Hepatitis C, Chronic
Conditions
Brief summary
This study will evaluate the addition of a higher-dose induction treatment period with peginterferon (PEG-IFN) alfa-2a (Pegasys) and ribavirin prior to standard-dose treatment with PEG-IFN alfa-2a and ribavirin, compared to standard-dose treatment, in treatment-naive participants with CHC, genotype 1 infection.
Interventions
PEG-IFN alfa-2a will be administered once weekly for 48 weeks, at doses specified in respective arms.
Ribavirin 1000 or 1200 mg orally daily in divided doses, with the dose determined based on body weight, for 48 weeks.
Sponsors
Study design
Eligibility
Inclusion criteria
* Diagnosis of chronic CHC, genotype 1 * Chronic liver disease consistent with CHC on a biopsy sample obtained within the previous 36 months as judged by a local pathologist (all countries except Australia) * Infection with Hepatitis C virus (Australian sites only had to meet Section 100 criteria for treatment with PEG-IFN alfa-2a plus ribavirin) * Compensated liver disease * Naive to interferon-based therapy for CHC infection
Exclusion criteria
* Systemic antiviral, antineoplastic, or immunomodulatory treatment within 6 months of study drug * Coinfection with active hepatitis A or B virus, or with human immunodeficiency virus (HIV) * Chronic liver disease other than CHC infection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Sustained Virological Response According to Scheduled Treatment Period | Week 72 | Sustained virological response was calculated as the percentage of participants with undetectable (less than \[\<\] 15 international units per milliliter \[IU/mL\]) hepatitis C virus (HCV) ribonucleic acid (RNA) as measured by the Roche TaqMan HCV Test 24 weeks after completion of the scheduled 48-week treatment period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With End-of-Treatment Virological Response According to Scheduled Treatment Period | Weeks 48 | Virological response at the end of the scheduled treatment period was defined as the percentage of participants with undetectable (\<15 IU/mL) HCV RNA as measured by the Roche TaqMan HCV Test at Week 48. |
| Percentage of Participants With Virological Responses Over Time | Weeks 4, 8, 12, and 24 | Virological response was defined as undetectable HCV RNA (\<15 IU/mL) as measured by the Roche TaqMan HCV Test. Participants without HCV RNA measurements at a study week are considered non responders at that study week. |
| Percentage of Participants With Relapse of End-of-treatment Virological Response | Actual end of treatment (Week 48) up to last follow up (maximum up to Week 72) | Relapse was determined based on virological response at the actual end of treatment and was calculated by dividing the number of participants who achieved a virological response at end of treatment but later had detectable HCV RNA at the last assessment post-treatment by the number of participants with a virological response at end of treatment, defined as undetectable HCV RNA (\<15 IU/mL). Participants who achieved a virological response at end of treatment but did not have any HCV RNA assessment during follow-up were excluded and were not considered as having relapsed. However, if no assessment was available within the end of-treatment time window but the participant had a sustained virological response according to the actual treatment period, backward imputation was used and the participant was considered to have achieved an end-of-treatment virological response in the analysis. |
| Percentage of Participants With Predictive Values of Virological Response for Sustained Virological Response | Weeks 4, 12, and 72 | The ability of virological responses to predict sustained virological response according to the scheduled treatment periods was assessed in terms of positive predictive value (PPV) and negative predictive value (NPV). The PPV indicates probability of achievement of viral suppression (undetectable HCV RNA) for achieving a sustained virological response and the NPV indicates probability of not achieving viral suppression for not achieving a sustained virological response. The PPV at Week 4 or 12 was calculated as the number of participants who achieved viral suppression both at Week 4 or 12 and at Week 72 divided by the number of participants who achieved viral suppression at Week 4 or 12, multiplied by 100. The NPV at Week 4 or 12 was calculated as the number of participants who failed to achieve viral suppression at Week 4 or 12 and at Week 72 divided by the number of participants who failed to achieve viral suppression at Week 4 or 12, multiplied by 100. |
| Change From Baseline in Log10 HCV RNA Values | Baseline, Weeks 4, 8, 12, 24, and at end of treatment (EoT) (maximum up to Week 48) | The mean decrease in log10 HCV RNA levels from baseline was assessed in both the induction group and the standard group. |
Countries
Argentina, Australia, Canada, Mexico, New Zealand, Thailand
Participant flow
Recruitment details
Out of total 896 randomized participants, 25 participants (15 in the induction group and 10 in the standard group) did not receive study drug.
