Hepatitis C, Chronic
Conditions
Brief summary
This 2-arm study will compare the efficacy and safety of treatment with Pegasys (180 µg weekly) plus Copegus (800 mg daily) and Pegasys (180 µg weekly) plus Copegus (1000-1200 mg daily) in interferon-naive patients with CHC genotype 1 co-infected with HIV-1. Treatment will be administered for 48 weeks, and this will be followed by 24 treatment-free weeks. The anticipated time on study treatment is 3-12 months, and the target sample size is 100-500 individuals.
Interventions
180 µg subcutaneously weekly for 48 weeks
800 mg orally daily for 48 weeks
Sponsors
Study design
Eligibility
Inclusion criteria
* Adult patients, ≥18 years of age * CHC genotype 1 * Stable HIV-1 infection
Exclusion criteria
* Previous treatment with an alpha interferon, ribavirin, viramidine, levovirin, amantadine or investigational HCV protease or polymerase inhibitors * Medical condition associated with liver disease other than CHC infection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Sustained Virological Response (SVR) | Week 72 | SVR was defined by the percentage of patients with undetectable Hepatitis C virus (HCV) ribonucleic acid (RNA) at 24 weeks after completion of the 48-week treatment period (i.e., a single last HCV RNA \< 20 IU/mL measured ≥ Day 477 \[≥ Week 68\]). Patients without an HCV measurement at the end of the 24-week untreated follow-up period were considered nonresponders. |
| Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Up to Week 72 | Adverse events of anemia included hemolytic anemia, aplasia pure red cell, and pancytopenia. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Relapse of Virological Response | Weeks 48 and 72 | Relapse of virological response was calculated by dividing the number of patients who achieved a virological response at the end of treatment but had detectable HCV RNA at the last assessment posttreatment by the number of patients with a virological response at the end of treatment who had at least one HCV RNA assessment posttreatment. |
| Virological Response at End of Treatment Period | Week 48 | Virological response at the end of the treatment period was defined as a single last HCV RNA measurement \<20 IU/mL at the completion of the treatment period (Days 324 to 351). Patients without an HCV measurement at Week 48 were considered nonresponders. |
| Early Virological Response (EVR), Partial EVR and Complete EVR by Week 12 | Week 12 | EVR: Undetectable HCV RNA \<20 IU/mL or ≥2 log10 drop from pretreatment level, by Week 12 (a single last HCV RNA \<20 IU/mL or ≥2 log10 drop from pretreatment level in the time window of Days 2 to 99). Partial EVR: Detectable HCV RNA but ≥2 log10 drop from pretreatment, by Week 12 (a single last HCV RNA detectable but ≥2 log10 drop from pretreatment in the time window of Days 2 to 99). Complete EVR: Undetectable HCV RNA \<20 IU/mL, by Week 12 (a single last HCV RNA \<20 IU/mL in the time window of Days 2 to 99). Patients without an HCV measurement by Week 12 were considered nonresponders. |
| Rapid Virological Response (RVR) by Week 4 | Week 4 | RVR was defined as an undetectable HCV RNA \< 20 IU/mL (a single last HCV RNA \< 20 IU/mL falling in the time window of Days 2 to 43). Patients without an HCV measurement by Week 4 were considered nonresponders. |
| Virological Response at Weeks 4, 12 and 24 | Weeks 4, 12 and 24 | Virological response at Weeks 4, 12 and 24 was also defined as a single last undetectable HCV RNA (\< 20 IU/mL) falling within the visit windows of Days 16 to 43, 72 to 99, and 156 to 183, respectively. Patients without an HCV measurement at a study week were considered nonresponders at that study week. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | 138 |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | 277 |
| Total | 415 |
Baseline characteristics
| Characteristic | Total | PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg |
|---|---|---|---|
| Age Continuous | 45.4 Years STANDARD_DEVIATION 8.24 | 45.5 Years STANDARD_DEVIATION 8.16 | 45.2 Years STANDARD_DEVIATION 8.39 |
| Age, Customized < 65 years | 407 Participants | 273 Participants | 134 Participants |
| Age, Customized >=65 years | 3 Participants | 2 Participants | 1 Participants |
| Gender Female | 80 Participants | 51 Participants | 29 Participants |
| Gender Male | 330 Participants | 224 Participants | 106 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 132 / 135 | 264 / 274 |
| serious Total, serious adverse events | 21 / 135 | 46 / 274 |
Outcome results
Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia
Adverse events of anemia included hemolytic anemia, aplasia pure red cell, and pancytopenia.
