Study to Evaluate the Safety and Efficacy of Daclatasvir/Sofosbuvir/Ribavirin for 16 Versus 24 Weeks for HCV Genotype 3 Cirrhotics

Tarek I. Hassanein, M.D., FACP, FAG, AGAF

Status and phase: Completed; Phase 4

Conditions: Cirrhosis; Hepatitis C

Treatments: Drug: Sofosbuvir, Sovaldi; Drug: Ribavirin; Drug: daclatasvir

Study type: Interventional

Funder types: Other

Identifiers

NCT02304159

AI444284

Details and patient eligibility

About

This is a randomized, open label, single center safety and efficacy study. At least 40 cirrhotic subjects with HCV genotype 3 will receive standard of care treatment of sofosbuvir and ribavirin (SOF/RBV) as well as 60 mg daily of Daclatasvir (investigational product). Subjects will be randomized in a 1:1 to receive either:

• Group A: 16 weeks of DCV/SOF/RBV
• Group B: 24 weeks of DCV/SOF/RBV

Subjects will return to the study center at various time points throughout the 16 or 24 weeks of treatment in addition to 12 weeks post taking last dose of study drug to monitor safety and efficacy. These visits will be according to standard of care.

Enrollment: 39 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Signed, written, informed consent must be available from the subject before any study-specific procedures are performed;

2. Male or female 18-75 years of age;

3. All of the following at least 6 months prior to screening visit:

   • Documented HCV infection based on history of a positive serum anti-HCV antibody test and/or detectable levels of HCV RNA >= 10,000 IU/mL, and
   • Documented HCV genotype 3.

4. Subjects with evidence of cirrhosis defined by either a liver biopsy <= 3 years from screening demonstrating a Metavir Fibrosis Score of F4 (or equivalent); OR Fibroscan® <= 1 year from screening > 12.5 kPa. If a subject is evaluated by more than one testing method, then the liver biopsy results take precedence;

5. Women of childbearing potential (WOCBP) must:

   • have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 24 hours prior to the start of study drug.
   • WOCBP must agree to follow instructions for method(s) of contraception for 7 months post-treatment completion.
   • Men who are sexually active with WOCBP must agree to follow instructions for method(s) of contraception for the following duration for 7 months post-treatment completion.
   • Investigators shall counsel WOCBP and male subjects who are sexually active with WOCBP on the importance of pregnancy prevention and the implications of an unexpected pregnancy Investigators shall advise WOCBP and male subjects who are sexually active with WOCBP on the use of highly effective methods of contraception. Highly effective methods of contraception have a failure rate of < 1% per year when used consistently and correctly.

6. At minimum the subject agrees to the use of two methods of contraception, with at least one method being highly effective as listed below:

Highly Effective Methods of Contraception

• Male condoms with spermicide
• Hormonal methods of contraception including combined oral contraceptive pills, vaginal ring, injectables, implants, and intrauterine devices (IUDs) such as Mirena® by male subject's WOCBP partner. Female partners of male subjects participating in the study may use hormone-based contraceptives as one of the acceptable methods of contraception since they will not be receiving study drug. WOCBP cannot use hormonal contraception as one of the two methods of contraception because there are no data on the effectiveness of systemic hormonal contraceptives in women taking SOF. However, WOCBP can continue to use hormonal contraceptives, if necessary, in addition to 2 other non-hormonal methods of contraception
• Nonhormonal IUDs, such as ParaGard®
• Tubal Ligation
• Vasectomy
• Complete Abstinence - defined as complete avoidance of heterosexual intercourse and is an acceptable form of contraception for all study drugs. Subjects who choose complete abstinence are not required to use a second method of contraception, but female subjects must continue to have pregnancy tests. Acceptable alternate methods of highly effective contraception must be discussed in the event that the subject chooses to forego complete abstinence.

Less Effective Methods of Contraception

• Diaphragm with spermicide
• Cervical cap with spermicide
• Vaginal sponge
• Male condom without spermicide
• Progestin only pills
• Female condom; A male and female condom must not be used together

Azoospermic males, women who are not of childbearing potential and WOCBP who abstain from heterosexual activity on a continuous basis, are exempt from contraceptive requirements. However, WOCBP who abstain from heterosexual activity on a continuous basis must still undergo pregnancy testing.

