Chronic Hepatitis C, Decompensated Cirrhosis, Hepatitis C Virus
Conditions
Keywords
Cirrhosis, Hepatitis C, Child-Pugh B, Hepatitis C Genotype 4, Interferon-Free, Hepatitis C Genotype 1, Chronic Hepatitis C, Decompensated Cirrhosis, Hepatitis C Virus
Brief summary
The primary objectives of this study are to assess the safety and the SVR12 rate of ombitasvir/paritaprevir/ritonavir and dasabuvir with RBV in GT1-infected participants with decompensated cirrhosis.
Interventions
tablet; paritaprevir co-formulated with ritonavir and ombitasvir
tablet
tablet
Sponsors
Study design
Eligibility
Inclusion criteria
1. HCV GT1- or GT4-infection defined as: positive for anti-HCV Ab, HCV RNA \> 1,000 IU/mL and laboratory result indicating HCV GT1 or GT4 infection at Screening. 2. Evidence of cirrhosis by prior liver biopsy, FibroScan or by radiograph (i.e., computed tomography \[CT\] scan or magnetic resonance imaging \[MRI\]). 3. Child-Pugh Score of 7 - 9, inclusive, at time of Screening.
Exclusion criteria
1. Women who are pregnant or breastfeeding. 2. Positive test result for Hepatitis B surface antigen (HbsAg) or anti-HIV antibodies (HIV Ab). 3. Prior or current use of any other investigational or commercially available anti-HCV agents other than interferon/RBV and/or pegylated interferon (pegIFN)/RBV (including but not limited to telaprevir, boceprevir, sofosbuvir and simeprevir). 4. Confirmed presence of hepatocellular carcinoma indicated on imaging techniques such as CT scan or MRI within 3 months prior to Screening or on an ultrasound performed at Screening (a positive ultrasound result will be confirmed with CT scan or MRI). 5. Any current or past evidence of Child-Pugh C classification.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentages of Participants With Sustained Virologic Response 12 Weeks Post-Treatment (SVR12) in Group 1 and in Group 2 | 12 weeks after the last actual dose of study drug | SVR12, defined as HCV RNA \< lower limit of quantification (LLOQ) in the SVR12 window (12 weeks after the last actual dose of study drug) without any confirmed quantifiable (≥ LLOQ) post-treatment value before or during that SVR window. Flanking imputation: for participants with missing HCV RNA at a visit who have an undetectable HCV RNA or unquantifiable HCV RNA at the preceding visit and the succeeding visit, the missing value was imputed as undetectable or unquantifiable. For SVR analyses, if there was no value in the window after the flanking imputation but there was an HCV RNA value after the window, then it was imputed into the SVR window. After above imputations were applied, if there was still no value in the window but there was an HCV RNA value from a local laboratory present, then it was imputed into the SVR window. Otherwise, participants with missing data were counted as failures. The 95% confidence interval was calculated using the Wilson score method. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With SVR12 Non-Response Due to Experiencing On-Treatment Virologic Failure | Up to 24 weeks during treatment | On-treatment virologic failure was defined as: confirmed HCV RNA ≥ LLOQ after HCV RNA \< LLOQ during treatment; confirmed increase from nadir in HCV RNA (two consecutive HCV RNA measurements \> 1 log˅10 IU/mL above nadir) at any time point during treatment; or HCV RNA ≥ LLOQ persistently during treatment with at least 6 weeks (≥ 36 days) of treatment. The 95% confidence interval was calculated using Wilson score method. SVR12 was defined as HCV RNA \< LLOQ in the SVR12 window (12 weeks after the last actual dose of study drug) without any confirmed quantifiable (≥ LLOQ) post-treatment value before or during that SVR window. |
| Percentage of Participants With SVR12 Non-Response Due to Experiencing Relapse˅12 | Up to 12 weeks after the last actual dose of study drug | Relapse˅12 was defined as confirmed HCV RNA ≥ LLOQ between end of treatment and 12 weeks after last actual dose of active study drug (up to and including the SVR12 window) for a participant with HCV RNA \< LLOQ at final treatment visit who completes treatment and has post-treatment HCV RNA data. Completion of treatment was defined as a study drug duration ≥ 77 days for participants assigned to 12 weeks of treatment or ≥ 154 days for participants assigned to 24 weeks of treatment. SVR12 was defined as HCV RNA \< LLOQ in the SVR12 window (12 weeks after the last actual dose of study drug) without any confirmed quantifiable (≥ LLOQ) post-treatment value before or during that SVR window. The 95% confidence interval was calculated using the Wilson score method. |
| Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Up to post-treatment Week 12 | Improvement was defined as: * increase of more than 0.2 g/L from baseline to post-treatment Week 12 in albumin * decrease of more than 0.3 µmol/L from baseline to post-treatment Week 12 in bilirubin * decrease of more than 5 ng/mL from baseline to post-treatment Week 12 in alpha-fetoprotein * increase of more than 15\*10\^9/L from baseline to post-treatment Week 12 in platelet count * decrease of more than 0.2 from baseline to post-treatment Week 12 in international normalized ratio. |
| Percentage of Participants With SVR12 in Group 3 | 12 weeks after the last actual dose of study drug | SVR12, defined as HCV RNA \< LLOQ in the SVR12 window (12 weeks after the last actual dose of study drug) without any confirmed quantifiable (≥ LLOQ) post-treatment value before or during that SVR window. Flanking imputation: for participants with missing HCV RNA at a visit, who have an undetectable HCV RNA or unquantifiable HCV RNA at the preceding visit and the succeeding visit, the missing value was imputed as undetectable or unquantifiable. For SVR analyses, if there was no value in the window after the flanking imputation but there was an HCV RNA value after the window, then it was imputed into the SVR window. After above imputations were applied, if there was still no value in the window but there was an HCV RNA value from a local laboratory present, then it was imputed into the SVR window. Otherwise, participants with missing data were counted as failures. |
| Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Chld-Pugh Score | Up to post-treatment Week 12 | The The Child-Pugh score uses five clinical measures of liver disease (3 laboratory parameters and 2 clinical assessments) to measure severity of cirrhosis. Scores range from 5 to 15, with higher scores indicating more severity. Improvement was defined as a decrease of 1 or more from baseline to post-treatment Week 12. |
| Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Model for End-Stage Liver Disease (MELD) Score | Up to post-treatment Week 12 | MELD is a scoring system for assessing the severity of chronic liver disease. Scores range from 6 to 40, with higher scores indicating more severity. Improvement was defined as a decrease of 1 or more from baseline to post-treatment Week 12. |
| Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in FibroTest | Up to post-treatment Week 12 | The FibroTest score is used to assess liver fibrosis. Scores range from 0.00 to 1.00, with higher scores indicating a greater degree of fibrosis. Improvement was defined as a decrease of more than 0.2 from baseline to post-treatment Week 12. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Group 1: GT1B ombitasvir/paritaprevir/ritonavir 25/150/100 mg QD + dasabuvir 250 mg BID + RBV for 12 weeks in HCV GT1b-infected participants | 9 |
| Group 2: GT1 Non-B ombitasvir/paritaprevir/ritonavir 25/150/100 mg QD + dasabuvir 250 mg BID + RBV for 24 weeks in HCV GT1non-b (including GT1a)-infected participants | 24 |
| Group 3: GT4 ombitasvir/paritaprevir/ritonavir 25/150/100 mg QD + RBV for 24 weeks in HCV GT4-infected participants | 3 |
| Total | 36 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 0 | 1 | 1 |
| Overall Study | Withdrawal by Subject | 0 | 1 | 0 |
Baseline characteristics
| Characteristic | Group 1: GT1B | Group 2: GT1 Non-B | Group 3: GT4 | Total |
|---|---|---|---|---|
| Age, Customized < 65 years | 7 Participants | 20 Participants | 2 Participants | 29 Participants |
| Age, Customized >= 65 years | 2 Participants | 4 Participants | 1 Participants | 7 Participants |
| Sex: Female, Male Female | 2 Participants | 7 Participants | 1 Participants | 10 Participants |
| Sex: Female, Male Male | 7 Participants | 17 Participants | 2 Participants | 26 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 8 / 9 | 24 / 24 | 3 / 3 |
| serious Total, serious adverse events | 1 / 9 | 10 / 24 | 1 / 3 |
Outcome results
Percentages of Participants With Sustained Virologic Response 12 Weeks Post-Treatment (SVR12) in Group 1 and in Group 2
SVR12, defined as HCV RNA \< lower limit of quantification (LLOQ) in the SVR12 window (12 weeks after the last actual dose of study drug) without any confirmed quantifiable (≥ LLOQ) post-treatment value before or during that SVR window. Flanking imputation: for participants with missing HCV RNA at a visit who have an undetectable HCV RNA or unquantifiable HCV RNA at the preceding visit and the succeeding visit, the missing value was imputed as undetectable or unquantifiable. For SVR analyses, if there was no value in the window after the flanking imputation but there was an HCV RNA value after the window, then it was imputed into the SVR window. After above imputations were applied, if there was still no value in the window but there was an HCV RNA value from a local laboratory present, then it was imputed into the SVR window. Otherwise, participants with missing data were counted as failures. The 95% confidence interval was calculated using the Wilson score method.
Time frame: 12 weeks after the last actual dose of study drug
Population: Intent to treat population: all participants who received at least 1 dose of study drug; participants missing data = non-responders. See imputation details in the outcome measure description.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 1: GT1B | Percentages of Participants With Sustained Virologic Response 12 Weeks Post-Treatment (SVR12) in Group 1 and in Group 2 | 100 percentage of participants |
| Group 2: GT1 Non-B | Percentages of Participants With Sustained Virologic Response 12 Weeks Post-Treatment (SVR12) in Group 1 and in Group 2 | 95.8 percentage of participants |
Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Chld-Pugh Score
The The Child-Pugh score uses five clinical measures of liver disease (3 laboratory parameters and 2 clinical assessments) to measure severity of cirrhosis. Scores range from 5 to 15, with higher scores indicating more severity. Improvement was defined as a decrease of 1 or more from baseline to post-treatment Week 12.
Time frame: Up to post-treatment Week 12
Population: Intent to treat population: all participants who received at least 1 dose of study drug with values at both baseline and post-treatment Week 12.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 1: GT1B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Chld-Pugh Score | 66.7 percentage of participants |
| Group 2: GT1 Non-B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Chld-Pugh Score | 54.5 percentage of participants |
| Group 3: GT4 | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Chld-Pugh Score | 50.0 percentage of participants |
Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in FibroTest
The FibroTest score is used to assess liver fibrosis. Scores range from 0.00 to 1.00, with higher scores indicating a greater degree of fibrosis. Improvement was defined as a decrease of more than 0.2 from baseline to post-treatment Week 12.
Time frame: Up to post-treatment Week 12
Population: Intent to treat population: all participants who received at least 1 dose of study drug with values at both baseline and post-treatment Week 12.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 1: GT1B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in FibroTest | 0 percentage of participants |
| Group 2: GT1 Non-B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in FibroTest | 9.1 percentage of participants |
| Group 3: GT4 | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in FibroTest | 50.0 percentage of participants |
Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests
Improvement was defined as: * increase of more than 0.2 g/L from baseline to post-treatment Week 12 in albumin * decrease of more than 0.3 µmol/L from baseline to post-treatment Week 12 in bilirubin * decrease of more than 5 ng/mL from baseline to post-treatment Week 12 in alpha-fetoprotein * increase of more than 15\*10\^9/L from baseline to post-treatment Week 12 in platelet count * decrease of more than 0.2 from baseline to post-treatment Week 12 in international normalized ratio.
Time frame: Up to post-treatment Week 12
Population: Intent to treat population: all participants who received at least 1 dose of study drug with values at both baseline and post-treatment Week 12 for the respective parameter.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Group 1: GT1B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Platelet count | 22.2 percentage of participants |
| Group 1: GT1B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Alpha-fetoprotein | 33.3 percentage of participants |
| Group 1: GT1B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | International normalized ratio | 0 percentage of participants |
| Group 1: GT1B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Bilirubin | 66.7 percentage of participants |
| Group 1: GT1B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Albumin | 77.8 percentage of participants |
| Group 2: GT1 Non-B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Albumin | 77.3 percentage of participants |
| Group 2: GT1 Non-B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Bilirubin | 72.7 percentage of participants |
| Group 2: GT1 Non-B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Platelet count | 14.3 percentage of participants |
| Group 2: GT1 Non-B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | International normalized ratio | 0 percentage of participants |
| Group 3: GT4 | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Platelet count | 0 percentage of participants |
| Group 3: GT4 | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Albumin | 50.0 percentage of participants |
| Group 3: GT4 | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | Bilirubin | 100 percentage of participants |
| Group 3: GT4 | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Hepatic Function Tests | International normalized ratio | 0 percentage of participants |
Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Model for End-Stage Liver Disease (MELD) Score
MELD is a scoring system for assessing the severity of chronic liver disease. Scores range from 6 to 40, with higher scores indicating more severity. Improvement was defined as a decrease of 1 or more from baseline to post-treatment Week 12.