Time frame: Up to Week 72
Population: The Safety population included all patients randomized who received at least one dose of the study medication and had at least one postbaseline safety assessment: PEG-IFN alfa 2-a 180 μg + ribavirin 800 mg = 135 patients; PEG-IFN alfa 2-a 180 μg + ribavirin 1000 or 1200 mg = 274 patients.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Premature ribavirin withdrawal due to anemia | 2 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Serious adverse anemic event | 4 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | PEG-INF alfa-2a dose modification due to anemia | 2 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Ribavirin dose modification due to anemia | 10 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Premature PEG-INF alfa-2a withdrawal due to anemia | 1 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Adverse anemic event | 24 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Premature PEG-INF alfa-2a withdrawal due to anemia | 3 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Adverse anemic event | 32 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Ribavirin dose modification due to anemia | 18 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Serious adverse anemic event | 4 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | Premature ribavirin withdrawal due to anemia | 3 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Incidence of Adverse Events, Dose Reductions and Withdrawals Due to Anemia | PEG-INF alfa-2a dose modification due to anemia | 3 Percentage of participants |
Sustained Virological Response (SVR)
SVR was defined by the percentage of patients with undetectable Hepatitis C virus (HCV) ribonucleic acid (RNA) at 24 weeks after completion of the 48-week treatment period (i.e., a single last HCV RNA \< 20 IU/mL measured ≥ Day 477 \[≥ Week 68\]). Patients without an HCV measurement at the end of the 24-week untreated follow-up period were considered nonresponders.
Time frame: Week 72
Population: The All Patients Treated population included all patients randomized who had received at least one dose of study medication: PEG-IFN alfa 2-a 180 μg + ribavirin 800 mg = 135 patients; PEG-IFN alfa 2-a 180 μg + ribavirin 1000 or 1200 mg = 275 patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Sustained Virological Response (SVR) | 19 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Sustained Virological Response (SVR) | 22 Percentage of participants |
Early Virological Response (EVR), Partial EVR and Complete EVR by Week 12
EVR: Undetectable HCV RNA \<20 IU/mL or ≥2 log10 drop from pretreatment level, by Week 12 (a single last HCV RNA \<20 IU/mL or ≥2 log10 drop from pretreatment level in the time window of Days 2 to 99). Partial EVR: Detectable HCV RNA but ≥2 log10 drop from pretreatment, by Week 12 (a single last HCV RNA detectable but ≥2 log10 drop from pretreatment in the time window of Days 2 to 99). Complete EVR: Undetectable HCV RNA \<20 IU/mL, by Week 12 (a single last HCV RNA \<20 IU/mL in the time window of Days 2 to 99). Patients without an HCV measurement by Week 12 were considered nonresponders.