Exclusion criteria

1. Subjects who lack capacity to consent for themselves;

2. HCV Genotypes other than GT-3 infection; mixed genotype infections are not permitted;

3. Liver histology consistent with any other co-existing cause of chronic liver disease (apart from fatty liver and/or Chronic Hepatitis B Virus);

4. Body Mass Index > 40 at the Screening visit;

5. Any of the following within one month of screening:

   • Uncontrolled diabetes;
   • Unstable or uncontrolled thyroid disease (subjects requiring medication to control their thyroid disease are eligible if all other inclusion/exclusion criteria are met).

6. Any of the following within 6 months of screening visit, any of the following:

   • Decompensated liver disease, esophageal variceal bleeding, or a hepatic mass lesion suspicious for hepatocellular carcinoma (HCC);
   • Subjects who have been treated for HCV infection;
   • History of unstable or deteriorating cardiovascular or cerebrovascular disease;
   • Alcohol and/or drug.

7. QTcF ≥ 500 ms at the baseline visit.

8. Any of the following laboratory abnormalities within 8 weeks of the baseline visit:

   • Hemoglobin <8 g/dL;
   • Absolute neutrophil count <0.50 x 103 cells/μL;
   • Platelet count <25 x 103 cells/μL;
   • Total bilirubin >=3 mg/dL or >=34 mol/L (with the exception of subjects with Gilbert's syndrome);
   • Albumin <2.5g/dL;
   • Creatinine Clearance (CrCl) <=50 mL/min (as estimated by Cockcroft and Gault).
   • Serum ALT >=10 × ULN;
   • Alpha-fetoprotein >200ng/mL.

9. Prior exposure to NS5A inhibitors is prohibited but other classes and pegIFN/RBV are acceptable for treatment-experienced subjects;

10. Use of any prohibited or restricted treatment at least is five half-lives or 14 days (whichever is longer) of the first dose of study drug (refer to section 4.5);

11. History of cancer within 1 year of the screening visit with the exception of localized basal or squamous cell carcinoma;

12. Any gastrointestinal disease or surgical procedure that may impact the absorption of study drug. (Subjects who have had cholecystectomy are permitted to enter the study);

13. Known HIV infection;

14. Confirmed, uncontrolled hypertension (any screening systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 100 mmHg should be excluded);

15. Presence or history of non-HCV chronic liver disease, including autoimmune hepatitis, alpha-1-antitrypsin deficiency, hemochromatosis, Wilson's disease, drug- or toxin-induced liver disease, alcohol-related liver disease, primary biliary cirrhosis and sclerosing cholangitis. Subjects with fatty liver and/or chronic hepatitis B virus in addition to HCV may be considered in the study;

16. Uncontrolled seizures disorder;

17. History of hemoglobinopathies, (e.g., thalassemia, sickle cell anemia, spherocytosis) or other cause of hemolytic anemia, including autoimmune causes;

18. Active disease at screening visit known to cause significant alteration in immunologic function including hematologic malignancy, sarcoidosis or autoimmune disorder (e.g., rheumatoid arthritis, systemic lupus erythematosis, leukemia, lymphoma, autoimmune thyroid disease, scleroderma, unstable psoriasis, and multiple sclerosis);

19. Pregnant or lactating women or women who plan to become pregnant during the study;

20. History of hypersensitivity to drugs with a similar biochemical structure to DCV or SOF or RBV;

21. Any other criteria or known contraindication that would exclude the subject from receiving SOF or RBV (per the local label) or DCV;

22. Inability to tolerate oral medication;

23. Subjects, who in the opinion of the Investigator, are not suitable candidates for enrollment or who would not comply with the requirements of the study.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

39 participants in 2 patient groups

Group A - 16 weeks

Experimental group

Description:

Combination of sofosbuvir 400 mg daily, ribavirin 1000-1200 mg daily (weight based) and daclatasvir 60 mg daily for 16 weeks

Treatment:

Drug: daclatasvir

Drug: Ribavirin

Drug: Sofosbuvir, Sovaldi

Group B - 24 weeks

Active Comparator group

Description:

Combination of sofosbuvir 400 mg daily, ribavirin 1000-1200 mg daily (weight based) and daclatasvir 60 mg daily for 24 weeks

Treatment:

Drug: daclatasvir

Drug: Ribavirin

Drug: Sofosbuvir, Sovaldi