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Standard of Care (SOC) With or Without CTS-1027 in Hepatitis C (HCV) Null-Responders

A Placebo-Controlled, Multicenter, Double-Blind, Randomized Trial of Pegylated Interferon Plus Ribavirin With or Without CTS-1027 in HCV Null-Responders

Status
Terminated
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01273064
Enrollment
114
Registered
2011-01-10
Start date
2011-01-31
Completion date
2011-10-31
Last updated
2012-06-11

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

Conditions

Hepatitis C

Keywords

HCV, Null Responders

Brief summary

Placebo controlled, double-blind, multicenter study utilizing standard of care (SOC) treatment (ribavirin plus pegylated interferon) in combination with CTS-1027 in genotype 1 chronic Hepatitis C (HCV) patients who were null-responders to previous SOC therapy(ies). Null-responders are defined as patients who failed to achieve a greater than 2 log drop in HCV-RNA (Hepatitis C Ribonucleic acid, also known as viral load) levels after 12 weeks of treatment (know as an early virologic response, or EVR) during previous SOC therapy. If, during previous SOC treatment, a patient had a less than 2 log decline in HCV-RNA at Week 12 but greater than 2 log decline in HCV-RNA at any time from Week 12 to Week 24, that patient is not a null-responder, and is excluded from study participation. If, during previous SOC treatment, a Week 12 HCV-RNA was not obtained, the post Week 12 response must have been \< 2 log decline (and still HCV-RNA positive) in order for the patient to be defined as a null-responder. Patients will be screened and have up to 4 weeks to qualify for study entry. During this screening period, clinical and laboratory tests will be performed. At Week 0/Day 1, patients will undergo centralized, stratified (based on ethnicity), randomization to one of four treatment arms: SOC + one of three doses of CTS-1027 or SOC + placebo. Study treatment will last 24, 48, or 60 weeks, based on each patient's response to study treatment. SOC + placebo patients who do not show a virologic response after 12 weeks of therapy will be rolled onto SOC + 15mg CTS-1027, while maintaining the study blind.

Detailed description

Placebo controlled, double-blind, multicenter study utilizing Standard of Care (SOC) in combination with CTS-1027 in genotype 1 chronic hepatitis C (HCV) patients who were null-responders to previous SOC therapy(ies). Null-responders are defined as patients who failed to achieve a greater than 2 log drop in HCV-RNA levels after 12 weeks of treatment (know as an early virologic response or EVR) during previous SOC therapy. If, during previous SOC treatment, a patient had \< 2 log decline in HCV-RNA at Week 12 but \> 2 log decline in HCV-RNA at any time from Week 12 to Week 24, that patient is not a null-responder and is excluded from study participation. If, during previous SOC treatment, a Week 12 HCV-RNA was not obtained, the post Week 12 response must have been \< 2 log decline (and still HCV-RNA positive) in order for the patient to be defined as a null-responder. Patients will be screened and have up to 4 weeks to qualify for study entry. During this screening period, clinical and laboratory tests will be performed. At Week 0/Day 1, patients will undergo centralized, stratified (based on ethnicity), randomization to one of four treatment arms: SOC + one of three doses of CTS-1027 or SOC + placebo. Study treatment will last 24, 48, or 60 weeks, based on each patient's response to study treatment. The Principal Investigators, other site personnel, and patients will be blinded to the HCV-RNA results for the first 12 weeks of therapy. At Week 12, the study treatment blind will be broken by the study's Interactive Web Randomization System (IWRS). However, the Principal Investigators, other investigative site personnel, patients, and Sponsor will remain blinded to treatment allocation until Week 24 (see below). The patients on the SOC + placebo arm will continue treatment as follows: * Patients on SOC + placebo who do not achieve at least a 2 log decline in their HCV-RNA at Week 12 will be automatically rolled-over into the SOC + 15 mg CTS-1027 twice a day (BID) arm. The treatment duration for these patients will be 60 weeks (i.e., 12 weeks on SOC + placebo, followed by 48 weeks on SOC + 15 mg BID). * Those patients on SOC + placebo who achieve ≥ 2 log decline at Week 12 will continue on SOC therapy until Week 48. Patients in the SOC + CTS-1027 arms will continue with the same treatment regimen for the initial 24 weeks regardless of HCV-RNA changes. At Week 24, the study blind will be formally broken. Patients will continue the study as follows: * Patients in the SOC + CTS-1027 arms who achieve ≥ 2 log HCV-RNA decline by Week 24 will continue with the same treatment regimen they were assigned during the Double-Blind Phase for an additional 24 weeks. * Patients in the SOC + CTS-1027 15 mg BID and the SOC + CTS-1027 30 mg BID arms who achieve a \<2 log HCV-RNA decline by Week 24 will escalate to the next higher dose of CTS-1027 for an additional 24 weeks. * Patients in the SOC + CTS-1027 60 mg BID arm who do not achieve at least a 2 log HCV-RNA decline by Week 24 will be discontinued from the study. All patients will be seen 4 and 12 weeks (Follow-Up Period) after the end of treatment. If a patient's HCV-RNA is undetectable at the end of treatment, he/she will be seen for an additional follow-up visit 24 weeks after the end of treatment.

