E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
HCV infection |
Infección VHC |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Virus Diseases [C02] |
MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the efficacy, in terms of the rate of patients achieving SVR12, of ELB / GRA retreatment plus SOF and ribavirin for 16 weeks in patients infected with hepatitis C virus genotypes 1, 4 who have failed treatment with regimens based In NS5A |
Evaluar la eficacia, en términos de tasa de pacientes que alcanzan la RVS12, del retratamiento con ELB/GRA más SOF y ribavirina durante 16 semanas en pacientes infectados por el virus de la hepatitis C genotipos 1, 4 que han fallado al tratamiento con regímenes basados en NS5A |
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E.2.2 | Secondary objectives of the trial |
-Analyze the impact of VARs NS5A on RVS12 that is achieved with ELB / GRA plus SOF and ribavirin in patients with HCV genotype 1a, genotype 1b, genotype 4, for whom treatment with NS5A based regimens failed.
- Analyze the impact of VARs NS5A on RVS24 that is achieved with ELB / GRA plus SOF and ribavirin in patients with HCV genotypes 1, 4 who have failed treatment with regimens based on NS5A.
- Analyze the occurrence of resistance in patients who do not reach SVR12 after 16 weeks of re-treatment with ELB / GRA plus SOF and ribavirin.
- Analyze the impact of VARs NS5A on RVS12 that is achieved with ELB / GRA plus SOF and ribavirin in HIV-1 patients
- Analyze the impact of ELB / GRA retreatment plus SOF and ribavirin in HIV-1 subjects
Develop HIV-1 virological failure.
- Evaluate the safety profile of the treatment combination formed by ELB / GRA plus SOF and ribavirin.
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- Analizar el impacto de VARs NS5A en RVS12 que se logra con ELB/GRA más SOF y ribavirina en pacientes con VHC genotipo 1a, genotipo 1b, genotipo 4, para los cuales haya fallado el tratamiento con regímenes basados en NS5A.
- Analizar el impacto de VARs NS5A en RVS24 que se logra con ELB/GRA más SOF y ribavirina en pacientes con VHC genotipos 1, 4 que han fallado el tratamiento con regímenes basados en NS5A.
- Analizar la aparición de resistencias en aquellos pacientes que no alcancen RVS12 tras 16 semanas de retratamiento con ELB/GRA más SOF y ribavirina.
- Analizar el impacto de VARs NS5A en RVS12 que se logra con ELB/GRA más SOF y ribavirina en pacientes VIH-1
- Analizar el impacto del retratamiento con ELB/GRA más SOF y ribavirina en sujetos VIH-1 que
desarrollen fallo virológico VIH-1.
- Evaluar el perfil de seguridad de la combinación de tratamiento formada por ELB/GRA más SOF y ribavirina. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Adults with chronic HCV genotype 1, 4 infection with or without HIV infection aged 18 years or above
- Concentration of HCV RNA plasma of at least 1000 IU / mL
- Subjects previously treated with NS5A-based regimens for at least 8 weeks.
- Patients with HCV relapse after receiving a complete treatment with NS5A-based AAD regimen for at least 8 weeks and becoming undetectable at the end of treatment. Relapse is defined as a confirmed HCV RNA detectable upon completion of NS5A-based AAD therapy against HCV.
- Subjects with compensated hepatic cirrhosis (Child A) could be included.
- For patients with HIV coinfection:
- Being infected with HIV-1, documented by any HIV rapid test with the corresponding license and confirmed by a Western blot or second antibody test using a method other than the initial rapid HIV method and / or E / CIA or By HIV-1 p24 antigen or viral load of HIV-1 RNA plasma.
- Be on stable HIV antiretroviral therapy (ART) for at least 4 weeks prior to entry into the study using a dual ITN backbone of tenofovir or abacavir and emtricitabine or lamivudine PLUS raltegravir or dolutegravir or rilpivirine (with CD4 + > 100 cells / mm 3 and undetectable HIV-1 RNA at baseline. Results from prior analysis will be accepted within 24 weeks prior to study entry). |
- Adultos con infección crónica de VHC genotipo 1, 4 con o sin infección por VIH con una edad de 18 años o superior
- Concentración de plasma de ARN del VHC de al menos 1000 UI/mL
- Sujetos previamente tratados con regímenes basados en NS5A durante al menos 8 semanas.
- Sujetos con recaída de VHC tras recibir un tratamiento completo con régimen de AAD basado en NS5A durante al menos 8 semanas y tras llegar a ser indetectable al final del tratamiento. La recaída se define como un ARN del VHC confirmado detectable tras la finalización de la terapia de AAD basado en NS5A contra VHC.
- Se podría incluir a sujetos con cirrosis hepática compensada (Child A).
- Para pacientes con coinfección por VIH:
--Estar infectado por VIH-1, documentado mediante cualquier prueba rápida de VIH con la licencia correspondiente y confirmado mediante una prueba Western blot o una segunda prueba de anticuerpos mediante un método distinto al método rápido inicial de VIH y/o E/CIA o mediante antígeno p24 VIH-1 o carga viral de plasma de ARN del VIH-1.
--Estar en terapia antiretroviral estable de VIH (TARV) durante al menos 4 semanas antes de la entrada en el estudio mediante un backbone dual ITIN de tenofovir o abacavir y emtricitabina o lamivudina MÁS raltegravir o dolutegravir o rilpivirina (con recuento de células T CD4+ > 100 células/mm3 y ARN del VIH-1 indetectable en visita basal. Se aceptarán los resultados de una analítica previa dentro de las 24 semanas antes de la entrada del estudio). |
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E.4 | Principal exclusion criteria |
- Subjects with hepatitis other than C or steatosis.
- Subjects previously treated less than 8 weeks with regimens based on NS5A.
