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    Summary
    EudraCT Number:2022-001993-78
    Sponsor's Protocol Code Number:VIR-CHDV-V201
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-11-18
    Trial 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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2022-001993-78
    A.3Full title of the trial
    A Phase 2 Study to Evaluate Efficacy, Safety and Tolerability of VIR-2218 and VIR-3434 in Participants with Chronic Hepatitis D Virus Infection (SOLSTICE)
    Studio di fase 2 volto a valutare l'efficacia, la sicurezza e la tollerabilità di VIR-2218 e VIR-3434 in partecipanti con infezione cronica da virus dell'epatite D (SOLSTICE)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study to Evaluate Investigational Therapies in Chronic Hepatitis D Virus Infection
    Studio per la valutazione di terapie sperimentali nell'infezione cronica da virus dell'epatite D
    A.3.2Name or abbreviated title of the trial where available
    SOLSTICE
    SOLSTICE
    A.4.1Sponsor's protocol code numberVIR-CHDV-V201
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT05461170
    A.5.4Other Identifiers
    Name:INDNumber:161929
    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 SponsorVir Biotechnology, 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 supportVir Biotechnology, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationPharmaceutical Product Development (PPD)
    B.5.2Functional name of contact pointTracy Spaeth King
    B.5.3 Address:
    B.5.3.1Street Address929 North Front Street
    B.5.3.2Town/ cityWilmington, NC
    B.5.3.3Post code28401-3331
    B.5.3.4CountryUnited States
    B.5.4Telephone number00114423403343
    B.5.5Fax number0015127477398
    B.5.6E-mailTracy.SpaethKing@ppd.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 nameVIR-2218
    D.3.2Product code [VIR-2218]
    D.3.4Pharmaceutical form Solution for injection/infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.9.1CAS number 2648009-53-2
    D.3.9.2Current sponsor codeALN-81890 o AD-81890
    D.3.9.4EV Substance CodeSUB222707
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 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 nameVIR-3434
    D.3.2Product code [VIR-3434]
    D.3.4Pharmaceutical form Lyophilisate for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNtobevibart
    D.3.9.1CAS number 2645440-65-7
    D.3.9.2Current sponsor codeVIR-3434
    D.3.9.4EV Substance CodeSUB215892
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number300
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 Hepatitis D Virus (HDV) Infection
    Infezione da virus dell'epatite D cronica (HDV)
    E.1.1.1Medical condition in easily understood language
    Chronic Hepatitis D Virus (HDV) Infection
    Infezione da virus dell'epatite D cronica (HDV)
    E.1.1.2Therapeutic area Diseases [C] - Virus Diseases [C02]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.1
    E.1.2Level PT
    E.1.2Classification code 10019762
    E.1.2Term Hepatitis D
    E.1.2System Organ Class 10021881 - Infections and infestations
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10047455
    E.1.2Term Viral hepatitis B without mention of hepatic coma, with hepatitis delta
    E.1.2System Organ Class 10021881 - Infections and infestations
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    -To evaluate the efficacy of VIR-2218 and VIR-3434 in participants with chronic HBV/HDV coinfection

    -To evaluate the safety of VIR-2218 and VIR-3434 in participants with chronic HBV/HDV coinfection
    -Per valutare l'efficacia di VIR-2218 e VIR-3434 in partecipanti con coinfezione cronica da HBV/HDV

    -Per valutare la sicurezza di VIR-2218 e VIR-3434 in partecipanti con coinfezione cronica da HBV/HDV
    E.2.2Secondary objectives of the trial
    -To evaluate the efficacy of VIR-2218 and VIR-3434 in participants with chronic HBV/HDV coinfection on HDV RNA and ALT normalization

    -To assess the immunogenicity of VIR-3434 (for cohorts with VIR-3434)

    -To assess the effects of VIR-2218 and VIR-3434 on liver fibrosis and hepatic function
    -Per valutare l'efficacia di VIR-2218 e VIR-3434 in partecipanti con coinfezione cronica da HBV/HDV sulla normalizzazione dell'RNA dell'HDV e dell'ALT
    -Per valutare l'immunogenicità di VIR-3434 (per coorti con VIR-3434)
    -Per valutare gli effetti di VIR-2218 e VIR-3434 sulla fibrosi epatica e sulla funzione epatica
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives

    Other types of substudies
    Specify title, date and version of each substudy with relative objectives: 1. Optional Liver Biopsy
    -To assess changes in liver fibrosis during treatment with the study drug
    -To assess HBV and HDV replication in hepatocytes as well as for
    exploratory studies
    2. Optional VIR-3434 PK Sub-study
    -To better characterize the PK properties of VIR-3434 in participants
    with baseline HBsAg > 3000 IU/mL

    Altre tipologie di sottostudi
    specificare il titolo, la data e la versione di ogni sottostudio con i relativi obiettivi: 1. Biopsia epatica facoltativa
    -Per valutare i cambiamenti nella fibrosi epatica durante il trattamento con il farmaco in studio
    -Per valutare la replicazione di HBV e HDV negli epatociti e per studi esplorativi
    2. Sottotudio VIR-3434 PK facoltativo
    -Per caratterizzare meglio le proprietà farmacocinetiche di VIR-3434 in partecipanti con HBsAg basale > 3000 UI/mL
    E.3Principal inclusion criteria
    Age
    1. Age > and = 18 (or age of legal consent, whichever is older) to < 70 years at the time of screening
    Type of Participant and Disease Characteristics
    2. Chronic HBV infection defined as a positive serum HBsAg, HBV DNA, or HBeAg on 2 occasions at least 6 months apart based on previous (within the past 12 months) or current laboratory documentation (any combination of these tests performed 6 months apart is acceptable)
    3. On locally approved NRTI therapy for at least 12 weeks prior to Day 1
    4. HBsAg > 0.05 IU/mL at screening
    5. Positive HDV antibody for at least 6 months prior to screening and HDV RNA> and = 500 IU/mL at screening
    6. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) > ULN and < 5 x ULN
    Weight
    7. Body Mass Index (BMI) > and = 18 kg/m2 to < and = 40 kg/m2
    Sex and Contraceptive/Barrier Requirements
    8. Female participants must have a negative pregnancy test or confirmation of postmenopausal status. Postmenopausal status is defined as 12 months with no menses without an alternative medical cause. Confirmation of negative follicle stimulating hormone (FSH) is required to confirm postmenopausal status (see Section 10.6 for additional details). Women of childbearing potential (WOCBP) must have a negative blood pregnancy test at screening and a negative urine pregnancy test on Day 1, cannot be breast feeding, and must be willing to use highly effective methods of contraception (Section 10.6) 14 days before study drug administration through 48 weeks after the last dose of VIR-2218 or VIR-3434. Female participants must also agree to refrain from egg donation and in vitro fertilization from the time of study drug administration through 48 weeks after the last dose of VIR-2218 or VIR-3434.
    9. Male participants with female partners of childbearing potential must agree to meet 1 of the following contraception requirements from the time of study drug administration through 48 weeks after the last dose of VIR-2218 or VIR-3434: documentation of vasectomy or azoospermia, or male condom use plus partner use of 1 of the contraceptive options listed for contraception for WOCBP (Section 10.6). Male participants must also agree to not donate sperm from the time of first study drug administration through 48 weeks after the last dose of VIR-2218 or VIR-3434.
    Informed Consent
    10. Capable of giving signed informed consent as described in Section 10.8, which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol
    Other Inclusion Criteria
    11. 12-lead electrocardiogram (ECG) within normal limits; or, with no clinically significant abnormalities at screening, as determined by the clinical investigator.
    12. Agrees not to donate blood during the duration of the study and for an additional 3 months after the last dose study drug.
    Cohort Specific Inclusion Criteria
    13. Cohort 1 specific inclusion criteria
    • Noncirrhotic