Interventions

Supplied in 30mg, 10mg, or 5mg tablets (depending on dose arm) taken twice daily for up to 48 weeks.

DRUGpegylated interferon

180 micrograms in 0.5 ml of solution subcutaneously (SQ), delivered in single use syringes administered once per week, for up to 48 weeks.

DRUGRibavirin

200 mg capsules of ribavirn taken in two divided daily doses totaling 1000 mg (5 capsules) for patients weighing 75 kg or less, or 1200 mg (6 capsules) for patients weighing more than 75 kg

DRUGPlacebo

Tablets identical in appearance to CTS-1027 containing inactive ingredients. Placebo arm patients: Two tablets taken twice daily, for a total daily dose of four tablets. 30 mg CTS-1027 patients: One tablet taken twice daily, for a total daily dose of two tablets. One bottle of placebo is added to the 30mg kits in order to maintain the study blind (all patients recieve two-bottle kits of CTS-1027 and/or placebo).

Sponsors

Conatus Pharmaceuticals Inc.
Lead SponsorINDUSTRY

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

1. 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 study 2. HCV genotype 1 infected null responders to prior therapy comprised of pegylated interferon and ribavirin (standard of care, SOC) defined as: * Failure to achieve an early virologic response (\< 2 log decline in HCV-RNA by Week 12), or * If Week 12 HCV-RNA was not obtained, post Week 12 HCV-RNA response was \< 2 log decline 3. Screening HCV-RNA viral load of \> 5.0 log (i.e., \>100,000 IU/mL) 4. alpha-fetoprotein (AFP) less than or equal to 100 ng/mL 5. Hemoglobin greater than or equal to 12 g/dL for women and greater than or equal to 13 g/dL for men, hemoglobin A1c less than or equal to 7.5 %, platelet count greater than or equal to 90 x 10\^9/L, and white blood cell count greater than or equal to 1.5 x 10\^9/L 6. Thyroid Stimulating Hormone (TSH) within normal limits 7. In the opinion of the Principal Investigator, the patient met the 80%/80%/80% rule during the previous pegylated interferon and ribavirin therapy (i.e., received at least 80% of the pegylated interferon and ribavirin doses, at least 80% of the dose size, for at least 80% of the treatment duration) 8. 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 study.

Exclusion criteria

1. \< 2 log decline in HCV-RNA at Week 12 but \> 2 log decline at any time from Week 12 to Week 24 during prior therapy with pegylated interferon and ribavirin (prior standard of care therapy) 2. Decompensated or severe liver disease defined by one or more of the following criteria: * Prothrombin time 4 seconds \> control or INR (international normalized ratio) \> 1.2 * Total bilirubin ≥ 1.5 mg/dL or direct bilirubin ≥ 1 mg/dL * Serum albumin below normal limits * aspartate aminotransferase (AST) or alanine aminotransferase (ALT)\> 5 x upper limit of normal (ULN) at screening * Presence of ascites 3. Hepatic encephalopathy 4. Hepatocellular carcinoma (HCC) or suspicion of HCC clinically or on ultrasound (or other imaging techniques) 5. Clinically significant ocular findings such as retinopathy, cotton wool spots, optic nerve disorder, retinal hemorrhage, or other abnormality 6. Known history or presence of human immunodeficiency virus (HIV) infection 7. Co-infection with hepatitis B virus (HBV) 8. If female: pregnant, lactating, or positive serum or urine pregnancy test 9. Male partners of women who are currently pregnant 10. Renal impairment (creatinine \> 1.2 x ULN), serum creatinine clearance \< 50 mL/min, or hepatorenal syndrome with ascites 11. Hospitalization for liver disease within 60 days of screening 12. History of alcohol abuse (\> 50 g per day) within the past year 13. History of severe psychiatric disease, especially depression, characterized by: * Suicide attempt * Hospitalization for psychiatric disease * Period of disability as a result of psychiatric disease 14. Prior exposure to CTS-1027 15. Patients who qualify as a null-responder based on treatment(s) other than pegylated interferon and ribavirin 16. History or presence of clinically concerning cardiac arrhythmias or prolongation of pre-dose corrected Q-T interval (QTc) of \> 450 milliseconds 17. History of or current autoimmune disease 18. Diagnosis of or symptoms suggestive of fibromyalgia 19. Currently on liver transplantation waiting list or recipient of any organ transplant 20. 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 five or more years 21. Exposure to any other investigational treatment for any aspect of disease associated with HCV during the past 6 months 22. Exposure to any investigational drug or device within 30 days of dosing, or scheduled receipt of another investigational drug or device during the course of this study.