- Evidence of previous hepatocellular carcinoma although it has criteria of cure
- Subjects with past or current decompensated liver disease; Only decompensated patients who have received a liver transplant and have not decompensated after transplantation will be included.
- Subjects suspected of clinical or genotypic reinfection of HCV.
- Subject with HCV response regrowth while receiving NS5A-based ADA therapy against HCV. Said regrowth is defined as a confirmation of detectable HCV RNA after achieving undetectable HCV RNA during NS5A-based ADA therapy against HCV.
- Recent history of drug or alcohol abuse.
- Important comorbidities.
- Pregnant women, breastfeeding, or women who do not use contraceptive methods, if they are women of childbearing age. Women of childbearing age are defined as those women who have not undergone permanent infertility procedures or who have been amenorrheic for less than 12 months.
- Subjects with a glomerular filtration rate lower than 30 ml / min. |
- Sujetos con hepatitis distinta de la C o esteatosis.
- Sujetos previamente tratados menos de 8 semanas con regímenes basados en NS5A.
- Evidencias de carcinoma hepatocelular previo aunque tenga criterios de curación
- Sujetos con enfermedad hepática descompensada pasada o actual; sólo se incluirán los pacientes descompensados que hayan recibido un trasplante hepático y no se haya descompensado después del trasplante.
- Sujetos con sospecha de reinfección clínica o genotípica de VHC.
- Sujeto con rebrote de respuesta al VHC mientras recibe terapia de AADs basados en NS5A contra el VHC. Dicho rebrote se define como una confirmación de ARN del VHC detectable tras lograr un ARN del VHC indetectable durante la terapia de AADs basados en NS5A contra el VHC.
- Historial reciente de abuso de drogas o alcohol.
- Comorbilidades importantes.
- Mujeres embarazadas, en periodo de lactancia, o mujeres que no utilicen métodos anticonceptivos, si son mujeres en edad fértil. Se definen mujeres en edad fértil como aquellas mujeres que no hayan sido sometidas a procedimientos de infertilidad permanente o que sean amenorreicas desde hace menos de 12 meses.
- Sujetos con una tasa de filtrado glomerular inferior a 30 ml/min. |
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E.5 End points |
E.5.1 | Primary end point(s) |
- Rate of patients achieving SVR12. |
- Tasa de pacientes que alcanzan la RVS12. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Week 12 post treatment. |
Semana 12 post tratamiento |
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E.5.2 | Secondary end point(s) |
- The proportion of subjects infected with HCV genotype 1a with reference VARsNS5A that achieve RVS12.
- The proportion of subjects infected with HCV genotype 1b with reference VARsNS5A that achieve RVS12.
- The proportion of subjects infected with HCV genotype 4 with reference to NS5A VARs that achieved RVS12.
- The proportion of subjects infected with HCV genotype 1a with reference VARsNS3 that achieve RVS12.
- The proportion of subjects infected with HCV genotype 1b with reference to NS3 VARs that achieved RVS12.
- The proportion of subjects infected with HCV genotype 4 with reference to NS3 VARs that achieved RVS12.
- The proportion of subjects infected with HCV genotypes 1.4 with reference VARs NS5A who achieved RVS24.
- Viral resistance variants (VARs) will be analyzed for NS5A or elbasvir, NS3 or grazoprevir and NS5B or SOF at any time in the study.
- The proportion of subjects who develop HIV-1 virological failure (HIV RNA> 200 copies / mL), confirmed in 2 consecutive tests with at least 2 weeks between them.
The secondary security variables are:
- The proportion of subjects experiencing adverse events of high laboratory values who report as ECI at any time during the study period.
- The proportion of subjects with adverse experiences:
1. At least one adverse experience
2. Adverse experience related to medication
3. Severe adverse experience
4. A serious adverse experience related to medication
5. An adverse experience leading to disruption |
- La proporción de sujetos infectados con VHC genotipo 1a con referencia VARsNS5A que logren RVS12.
- La proporción de sujetos infectados con VHC genotipo 1b con referencia VARsNS5A que logren RVS12.
- La proporción de sujetos infectados con VHC genotipo 4 con referencia VARs NS5A que logren RVS12.
- La proporción de sujetos infectados con VHC genotipo 1a con referencia VARsNS3 que logren RVS12.
- La proporción de sujetos infectados con VHC genotipo 1b con referencia VARs NS3 que logren RVS12.
- La proporción de sujetos infectados con VHC genotipo 4 con referencia VARs NS3 que logren RVS12.
- La proporción de sujetos infectados con VHC genotipos 1,4 con referencia VARs NS5A que logren RVS24.
- Se analizará la aparición de variantes de resistencia (VARs) virales a NS5A o elbasvir, a NS3 o grazoprevir y a NS5B o SOF en cualquier momento del estudio.
- La proporción de sujetos que desarrollen fallo virológico VIH-1 (ARN del VIH > 200 copias/mL), confirmado en 2 pruebas consecutivas con al menos 2 semanas entre sí.
Las variables secundarias de seguridad son:
- La proporción de sujetos que experimentan eventos adversos de valores elevados de laboratorio que se comuniquen como ECI en cualquier momento durante el periodo del estudio.
- La proporción de sujetos con experiencias adversas:
1. Al menos una experiencia adversa
2. Una experiencia adversa relacionada con la medicación
3. Una experiencia adversa grave
4. Una experiencia adversa grave relacionada con la medicación
5. Una experiencia adversa que lleva a la interrupción |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
- Week 12 post treatment, week 24 post treatment.
- At any time during the study |
- Semana 12 post tratamiento, semana 24 post tratamiento
- En cualquier momento del estudio |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
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
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Last patient last visit |
Última visita del último paciente |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | |