hepatitis C
HIV-1-infection
Liver Diseases

Interventions: Drug: Sofosbuvir/Velpatasvir (SOF/VEL)
Other: Minimal Monitoring (MINMON) Strategy

Registration Number: NCT03512210

Lead Sponsor: Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections

Brief Summary: To achieve global hepatitis C virus (HCV) elimination by 2030, 80% of the \~71 million people with chronic HCV infection will need to be treated, necessitating simplification of treatment delivery and associated laboratory monitoring without compromising efficacy or safety. The COVID-19 pandemic has further highlighted the need for innovative models of health care delivery that minimize face-to-face patient-provider contact. The purpose of this study was to evaluate the feasibility, safety, and efficacy of a minimal monitoring (MINMON) strategy to deliver interferon- and RBV-free, pan-genotypic DAA therapy to treat active HCV in HCV treatment naïve participants.

Detailed Description: This study evaluated the feasibility, safety, and efficacy of a minimal monitoring (MINMON) strategy of delivering interferon- and ribavirin (RBV)-free, pan-genotypic direct-acting antiviral (DAA) therapy to treat active hepatitis C virus (HCV) in HCV treatment naïve participants, with or without HIV-1 co-infection, and with no evidence of decompensated cirrhosis.

The MINMON intervention included four components: 1) No pre-treatment HCV genotyping; 2) Entire 12-week treatment course (84 tablets) dispensed to participants at study entry; 3) No scheduled on-treatment laboratory monitoring or clinic visits prior to SVR evaluation scheduled 24 weeks following entry; 4) Remote contact with participants at week 4 for adherence counseling and locator update, and week 22 for scheduling of SVR visit and locator update.

At study entry, all participants received a single-tablet, fixed-dose combination (FDC) of sofosbuvir/velpatasvir (SOF/VEL) for 12 weeks.

The trial was designed to accrue 400 adult participants who may be co-infected with HIV-1 (limited to no more than 200 participants), and whose liver disease state is either no cirrhosis (defined by Fibrosis-4 score) or compensated cirrhosis (defined by Fibrosis-4 and Child-Turcotte-Pugh (CTP) scores, and limited to no more than 80 participants). Accrual from research sites in the United States was limited to no more than 132 participants.

The study proceeded in two steps: Step 1: MINMON intervention and Step 2: post-MINMON follow up.

During Step 1 (MINMON intervention), participants were contacted remotely at week 4 to inquire about study medication adherence and confirm locator information, and again at week 22 to schedule the sustained virologic response (SVR) evaluation and confirm locator information. Unplanned in-person clinic visits before week 22 were permissible to address common treatment toxicities that could not be managed remotely. The primary efficacy outcome measure, sustained virologic response (SVR), was evaluated starting at the week 24 study visit. Early discontinuation of treatment did not alter the timing of the SVR evaluation. If the week 24 visit was missed, SVR could be evaluated at any time up to 76 weeks following study entry.

Following SVR evaluation, participants entered Step 2 for two additional post-SVR evaluation study visits at weeks 48 and 72. Participants were contacted remotely at weeks 42 and 68 to schedule such visits. The schedule of additional post-MINMON evaluation visits were dependent on the week of Step 2 entry.

In version 1 of the study, total study duration was up to 76 weeks. Due to the COVID-19 Pandemic, the window of the week 72 visit was extended for participants who completed SVR evaluations and registered to Step 2 to October 31, 2020 for US sites and to February 28, 2021 for non-US sites. This extension did not alter the window for SVR evaluation.

All scheduled in-clinic study visits included a physical exam, blood collection, and collection of plasma samples. For participants able to become pregnant, pregnancy testing was conducted at screening, entry, and at any in-clinic visit during Step 1 if pregnancy was suspected. Liver Elastography was an optional evaluation.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 400

Inclusion Criteria

Active Hepatitis C (HCV) infection, defined by HCV RNA >1000 international units (IU/mL) within 35 days prior to study entry
HCV treatment naïve
Liver disease staged as either non-cirrhotic (Fibrosis-4 (FIB-4) Score <3.25) or compensated cirrhotic (FIB-4 Score ≥3.25 and Child-Turcotte-Pugh (CTP) ≤Score 6) within 35 days prior to study entry
HIV-1 negative, or HIV-1 positive with either a) Non-efavirenz containing antiretroviral therapy (ART) started at least 14 days prior to study entry with plasma HIV-1 RNA <400 copies/mL within 90 days prior to study entry or b) not taking ART and CD4+ cell count >350 cells/uL within 90 days prior to study entry
The following laboratory values obtained within 35 days prior to study entry:
- Albumin >3.0 g/L
- Hemoglobin >8.0 g/dL for women; >9.0 g/dL for men
- Platelet count >50,000/mm^3
- Calculated creatinine clearance (CrCl) >30 mL/min
- Aspartate aminotransferase (AST) <10 times the upper limit of the normal range (ULN)
- Alanine transaminase (ALT) <10 times the ULN
- Total bilirubin <1.5 times the ULN for participants not on atazanavir (ATV); <3 times the ULN for participants on ATV
- International normalized ratio (INR) <1.5 times the ULN
For females of reproductive potential, a negative serum or urine pregnancy test within 48 hours prior to study entry
All participants of reproductive potential must have agreed not to participate in conception process (e.g., active attempt to become pregnant or to impregnate, sperm donation, in vitro fertilization) while on study treatment and for 6 weeks after stopping study treatment
If participating in sexual activity that could lead to pregnancy, the all participants of reproductive potential had to agree to use at least one reliable methods of contraception while on study treatment and for 6 weeks after stopping study treatment
Participants who were not of reproductive potential were eligible without requiring the use of contraceptives.
Life expectancy >12 months
Ability and willingness to be contacted remotely
Ability and willingness of participant to provide informed consent.

Exclusion Criteria

Positive for hepatitis B virus (HBV) surface antigen
For cirrhotic participants, CTP score >6 corresponding to Class B or C
Breastfeeding or pregnancy
Known allergy/sensitivity or any hypersensitivity to components of study drugs or their formulation
Active drug or alcohol use or dependence and other conditions that, in the opinion of the site investigator, would interfere with adherence to study requirements.
Acute or serious illness requiring systemic treatment and/or hospitalization within 35 days prior to study entry
For HIV positive participants, presence of active or acute AIDS-defining opportunistic infections within 35 days prior to study entry
Any history of hepatic decompensation including ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, and/or bleeding esophageal varices
Use of prohibited medications within the past 14 days prior to study entry

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
MINMON 24 weeks with SOF/VEL 12 Weeks	Sofosbuvir/Velpatasvir (SOF/VEL)	Participants received Sofosbuvir/Velpatasvir (SOF/VEL \[Tradename: Epclusa®\]) tablet for 12 weeks with a minimal monitoring (MINMON) strategy for 24 weeks
MINMON 24 weeks with SOF/VEL 12 Weeks	Minimal Monitoring (MINMON) Strategy	Participants received Sofosbuvir/Velpatasvir (SOF/VEL \[Tradename: Epclusa®\]) tablet for 12 weeks with a minimal monitoring (MINMON) strategy for 24 weeks

Primary Outcome Measures

Name	Time	Method
Percentage of Participants With Sustained Virologic Response 12 (SVR12)	From at least 22 weeks and up to 76 weeks from treatment initiation	SVR12 was defined as plasma HCV RNA less than the lower limit of quantification (LLOQ) from the earliest sample drawn at least 22 weeks following study treatment initiation (i.e. at a visit scheduled at least 10 weeks after scheduled end of study treatment). Participants without any HCV RNA result at least 22 weeks after treatment initiation will be considered as having HCV RNA greater than the LLOQ. LLOQ was defined as \<15 IU/mL for results tested at USA centralized testing laboratory Quest using the "Roche COBAS® HCV Quantitative nucleic acid test for use on the COBAS® 6800/8800" assays for quantitation (and detection) of HCV, and \<12 IU/mL for results tested at regional international labs using "Abbott RealTime HCV" assay for quantitation (and detection) of HCV. A two-sided 95%, confidence interval was calculated for this percentage using the Wilson (score) method.
Percentage of Participants With an Occurrence of Serious Adverse Events According to International Council for Harmonization (ICH) Criteria	From treatment initiation to 28 weeks	Serious adverse events (SAEs) as defined by ICH guidelines. A two-sided, 95% confidence interval was calculated for the percentage using the Wilson (score) method.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants With at Least One Unplanned Clinic Visit Prior to SVR12 Evaluation	From treatment initiation to 22 weeks	According to the study minimal monitoring intervention, there were no planned clinic visits prior to study week 24, when SVR12 was scheduled to be evaluated. An unplanned clinic visit was defined as an in-clinic visit occurring from treatment initiation to up to week 22. A two-sided, 95% confidence interval was calculated for the percentage using the Wilson (score) method.
Percentage of Participants With an Occurrence of One or More Non-serious, Grade >= 3 Adverse Event (AE), or Treatment Limiting AE.	From treatment initiation to 28 weeks	AEs included all primary diagnoses, primary signs/symptoms, and primary laboratory abnormalities that either had severity grade ≥ 3 or led to a change in study medication. Serious Adverse Events (SAE) by International Council for Harmonization (ICH) criteria were excluded as they contributed to the primary safety outcome measure. Severity grading was based on DAIDS AE Grading Table, Corrected Version 2.1. A two-sided, 95% confidence interval was calculated for the percentage using the Wilson (score) method.
Percentage of Participants Who Prematurely Discontinued HCV Study Medications	From at least 22 weeks and up to 76 weeks from treatment initiation	Since there were no planned clinic visits during the 12 week study medication period, the last dose of study treatment was self-reported by participants, and recorded at the SVR evaluation visit at 24 weeks. Premature treatment discontinuation was defined when the self-reported final dose date was \<11 weeks (\<77 days) after the date of initial dose (accounting for any reported treatment holds). Participants discontinuing study follow up without information about completion of HCV study medications were counted as having prematurely discontinued medications. A two-sided, 95% confidence interval was calculated for the percentage using the Wilson (score) method.