    - Liver biopsy with METAVIR F0-F3 or Liver elastography (eg, Fibroscan®)
    < 12 kilopascal (kPa) within the 12 months prior to screening
    - Creatinine clearance (CLcr) > and = 30 mL/min as calculated by the Cockcroft-Gault formula at screening
    - Platelet count > 150,000 cells/mm3 (/µL)
    • Cirrhotic
    - Liver biopsy with METAVIR F4 or Liver elastography (Fibroscan®) > and = 12 kPa (Cohort 2) within the 12 months prior to screening
    - CLcr > and = 60 mL/min as calculated by the Cockcroft-Gault formula at screening
    - CPT score of 5 or 6, inclusive at screening and at start of study
    14. Cohorts 2a, 2b1, 2b2 and 2c specific inclusion criteria
    • Noncirrhotic
    -Liver biopsy with METAVIR F0-F3 or Liver elastography (eg, Fibroscan®) < 12 kPa within the 12 months prior to screening
    -CLcr > and = 30 mL/min as calculated by the Cockcroft-Gault formula at screening
    -Platelet count > 150,000 cells/mm3 (/µL)
    • CPT-A Cirrhotic
    -Liver biopsy with METAVIR F4 or Liver elastography (eg, Fibroscan®) > and = 12 kPa within the 12 months prior to screening
    -CLcr > and = 60 mL/min as calculated by the Cockcroft-Gault formula at screening
    -Platelet count > 90,000 cells/mm3 (/µL)
    -CPT score of 5 or 6, inclusive at screening and at start of study
    *Alternatives to Fibroscan, eg, 2D-Shear Wave Elastography, can be allowed following approval of the sponsor
    1.Età: da > e = 18 (o età del consenso legale, a seconda di quale sia la maggiore) fino a < 70 anni al momento dello screening
    2.Infezione cronica da HBV definita come siero positivo per HBsAg, HBV DNA o HBeAg in 2 occasioni a distanza di almeno 6 mesi in base alla documentazione di laboratorio precedente (negli ultimi 12 mesi) o attuale (è accettabile qualsiasi combinazione di questi test eseguita a distanza di 6 mesi)
    3.In terapia con NRTI approvata localmente per almeno 12 settimane prima del giorno 1
    4.HBsAg > 0,05 UI/mL allo screening
    5.Positivo per l'anticorpo anti-HDV per almeno 6 mesi prima dello screening e HDV RNA > e = 500 UI/mL allo screening
    6.ALT e AST > ULN e < 5 x ULN
    7.Indice di massa corporea (BMI) da > e =18 kg/m2 a < e = 40 kg/m2
    8.Le partecipanti di sesso femminile devono avere un test di gravidanza negativo o una conferma dello stato postmenopausale. Lo stato postmenopausale è definito come 12 mesi senza mestruazioni senza una causa medica alternativa. Per confermare lo stato postmenopausale è necessaria la conferma dell'ormone follicolo stimolante (FSH) negativo (vedere paragrafo 10.6 per ulteriori dettagli). Le donne in età fertile (WOCBP) devono avere un test di gravidanza del sangue negativo allo screening e un test di gravidanza sulle urine negativo il giorno 1, non possono allattare al seno e devono essere disposte a utilizzare metodi contraccettivi altamente efficaci (Sezione 10.6) da 14 giorni prima della somministrazione del farmaco in studio fino a 48 settimane dopo l'ultima dose di VIR-2218 o VIR-3434. Le partecipanti di sesso femminile devono anche accettare di astenersi dalla donazione di ovuli e dalla fecondazione in vitro dal momento della somministrazione del farmaco in studio fino a 48 settimane dopo l'ultima dose di VIR-2218 o VIR-3434.
    9.I partecipanti di sesso maschile con partner di sesso femminile in età fertile devono accettare di soddisfare 1 dei seguenti requisiti contraccettivi dal momento della somministrazione del farmaco in studio fino a 48 settimane dopo l'ultima dose di VIR-2218 o VIR-3434: documentazione di vasectomia o azoospermia, o uso del preservativo maschile più l'uso da parte della partner di 1 delle opzioni contraccettive elencate per la contraccezione per le donne fertili (Sezione 10.6). I partecipanti maschi devono anche accettare di non donare sperma dal momento della prima somministrazione del farmaco in studio fino a 48 settimane dopo l'ultima dose di VIR-2218 o VIR-3434.
