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    Summary
    EudraCT Number:2013-002802-30
    Sponsor's Protocol Code Number:GS-US-337-0124
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2013-12-05
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2013-002802-30
    A.3Full title of the trial
    A Phase 2, Multicenter, Open-Label Study to Investigate the Safety and Efficacy of Sofosbuvir/Ledipasvir Fixed-Dose Combination + Ribavirin Administered in Subjects Infected with Chronic HCV who have Advanced Liver Disease or are Post-Liver Transplant
    Estudio de fase II, multicéntrico, abierto, para investigar la seguridad y eficacia de una dosis fija de la combinación de sofosbuvir/ledipasvir + ribavirina administrada en sujetos con infección crónica por VHC con enfermedad hepática avanzada o tras trasplante de hígado
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    An international study to assess the safety and efficacy of a combination of new investigational drugs in hepatitis C virus infected patients with advanced liver disease or require treatment after liver transplantation.
    Un estudio internacional para evaluar la seguridad y eficacia de una combinación de nuevos fármacos en investigación en pacientes infectados por el virus de la hepatitis C con enfermedad hepática avanzada o si es requerido tratamiento después del trasplante hepático.
    A.4.1Sponsor's protocol code numberGS-US-337-0124
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorGilead Sciences, Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportGilead Sciences Inc
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGilead Sciences Inc
    B.5.2Functional name of contact pointMedical Monitor
    B.5.3 Address:
    B.5.3.1Street Address333 Lakeside Drive
    B.5.3.2Town/ cityFoster City, CA
    B.5.3.3Post code94404
    B.5.3.4CountryUnited States
    B.5.4Telephone number+16505743000
    B.5.5Fax number+16505789264
    B.5.6E-mailclinical.trials@gilead.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameSofosbuvir/GS-5885 FDC
    D.3.2Product code GS-7977/GS-5885 FDC
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNSofosbuvir
    D.3.9.1CAS number 1190307-88-0
    D.3.9.2Current sponsor codeGS-7977
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number400
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNGS-5885
    D.3.9.2Current sponsor codeGS-5885
    D.3.9.3Other descriptive nameGS-5885
    D.3.9.4EV Substance CodeSUB32080
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number90
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Ribasphere Tablets
    D.2.1.1.2Name of the Marketing Authorisation holderThree Rivers Pharmaceuticals, LLC
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameRibasphere
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNRibavirin
    D.3.9.1CAS number 36791-04-5
    D.3.9.4EV Substance CodeSUB10297MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Chronic Genotype 1 and Genotype 4 Hepatitis C Virus Infection
    Infección con virus de la petatis C (VHC) crónico de genotipos 1 y 4
    E.1.1.1Medical condition in easily understood language
    Hepatitis C Virus Infection
    Infección con Virus de la Hepatitis C
    E.1.1.2Therapeutic area Diseases [C] - Virus Diseases [C02]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 16.1
    E.1.2Level LLT
    E.1.2Classification code 10019751
    E.1.2Term Hepatitis C virus
    E.1.2System Organ Class 100000004848
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objectives of this study are:
    ? To explore the antiviral efficacy of combination therapy with SOF/LDV FDC + RBV for 12 or 24 weeks in subjects with advanced liver disease (either pre-liver transplant or not currently wait-listed) and post-liver transplant HCV subjects with cirrhosis as measured by SVR 12 weeks after discontinuation of therapy (SVR12 defined as HCV RNA < Lower Limit of Quantification [LLOQ] 12 weeks post-treatment)