Trial Locations

Locations (38): Johns Hopkins University CRS (201)
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Baltimore, Maryland, United States
New Jersey Medical School Clinical Research Center CRS (31786)
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Newark, New Jersey, United States
Greensboro CRS (3203)
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Greensboro, North Carolina, United States
Hosp. of the Univ. of Pennsylvania CRS (6201)
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Philadelphia, Pennsylvania, United States
Pittsburgh CRS (1001)
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Pittsburgh, Pennsylvania, United States
Trinity Health and Wellness Center CRS (31443)
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Dallas, Texas, United States
University of the Witwatersrand Helen Joseph (WITS HJH) CRS (11101)
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Johannesburg, Gauteng, South Africa
Family Clinical Research Unit (FAM-CUR) CRS (8950)
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Cape Town, West Cape, South Africa
Whitman Walker Health CRS (31791)
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Washington, District of Columbia, United States
Thai Red Cross AIDS Research Centre (TRC-ARC) CRS (31802)
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Bangkok, Patumwan, Thailand
Chiang Mai University HIV Treatment CRS (31784)
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Chiang Mai, Thailand
Massachusetts General Hospital (MGH) CRS (101)
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Boston, Massachusetts, United States
Case CRS (2501)
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Cleveland, Ohio, United States
Univ. of Cincinnati CRS (2401)
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Cincinnati, Ohio, United States
Vanderbilt Therapeutics (VT) CRS (3652)
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Nashville, Tennessee, United States
Alabama CRS (31788)
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Birmingham, Alabama, United States
Ucsd, Avrc Crs (701)
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San Diego, California, United States
Rush Univ. Med. Ctr. ACTG CRS (2702)
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Chicago, Illinois, United States
Washington U CRS (2101)
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Saint Louis, Missouri, United States
UCLA CARE Center CRS (601)
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Los Angeles, California, United States
University of Rochester Adult HIV Therapeutic Strategies Network CRS (31787)
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Rochester, New York, United States
Columbia Physicians and Surgeons CRS (30329)
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New York, New York, United States
The Ponce de Leon Center CRS (5802)
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Atlanta, Georgia, United States
Ucsf Aids Crs (801)
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San Francisco, California, United States
Northwestern University CRS (2701)
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Chicago, Illinois, United States
Weill Cornell Chelsea CRS (7804)
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New York, New York, United States
Hospital Nossa Senhora da Conceicao CRS (12201)
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Porto Alegre, RS, Brazil
Puerto Rico-AIDS CRS (5401)
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San Juan, Puerto Rico
Houston AIDS Research Team CRS (31473)
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Houston, Texas, United States
Joint Clinical Research Centre (JCRC) (12401)
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Kampala, Uganda
University of Southern California (1201)
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Los Angeles, California, United States
University of Colorado Hospital CRS (6101)
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Aurora, Colorado, United States
Weill Cornell Upton CRS (7803)
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New York, New York, United States
Brigham and Women's Hosp. ACTG CRS (107)
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Boston, Massachusetts, United States
Unc Aids Crs (3201)
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Chapel Hill, North Carolina, United States
The Ohio State Univ. AIDS CRS (2301)
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Columbus, Ohio, United States
Instituto de Pesquisa Clinica Evandro Chagas (12101)
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Rio de Janeiro, Brazil
The Miriam Hospital ACTG CRS (2951)
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Providence, Rhode Island, United States