    10.In grado di fornire il consenso informato firmato come descritto nella Sezione 10.8, che include il rispetto dei requisiti e delle restrizioni elencati nel ICF e nel presente protocollo
    11.ECG a 12 derivazioni nei limiti di normalità; o senza anomalie clinicamente significative allo screening, come determinato dallo sperimentatore clinico.
    12.Accetta di non donare sangue durante la durata dello studio e per altri 3 mesi dopo l'ultima dose del farmaco in studio.
    13.Criteri di inclusione specifici della coorte 1
    • Non cirrotico
    - Biopsia epatica con METAVIR F0-F3 o elastografia epatica (es. Fibroscan®)
    < 12 kilopascal (kPa) nei 12 mesi precedenti lo screening
    -CLcr > e = 30 mL/min come calcolato dalla formula di Cockcroft-Gault allo screening
    -Conta piastrinica > 150.000 cellule/mm3 (/pL)
    • Cirrotico
    -Biopsia epatica con METAVIR F4 o Elastografia epatica (Fibroscan®) > e =
    12 kPa (Coorte 2) nei 12 mesi precedenti lo screening
    -CLcr > e = 60 mL/min come calcolato dalla formula di Cockcroft-Gault allo screening
    -Punteggio CPT di 5 o 6, inclusi allo screening e all'inizio dello studio
    14.Criteri di inclusione specifici per le coorti 2a, 2b1, 2b2 e 2c
    • Non cirrotico
    -Biopsia epatica con METAVIR F0-F3 o elastografia epatica (es. Fibroscan®) < 12 kPa nei 12 mesi precedenti lo screening
    -CLcr > e = 30 mL/min come calcolato dalla formula di Cockcroft-Gault allo screening
    -Conta piastrinica > 150.000 cellule/mm3 (/pL)
    • CPT-A cirrotico
    -Biopsia epatica con METAVIR F4 o elastografia epatica (p. es., Fibroscan®) > e = 12 kPa nei 12 mesi precedenti lo screening
    -CLcr > e = 60 mL/min come calcolato dalla formula di Cockcroft-Gault allo screening
    -Conta piastrinica > 90.000 cellule/mm3 (/pL)
    -Punteggio CPT di 5 o 6, inclusi allo screening e all'inizio dello studio
    *Alternative al Fibroscan, ad esempio, 2D-Shear Wave Elastography, possono essere consentite previa approvazione dello sponsor
    E.4Principal exclusion criteria
    Medical Conditions
    1. History of clinically significant liver disease from non-HBV and non-HDV etiology as determined by the investigator
    2. History of clinically significant immune complex disease as determined by the investigator
    3. History of clinically significant autoimmune disorder as determined by the investigator
    4. History of HBV-related extrahepatic disease, including but not limited to HBV-related rash, arthritis, or glomerulonephritis
    5. History of allergic reactions, hypersensitivity, or intolerance to study drug, its metabolites or excipients
    6. Anti-HBs >10 mIU/L at screening
    7. Corrected QT interval (QTc) > 450 milliseconds
    8. AST or ALT > 5x ULN
    9. Total bilirubin > 2.0 mg/dL
    10. Serum albumin < 30 g/L
    11. Absolute neutrophil count < 1,000/mm3 (/µL)
    12. International normalized ratio (INR) > 1.5
    13. Hemoglobin < 8 g/dL
    14. History of anaphylaxis
    15. History of malignancy diagnosed or treated within 5 years (localized treatment of squamous or noninvasive basal cell skin cancers is permitted; cervical carcinoma in
    situ is allowed if appropriately treated prior to screening); participants under evaluation for malignancy are not eligible
    16. History of or listed for bone marrow or solid organ transplant
    17. Known active infection other than chronic HBV and HDV infection or any clinically significant acute condition such as fever (> 38° C) or acute respiratory illness within 7 days prior to Day 1
    18. Coinfection with human immunodeficiency virus (HIV), hepatitis A virus (HAV), hepatitis C virus (HCV) or hepatitis E virus (HEV). Participants who are HCV antibody positive and HCV RNA negative are eligible. Participants who are HAV or HEV immunoglobulin M antibody (IgM) positive are not eligible. Participants who are asymptomatic and HAV or HEV immunoglobulin G antibody (IgG) positive are eligible.