    ? To evaluate the safety and tolerability of SOF/LDV FDC + RBV administered for 12 or 24 weeks in each patient population
    El objetivo principal de este estudio es el siguiente:
    ? Explorar la eficacia antiviral de la terapia combinada de una dosis fija de la combinación (DFC) sofosbuvir/ledipasvir (SOF /LDV) + ribavirina (RBV) durante 12 o 24 semanas en sujetos con enfermedad hepática avanzada (antes del trasplante de hígado o que no estén actualmente en lista de espera) y sujetos con VHC tras trasplante de hígado, medida mediante la respuesta virológica sostenida (RVS) 12 semanas después de interrumpir la terapia (RVS12 definida como ARN del VHC < límite inferior de cuantificación [LLOQ] en la semana 12 después del tratamiento)
    ? Evaluar la seguridad y la tolerabilidad de la DFC de SOF/LDV + RBV administrada durante 12 o 24 semanas en cada población de pacientes
    E.2.2Secondary objectives of the trial
    The secondary objectives of this study are:
    ? To determine the proportion of subjects who attain SVR at 2, 4, 8, and 24 weeks after discontinuation of therapy (SVR2, SVR4, SVR8, and SVR24)
    ? To determine if the administration of SOF/LDV FDC to HCV-infected subjects undergoing liver transplantation can prevent post-transplant recurrence as determined by a sustained post-transplant virological response (HCV RNA <LLOQ) at 12 weeks post-transplant (in those subjects who undergo liver transplants while on study)
    ? To determine therapeutic efficacy as measured by the change of CPT score and MELD score
    ? To evaluate the emergence of viral resistance to SOF/LDV FDC during and after treatment discontinuation
    ? To evaluate the kinetics of circulating HCV RNA during and after treatment
    ? To characterize steady-state PK of study drugs
    Los objetivos secundarios de este estudio son:
    ? Para determinar la proporción de pacientes que alcanzaron una RVS a las 2, 4, 8 y 24 semanas después de la interrupción del tratamiento (RVS2, RVS4, RVS8 y RVS24)
    ? Para determinar si la administración de SOF / LDV de DFC a sujetos infectados por el VHC sometidos a trasplante de hígado puede prevenir la recurrencia post-trasplante, determinada por una respuesta virológica sostenida después del trasplante (ARN del VHC <LLOQ) a las 12 semanas post-trasplante (en los sujetos que se someten a trasplantes de hígado durante el estudio)
    ? Para determinar la eficacia terapéutica, medida por el cambio en la puntuación CPT y la puntuación MELD
    ? Para evaluar la aparición de resistencia viral a la DFC de SOF/LDV durante y después de la interrupción del tratamiento
    ? Evaluar la cinética del ARN circulante del VHC durante y después del tratamiento
    ? Caracterizar la FC en estado estable de los fármacos del estudio
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    Pharmacogenomics (PG) Substudy
    All subjects will be eligible to participate in the PG substudy if a separate consent is obtained. A blood sample should be drawn at the Day 1 visit. If not obtained at Day 1 visit, the sample may be
    drawn at any time during the study.

    Pharmacokinetic (PK) Substudy
    Up to 15 subjects per group who provide separate consent will participate in a PK substudy and will have intensive PK sample collection (samples obtained up to 24 hours after dosing) performed at Week 2 or Week 4 following initiation of SOF/LDV FDC + RBV dosing to determine the steady state PK of SOF and metabolites, LDV, and RBV if appropriate.