Time frame: Week 12
Population: The All Patients Treated population included all patients randomized who had received at least one dose of study medication: PEG-IFN alfa 2-a 180 μg + ribavirin 800 mg = 135 patients; PEG-IFN alfa 2-a 180 μg + ribavirin 1000 or 1200 mg = 275 patients.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Early Virological Response (EVR), Partial EVR and Complete EVR by Week 12 | Early Virological Response | 51 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Early Virological Response (EVR), Partial EVR and Complete EVR by Week 12 | Partial Early Virological Response | 25 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Early Virological Response (EVR), Partial EVR and Complete EVR by Week 12 | Complete Early Virological Response | 26 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Early Virological Response (EVR), Partial EVR and Complete EVR by Week 12 | Early Virological Response | 61 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Early Virological Response (EVR), Partial EVR and Complete EVR by Week 12 | Partial Early Virological Response | 35 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Early Virological Response (EVR), Partial EVR and Complete EVR by Week 12 | Complete Early Virological Response | 26 Percentage of participants |
Rapid Virological Response (RVR) by Week 4
RVR was defined as an undetectable HCV RNA \< 20 IU/mL (a single last HCV RNA \< 20 IU/mL falling in the time window of Days 2 to 43). Patients without an HCV measurement by Week 4 were considered nonresponders.
Time frame: Week 4
Population: The All Patients Treated population included all patients randomized who had received at least one dose of study medication: PEG-IFN alfa 2-a 180 μg + ribavirin 800 mg = 135 patients; PEG-IFN alfa 2-a 180 μg + ribavirin 1000 or 1200 mg = 275 patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Rapid Virological Response (RVR) by Week 4 | 8 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Rapid Virological Response (RVR) by Week 4 | 7 Percentage of participants |
Relapse of Virological Response
Relapse of virological response was calculated by dividing the number of patients who achieved a virological response at the end of treatment but had detectable HCV RNA at the last assessment posttreatment by the number of patients with a virological response at the end of treatment who had at least one HCV RNA assessment posttreatment.
Time frame: Weeks 48 and 72
Population: Within the All Patients Treated population, patients with a response at end of treatment: PEG-IFN alfa 2-a 180 μg + ribavirin 800 mg = 37 patients; PEG-IFN alfa 2-a 180 μg + ribavirin 1000 or 1200 mg = 83 patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Relapse of Virological Response | 32 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Relapse of Virological Response | 36 Percentage of participants |
Virological Response at End of Treatment Period
Virological response at the end of the treatment period was defined as a single last HCV RNA measurement \<20 IU/mL at the completion of the treatment period (Days 324 to 351). Patients without an HCV measurement at Week 48 were considered nonresponders.
Time frame: Week 48
Population: The All Patients Treated population included all patients randomized who had received at least one dose of study medication: PEG-IFN alfa 2-a 180 μg + ribavirin 800 mg = 135 patients; PEG-IFN alfa 2-a 180 μg + ribavirin 1000 or 1200 mg = 275 patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Virological Response at End of Treatment Period | 30 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Virological Response at End of Treatment Period | 35 Percentage of participants |
Virological Response at Weeks 4, 12 and 24
Virological response at Weeks 4, 12 and 24 was also defined as a single last undetectable HCV RNA (\< 20 IU/mL) falling within the visit windows of Days 16 to 43, 72 to 99, and 156 to 183, respectively. Patients without an HCV measurement at a study week were considered nonresponders at that study week.
Time frame: Weeks 4, 12 and 24
Population: The All Patients Treated population included all patients randomized who had received at least one dose of study medication: PEG-IFN alfa 2-a 180 μg + ribavirin 800 mg = 135 patients; PEG-IFN alfa 2-a 180 μg + ribavirin 1000 or 1200 mg = 275 patients.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Virological Response at Weeks 4, 12 and 24 | Week 4 | 8 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Virological Response at Weeks 4, 12 and 24 | Week 12 | 25 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 800 mg | Virological Response at Weeks 4, 12 and 24 | Week 24 | 33 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Virological Response at Weeks 4, 12 and 24 | Week 12 | 25 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Virological Response at Weeks 4, 12 and 24 | Week 24 | 40 Percentage of participants |
| PEG-IFN Alfa-2a 180 μg + Ribavirin 1000 or 1200 mg | Virological Response at Weeks 4, 12 and 24 | Week 4 | 7 Percentage of participants |