    19. Any clinically significant medical or psychiatric condition that may interfere with study intervention, assessment, or compliance with the protocol or otherwise makes the participant unsuitable for participation in the study, as determined by the investigator. Participants with controlled Diabetes Mellitus are eligible.
    20. Acute or worsening chronic hepatitis, fluctuating or rapidly deteriorating hepatic function or use of any therapy known to exacerbate hepatic dysfunction in the opinion
    of the investigator.
    Prior/Concomitant Therapy
    21. Therapy with an immunomodulatory agent, IFN-a (eg, IFN-alfa-2a or IFN-alfa-2b, or pegylated IFN-alfa-2a or alfa 2b), immunosuppressants (eg, disease-modifying antirheumatic drugs), cytotoxic or chemotherapeutic agent, or chronic systemic corticosteroids within 6 months of screening.
    22. Received an HDV active agent (including lonafarnib and bulevirtide) within 90 days or 5 half-lives (if known), whichever is longer, before study drug administration or are active in the Follow-Up period of another clinical study involving interventional treatment. Participants must also agree not to take part in any other interventional study at any time during their participation in this study, inclusive of the Follow-Up Period.
    23. Receipt of an oligonucleotide (eg, siRNA, antisense oligonucleotide) with activity against HBV within 48 weeks before study drug administration
    24. Receipt of VIR-3434 or any antibody targeting HBV or HDV within 24 weeks of first study drug administration
    Additional Exclusions
    25. History or clinical evidence of alcohol or drug abuse within the 12 months before screening or a positive drug screen at screening unless it can be explained by a prescribed medication (the diagnosis and prescription must be approved by the investigator). Cannabis use is permitted.
    Additional Exclusions Criteria for Hepatically Impaired Participants
    26. Participants requiring paracentesis > 1 time per month.
    27. Participants with refractory encephalopathy or significant Central Nervous System disease as judged by the investigator.
    28. History of gastric or esophageal variceal bleeding within the past 6 months.
    29. Participants with Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement.
    30. Presence of hepatopulmonary or hepatorenal syndrome.
    31. Presence of primary cholestatic liver diseases.
    32. Inability or unwillingness to comply with dietary recommendations for liver cirrhosis and hepatic impairment as advised by the investigator and lifestyle considerations outlined in this protocol.
    Condizioni mediche
    1.Anamnesi di malattia epatica clinicamente significativa a eziologia non HBV e non HDV determinata dallo sperimentatore
    2.Anamnesi di malattia da immunocomplessi clinicamente significativa determinata dallo sperimentatore
    3.Anamnesi di malattia autoimmune clinicamente significativa determinata dallo sperimentatore
    4.Anamnesi di malattia extraepatica correlata all'HBV, inclusi, a titolo esemplificativo ma non esaustivo, eruzione cutanea, artrite o glomerulonefrite correlati all'HBV
    5.Anamnesi di reazioni allergiche, ipersensibilità o intolleranza al farmaco in studio, ai suoi metaboliti o eccipienti
    6.Anti-HBs >10 mUI/L allo screening
    7.Intervallo QT corretto (QTc) > 450 millisecondi
    8.AST o ALT > 5x ULN
    9.Bilirubina totale > 2,0 mg/dL
    10.Albumina sierica < 30 g/L
    11.Conta assoluta dei neutrofili < 1.000/mm3 (/pL)
    12.Rapporto internazionale normalizzato (INR) > 1,5
    13.Emoglobina < 8 g/dL
    14.Anamnesi di anafilassi
    15.Anamnesi di tumore maligno diagnosticato o trattato entro 5 anni (è consentito il trattamento localizzato dei tumori cutanei basocellulari squamosi o non invasivi; carcinoma cervicale in situ è consentito se adeguatamente trattato prima dello screening); i partecipanti in fase di valutazione per malignità non sono ammissibili