    Liver Explant Substudy
    If a subject has a liver transplant during the study, and provides consent, tissue samples from the explanted liver will be obtained (where possible). Multiple tissue samples will be collected and
    analyzed for intrahepatic HCV RNA, possible viral sequencing, immunohistochemistry staining, intrahepatic drug concentrations (SOF, its metabolites, LDV, as appropriate and if possible), and
    key additional tissue biomarkers associated with fibrosis and fibrogenesis.
    Subestudio de farmacogenómica (FG)
    Todos los sujetos serán aptos para participar en el subestudio de FG si se obtiene un consentimiento separado. Se debe extraer una muestra de sangre en la visita del día 1. Si no se obtiene en la visita del día 1, la muestra se puede tomar en cualquier momento durante el estudio.
    Subestudio de farmacocinética (FC)
    Un máximo de 15 sujetos por grupo que den su consentimiento separado participarán en un subestudio de FC y se someterán a una recogida intensiva de muestras para FC (muestras obtenidas como máximo 24 horas después de la dosificación) realizadas en la semana 2 o la semana 4 después del inicio de la pauta de DFC de SOF/LDV + RBV para determinar la FC en estado estable de SOF y de los metabolitos, de LDV y de RBV si procede.
    Subestudio de explante hepático
    Si un sujeto se ha sometido a un trasplante de hígado durante el estudio, y da su consentimiento, se obtendrán muestras de tejido del hígado explantado (cuando sea posible). Se tomarán y se analizarán varias muestras de tejido para ARN de VHC intrahepático, posible secuenciación viral, tinción inmunohistoquímica, concentraciones del fármaco intrahepáticas (SOF, sus metabolitos, LDV, según proceda y si es posible) y marcadores tisulares clave adicionales asociados con la fibrosis y la fibrogénesis.
    E.3Principal inclusion criteria
    1. Willing and able to provide written informed consent or for those subjects where hepatic encephalopathy affects their ability to provide initial or ongoing consent, has an appropriate and legally-authorized representative (LAR) willing and able to provide consent on behalf of the subject.
    2. Male or female, Age > or = 18 years
    3. Chronic genotype 1 and 4
    4. HCV RNA infection with quantifiable virus at Screening
    5. Confirmation of chronic (non-acute) HCV infection documented by either:
    a. A positive anti-HCV antibody test or positive HCV RNA or positive HCV
    genotyping test at least 6 months prior to the Day 1 visit, or
    b. A liver biopsy performed prior to the Day 1 visit with evidence of chronic HCV
    infection.
    6. Screening ECG without clinically significant abnormalities.
    7. Negative serum pregnancy test for female subjects (unless surgically sterile or greater
    than two years post-menopausal; please see Appendix 4).
    8. Male subjects and female subjects of childbearing potential who engage in heterosexual
    intercourse must agree to use protocol specified method(s) of contraception as described
    in Appendix 4.
    9. Lactating females must agree to discontinue nursing before the study drugs are
    administered
    10. Subject must be able to comply with the dosing instructions for study drug administration
    and able to complete the study schedule of assessments, including all required
    post-treatment visits.
    11. Ability to determine the presence/absence of cirrhosis for all groups except Cohort B,
    Group 7 (which may or may not have cirrhosis)
    a. Cirrhosis is defined as any one of the following:
    ? Liver biopsy showing cirrhosis
    ? Fibroscan (in countries where locally approved) showing cirrhosis or results > 12.5 kPa
    ? A FibroTest® score of >0.75 AND an AST:Platelet Ratio Index (APRI) of
    >2 performed during screening
    b. Absence of cirrhosis is defined as any one of the following:
    ? Liver biopsy within 2 years of Screening showing absence of cirrhosis
    ? Fibroscan (in countries where locally approved) with a result of ? 12.5 kPa within ? 6 months of Baseline/Day1
    ? A FibroTest® score of ? 0.48 AND APRI of ? 1 performed during Screening In the absence of a definitive diagnosis of presence or absence of cirrhosis by the above criteria, a liver biopsy is required; liver biopsy results will supersede blood test results and be considered definitive.

    Inclusion Criteria Exclusively for Cohort A
    12. Has never received a liver transplant, and if listed for transplant, expected to be at least 12 weeks prior to transplant (from anticipated Day 1 of dosing). The subject may be a candidate for a living donor transplant, as long as it is anticipated to be at least 12 weeks before the transplant surgery will occur.

    Inclusion Criteria Exclusively for Cohort B, all Groups
    13. Post-liver transplant (primary or secondary, cadaveric or living donor), at least 3 months since transplant procedure for all groups except Cohort B, Group 4, which must be at least 2 months since the transplant procedure).
    14. Subjects may be on the waiting list for a second or third transplant. Subjects who are on the waiting list for a liver transplant must be waiting to receive an HCV negative organ.