Participants by arm
| Arm | Count |
|---|---|
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment Participants received 12 weeks of induction therapy with PEG-IFN alfa-2a, 360 mcg SC once weekly, along with ribavirin, 1000 or 1200 mg orally daily in divided doses, with the dose determined based on body weight. Thereafter, the dose of PEG-IFN alfa-2a was reduced to 180 mcg SC once weekly and the ribavirin dose was maintained for the next 36 weeks of treatment. | 433 |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment Participants received 48 weeks of standard therapy with PEG-IFN alfa-2a, 180 mcg SC once weekly, along with ribavirin, 1000 or 1200 mg orally daily in divided doses, with the dose determined based on body weight. | 438 |
| Total | 871 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 35 | 29 |
| Overall Study | Death | 1 | 1 |
| Overall Study | Entry Criteria Violation | 6 | 6 |
| Overall Study | Failure to Return | 11 | 13 |
| Overall Study | Insufficient Therapeutic Response | 53 | 83 |
| Overall Study | Laboratory Test Abnormality | 4 | 2 |
| Overall Study | Other/Administrative | 5 | 3 |
| Overall Study | Protocol Violation | 3 | 1 |
| Overall Study | Refused Treatment/Did not Cooperate | 10 | 8 |
Baseline characteristics
| Characteristic | PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Total |
|---|---|---|---|
| Age, Continuous | 43.6 years STANDARD_DEVIATION 9.55 | 43.3 years STANDARD_DEVIATION 9.19 | 43.4 years STANDARD_DEVIATION 9.37 |
| Sex: Female, Male Female | 135 Participants | 153 Participants | 288 Participants |
| Sex: Female, Male Male | 298 Participants | 285 Participants | 583 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 428 / 433 | 430 / 438 |
| serious Total, serious adverse events | 46 / 433 | 45 / 438 |
Outcome results
Percentage of Participants With Sustained Virological Response According to Scheduled Treatment Period
Sustained virological response was calculated as the percentage of participants with undetectable (less than \[\<\] 15 international units per milliliter \[IU/mL\]) hepatitis C virus (HCV) ribonucleic acid (RNA) as measured by the Roche TaqMan HCV Test 24 weeks after completion of the scheduled 48-week treatment period.
Time frame: Week 72
Population: ITT analysis population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With Sustained Virological Response According to Scheduled Treatment Period | 53 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With Sustained Virological Response According to Scheduled Treatment Period | 50 percentage of participants |
Change From Baseline in Log10 HCV RNA Values
The mean decrease in log10 HCV RNA levels from baseline was assessed in both the induction group and the standard group.
Time frame: Baseline, Weeks 4, 8, 12, 24, and at end of treatment (EoT) (maximum up to Week 48)
Population: ITT analysis population; Here, number of participants analyzed = number of participants evaluable for this outcome measure; 'n' = number of participants analyzed at specified time point for reported group, respectively.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Change From Baseline in Log10 HCV RNA Values | Baseline (n=427,431) | 6.19 Log 10 IU/mL | Standard Deviation 0.72 |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Change From Baseline in Log10 HCV RNA Values | Change at Week 4 (n=410,412) | -3.42 Log 10 IU/mL | Standard Deviation 1.59 |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Change From Baseline in Log10 HCV RNA Values | Change at Week 8 (n=399,406) | -4.26 Log 10 IU/mL | Standard Deviation 1.36 |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Change From Baseline in Log10 HCV RNA Values | Change at Week 12 (n=406,407) | -4.57 Log 10 IU/mL | Standard Deviation 1.21 |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Change From Baseline in Log10 HCV RNA Values | Change at Week 24 (n=369,369) | -4.58 Log 10 IU/mL | Standard Deviation 1.37 |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Change From Baseline in Log10 HCV RNA Values | Change at EoT (n=425,426) | -4.49 Log 10 IU/mL | Standard Deviation 1.44 |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Change From Baseline in Log10 HCV RNA Values | Change at Week 24 (n=369,369) | -4.28 Log 10 IU/mL | Standard Deviation 1.7 |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Change From Baseline in Log10 HCV RNA Values | Baseline (n=427,431) | 6.17 Log 10 IU/mL | Standard Deviation 0.76 |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Change From Baseline in Log10 HCV RNA Values | Change at Week 12 (n=406,407) | -4.04 Log 10 IU/mL | Standard Deviation 1.67 |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Change From Baseline in Log10 HCV RNA Values | Change at Week 4 (n=410,412) | -2.75 Log 10 IU/mL | Standard Deviation 1.71 |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Change From Baseline in Log10 HCV RNA Values | Change at EoT (n=425,426) | -4.13 Log 10 IU/mL | Standard Deviation 1.76 |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Change From Baseline in Log10 HCV RNA Values | Change at Week 8 (n=399,406) | -3.68 Log 10 IU/mL | Standard Deviation 1.72 |
Percentage of Participants With End-of-Treatment Virological Response According to Scheduled Treatment Period
Virological response at the end of the scheduled treatment period was defined as the percentage of participants with undetectable (\<15 IU/mL) HCV RNA as measured by the Roche TaqMan HCV Test at Week 48.