Time frame: Up to post-treatment Week 12
Population: Intent to treat population: all participants who received at least 1 dose of study drug with values at both baseline and post-treatment Week 12.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 1: GT1B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Model for End-Stage Liver Disease (MELD) Score | 87.5 percentage of participants |
| Group 2: GT1 Non-B | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Model for End-Stage Liver Disease (MELD) Score | 61.9 percentage of participants |
| Group 3: GT4 | Percentage of Participants With Improvement From Baseline to Post-Treatment Week 12 in Model for End-Stage Liver Disease (MELD) Score | 100 percentage of participants |
Percentage of Participants With SVR12 in Group 3
SVR12, defined as HCV RNA \< LLOQ in the SVR12 window (12 weeks after the last actual dose of study drug) without any confirmed quantifiable (≥ LLOQ) post-treatment value before or during that SVR window. Flanking imputation: for participants with missing HCV RNA at a visit, who have an undetectable HCV RNA or unquantifiable HCV RNA at the preceding visit and the succeeding visit, the missing value was imputed as undetectable or unquantifiable. For SVR analyses, if there was no value in the window after the flanking imputation but there was an HCV RNA value after the window, then it was imputed into the SVR window. After above imputations were applied, if there was still no value in the window but there was an HCV RNA value from a local laboratory present, then it was imputed into the SVR window. Otherwise, participants with missing data were counted as failures.
Time frame: 12 weeks after the last actual dose of study drug
Population: Intent to treat population: all participants who received at least 1 dose of study drug; participants missing data = non-responders. See imputation details in the outcome measure description.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 1: GT1B | Percentage of Participants With SVR12 in Group 3 | 66.7 percentage of participants |
Percentage of Participants With SVR12 Non-Response Due to Experiencing On-Treatment Virologic Failure
On-treatment virologic failure was defined as: confirmed HCV RNA ≥ LLOQ after HCV RNA \< LLOQ during treatment; confirmed increase from nadir in HCV RNA (two consecutive HCV RNA measurements \> 1 log˅10 IU/mL above nadir) at any time point during treatment; or HCV RNA ≥ LLOQ persistently during treatment with at least 6 weeks (≥ 36 days) of treatment. The 95% confidence interval was calculated using Wilson score method. SVR12 was defined as HCV RNA \< LLOQ in the SVR12 window (12 weeks after the last actual dose of study drug) without any confirmed quantifiable (≥ LLOQ) post-treatment value before or during that SVR window.
Time frame: Up to 24 weeks during treatment
Population: Intent to treat population: all participants who received at least 1 dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 1: GT1B | Percentage of Participants With SVR12 Non-Response Due to Experiencing On-Treatment Virologic Failure | 0 percentage of participants |
| Group 2: GT1 Non-B | Percentage of Participants With SVR12 Non-Response Due to Experiencing On-Treatment Virologic Failure | 0 percentage of participants |
| Group 3: GT4 | Percentage of Participants With SVR12 Non-Response Due to Experiencing On-Treatment Virologic Failure | 0 percentage of participants |
Percentage of Participants With SVR12 Non-Response Due to Experiencing Relapse˅12
Relapse˅12 was defined as confirmed HCV RNA ≥ LLOQ between end of treatment and 12 weeks after last actual dose of active study drug (up to and including the SVR12 window) for a participant with HCV RNA \< LLOQ at final treatment visit who completes treatment and has post-treatment HCV RNA data. Completion of treatment was defined as a study drug duration ≥ 77 days for participants assigned to 12 weeks of treatment or ≥ 154 days for participants assigned to 24 weeks of treatment. SVR12 was defined as HCV RNA \< LLOQ in the SVR12 window (12 weeks after the last actual dose of study drug) without any confirmed quantifiable (≥ LLOQ) post-treatment value before or during that SVR window. The 95% confidence interval was calculated using the Wilson score method.
Time frame: Up to 12 weeks after the last actual dose of study drug
Population: Intent to treat population: all participants who received at least 1 dose of study drug and who had an assessment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 1: GT1B | Percentage of Participants With SVR12 Non-Response Due to Experiencing Relapse˅12 | 0 percentage of participants |
| Group 2: GT1 Non-B | Percentage of Participants With SVR12 Non-Response Due to Experiencing Relapse˅12 | 0 percentage of participants |
| Group 3: GT4 | Percentage of Participants With SVR12 Non-Response Due to Experiencing Relapse˅12 | 0 percentage of participants |