    Inclusion Criteria Exclusively for Cohort B, Group 7 (FCH) only
    15. Subject must be within 18 months of transplant at screening
    16. Histological evidence of fibrosing cholestatic hepatitis on post-transplant liver biopsy performed within 6 months of screening, confirmed by sponsor medical review prior to randomization
    17. Bilirubin ? 2.5x ULN
    18. Ultrasound of liver and biliary tree with Doppler or other imaging study no finding of hepatic artery thrombosis within 6 months prior to screening
    1. Estar dispuestos y ser capaces de otorgar su consentimiento informado por escrito o, en el caso de aquellos sujetos cuya encefalopatía hepática afecte a su capacidad de proporcionar consentimiento inicial o permanente, poseer un representante adecuado y legalmente autorizado (RLA) dispuesto y capaz de otorgar el consentimiento en nombre del sujeto.
    2. Varones o mujeres de 18 años de edad.
    3. Genotipos crónicos 1 y 4.
    4. Infección por el ARN del VHC con carga vírica cuantificable en la selección.
    5. Confirmación de infección crónica (no aguda) por el VHC documentada mediante:
    a. Pruebas positivas de anticuerpos contra el VHC, de ARN del VHC o de genotipificación del VHC obtenidas al menos 6 meses antes de la visita del día 1, o bien
    b. Una biopsia hepática realizada antes de la visita del día 1 con evidencia de infección crónica por el VHC.
    6. ECG en el momento de la selección sin anomalías clínicamente significativas.
    7. Prueba negativa de embarazo en suero para los sujetos de sexo femenino (a menos que se hayan sometido a esterilización quirúrgica o sean posmenopáusicas desde hace más de dos años; véase el apéndice 4).
    8. Los sujetos de sexo masculino y femenino en edad fértil que mantengan relaciones heterosexuales deben aceptar el uso del/de los método(s) anticonceptivo(s) especificado(s) en el protocolo descrito(s) en el apéndice 4.
    . Las mujeres en periodo de lactancia deben aceptar dejar de dar el pecho antes de la administración de los fármacos del estudio
    10. Los sujetos deben ser capaces de cumplir las instrucciones de dosificación para la administración del fármaco del estudio y el calendario de evaluaciones del estudio, incluidas todas las visitas de postratamiento requeridas.
    11. Capacidad para determinar la presencia/ausencia de cirrosis en todos los grupos, excepto en la cohorte B, grupo 7 (que puede tener o no cirrosis).
    a. La cirrosis se define como la presencia de cualquiera de las condiciones siguientes: Biopsia hepática que muestre presencia de cirrosis
    Fibroscan (en los países donde esté aprobado localmente) que muestre cirrosis o resultados >12,5 kPa
    Puntuación en FibroTest® de >0,75, ADEMÁS DE un índice de la relación AST/plaquetas (APRI) >2, obtenidos durante la selección
    b. La ausencia de cirrosis se define como la presencia de cualquiera de las condiciones siguientes:
    Biopsia hepática en los dos años anteriores a la selección que muestra ausencia de cirrosis
    Fibroscan (en los países donde esté aprobado localmente) que muestre un resultado ?12,5 kPa en los ?6 meses antes de la visita inicial/día 1
    Puntuación en FibroTest® ?0,48, ADEMÁS DE APRI ?1 obtenidos durante la selección
    En ausencia de un diagnóstico definitivo de presencia o ausencia de cirrosis según los criterios anteriores, será necesario realizar una biopsia hepática; los resultados de la biopsia hepática tendrán prioridad sobre los de los análisis de sangre y se considerarán definitivos.
    Criterios de inclusión exclusivamente para la cohorte A
    12. No haber recibido ningún trasplante hepático y, en caso de estar en lista de espera para un trasplante, que se prevea que falten al menos 12 semanas para el trasplante (contadas desde el día 1 previsto para la administración del fármaco). El sujeto puede ser candidato para un trasplante de un donante vivo, siempre y cuando esté previsto que falten al menos 12 semanas para la intervención de trasplante.

    Criterios de inclusión exclusivamente para la cohorte B, todos los grupos
    13. Postrasplante hepático (primario o secundario, de cadáver o de donante vivo), al menos 3 meses después de la intervención del trasplante en todos los grupos, excepto en la cohorte B, grupo 4, donde deben haber transcurrido al menos 2 meses de la intervención del trasplante.
    14. Los sujetos pueden estar en lista de espera para un segundo o un tercer trasplante. Los sujetos que se hallen en lista de espera para un trasplante hepático deben estar esperando recibir un órgano negativo para el VHC.

