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Comparison of Sofosbuvir/Velpatasvir Fixed Dose Combination for 12 Weeks With Sofosbuvir and Ribavirin for 24 Weeks in Adults With Chronic Genotype 3 HCV Infection

A Phase 3, Multicenter, Randomized, Open-Label Study to Compare the Efficacy and Safety of Sofosbuvir/GS-5816 Fixed Dose Combination for 12 Weeks With Sofosbuvir and Ribavirin for 24 Weeks in Subjects With Chronic Genotype 3 HCV Infection

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02201953
Acronym
ASTRAL-3
Enrollment
558
Registered
2014-07-28
Start date
2014-07-31
Completion date
2015-12-31
Last updated
2018-11-16

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

Conditions

Hepatitis C Virus Infection

Keywords

Sofosbuvir, Velpatasvir, SOF/VEL, GS-5816, Hepatitis C, HCV, Cirrhosis, Genotype 3

Brief summary

The primary objectives of this study are to compare the efficacy of treatment with sofosbuvir/velpatasvir (SOF/VEL) fixed-dose combination (FDC) for 12 weeks with that of sofosbuvir (SOF) + ribavirin (RBV) for 24 weeks and to evaluate the safety and tolerability of each treatment regimen in participants with chronic genotype 3 hepatitis C virus (HCV) infection.

Interventions

DRUGSOF

400 mg tablet administered orally once daily

DRUGRBV

Tablets administered orally in a divided daily dose according to package insert weight-based dosing recommendations (\< 75 kg = 1000 mg and ≥ 75 kg = 1200 mg)

DRUGSOF/VEL

400/100 mg FDC tablet administered orally once daily

Sponsors

Gilead Sciences
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

Inclusion criteria

* Willing and able to provide written informed consent * HCV RNA ≥ 10\^4 IU/mL * HCV genotype 3 * Chronic HCV infection (≥ 6 months) * Females of childbearing potential must have a negative serum pregnancy test * Males and females of childbearing potential who engage in heterosexual intercourse must agree to use protocol specified method(s) of contraception

Exclusion criteria

* Current or prior history of clinically-significant illness (other than HCV) that may interfere with subject treatment, assessment or compliance with the protocol * Screening ECG with clinically significant abnormalities * Laboratory results outside of acceptable ranges at Screening * Pregnant or nursing female or male with pregnant female partner * Chronic liver disease of a non-HCV etiology (e.g., hemochromatosis, Wilson's disease, alfa-1 antitrypsin deficiency, cholangitis) * Infection with hepatitis B virus (HBV) or human immunodeficiency virus (HIV)

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Participants With Sustained Virologic Response (SVR) 12 Weeks After Discontinuation of Therapy (SVR12)Posttreatment Week 12SVR12 was defined as HCV RNA \< the lower limit of quantitation (LLOQ; ie, 15 IU/mL) at 12 weeks after stopping study treatment.
Percentage of Participants Who Permanently Discontinued Any Study Drug Due to an Adverse EventUp to 24 weeks

Secondary

MeasureTime frameDescription
Percentage of Participants With SVR at 4 and 24 Weeks After Discontinuation of Therapy (SVR4 and SVR24)Posttreatment Weeks 4 and 24SVR4 and SVR24 are defined as HCV RNA \< LLOQ at 4 and 24 weeks following the last dose of study drug.
Percentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24
Change From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Baseline; Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24
Percentage of Participants With Virologic FailureUp to Posttreatment Week 24Virologic failure was defined as: * On-treatment virologic failure: * Breakthrough (confirmed HCV RNA ≥ LLOQ after having previously had HCV RNA \< LLOQ while on treatment), or * Rebound (confirmed \> 1 log10 IU/mL increase in HCV RNA from nadir while on treatment), or * Non-response (HCV RNA persistently ≥ LLOQ through 8 weeks of treatment) * Virologic relapse: * Confirmed HCV RNA ≥ LLOQ during the posttreatment period having achieved HCV RNA \< LLOQ at last on-treatment visit.

Countries

Australia, Canada, France, Germany, Italy, New Zealand, Puerto Rico, United Kingdom, United States

Participant flow

Recruitment details

Participants were enrolled at study sites in Australia, North America, Europe, and New Zealand. The first participant was screened on 14 July 2014. The last study visit occurred on 15 December 2015.

Pre-assignment details

652 participants were screened.

