Pilot Study on the Efficacy of Pegylated Interferon-Ribavirin-Boceprevir Triple Therapy in Patients Infected With Genotype 1 HCV With Cirrhosis and Awaiting Liver Transplantation (ANRS HC 29 BOCEPRETRANSPLANT)
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 发起方
- 入组人数
- 58
- 试验地点
- 19
- 主要终点
- Sustained Virologic Response (SVR) Rate
研究概览
简要总结
Evaluation of efficacy of triple therapy with pegylated interferon, ribavirin, and boceprevir in patients with genotype 1 chronic hepatitis C, who are treatment-naive, have relapsed, or are non-responders with cirrhosis and awaiting liver transplantation, with a MELD score less than or equal to 18
详细描述
Evaluation of sustained virological response defined as the proportion of patients with undetectable hepatitis C virus RNA 24 weeks after discontinuation of therapy and/or after liver transplantation in patients with genotype 1, who are treatment-naive, have relapsed, or are non-responders with cirrhosis and awaiting liver transplantation, with a MELD score less than or equal to 18
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —(Adult, Older Adult)
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult 18 years and older
- •Chronic infection with hepatitis C virus proven with positive PCR for more than 6 months
- •Viral genotype 1
- •Cirrhosis while awaiting liver transplantation
- •MELD score < or equal to 18
- •With or without hepatocellular carcinoma
- •Naive to antiviral C treatment
- •Failure on a previous treatment. Failure is defined as the persistence of detectable HCV RNA. The previous HCV failure treatment profile must be able to be documented according to the following terminology:- Relapsing patient: HCV RNA undetectable at the end of treatment, becoming detectable again after the discontinuation of treatment- Breakthrough: increase of viremia of 1 log or more during the treatment - Non-responding patient with partial response: HCV RNA detectable at W24 without ever having been undetectable and with a decrease in HCV RNA ≥ 2 log at W12 - Non-responding patient with nul response: decrease in HCV RNA < 2 log at W12
- •No need for prior treatment wash-out
- •Negative pregnancy test in women of child-bearing age
- •Double method of contraception in men and women of child-bearing age during the entire duration of treatment and the 6 months following its discontinuation
- •Free, informed, and written consent (signed on the day of pre-enrollment at the latest and before all exams required by the study)
- •Person enrolled in or a beneficiary of a social security/Universal Health Insurance Coverage
- •Inclusion approved by the Decision Support Committee
排除标准
- •Previous HCV treatment with boceprevir or telaprevir
- •Alcohol consumption > 40 g/day
- •Toxicomania constituting a barrier for starting therapy according to the opinion of the investigator. Patients included in a methadone or buprenorphine replacement program may be enrolled
- •MELD > 18
- •Non controlled sepsis
- •Platelets < 50,000/mm3
- •Neutrophil granulocyte levels < 1000/mm3
- •Creatinine clearance < 50 mL/min (MDRD)
- •Hb < 10 g/dL
- •Uncontrolled psychiatric problems
- •Contraindications to boceprevir
- •Contraindication to interferon or ribavirin
- •Subject with major complications of cirrhosis
- •HIV coinfection
- •HBV coinfection (unless this is treated effectively with analogues, as proven by undetectable viremia for at least 12 months)
- •Other infectious disease underway
- •Neoplastic disease other than hepatocellular carcinoma during the previous year, or neoplastic disease for which the prognosis is less than 3 years
- •Treatment with immunosuppressors (including corticosteroids), antivirals other than those for the study, except aciclovir
- •Consumption of St. John's wort
- •Associated treatments including a molecule or substance that could interfere with the pharmacokinetic characteristics of boceprevir
- •History of a lactose allergy
- •Person participating in another study including an exclusion period that is still underway during pre-enrollment
- •So-called vulnerable populations (minors, people under guardianship or protection, or a private individual under protection from making legal or administrative decisions)
- •Pregnancy, breast-feeding
研究组 & 干预措施
Boceprevir, Pegylated interferon and Ribavirin
- Lead-in phase (4 week): Pegylated interferon + Ribavirin