    Criterios de inclusión exclusivamente para la cohorte B, grupo 7 (HCF) solamente
    15. El sujeto debe hallarse en los 18 meses siguientes al trasplante en el momento de la selección.
    16. Indicios histológicos de hepatitis colestásica fibrosante en una biopsia hepática postrasplante realizada en los 6 meses previos a la selección, confirmada mediante revisión médica del promotor antes de la aleatorización.
    17. Bilirrubina ?2,5 x LSN.
    18. Ecografía hepática y del árbol biliar con Doppler u otro estudio de diagnóstico por imagen sin hallazgos de trombosis arterial hepática en los 6 meses previos a la selección.
    E.4Principal exclusion criteria
    1. Any serious or active medical or psychiatric illness which, in the opinion of the investigator, would interfere with subject treatment, assessment, or compliance
    2. HIV infection or chronic hepatitis B virus (HBV) infection (HBsAg positive)
    3. Difficulty with blood collection and/or poor venous access for the purposes of phlebotomy.
    4. Gastrointestinal disorder or post-operative condition that could interfere with the absorption of the study drug.
    5. Alpha-fetoprotein (AFP) > 50 unless negative imaging for hepatic masses within the last
    6 months or during screening
    6. Current malignancy (with exception of certain resolved skin cancers or other early cancer for which surgical resection is considered to be completely curative), including hepatocellular carcinoma
    7. Treatment with IFN, RBV, telaprevir or boceprevir or any other approved or experimental medication with known anti-HCV activity within 1 month prior to screening date
    8. Any prior exposure to an HCV NS5a specific inhibitor
    9. Use of GM-CSF, epoetin alfa or other therapeutic hematopoietic agents within 2 weeks of Screening
    10. History of clinically significant medical condition associated with other chronic liver disease (e.g., hemochromatosis, autoimmune hepatitis, Wilson?s disease, ?-1-antitrypsin deficiency, alcoholic liver disease, non-alcoholic steatohepatitis, or toxin exposures) that may affect the ability to respond to HCV therapy.
    11. Active spontaneous bacterial peritonitis at screening
    12. Hematological and biochemical parameters, including:
    a. Hemoglobin (Hb) < 10 g/dL
    b. Platelets ? 30,000/ mm3
    c. ALT, AST, or alkaline phosphatase ? 10 ULN, sodium <125 mmol/L
    d. Total bilirubin > 10mg/dL (except for the FCH cohort)
    e. Serum creatinine > 2.5x upper limit of normal and/or evidence of renal impairment (CrCl < 40 mL/min).
    13. Infection requiring systemic antibiotics at the time of screening
    14. Participation in a clinical study with an investigational drug or biologic within 1 month prior to screening visit, unless information on the investigational drug is available to indicate that there is no potential drug interaction (safety or efficacy)
    15. Active or recent history (? 6 months) of drug or alcohol abuse
    16. Any contraindication to RBV therapy, per the approved package insert
    17. Any history of organ transplant other than liver or kidney
    18. Any medications from Section 5.4 prohibited from used within 28 days prior to the Day 1 visit through the end of treatment
    19. Known hypersensitivity to RBV, LDV, SOF, or formulation excipients.

    Exclusion criteria Exclusively for Cohort A subjects:
    20. Medical justification for any MELD exception points (for HCC, current hepatopulmonary syndrome, intractable encephalopathy, or any other reason)
    21. History of hepatopulmonary syndrome
    22. Chronic use of systemic immunosuppressive agents (for autoimmune diseases, etc)

    Exclusion Criteria Exclusively for Cohort B, all Groups:
    23. Current use of corticosteroids at any dose > 10 mg of prednisone/day (or equivalent dose of other corticosteroid)
    24. Histological evidence of unresolved rejection requiring treatment or expected to require treatment during the study period
    25. Use or planned use of T-cell depleting/masking antibodies, systemic antineoplastic agents, or cyclosporine at a dose of > 300 mg/day
    26. Subjects with a Child-Pugh Score of 13-15, due to the serious medical condition and poor prognosis for these patients