Participants by arm

ArmCount
SOF/VEL 12 Weeks
SOF/VEL (400/100 mg) FDC tablet administered orally once daily for 12 weeks
277
SOF+RBV 24 Weeks
SOF 400 mg tablet once daily + RBV tablets (1000 or 1200 mg daily based on weight) administered orally for 24 weeks
275
Total552

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event05
Overall StudyDeath03
Overall StudyLack of Efficacy930
Overall StudyLost to Follow-up88
Overall StudyRandomized but Never Treated15
Overall StudyWithdrew Consent25

Baseline characteristics

CharacteristicSOF+RBV 24 WeeksTotalSOF/VEL 12 Weeks
Age, Continuous50 years
STANDARD_DEVIATION 10
50 years
STANDARD_DEVIATION 10.2
49 years
STANDARD_DEVIATION 10.4
Cirrhosis Status
Missing
5 participants5 participants0 participants
Cirrhosis Status
No
187 participants384 participants197 participants
Cirrhosis Status
Yes
83 participants163 participants80 participants
Ethnicity (NIH/OMB)
Hispanic or Latino
11 Participants22 Participants11 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
263 Participants529 Participants266 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
1 Participants1 Participants0 Participants
HCV Genotype
Genotype 3a
250 participants515 participants265 participants
HCV Genotype
Genotype 3b
5 participants7 participants2 participants
HCV Genotype
Genotype 3h
2 participants2 participants0 participants
HCV Genotype
Genotype 3k
0 participants1 participants1 participants
HCV Genotype
Genotype 3 (No Confirmed Subtype)
18 participants27 participants9 participants
HCV RNA6.3 log10 IU/mL
STANDARD_DEVIATION 0.71
6.3 log10 IU/mL
STANDARD_DEVIATION 0.72
6.2 log10 IU/mL
STANDARD_DEVIATION 0.72
HCV RNA Category
< 800,000 IU/mL
81 participants167 participants86 participants
HCV RNA Category
≥ 800,000 IU/mL
194 participants385 participants191 participants
IL28b Status
CC
111 participants216 participants105 participants
IL28b Status
CT
133 participants281 participants148 participants
IL28b Status
TT
31 participants55 participants24 participants
Prior HCV Treatment Experience
Treatment-Experienced
71 participants142 participants71 participants
Prior HCV Treatment Experience
Treatment-Naive
204 participants410 participants206 participants
Race/Ethnicity, Customized
American Indian or Alaska Native
3 participants4 participants1 participants
Race/Ethnicity, Customized
Asian
29 participants52 participants23 participants
Race/Ethnicity, Customized
Black or African American
1 participants4 participants3 participants
Race/Ethnicity, Customized
Native Hawaiian or Pacific Islander
2 participants2 participants0 participants
Race/Ethnicity, Customized
Not Disclosed
1 participants1 participants0 participants
Race/Ethnicity, Customized
White
239 participants489 participants250 participants
Region of Enrollment
Australia
44 participants93 participants49 participants
Region of Enrollment
Canada
18 participants33 participants15 participants
Region of Enrollment
France
52 participants100 participants48 participants
Region of Enrollment
Germany
35 participants66 participants31 participants
Region of Enrollment
Italy
11 participants18 participants7 participants
Region of Enrollment
New Zealand
8 participants17 participants9 participants
Region of Enrollment
United Kingdom
47 participants105 participants58 participants
Region of Enrollment
United States
60 participants120 participants60 participants
Sex: Female, Male
Female
101 Participants208 Participants107 Participants
Sex: Female, Male
Male
174 Participants344 Participants170 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
216 / 277243 / 275
serious
Total, serious adverse events
6 / 27715 / 275

Outcome results

Primary

Percentage of Participants Who Permanently Discontinued Any Study Drug Due to an Adverse Event

Time frame: Up to 24 weeks

Population: Safety Analysis Set

ArmMeasureValue (NUMBER)
SOF/VEL 12 WeeksPercentage of Participants Who Permanently Discontinued Any Study Drug Due to an Adverse Event0 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants Who Permanently Discontinued Any Study Drug Due to an Adverse Event3.3 percentage of participants
Primary

Percentage of Participants With Sustained Virologic Response (SVR) 12 Weeks After Discontinuation of Therapy (SVR12)

SVR12 was defined as HCV RNA \< the lower limit of quantitation (LLOQ; ie, 15 IU/mL) at 12 weeks after stopping study treatment.