Design outcomes

Primary

MeasureTime frameDescription
Sustained Virologic ResponseBaseline and 24 weeks after the end of treatment (Week 72)Percent of patients that achieve a sustained virologic response (SVR) at Week 72 defined as HCV-RNA (Hepatitis C virus ribonucleic acid, also known as 'viral load') level below the quantification limit (BQL) at Week 72.

Secondary

MeasureTime frameDescription
Greater Than 2 Log Decline in HCV-RNA at Study Weeks 12, 24 and 48Baseline, and Study Weeks 12, 24, and 48Percent of patients experiencing a drop in Hepatitis C virus ribonucleic acid (HCV-RNA, also known as viral load) levels in the blood equal to, or greater than, 2 log from before treatment (baseline) through 12, 24, and 48 weeks of treatment.

Countries

United States

Participant flow

Participants by arm

ArmCount
CTS-1027 60 mg + Ribavirin + Peglyated Interferon
Standard of Care (ribavirin plus pegylated interferon) plus CTS-1027,60 mg (supplied in 30 mg tablets) taken twice daily, for a total daily dose of 120 mg
23
CTS-1027 30 mg + Ribavirin + Pegylated Interferon
Standard of Care (ribavirin plus pegylated interferon) plus CTS-1027 30 mg (supplied in 30 mg tablets) taken twice daily for a total daily dose of 60 mg.
30
CTS-1027 15 mg + Ribavirin + Pegylated Interferon
Standard of Care (ribavirin plus pegylated interferon) plus CTS-1027 15 mg (supplied in 5 mg and 10 mg tablets) taken twice daily, for a total daily dose of 30 mg
31
Placebo + Ribavirin + Pegylated Interferon
Standard of Care (ribavirin plus pegylated interferon) plus placebo (2 tablets identical in appearance to CTS-1027) taken twice daily, for a total daily dose of 4 tablets
20
Placebo + CTS-1027 15mg + Ribavirin + Pegylated Interferon
Standard of Care (ribavirin plus pegylated interferon) plus placebo (2 tablets identical in appearance to CTS-1027) taken twice daily, for a total daily dose of 4 tablets for the first 12 weeks. Crossover to Standard of Care (ribavirin plus pegylated interferon) plus CTS-1027 15mg (supplied in 5 mg and 10 mg tablets) taken twice daily, for a total daily dose of 30 mg starting at Week 12
10
Total114

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003FG004
Overall StudyAdverse Event51321
Overall StudyLost to Follow-up10000
Overall StudyPhysician Decision00001
Overall StudyStudy Termination132726168
Overall StudyWithdrawal by Subject42220

Baseline characteristics

CharacteristicCTS-1027 30 mg + Ribavirin + Pegylated InterferonCTS-1027 15 mg + Ribavirin + Pegylated InterferonPlacebo + Ribavirin + Pegylated InterferonCTS-1027 60 mg + Ribavirin + Peglyated InterferonPlacebo + CTS-1027 15mg + Ribavirin + Pegylated InterferonTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
1 Participants3 Participants0 Participants0 Participants2 Participants6 Participants
Age, Categorical
Between 18 and 65 years
29 Participants28 Participants20 Participants23 Participants8 Participants108 Participants
Age Continuous55.1 years
STANDARD_DEVIATION 6
50.5 years
STANDARD_DEVIATION 11.3
52.8 years
STANDARD_DEVIATION 7.1
53.1 years
STANDARD_DEVIATION 7
57.7 years
STANDARD_DEVIATION 5.9
53.2 years
STANDARD_DEVIATION 8.3
Region of Enrollment
United States
30 participants31 participants20 participants23 participants10 participants114 participants
Sex: Female, Male
Female
10 Participants12 Participants6 Participants10 Participants3 Participants41 Participants
Sex: Female, Male
Male
20 Participants19 Participants14 Participants13 Participants7 Participants73 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —— / —— / —
other
Total, other adverse events
23 / 2328 / 3026 / 3119 / 209 / 10
serious
Total, serious adverse events
2 / 230 / 300 / 311 / 201 / 10

Outcome results

Primary

Sustained Virologic Response

Percent of patients that achieve a sustained virologic response (SVR) at Week 72 defined as HCV-RNA (Hepatitis C virus ribonucleic acid, also known as 'viral load') level below the quantification limit (BQL) at Week 72.

Time frame: Baseline and 24 weeks after the end of treatment (Week 72)

Population: Due to the premature discontinuation of this study and termination of the entire CTS-1027 program, an efficacy analysis was not conducted. No patients completed the study.

Secondary

Greater Than 2 Log Decline in HCV-RNA at Study Weeks 12, 24 and 48

Percent of patients experiencing a drop in Hepatitis C virus ribonucleic acid (HCV-RNA, also known as viral load) levels in the blood equal to, or greater than, 2 log from before treatment (baseline) through 12, 24, and 48 weeks of treatment.

Time frame: Baseline, and Study Weeks 12, 24, and 48

Population: Due to the premature discontinuation of this study and termination of the entire CTS-1027 program, an efficacy analysis was not conducted. No patients completed the study.

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