Hepatitis C, Chronic
Conditions
Brief summary
The primary objective is to assess the safety, efficacy and tolerability of the combination of PEG-Intron plus REBETOL in pediatric subjects with chronic hepatitis C. The secondary objective is to measure the multiple-dose pharmacokinetics of PEG-Intron and REBETOL in pediatric subjects with chronic hepatitis C.
Detailed description
This global, multicenter, open-label Phase 3 study will evaluate the safety, efficacy and tolerability of PEG-Intron plus REBETOL in previously untreated pediatric subjects, ages 3 through 17 years, with chronic hepatitis C.
Interventions
BIOLOGICALpeginterferon alfa-2b (PEG2b) (SCH 54031)
PEG2b 1.5 μg/kg/wk given subcutaneously (once weekly) for 48 weeks.
15 mg/kg/day for up to 48 weeks
Sponsors
Merck Sharp & Dohme LLC
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
3 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
* Children age 3-17 years old * Individuals weighing ≤ 90 kg * Previously untreated children with chronic hepatitis C (HCV RNA qPCR plasma positive) * Individuals with any HCV (hepatitis C virus) genotype * Hematology laboratory results of: * Hemoglobin (HGB) ≥ 11 g/dL for females or ≥ 12g/dL for males, * White Blood Cell Count (WBC) ≥ 3,000/mm\^3, * Neutrophils ≥ 1,500/mm\^3, * Platelets ≥ 100,000/mm\^3 * Chemistry laboratory results of: * Normal Thyroid Stimulating Hormone (TSH), albumin, creatinine, and Bilirubin, * Antinuclear antibody (ANA) ≤ 1:160, * Fasting Glucose 70-140 mg/dL. Note: If glucose levels are between 116-140 mg/dL or an individual has diabetes, HbA1C must be ≤ 8.5% * Compensated liver disease * Historic or pre-treatment liver biopsy slides available * No significant co-existing psychiatric disease * Those with diabetes, hypertension, or birth prior to 32 weeks gestational age must have normal eye exams and retinal photographs (these will be done as part of the study before hepatitis C treatment is given) * Patients and partners of patients willing to use adequate contraception during the course of the study * Abstain from alcohol and any other illicit drugs
Exclusion criteria
* Serum ALT \>10 times the upper limit of normal within the 6 months prior to study * Previous hepatitis C treatment * Children with liver disease not caused by hepatitis C * Most recent liver biopsy is normal * Individuals infected with the hepatitis B virus and/or human immunodeficiency virus (HIV) * Known blood disorders such as hemoglobinopathy, coagulopathy, or G6PD deficiency * Known immunodeficiency disorders requiring immunoglobulin therapy * Body organ transplant * Any known or suspected cancer within the past 5 years * Children with chronic pulmonary disease * Individuals who have a medical condition that would likely require systemic steroids * Those with a history of central nervous system (CNS) trauma or seizure disorders * Individuals with pre-existing psychiatric disorders including but not limited to moderate to severe depression * Current or previous use of lithium or antipsychotic drugs * Patients with clinically significant electrocardiogram (ECG) abnormalities and/or significant cardiovascular dysfunction (e.g., angina, congestive heart failure, recent myocardial infarction, uncontrolled hypertension, significant arrhythmia, cardiac sequelae from Kawasaki disease, cardiomyopathy, and/or history of congenital heart disease) * Insulin-dependent diabetes mellitus or poorly controlled non-insulin dependent diabetes mellitus * Immunologically mediated disease (e.g., inflammatory bowel disease \[Crohn's disease, ulcerative colitis\], rheumatoid arthritis, idiopathic thrombocytopenic purpura, systemic lupus erythematosus, autoimmune hemolytic anemia, scleroderma, severe psoriasis, or symptomatic thyroid disorder) * History of substance abuse, including alcohol (e.g., binge drinking, blackouts), intravenous drugs and inhaled drugs * Subjects who have a history of pregnancy or who are pregnant and/or breast feeding. Subjects who intend to become pregnant during the study period. Subjects with partners who intend to become pregnant during the study period * Subjects with clinically significant retinal abnormalities such as known retinopathy of prematurity or other retinopathies
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With a Sustained Virologic Response (SVR) at 24 Weeks Post-treatment | Up to 48-week treatment duration. Follow-up of 24 weeks. | SVR is defined as undetectable hepatitis C virus ribonucleic acid (HCV-RNA) at 24 weeks post-treatment |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| PEG-Intron Plus REBETOL SCH 54031 PEG-Intron (peginterferon alfa-2b) 60 µg/m2 subcutaneous injection once weekly plus SCH 18908 REBETOL (ribavirin) 15 mg/kg PO daily in two divided doses for 48 weeks for subjects with Genotypes 1,4,5,6 and high-viral-load (≥600,000 IU/mL) Genotype 3 subjects. For subjects with Genotype 2 or low-viral-load Genotype 3 (\<600,000 IU/mL), the same treatment will be given for 24 weeks. | 107 |
| Total | 107 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
| Overall Study | Discontinuation unrelated to treatment | 2 |
| Overall Study | Lack of Efficacy | 26 |
Baseline characteristics
| Characteristic | PEG-Intron Plus REBETOL |
|---|---|
| Age, Continuous | 9.7 years STANDARD_DEVIATION 4 |
| Sex: Female, Male Female | 56 Participants |
| Sex: Female, Male Male | 51 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 107 / 107 |
| serious Total, serious adverse events | 3 / 107 |
Outcome results
Primary
Number of Participants With a Sustained Virologic Response (SVR) at 24 Weeks Post-treatment
SVR is defined as undetectable hepatitis C virus ribonucleic acid (HCV-RNA) at 24 weeks post-treatment
Time frame: Up to 48-week treatment duration. Follow-up of 24 weeks.
Population: Carry Forward analysis of participants who received at least one dose of study medication. This dataset includes one subject with undetectable HCV-RNA at Follow-up Week 12 (FW 12) but missing data at FW 24; this subject was considered a sustained responder in the Carry Forward analysis.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PEG-Intron Plus REBETOL | Number of Participants With a Sustained Virologic Response (SVR) at 24 Weeks Post-treatment | 70 Participants |
95% CI: [0.564, 0.744]