Time frame: Posttreatment Week 12

Population: Full Analysis Set: participants who were randomized into the study and received at least 1 dose of study drug.

ArmMeasureValue (NUMBER)
SOF/VEL 12 WeeksPercentage of Participants With Sustained Virologic Response (SVR) 12 Weeks After Discontinuation of Therapy (SVR12)95.3 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With Sustained Virologic Response (SVR) 12 Weeks After Discontinuation of Therapy (SVR12)80.7 percentage of participants
95% CI: [9.2, 19.6]
Comparison: If the lower bound of 95% CI on the difference was \> -10%, the p-value tested for the superiority of SOF/VEL for 12 weeks over SOF+RBV for 24 weeks. Superiority was demonstrated if the two-sided p-value is less than 0.05.p-value: <0.001Cochran-Mantel-Haenszel
Secondary

Change From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24

Time frame: Baseline; Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24

Population: Participants in the Full Analysis Set with available data were analyzed.

ArmMeasureGroupValue (MEAN)Dispersion
SOF/VEL 12 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 1 (SOF/VEL: N =272; SOF+RBV: N =268)-4.26 log10 IU/mLStandard Deviation 0.644
SOF/VEL 12 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 2 (SOF/VEL: N =274; SOF+RBV: N =272)-4.82 log10 IU/mLStandard Deviation 0.769
SOF/VEL 12 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 4 (SOF/VEL: N =276; SOF+RBV: N =270)-5.02 log10 IU/mLStandard Deviation 0.776
SOF/VEL 12 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 6 (SOF/VEL: N =275; SOF+RBV: N =269)-5.06 log10 IU/mLStandard Deviation 0.718
SOF/VEL 12 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 8 (SOF/VEL: N =276; SOF+RBV: N =269)-5.07 log10 IU/mLStandard Deviation 0.728
SOF/VEL 12 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 10 (SOF/VEL: N =276; SOF+RBV: N =267)-5.07 log10 IU/mLStandard Deviation 0.723
SOF/VEL 12 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 12 (SOF/VEL: N =275; SOF+RBV: N =264)-5.08 log10 IU/mLStandard Deviation 0.721
SOF/VEL 12 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 16 (SOF/VEL: N = 0; SOF+RBV: N = 262)NA log10 IU/mL
SOF/VEL 12 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 20 (SOF/VEL: N = 0; SOF+RBV: N = 259)NA log10 IU/mL
SOF/VEL 12 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 24 (SOF/VEL: N = 0; SOF+RBV: N = 255)NA log10 IU/mL
SOF+RBV 24 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 16 (SOF/VEL: N = 0; SOF+RBV: N = 262)-5.11 log10 IU/mLStandard Deviation 0.765
SOF+RBV 24 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 1 (SOF/VEL: N =272; SOF+RBV: N =268)-4.16 log10 IU/mLStandard Deviation 0.64
SOF+RBV 24 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 10 (SOF/VEL: N =276; SOF+RBV: N =267)-5.14 log10 IU/mLStandard Deviation 0.71
SOF+RBV 24 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 2 (SOF/VEL: N =274; SOF+RBV: N =272)-4.79 log10 IU/mLStandard Deviation 0.702
SOF+RBV 24 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 24 (SOF/VEL: N = 0; SOF+RBV: N = 255)-5.14 log10 IU/mLStandard Deviation 0.715
SOF+RBV 24 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 4 (SOF/VEL: N =276; SOF+RBV: N =270)-5.09 log10 IU/mLStandard Deviation 0.699
SOF+RBV 24 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 12 (SOF/VEL: N =275; SOF+RBV: N =264)-5.14 log10 IU/mLStandard Deviation 0.711
SOF+RBV 24 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 6 (SOF/VEL: N =275; SOF+RBV: N =269)-5.13 log10 IU/mLStandard Deviation 0.712
SOF+RBV 24 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 20 (SOF/VEL: N = 0; SOF+RBV: N = 259)-5.14 log10 IU/mLStandard Deviation 0.715
SOF+RBV 24 WeeksChange From Baseline in HCV RNA at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Change at Wk 8 (SOF/VEL: N =276; SOF+RBV: N =269)-5.13 log10 IU/mLStandard Deviation 0.712
Secondary

Percentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24

Time frame: Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24

Population: Participants in the Full Analysis Set with available data were analyzed.