    Exclusion criterion Exclusively for Cohort B, Group 3:
    27. Any clinical evidence of portal hypertension [history of ascites, esophageal or gastric
    varices, hepatic encephalopathy, or coagulopathy (INR >1.2 at screening)]

    Exclusion criterion Exclusively for Cohort B, Group 7
    28. Presence of alternative explanations for cholestatis/hyperbilirubinemia such as biliary or
    hepatic artery complications, and drug induced injury
    1. Enfermedades médicas o psiquiátricas graves o activas que, en opinión del investigador, puedan interferir en el tratamiento, la evaluación o el cumplimiento por parte del sujeto.

    2. Infección con el VIH o infección crónica con el virus de la hepatitis B (VHB) (positivo para el HBsAg).

    3. Dificultades para la extracción de sangre o mal acceso venoso para una flebotomía.

    4. Trastornos gastrointestinales o enfermedad posoperatoria que pueda interferir en la absorción del fármaco del estudio.

    5. Alfafetoproteína (AFP) >50, a menos que las imágenes sean negativas para masas hepáticas en los últimos 6 meses o durante la selección.

    6. Neoplasia maligna en curso (a excepción de ciertos cánceres de piel que hayan desaparecido u otros cánceres en estadios iniciales cuya resección quirúrgica se considere totalmente curativa), incluido el carcinoma hepatocelular.

    7. Tratamiento con IFN, RBV, telaprevir o boceprevir, o con cualquier otro medicamento aprobado o experimental con actividad conocida contra el VHC durante el mes previo a la fecha de selección.

    8. Cualquier exposición previa a un inhibidor específico de la NS5a del VHC.

    9. Consumo de FEC-GM, epoetina alfa u otros hematopoyéticos terapéuticos en las 2 semanas previas a la selección.

    10. Antecedentes de una enfermedad médica clínicamente significativa asociada a otra enfermedad hepática crónica (p. ej., hemocromatosis, hepatitis autoinmunitaria, enfermedad de Wilson, deficiencia de ?-1-antitripsina, hepatopatía alcohólica, esteatohepatitis no alcohólica o exposiciones a toxinas) que puedan afectar a la capacidad de responder al tratamiento contra el VHC.

    11. Peritonitis bacteriana espontánea activa en la selección.

    12. Parámetros hematológicos y bioquímicos, incluidos:

    a. Hemoglobina (Hb) <10 g/dl

    b. Plaquetas ?30 000/mm3

    c. ALT, AST o fosfatasa alcalina ?10 LSN, sodio <125 mmol/l

    d. Bilirrubina total >10 mg/dl (excepto en la cohorte de HCF)

    e. Creatinina sérica >2,5 x límite superior de la normalidad o indicios de insuficiencia renal (ACr <40 ml/min).

    13. Infección que requiera antibióticos sistémicos en el momento de la selección.

    14. Participación en un estudio clínico con un fármaco experimental o biológico durante el mes previo a la visita de selección, a menos que se disponga de información sobre dicho fármaco que indique que no existe posibilidad de interacción farmacológica (seguridad o eficacia).

    15. Toxicomanía o alcoholismo actual o reciente (?6 meses).

    16. Cualquier contraindicación al tratamiento con RBV según el prospecto aprobado.

    17. Antecedentes de trasplante de órganos distintos del hígado o del riñón.

    18. Cualquiera de los medicamentos de la sección 5.4, prohibidos desde 28 días antes de la visita del día 1 hasta el final del tratamiento.

    19. Hipersensibilidad conocida a la RBV, al LDV, al SOF o a los excipientes de la formulación.

    Criterios de exclusión únicamente para los sujetos de la cohorte A:

    20. Justificación médica para cualquier punto de excepción de MEHT (CHC, síndrome hepatopulmonar en curso, encefalopatía intratable o cualquier otro motivo).