- Triple therapy regimen for 44 weeks :Boceprevir + Pegylated interferon + Ribavirin
- Pegylated interferon + Ribavirin therapy until transplantation (less or equal to 24 weeks)
干预措施: Boceprevir (Drug)
Boceprevir, Pegylated interferon and Ribavirin
- Lead-in phase (4 week): Pegylated interferon + Ribavirin
- Triple therapy regimen for 44 weeks :Boceprevir + Pegylated interferon + Ribavirin
- Pegylated interferon + Ribavirin therapy until transplantation (less or equal to 24 weeks)
干预措施: Peg-Interferon α-2b or Peg-Interferon α-2a (Biological)
Boceprevir, Pegylated interferon and Ribavirin
- Lead-in phase (4 week): Pegylated interferon + Ribavirin
- Triple therapy regimen for 44 weeks :Boceprevir + Pegylated interferon + Ribavirin
- Pegylated interferon + Ribavirin therapy until transplantation (less or equal to 24 weeks)
干预措施: Ribavirin (Drug)
结局指标
主要结局
Sustained Virologic Response (SVR) Rate
时间窗: Week 24 after the discontinuation of antiviral C treatment and at the time of liver transplantation or at the time of liver transplantation
Evaluation of sustained virologic response to antiviral C treatment depends of time of liver transplantation that can be performed between week 16 and week 96 of the trial: * If the liver transplant is realized after the discontinuation of antiviral C treatment,sustained virologic response should be evaluated 6 months after the discontinuation of antiviral C treatment and at the time of liver transplantation. * If the liver transplant is realized before the discontinuation of antiviral C treatment,sustained virologic response should be evaluated at the time of liver transplantation.
次要结局
- Resistant mutations in plasma and liver samples (both explanted liver and graft)(Week 16 up to week 96)
- Survival after transplantation(Week 16 up to week 96)
- SVR prognosis factors(Week-4 up week 144)
- The mean time elapsed between registration on the transplantation list and the date of transplantation(Week16 up to week 96)
- Area Under the Plasma Concentration Time Curve (AUC) From 0-8h of Boceprevir(At week 16 and at week 24 and if the MELD score has changed by more than three points)
- Minimum Plasma Concentration (Cmin) of Boceprevir(At week 16 and at week 24 and if the MELD score has changed by more than three points)
- Compliance rate.(week 12, week 24, week 36, week 48, week 72 - after Liver transplant:Day 0)
- The percentage of virologic failure(week 4 and week 48)
- Sepsis according to Systemic Inflammatory Response System (SIRS) Criteria(From day 0 to week 72)
- Cirrhosis impairment(From day 0 to week 72)
- Measurement of the residual plasma concentration (Cres) of ribavirin(at Week 4 and Week 8)
- The predictive value of on-treatment HCV RNA on SVR(During weeks 1, 4, 5, 6, 7, 8, 12, 16, 20, and 24 (before transplantation))
- Survival rate within one year after liver transplantation(week 64 up to week 144)
- Maximum Plasma Concentration (Cmax) of Boceprevir(At week 16 and at week 24 and if the MELD score has changed by more than three points)
- Time of Maximum Plasma Concentration (Tmax) of Boceprevir(At week 16 and at week 24 and if the MELD score has changed by more than three points)
- Number of participants with adverse events as a measure of safety and tolerability(From week 0 to week 144)
- Perceived symptoms(at day 0, week 24, week 48 and every 24 week up liver transplant - post liver transplant: day 0, week 24 and week 48)
- The percentage of relapse after transplantation(Between week 16 and week 144)
- Boceprevir resistant mutations(From week 5 to week 48 or after week 48)
- Virological Response in participants with and without Insulin Resistance(At week 4, 8, 16, 28 and 48 during therapy)
- Relationship between the presence of a polymorphism to the ITPA gene and the onset of hemolytic anemia(After week 144)
- Correlation study between the presence of an elevated level of IP-10 during triple therapy and the absence of sustained virologic response(From week 4 to week 48)
- Insulin Resistance (HOMA-IR)(At baseline, week 48 and at the last follow-up visit)
- Relationship between the presence of a polymorphism in the IL28B gene (donor and recipient) and SVR(After week 144)
- Histological severity of HCV recurrence after liver transplantation(At week 20 up to week 100, at week 40 up to week 120, at week 64 up to week 144)