Time frame: Weeks 48
Population: ITT analysis population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With End-of-Treatment Virological Response According to Scheduled Treatment Period | 70 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With End-of-Treatment Virological Response According to Scheduled Treatment Period | 66 percentage of participants |
Percentage of Participants With Predictive Values of Virological Response for Sustained Virological Response
The ability of virological responses to predict sustained virological response according to the scheduled treatment periods was assessed in terms of positive predictive value (PPV) and negative predictive value (NPV). The PPV indicates probability of achievement of viral suppression (undetectable HCV RNA) for achieving a sustained virological response and the NPV indicates probability of not achieving viral suppression for not achieving a sustained virological response. The PPV at Week 4 or 12 was calculated as the number of participants who achieved viral suppression both at Week 4 or 12 and at Week 72 divided by the number of participants who achieved viral suppression at Week 4 or 12, multiplied by 100. The NPV at Week 4 or 12 was calculated as the number of participants who failed to achieve viral suppression at Week 4 or 12 and at Week 72 divided by the number of participants who failed to achieve viral suppression at Week 4 or 12, multiplied by 100.
Time frame: Weeks 4, 12, and 72
Population: ITT analysis population; participants who did not have an HCV RNA measurement at Week 4 or 12 and at Week 72 were excluded from the analysis. Here, number of participants analyzed = number of participants evaluable for this outcome measure; 'n' = number of participants analyzed at specified time point for reported group, respectively.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With Predictive Values of Virological Response for Sustained Virological Response | Week 4: PPV (n= 416, 419) | 76 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With Predictive Values of Virological Response for Sustained Virological Response | Week 4: NPV (n= 416, 419) | 60 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With Predictive Values of Virological Response for Sustained Virological Response | Week 12: PPV (n= 412, 413) | 66 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With Predictive Values of Virological Response for Sustained Virological Response | Week 12: NPV (n= 412, 413) | 87 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With Predictive Values of Virological Response for Sustained Virological Response | Week 12: NPV (n= 412, 413) | 87 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With Predictive Values of Virological Response for Sustained Virological Response | Week 4: PPV (n= 416, 419) | 80 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With Predictive Values of Virological Response for Sustained Virological Response | Week 12: PPV (n= 412, 413) | 72 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With Predictive Values of Virological Response for Sustained Virological Response | Week 4: NPV (n= 416, 419) | 60 percentage of participants |
Percentage of Participants With Relapse of End-of-treatment Virological Response
Relapse was determined based on virological response at the actual end of treatment and was calculated by dividing the number of participants who achieved a virological response at end of treatment but later had detectable HCV RNA at the last assessment post-treatment by the number of participants with a virological response at end of treatment, defined as undetectable HCV RNA (\<15 IU/mL). Participants who achieved a virological response at end of treatment but did not have any HCV RNA assessment during follow-up were excluded and were not considered as having relapsed. However, if no assessment was available within the end of-treatment time window but the participant had a sustained virological response according to the actual treatment period, backward imputation was used and the participant was considered to have achieved an end-of-treatment virological response in the analysis.
Time frame: Actual end of treatment (Week 48) up to last follow up (maximum up to Week 72)
Population: ITT analysis population. Here, number of participants analyzed signifies participants who had end of treatment virologic response and had HCV RNA measurement available during follow-up.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With Relapse of End-of-treatment Virological Response | 24 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With Relapse of End-of-treatment Virological Response | 22 percentage of participants |
Percentage of Participants With Virological Responses Over Time
Virological response was defined as undetectable HCV RNA (\<15 IU/mL) as measured by the Roche TaqMan HCV Test. Participants without HCV RNA measurements at a study week are considered non responders at that study week.
Time frame: Weeks 4, 8, 12, and 24
Population: ITT analysis population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With Virological Responses Over Time | Week 4 | 36.0 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With Virological Responses Over Time | Week 8 | 60.5 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With Virological Responses Over Time | Week 12 | 74.4 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Induction Treatment | Percentage of Participants With Virological Responses Over Time | Week 24 | 75.1 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With Virological Responses Over Time | Week 24 | 67.8 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With Virological Responses Over Time | Week 4 | 26.3 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With Virological Responses Over Time | Week 12 | 61.6 percentage of participants |
| PEG-IFN Alfa-2a+Ribavirin - Standard Treatment | Percentage of Participants With Virological Responses Over Time | Week 8 | 49.8 percentage of participants |