HCV
Conditions
Keywords
Epclusa, Pharmacokinetics, Crushing
Brief summary
Epclusa® is a pan-genotypic, once-daily tablet for the treatment of chronic hepatitis C virus (HCV) infection containing the NS5B- polymerase inhibitor sofosbuvir (SOF, nucleotide analogue) 400 mg and the NS5A inhibitor velpatasvir (VEL) 100 mg. For patients with swallowing difficulties, administration of whole tablets can be problematic. In addition, HCV patients that are hospitalized (at intensive care units) due to severe illness (co-infections/ liver failure) might not be able to swallow medication. Therefore it is useful to know whether it is possible to administer SOF/VEL through a different route, like a feeding tube. In daily practice, information about the safety and efficacy of crushed tablets is lacking which might result in interruption or discontinuation of expensive HCV therapy. However, it is not recommended to interrupt treatment because there is no evidence about the efficacy of the therapy after discontinuation (and restart). Currently, patients and healthcare professionals are crushing SOF/VEL tablets without information about efficacy and safety. Depending on the biopharmaceutical characteristics of a drug formulation, crushing tablets can lead to altered pharmacokinetics of drugs. It is important to know whether pharmacokinetic parameters are influenced by crushing of tablets; both a decrease and an increase in exposure may occur. A decrease of the plasma concentrations of SOF and/or VEL potentially reduces the therapeutic effect of the drugs. Higher doses or switching to other HCV-drugs might be needed. In contrast, in case a higher Cmax,ss and/or exposure occurs there might be an increased risk of toxicity. As a result, crushing the drug is a contra-indication based on the available data. Therefore this study will be conducted to investigate whether a crushed SOF/VEL tablet is bioequivalent to SOF/VEL as a whole tablet.
Interventions
DRUGsofosbuvir/velpatasvir tablet
Single-dose SOF/VEL as a whole tablet in a fasted state.
DRUGsofosbuvir/velpatasvir crushed
Single-dose crushed SOF/VEL in a fasted state.
Sponsors
Radboud University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
NONE
Intervention model description
Bio-equivalence Study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients with SOF/VEL treatment for the treatment of chronic HCV genotype 1 through 6. 2. Patient is at least 18 at the day of screening. 3. Patient is able and willing to sign the Informed Consent Form. 4. Patient is able and willing to follow protocol requirements.
Exclusion criteria
1. Pregnant female (as confirmed by an hCG urine test performed at screening) or breast-feeding female. 2. Relevant history or current condition that might interfere with drug absorption, distribution, metabolism or excretion. 3. Inability to understand the nature and extent of the study and the procedures required. 4. Clinically relevant low hemoglobin concentration at screening judged by the patient's own hepatologist.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| AUC | Up to 24 hours after administration |
| Cmax | one dosing interval after administration of SOF/VEL (up to 24 hours) |
Secondary
| Measure | Time frame |
|---|---|
| Adverse events | During the entire conduct of the study, maximum of two weeks |
Countries
Germany, Netherlands
Outcome results
None listed