Hepatitis C
Conditions
Keywords
HCV, interferon-naive
Brief summary
The study is intended to determine whether CTS-1027 either alone or in combination with ribavirin is safe and effective in Hepatitis C patients who have not previously been treated with interferon.
Detailed description
There are approximately 1 million Hepatitis C (HCV) patients in the US who have failed to respond to, or cannot tolerate, interferon or interferon plus ribavirin therapy. Significant adverse effects of interferon therapy include bone marrow depression (with reduced white blood cell and platelet counts) and major psychiatric disorders (especially depression). Ribavirin is associated with hemolytic anemia in a minority of patients who are treated with it. Patients with chronic HCV infection have a very low incidence of spontaneous viral clearance, have progressive disease, and have a continuing medical need for more efficacious and safer therapy. There is a significant unmet medical need for therapy in HCV patients who cannot (or will not) tolerate interferon-based treatment. This trial will evaluate the effects of CTS-1027 with or without ribavirin in patients who are previously untreated with interferon including patients with major psychiatric disorders, uncontrolled autoimmune disease, and patients who simply decline treatment.
Interventions
DRUGribavirin
200 mg capsules, either 1000 or 1200 mg taken twice daily for up to 24 weeks
DRUGCTS-1027
5 and 10 mg tablets, 15 mg taken twice daily, for up to 24 weeks
Capsules identical to ribavirin in appearance containing inactive ingredients
Sponsors
Conatus Pharmaceuticals Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Male or female patients of minimum adult legal age (according to local laws for signing the informed consent document), able to provide written informed consent, and understand and comply with the requirements of the trial * A history of chronic (\> 6 months duration) genotype 1 Hepatitis C (HCV) infection * Unsuitable for interferon-based HCV treatment, defined as at least one of the following three criteria: * Contra-indicated for interferon treatment due to current or prior psychiatric disorders * Patient's decision to not pursue interferon-based therapy * In the opinion of the Principal Investigator, the patient is not a suitable candidate for interferon-based therapy * a-fetoprotein (AFP) \<= 50 ng/mL * Hemoglobin ≥ 12 g/dL, platelet count ≥ 100 x 109/L, and white blood cell count ≥ 1.5 x 109/L * Willingness to utilize two reliable forms of contraception (for both males and females of childbearing potential) from screening to at least six months after the completion of the trial.
Exclusion criteria
* Decompensated or severe liver disease defined by one or more of the following criteria: * Prothrombin time 3 seconds \> control * Direct bilirubin ≥ 1.5 x upper limit of normal range (ULN) * Serum albumin below normal limits * AST or ALT \> 7 x ULN at screening * Evidence of portal hypertension including: 1. Varices on esophagogastroduodenoscopy (EGD) with or without a history of gastrointestinal bleeding; or 2. Ascites * Cirrhosis defined by one or both of the following criteria: * Liver biopsy showing cirrhosis * Other clinical signs and symptoms suggestive of cirrhosis * Prior therapy for HCV with an interferon-based regimen * Hepatocellular carcinoma (HCC) or suspicion of HCC clinically or on ultrasound (or other imaging techniques) * Known history or presence of human immunodeficiency virus (HIV) infection * Co-infection with hepatitis B virus (HBV) * If female: pregnant, lactating, or positive serum pregnancy test * Renal impairment (creatinine \> 1.5 x ULN), creatinine clearance \< 50 mL/min, or hepatorenal syndrome * Hospitalization for liver disease within 60 days of screening * Use of concomitant or prior drug therapy for HCV three months prior to screening * Use of drugs of abuse in the prior three months (allowed if medically prescribed or indicated) * History of alcohol abuse (\> 50 g per day) within the past year * History or presence of clinically concerning cardiac arrhythmias or prolongation of pre-dose QT or QTc interval of \> 450 milliseconds * Other concomitant disease or condition likely to significantly decrease life expectancy (e.g., moderate to severe congestive heart failure) or any malignancy other than curatively treated skin cancer (basal cell or squamous cell carcinomas), unless adequately treated or in complete remission for ten or more years * Any patient who has received any investigational drug or device within 30 days of dosing, or who is scheduled to receive another investigational drug or device during the course of this trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change in HCV-RNA (Hepatitis C Virus Ribonucleic Acid) Levels From Baseline Through 24 Weeks of Treatment | Baseline and 24 weeks | Measure the mean absolute changes in HCV-RNA (Hepatitis C virus ribonucleic acid, also known as viral load) levels in the blood from before treatment (baseline) through 24 weeks of treatment. Mean Absolute Change in HCV-RNA (log) = log10(HCV-RNA Week 24) - log10(HCV-RNA Baseline) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change in Aminotransferases From Baseline to 24 Weeks of Treatment | Baseline and 24 weeks | Mean absolute changes in ALT (alanine aminotransferase)in the blood from before treatment (baseline)through 24 weeks of treatment are presented. Mean absolute change in ALT (IU/ml)= ALT(Week 24) - ALT(baseline) |
Countries
Puerto Rico, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| CTS-1027 + Ribavirin CTS-1027, 5mg and 10 mg tablets (one each) taken twice daily for a total daily dose of 30 mg.