ArmMeasureGroupValue (NUMBER)
SOF/VEL 12 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 12 (SOF/VEL: N = 275; SOF+RBV: N = 265)100.0 percentage of participants
SOF/VEL 12 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 16 (SOF/VEL: N = 0; SOF+RBV: N = 262)NA percentage of participants
SOF/VEL 12 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 20 (SOF/VEL: N = 0; SOF+RBV: N = 260)NA percentage of participants
SOF/VEL 12 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 24 (SOF/VEL: N = 0; SOF+RBV: N = 255)NA percentage of participants
SOF/VEL 12 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 1 (SOF/VEL: N = 277; SOF+RBV: N = 275)18.4 percentage of participants
SOF/VEL 12 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 2 (SOF/VEL: N = 276; SOF+RBV: N = 274)62.0 percentage of participants
SOF/VEL 12 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 4 (SOF/VEL: N = 276; SOF+RBV: N = 272)91.7 percentage of participants
SOF/VEL 12 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 6 (SOF/VEL: N = 276; SOF+RBV: N = 269)96.7 percentage of participants
SOF/VEL 12 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 8 (SOF/VEL: N = 276; SOF+RBV: N = 269)99.6 percentage of participants
SOF/VEL 12 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 10 (SOF/VEL: N = 276; SOF+RBV: N = 268)100.0 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 6 (SOF/VEL: N = 276; SOF+RBV: N = 269)98.9 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 12 (SOF/VEL: N = 275; SOF+RBV: N = 265)99.6 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 2 (SOF/VEL: N = 276; SOF+RBV: N = 274)50.0 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 16 (SOF/VEL: N = 0; SOF+RBV: N = 262)98.9 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 10 (SOF/VEL: N = 276; SOF+RBV: N = 268)99.3 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 20 (SOF/VEL: N = 0; SOF+RBV: N = 260)99.6 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 4 (SOF/VEL: N = 276; SOF+RBV: N = 272)88.2 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 24 (SOF/VEL: N = 0; SOF+RBV: N = 255)100.0 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 8 (SOF/VEL: N = 276; SOF+RBV: N = 269)99.3 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With HCV RNA < LLOQ at Weeks 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24Week 1 (SOF/VEL: N = 277; SOF+RBV: N = 275)17.5 percentage of participants
Secondary

Percentage of Participants With SVR at 4 and 24 Weeks After Discontinuation of Therapy (SVR4 and SVR24)

SVR4 and SVR24 are defined as HCV RNA \< LLOQ at 4 and 24 weeks following the last dose of study drug.

Time frame: Posttreatment Weeks 4 and 24

Population: Full Analysis Set

ArmMeasureGroupValue (NUMBER)
SOF/VEL 12 WeeksPercentage of Participants With SVR at 4 and 24 Weeks After Discontinuation of Therapy (SVR4 and SVR24)SVR496.8 percentage of participants
SOF/VEL 12 WeeksPercentage of Participants With SVR at 4 and 24 Weeks After Discontinuation of Therapy (SVR4 and SVR24)SVR2495.3 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With SVR at 4 and 24 Weeks After Discontinuation of Therapy (SVR4 and SVR24)SVR482.2 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With SVR at 4 and 24 Weeks After Discontinuation of Therapy (SVR4 and SVR24)SVR2480.7 percentage of participants
Secondary

Percentage of Participants With Virologic Failure

Virologic failure was defined as: * On-treatment virologic failure: * Breakthrough (confirmed HCV RNA ≥ LLOQ after having previously had HCV RNA \< LLOQ while on treatment), or * Rebound (confirmed \> 1 log10 IU/mL increase in HCV RNA from nadir while on treatment), or * Non-response (HCV RNA persistently ≥ LLOQ through 8 weeks of treatment) * Virologic relapse: * Confirmed HCV RNA ≥ LLOQ during the posttreatment period having achieved HCV RNA \< LLOQ at last on-treatment visit.

Time frame: Up to Posttreatment Week 24

Population: Full Analysis Set

ArmMeasureValue (NUMBER)
SOF/VEL 12 WeeksPercentage of Participants With Virologic Failure4.0 percentage of participants
SOF+RBV 24 WeeksPercentage of Participants With Virologic Failure14.2 percentage of participants

Source: ClinicalTrials.gov · Data processed: Mar 11, 2026