    21. Antecedentes de síndrome hepatopulmonar.

    22. Tratamiento crónico con inmunosupresores sistémicos (para enfermedades autoinmunitarias, etc.)

    Criterios de exclusión únicamente para la cohorte B, todos los grupos:

    23. Uso actual de corticoesteroides en cualquier dosis >10 mg/día de prednisona (o una dosis equivalente de otro corticoesteroide).

    24. Indicios histológicos de rechazo no resuelto, que requiera tratamiento o que se prevea que va a requerir tratamiento durante el período del estudio.
    25. Tratamiento actual o previsto con anticuerpos reductores/enmascaradores de linfocitos T, antineoplásicos sistémicos o ciclosporina a una dosis de >300 mg/día.

    26. Sujetos con una puntuación de Child-Pugh de 13-15, debido a la gravedad de su afección médica y al mal pronóstico de estos pacientes.

    Criterio de exclusión únicamente para la cohorte B, grupo 3:

    27. Cualquier indicio clínico de hipertensión portal (antecedentes de ascitis, varices esofágicas o gástricas, encefalopatía hepática o coagulopatía [INR >1,2 en la selección]).

    Criterio de exclusión únicamente para la cohorte B, grupo 7

    28. Presencia de explicaciones alternativas para la colestasis/hiperbilirrubinemia, como complicaciones biliares o de la arteria hepática, y lesión de etiología medicamentosa.
    E.5 End points
    E.5.1Primary end point(s)
    The primary efficacy endpoint is SVR12 (HCV RNA < lower limit of quantitation [LLOQ] 12 weeks after last dose of study drug) for subjects in the Full Analysis Set.
    E.5.1.1Timepoint(s) of evaluation of this end point
    12 weeks post last treatment dose
    E.5.2Secondary end point(s)
    The secondary efficacy endpoints include the proportion of subjects who attain SVR at 2, 4, 8 and 24 weeks after discontinuation of therapy (SVR2, SVR4, SVR8 and SVR24); proportion of subjects who have HCV RNA < LLOQ by visit while on treatment; absolute and change from Day 1 in HCV RNA through Week 8; virologic failure; and change from Day 1 in MELD and CPT scores. Subjects who have a liver transplant while on study will have data censored at time of transplant for the primary and secondary efficacy endpoints listed above.

    For those subjects who have a liver transplant while on study, the proportion of subjects with post-transplant virologic response (PTVR, defined as HCV RNA < LLOQ at 12 weeks post-transplant) will be summarized for subjects in the FAS who have HCV RNA < LLOQ at their last observed HCV RNA prior to transplant. Subjects who are transplanted with an HCV-infected liver will be excluded from analysis.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Secondary efficacy endpoints will be assessed 2, 4, 8 and 24 weeks following discontinuation of therapy; Other secondary endpoints will be assessed at the On-Treatment visits at Weeks 1, 2, 4, 6 8, 12, 16, 20,and 24 and at post treatment/ post transplant visits at Weeks 2, 4, 8, 12 and 24
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial7
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA24
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Belgium
    Canada
    France
    Germany
    Italy
    Austria
    Netherlands
    New Zealand
    Spain
    Switzerland
    United Kingdom
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    Last Subject Last Visit
    último sujeto última visita
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months7
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months7
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 360
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 40
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    This may be applicable to patients with hepatic encephalopathy.
    Esto puede ser aplicable a pacientes con encefalopatía hepática.
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state47
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 330
    F.4.2.2In the whole clinical trial 400
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Subjects who do not achieve SVR at/after the Post-treatment and/or Post-transplant Week 4 visit will be eligible for enrollment in the Sequence Registry Study in order to monitor the persistence of resistant mutations for up
    to 3 years (GS-US-248-0123).

    Subjects who achieve SVR at the Post-treatment and/or Post-transplant Week 24 follow-up visit will be eligible for enrollment in the SVR Registry Study in order to evaluate durability of SVR for up to 3 years post-treatment (GS-US-248-0122).
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2014-01-31
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2014-01-16
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2015-08-27
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