Ribavirin, 200 mg capsules, taken in two divided daily doses totaling 1000 mg daily for patients weighing 75kg or less, and 1200 mg daily for patients weighing more than 75 kg | 35 |
| CTS-1027 + Placebo CTS-1027, 5mg and 10 mg tablets (one each) taken twice daily for a total daily dose of 30 mg.
Placebo, incactive capsules identical in appearance to ribavirin capusules. Five (for patients weighing 75 kg or less) or six (for patients weighing more than 75 kg) capsules taken in two divided daily doses. | 35 |
| Total | 70 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 1 | 3 |
| Overall Study | Lost to Follow-up | 1 | 3 |
| Overall Study | moved out of state, missed medication | 0 | 2 |
| Overall Study | Physician Decision | 1 | 1 |
| Overall Study | Withdrawal by Subject | 2 | 2 |
Baseline characteristics
| Characteristic | CTS-1027 + Ribavirin | CTS-1027 + Placebo | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 2 Participants | 0 Participants | 2 Participants |
| Age, Categorical Between 18 and 65 years | 33 Participants | 35 Participants | 68 Participants |
| Age Continuous | 52.6 years STANDARD_DEVIATION 6.8 | 49.7 years STANDARD_DEVIATION 9.1 | 51.2 years STANDARD_DEVIATION 8.1 |
| Region of Enrollment Puerto Rico | 1 participants | 4 participants | 5 participants |
| Region of Enrollment United States | 34 participants | 31 participants | 65 participants |
| Sex: Female, Male Female | 12 Participants | 9 Participants | 21 Participants |
| Sex: Female, Male Male | 23 Participants | 26 Participants | 49 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 31 / 35 | 29 / 35 |
| serious Total, serious adverse events | 3 / 35 | 6 / 35 |
Outcome results
Primary
Mean Change in HCV-RNA (Hepatitis C Virus Ribonucleic Acid) Levels From Baseline Through 24 Weeks of Treatment
Measure the mean absolute changes in HCV-RNA (Hepatitis C virus ribonucleic acid, also known as viral load) levels in the blood from before treatment (baseline) through 24 weeks of treatment. Mean Absolute Change in HCV-RNA (log) = log10(HCV-RNA Week 24) - log10(HCV-RNA Baseline)
Time frame: Baseline and 24 weeks
Population: All patients receiving at least one dose of study drug were analyzed for safety.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| CTS-1027 + Ribavirin | Mean Change in HCV-RNA (Hepatitis C Virus Ribonucleic Acid) Levels From Baseline Through 24 Weeks of Treatment | -0.48 log (IU/mL) | Standard Deviation 0.5 |
| CTS-1027 + Placebo | Mean Change in HCV-RNA (Hepatitis C Virus Ribonucleic Acid) Levels From Baseline Through 24 Weeks of Treatment | -0.12 log (IU/mL) | Standard Deviation 0.76 |
Secondary
Mean Change in Aminotransferases From Baseline to 24 Weeks of Treatment
Mean absolute changes in ALT (alanine aminotransferase)in the blood from before treatment (baseline)through 24 weeks of treatment are presented. Mean absolute change in ALT (IU/ml)= ALT(Week 24) - ALT(baseline)
Time frame: Baseline and 24 weeks
Population: All patients dosed with at least one dose of study drug were analyzed.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| CTS-1027 + Ribavirin | Mean Change in Aminotransferases From Baseline to 24 Weeks of Treatment | -15.6 IU/mL | Standard Deviation 42.9 |
| CTS-1027 + Placebo | Mean Change in Aminotransferases From Baseline to 24 Weeks of Treatment | -16.5 IU/mL | Standard Deviation 65.5 |