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A Study of Induction Dosing With Peginterferon Alfa-2a and Ribavirin in Participants With Chronic Hepatitis C (CHC) Genotype 1 Infection

A Phase IV, Randomised, Multicentre, Efficacy and Safety Study Examining the Effect of Induction Dosing With the Combination of Peginterferon Alfa-2a and Ribavirin in Patients With Chronic Hepatitis C Infected With Hepatitis C Genotype 1

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00192647
Enrollment
896
Registered
2005-09-19
Start date
2004-08-31
Completion date
2009-03-31
Last updated
2016-08-04

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Hepatitis C, Chronic

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.

DRUGRibavirin

Ribavirin 1000 or 1200 mg orally daily in divided doses, with the dose determined based on body weight, for 48 weeks.

Sponsors

Hoffmann-La Roche
Lead SponsorINDUSTRY

Study design

Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No

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

MeasureTime frameDescription
Percentage of Participants With Sustained Virological Response According to Scheduled Treatment PeriodWeek 72Sustained 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

MeasureTime frameDescription
Percentage of Participants With End-of-Treatment Virological Response According to Scheduled Treatment PeriodWeeks 48Virological 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 TimeWeeks 4, 8, 12, and 24Virological 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 ResponseActual 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 ResponseWeeks 4, 12, and 72The 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 ValuesBaseline, 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

ArmCount
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
Total871

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event3529
Overall StudyDeath11
Overall StudyEntry Criteria Violation66
Overall StudyFailure to Return1113
Overall StudyInsufficient Therapeutic Response5383
Overall StudyLaboratory Test Abnormality42
Overall StudyOther/Administrative53
Overall StudyProtocol Violation31
Overall StudyRefused Treatment/Did not Cooperate108

Baseline characteristics

CharacteristicPEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPEG-IFN Alfa-2a+Ribavirin - Standard TreatmentTotal
Age, Continuous43.6 years
STANDARD_DEVIATION 9.55
43.3 years
STANDARD_DEVIATION 9.19
43.4 years
STANDARD_DEVIATION 9.37
Sex: Female, Male
Female
135 Participants153 Participants288 Participants
Sex: Female, Male
Male
298 Participants285 Participants583 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
428 / 433430 / 438
serious
Total, serious adverse events
46 / 43345 / 438

Outcome results

Primary

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

ArmMeasureValue (NUMBER)
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With Sustained Virological Response According to Scheduled Treatment Period53 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With Sustained Virological Response According to Scheduled Treatment Period50 percentage of participants
p-value: 0.289395% CI: [0.88, 1.52]Cochran-Mantel-Haenszel
Secondary

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.

ArmMeasureGroupValue (MEAN)Dispersion
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentChange From Baseline in Log10 HCV RNA ValuesBaseline (n=427,431)6.19 Log 10 IU/mLStandard Deviation 0.72
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentChange From Baseline in Log10 HCV RNA ValuesChange at Week 4 (n=410,412)-3.42 Log 10 IU/mLStandard Deviation 1.59
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentChange From Baseline in Log10 HCV RNA ValuesChange at Week 8 (n=399,406)-4.26 Log 10 IU/mLStandard Deviation 1.36
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentChange From Baseline in Log10 HCV RNA ValuesChange at Week 12 (n=406,407)-4.57 Log 10 IU/mLStandard Deviation 1.21
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentChange From Baseline in Log10 HCV RNA ValuesChange at Week 24 (n=369,369)-4.58 Log 10 IU/mLStandard Deviation 1.37
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentChange From Baseline in Log10 HCV RNA ValuesChange at EoT (n=425,426)-4.49 Log 10 IU/mLStandard Deviation 1.44
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentChange From Baseline in Log10 HCV RNA ValuesChange at Week 24 (n=369,369)-4.28 Log 10 IU/mLStandard Deviation 1.7
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentChange From Baseline in Log10 HCV RNA ValuesBaseline (n=427,431)6.17 Log 10 IU/mLStandard Deviation 0.76
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentChange From Baseline in Log10 HCV RNA ValuesChange at Week 12 (n=406,407)-4.04 Log 10 IU/mLStandard Deviation 1.67
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentChange From Baseline in Log10 HCV RNA ValuesChange at Week 4 (n=410,412)-2.75 Log 10 IU/mLStandard Deviation 1.71
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentChange From Baseline in Log10 HCV RNA ValuesChange at EoT (n=425,426)-4.13 Log 10 IU/mLStandard Deviation 1.76
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentChange From Baseline in Log10 HCV RNA ValuesChange at Week 8 (n=399,406)-3.68 Log 10 IU/mLStandard Deviation 1.72
Secondary

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

ArmMeasureValue (NUMBER)
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With End-of-Treatment Virological Response According to Scheduled Treatment Period70 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With End-of-Treatment Virological Response According to Scheduled Treatment Period66 percentage of participants
95% CI: [0.91, 1.63]
Secondary

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.

ArmMeasureGroupValue (NUMBER)
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With Predictive Values of Virological Response for Sustained Virological ResponseWeek 4: PPV (n= 416, 419)76 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With Predictive Values of Virological Response for Sustained Virological ResponseWeek 4: NPV (n= 416, 419)60 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With Predictive Values of Virological Response for Sustained Virological ResponseWeek 12: PPV (n= 412, 413)66 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With Predictive Values of Virological Response for Sustained Virological ResponseWeek 12: NPV (n= 412, 413)87 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With Predictive Values of Virological Response for Sustained Virological ResponseWeek 12: NPV (n= 412, 413)87 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With Predictive Values of Virological Response for Sustained Virological ResponseWeek 4: PPV (n= 416, 419)80 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With Predictive Values of Virological Response for Sustained Virological ResponseWeek 12: PPV (n= 412, 413)72 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With Predictive Values of Virological Response for Sustained Virological ResponseWeek 4: NPV (n= 416, 419)60 percentage of participants
Secondary

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.

ArmMeasureValue (NUMBER)
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With Relapse of End-of-treatment Virological Response24 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With Relapse of End-of-treatment Virological Response22 percentage of participants
Secondary

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

ArmMeasureGroupValue (NUMBER)
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With Virological Responses Over TimeWeek 436.0 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With Virological Responses Over TimeWeek 860.5 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With Virological Responses Over TimeWeek 1274.4 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Induction TreatmentPercentage of Participants With Virological Responses Over TimeWeek 2475.1 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With Virological Responses Over TimeWeek 2467.8 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With Virological Responses Over TimeWeek 426.3 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With Virological Responses Over TimeWeek 1261.6 percentage of participants
PEG-IFN Alfa-2a+Ribavirin - Standard TreatmentPercentage of Participants With Virological Responses Over TimeWeek 849.8 percentage of participants
Comparison: Week 495% CI: [1.24, 2.27]
Comparison: Week 895% CI: [1.24, 2.17]
Comparison: Week 1295% CI: [1.4, 2.53]
Comparison: Week 2495% CI: [1.08, 1.98]

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026