    16. Anamnesi o in attesa di trapianto di midollo osseo o di organi solidi
    17. Infezione attiva nota diversa dall'infezione cronica da HBV e HDV o qualsiasi condizione acuta clinicamente significativa come febbre (> 38 °C) o malattia respiratoria acuta nei 7 giorni prima del giorno 1
    18.Coinfezione con virus dell'immunodeficienza umana (HIV), virus dell'epatite A (HAV), virus dell'epatite C (HCV) o virus dell'epatite E (HEV).
    I partecipanti che sono positivi per gli anticorpi anti HCV e negativi per HCV RNA sono idonei. I partecipanti che sono positivi per l'anticorpo immunoglobulina M (IgM) anti-HAV o anti-HEV non sono idonei.
    I partecipanti asintomatici e positivi per gli anticorpi immunoglobulina G (IgG) anti-HAV o anti-HEV sono idonei.
    19.Qualsiasi condizione medica o psichiatrica clinicamente significativa che possa interferire con l'intervento, la valutazione o il rispetto del protocollo dello studio o che altrimenti rende il partecipante inadatto alla partecipazione allo studio, come determinato dallo sperimentatore. I partecipanti con diabete mellito controllato sono idonei.
    20.Epatite cronica acuta o in peggioramento, funzionalità epatica fluttuante o in rapido deterioramento o uso di qualsiasi terapia nota per esacerbare la disfunzione epatica secondo il parere dello sperimentatore.
    Terapia precedente/concomitante
    21.Terapia con un agente immunomodulatore, IFN-a (p. es., IFN-alfa-2a o IFN-alfa-2b, o IFN-alfa-2a o alfa 2b pegilato), immunosoppressori (p. es., farmaci antireumatici modificanti la malattia), agenti citotossici o chemioterapici o corticosteroidi sistemici cronici entro 6 mesi dallo screening.
    22.Aver ricevuto un agente attivo anti-HDV (inclusi lonafarnib e bulevirtide) entro 90 giorni o 5 emivite (se nota), a seconda di quale sia il periodo più lungo, prima della somministrazione del farmaco in studio o aver partecipato al periodo di follow-up di un altro studio clinico che prevede un trattamento interventistico. I partecipanti devono inoltre accettare di non prendere parte ad altri studi interventistici in nessun momento durante la loro partecipazione a questo studio, compreso il periodo di follow-up.
    23.Aver ricevuto un oligonucleotide (p. es., siRNA, oligonucleotide antisenso) con attività contro l'HBV nelle 48 settimane prima della somministrazione del farmaco in studio
    24.Aver ricevuto VIR-3434 o qualsiasi anticorpo anti-HBV o anti-HDV nelle 24 settimane dalla prima somministrazione del farmaco in studio
    Criteri di esclusione aggiuntivi
    25.Anamnesi o evidenza clinica di abuso di alcol o droghe nei 12 mesi precedenti lo screening o screening tossicologico positivo allo screening, a meno che non possa essere spiegato da un farmaco prescritto (la diagnosi e la prescrizione devono essere approvate dallo sperimentatore). È consentito l'uso di cannabis.
    Ulteriori criteri di esclusione per i partecipanti con compromissione epatica 26. Partecipanti che necessitano di paracentesi > 1 volta al mese.
    27.Partecipanti con encefalopatia refrattaria o significativa malattia del sistema nervoso centrale secondo il giudizio dello sperimentatore.
    28.Anamnesi di sanguinamento da varici gastriche o esofagee negli ultimi 6 mesi.
    29.Partecipanti con posizionamento di shunt portosistemico intraepatico transgiugulare (TIPS).
    30.Presenza di sindrome epatopolmonare o epatorenale.
    31.Presenza di malattie epatiche colestatiche primarie.
    32.Incapacità o riluttanza a rispettare le raccomandazioni dietetiche per cirrosi epatica e compromissione epatica come consigliato dallo sperimentatore e le considerazioni sullo stile di vita delineate in questo protocollo.
    E.5 End points
    E.5.1Primary end point(s)
    • Proportion of participants with = 2 log10 decrease in HDV RNA from baseline or HDV RNA < LLOQ (TND) and ALT normalization (<ULN) at Week 24 (Cohort 2 only)

    • Treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs)
    • Percentuale di partecipanti con riduzione > 2 log10 dell'RNA dell'HDV rispetto al basale o RNA dell'HDV < LLOQ (TND) e normalizzazione dell'ALT (<ULN) alla settimana 24 (solo coorte 2)
    • Eventi avversi emergenti dal trattamento (TEAE) ed eventi avversi gravi (SAE)
    E.5.1.1Timepoint(s) of evaluation of this end point
    • Week 24

    • Total study duration (up to 102 weeks)
    • Settimana 24
    • Durata totale dello studio (fino a 102 settimane)
    E.5.2Secondary end point(s)
    • Proportion of participants with = 2 log10 decrease in HDV RNA from baseline or HDV RNA < LLOQ (TD or TND) and ALT normalization (< ULN) at Week 12, Week 48, Week 72, and Week 96

    • Proportion of participants with = 2 log10 decrease in HDV RNA from baseline or HDV RNA < LLOQ (TD or TND) at Week 12, Week 24, Week 48, Week 72, and Week 96

    • Proportion of participants with = 2 log10 decrease in HDV RNA from baseline or HDV RNA < LLOQ (TD or TND) at Week 12, Week 24, Week 48, Week 72, and Week 96

    • Incidence of ADA and titers of ADA to VIR-3434 at each study visit up to Week 96 (for cohorts with VIR-3434)

    • Change from baseline in liver fibrosis at Week 48 and Week 96

    • Change from baseline in Model for End Stage Liver Disease (MELD) score at Week 12, Week 24, Week 36, Week 48, Week 60, Week 72, Week 84 and Week 96

    • Change from baseline CPT score at Week 24, Week 48, Week 72 and Week 96
    • Percentuale di partecipanti con riduzione > 2 log10 dell'RNA dell'HDV rispetto al basale o dell'RNA dell'HDV < LLOQ (TD o TND) e normalizzazione dell'ALT (< ULN) alle settimane 12, 48, 72 e 96
    • Percentuale di partecipanti con diminuzione > 2 log10 dell'RNA dell'HDV rispetto al basale o dell'RNA dell'HDV < LLOQ (TD o TND) alle settimane 12, 24, 48, 72 e 96
    • Percentuale di partecipanti con diminuzione > 2 log10 dell'RNA dell'HDV rispetto al basale o dell'RNA dell'HDV < LLOQ (TD o TND) alle settimane 12, 24, 48, 72 e 96
    • Incidenza di ADA e titoli di ADA per VIR-3434 a ogni visita di studio fino alla settimana 96 (per le coorti con VIR-3434)
    • Variazione rispetto al basale della fibrosi epatica alla settimana 48 e alla settimana 96
    • Variazione rispetto al basale nel punteggio MELD (Model for End Stage Liver Disease) alle settimane 12, 24, 36, 48, 60, 72, 84 e 96
    • Modifica dal punteggio CPT rispetto al basale alle settimane 24, 48,
    72 e 96
    E.5.2.1Timepoint(s) of evaluation of this end point
    Timepoints of each end point detailed in previous section (E.5.2).
    Punti temporali di ciascun punto finale dettagliati nella sezione precedente (E.5.2).
    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 Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    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 No
    E.8.1.2Open No
    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 Yes
    E.8.1.7.1Other trial design description
    In aperto, Randomizzato e Gruppi paralleli
    Open and Randomised
    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 trial6
    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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA7
    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 Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    New Zealand
    France
    Bulgaria
    Netherlands
    Romania
    Germany
    Italy
    Moldova, Republic of
    United Kingdom
    E.8.7Trial 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
    The end of study is defined as the last scheduled visit (or scheduled contact) of the last participant.
    La fine dello studio è definita come l'ultima visita programmata (o contatto programmato) dell'ultimo partecipante.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months1
    E.8.9.1In the Member State concerned days15
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months1
    E.8.9.2In all countries concerned by the trial days15
    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: 65
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 5
    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 No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state10
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 53
    F.4.2.2In the whole clinical trial 70
    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)
    Sponsor intends to provide continued access to investigational agents to participants deriving clinical benefit at EOS based on sponsor evaluation and in discussion with individual study investigators.Sponsor will provide access to investigational agents until they become commercially available, or until sponsor discontinues development.Any additional access or study drug administration will occur as part of a separate study protocol and only after all applicable HA and EC approvals are obtained
    Sponsor intende fornire un accesso continuo agli agenti sperimentali per i pt che traggono beneficio clinico a EOS sulla base della valutazione dello Sp e dopo discussione con gli sperimentatori. Lo Sp fornirà l'accesso fino a quando saranno disponibili in commercio o fino a quando interromperà lo sviluppo. Qualsiasi accesso o somministrazione del farmaco aggiuntivo avverrà come parte di un protocollo separato e solo dopo che tutte le approvazioni di CA e CE saranno state ottenute.
    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 Decision2023-02-02
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-12-20
    P. End of Trial
    P.End of Trial StatusOngoing
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