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Efficacy of All-Oral Anti-Viral Therapy for Symptomatic Hepatitis C Virus Infection-Related Cryoglobulinemia

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02825212
Recruitment Status : Completed
First Posted : July 7, 2016
Results First Posted : December 17, 2020
Last Update Posted : December 17, 2020
Gilead Sciences
Information provided by (Responsible Party):
Peter Gorevic, Icahn School of Medicine at Mount Sinai

Brief Summary:

10 patients with chronic genotype 1 HCV infection and mixed cryoglobulinemia will be treated with Ledipasvir/Sofosbuvir 90mg/400 mg FDC once daily for 12 weeks (naïve subjects or non-cirrhotic treatment experienced subjects) or 24 weeks (treatment experienced subjects with cirrhosis).

The researchers anticipate that approximately 20% of subjects may have cirrhosis.

Condition or disease Intervention/treatment Phase
Hepatitis C Cryoglobulinemia Drug: Harvoni Drug: Epclusa Phase 2 Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 10 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Efficacy of All-Oral Anti-Viral Therapy for Symptomatic Hepatitis C Virus Infection-Related Cryoglobulinemia
Study Start Date : February 2016
Actual Primary Completion Date : July 19, 2019
Actual Study Completion Date : July 19, 2019

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Participant with Symptomatic Hepatitis C Virus Infection-Related Cryoglobulinemia

Participants treated with either Harvoni or Epclusa

  • Harvoni 90mg/400 mg FDC once daily. Subjects will take 1 tablet daily with or without food.
  • Epclusa 400mg/100mg 400mg/100mg FDC once daily
Drug: Harvoni
12 weeks for naïve subjects or non-cirrhotic treatment experienced subjects; or 24 weeks for treatment experienced subjects with cirrhosis
Other Names:
  • Ledipasvir/Sofosbuvir

Drug: Epclusa
once daily for 12 weeks (naïve subjects, non-cirrhotic treatment experienced or treatment experienced subjects with compensated cirrhosis) for genotype 1-6 subjects.
Other Name: Sofosbuvir/Velpatasvir

Primary Outcome Measures :
  1. Sustained Virologic Response (SVR) [ Time Frame: 2-4 weeks and 24 weeks after treatment ]
    Number of participants who attain SVR, ie, cleared HCV

  2. Response in Patients With Mixed Cryoglobulinemia (MC) [ Time Frame: up to 24 weeks after treatment ]
    Response to medication in patients with MC categorized as either complete response (100% response) vs partial response (50% response).

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Subjects must meet all of the following inclusion criteria to be eligible for participation in this study.

  1. Willing and able to provide written informed consent
  2. Male or female, age ≥18 years
  3. HCV RNA ≥ 15 IU/mL at Screening
  4. HCV genotype 1
  5. Chronic HCV infection (≥ 6 months) documented by prior medical history or liver biopsy
  6. Classification as treatment naïve or treatment experienced:

    1. Treatment naïve is defined as having never been exposed to approved or experimental HCV-specific direct-acting antiviral agents or prior treatment of HCV with interferon or ribavirin or DAAs (except for SOF-containing regimens).
    2. Treatment experienced is defined as prior treatment failure or relapse to a regimen containing interferon either with or without RBV or DAAs (except for SOF-containing regimens) that was completed at least 8 weeks prior to Baseline/Day 1.

    The subject's medical records must include sufficient detail of prior virologic failure to allow for categorization of prior response, as either:

    1. Non-Responder: Subject did not achieve undetectable HCV RNA levels while on treatment, or
    2. Relapse/Breakthrough: Subject achieved undetectable HCV RNA levels during treatment or within 4 weeks of the end of treatment but did not achieve SVR.
  7. Cirrhosis determination (approximately 20% of subjects may have cirrhosis) a. Cirrhosis is defined as any one of the following:

    i) Any previous liver biopsy showing cirrhosis (e.g., Metavir score = 4 or Ishak score ≥5) ii) FibroMeter® score >0.442 or an AST:platelet ratio index (APRI) >2 during Screening iii) Fibroscan with a result of >12.5 kPa at any time prior to or during screening.

    b. Absence of cirrhosis is defined as any one of the following: i) Liver biopsy within 2 years of Screening showing absence of cirrhosis ii) FibroMeter® score <0.442 or APRI ≤ 1 performed during Screening iii) Fibroscan with a result of ≤12.5 kPa within 6 months of Baseline/Day 1 Fibroscan results will supersede FibroMeter® /APRI; liver biopsy results will supersede Fibrotest® /APRI or Fibroscan results and be considered definitive.

  8. Liver imaging (ultrasound, CT scan or MRI) within 6 months of screening is required in patients with cirrhosis to exclude hepatocellular carcinoma (HCC)
  9. Presence of MC vasculitis (please see criteria on the note below).
  10. Null or partial response to previous therapies for MC, including corticosteroids, cytotoxic agents (cyclophosphamide, azathioprine), hydroxychloroquine, methotrexate, mono- or combination therapy with IFNα/PEG-IFN and ribavirin, and/or CD20 depletion with Rituximab. a. Patients can be on ongoing treatment with one of the drugs described above at inclusion unless there is significant DDI.
  11. Subjects has the following laboratory parameters at screening:

    1. ALT <10 x the upper limit of normal (ULN)
    2. AST <10 x ULN
    3. Adequate bone marrow function as indicated hematologic parameters listed below and/or bone marrow cellularity >60-70% average for age.

    i. WBC >1500 /uL ii.Platelets > 50,000/uL

    d) Direct bilirubin >2 x ULN e) INR >1.5 x ULN unless subject has known hemophilia or is stable on an anticoagulant regimen affecting INR

  12. Females of childbearing potential must have a negative serum pregnancy test at Screening and a negative urine pregnancy test on Baseline/Day 1 prior to treatment.
  13. Male subjects and female subjects of childbearing potential who engage in heterosexual intercourse must agree to use protocol specified method(s) of contraception.
  14. Lactating females must agree to discontinue nursing before the study drug is administered.
  15. Subject must be of generally good health, with the exception of chronic HCV infection, as determined by the Investigator.
  16. Subject must be able to comply with the dosing instructions for study drug administration and able to complete the study schedule of assessments.

Note: Definition of Mixed Cryoglobulinemia (patients must meet one of the five overlapping syndromes listed below and the presence of cold-precipitable immune complexes in blood on two different occasions.

  • Clinical evidence of cryoglobulinemia, overlapping syndromes:

    1. Cutaneous vasculitis (Raynaud's phenomenon, purpura, skin ulcers, livedo, acrocyanosis)
    2. Glomerulonephritis (hypertension, hematuria, nephrotic syndrome)
    3. Arthropathy (arthralgias, arthritis)
    4. Neuropathy (peripheral and/or central nervous system, distal sensorimotor, mononeuritis multiplex)
    5. Sicca syndrome (xerostomia, xerophthalmia)

      Other factors that will be assessed / recorded in patients with MC will be:

    1. Associated laboratory abnormalities including:

  • Positive HCV serology (recombinant immunoblot assay), viral nucleic acid quantitation diagnostic for HCV infection, and reflex genotyping.
  • Evidence of glomerulonephritis, including an active urinary sediment, hypoalbuminemia (albumin <3gm/dL) and/or significant proteinuria (>300mg/day).
  • Abnormal nerve conduction testing. 2. Pathologic evidence of cryoglobulinemia including:
  • Leukocytoclastic vasculitis.
  • Membranoproliferative glomerulonephritis.
  • Vasculopathy and/or mononuclear cell infiltrates on sural nerve biopsy.
  • Lip biopsy suggestive for Sjogren's syndrome. 3. Laboratory evidence of cryoglobulinemia including:
  • Characterization of cryoprecipitable material in serum by immunofixation, cryocrit, and/or quantitation of protein.
  • Associated immunological abnormalities, such as depressed levels of complement, elevated titers of rheumatoid factor, abnormal immunoglobulin quantitations, and serum immunofixation carried out on serum and/or isolated cryoglobulins.

    4. Laboratory evidence of B-cell clonality, including:

  • IgMk determined by immunofixation of serum and/or cryoglobulin, and kappa excess >2.65:1 on Free Light Chain (FLC) assay

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02825212

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United States, New York
Icahn School of Medicine at Mount Sinai
New York, New York, United States, 10029
Sponsors and Collaborators
Icahn School of Medicine at Mount Sinai
Gilead Sciences
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Principal Investigator: Peter Gorevic, MD Icahn School of Medicine at Mount Sinai
  Study Documents (Full-Text)

Documents provided by Peter Gorevic, Icahn School of Medicine at Mount Sinai:
Diagnosis and treatment of HCV-related mixed cryoglobulinemia over the last decade at a Liver Referral Center Ando, Y, Gorevic, PD, Schiano TD. Hepatology 58 2013 : 1443 abstract
Gorevic, PD; "Mixed Cryoglobulinemia Cross-reactive Idiotypes: Structural and Clinical Significance" Cryoglobulinemia & Hepatitis C Infection, Dammacco, F (Editor); Springer Verlag, 2012, p. 99-107.
Gorevic PD and Galanakis DK;

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Responsible Party: Peter Gorevic, Professor, Icahn School of Medicine at Mount Sinai Identifier: NCT02825212    
Other Study ID Numbers: GCO 15-2282
IN-US-337-1716 ( Other Identifier: Gilead Sciences )
First Posted: July 7, 2016    Key Record Dates
Results First Posted: December 17, 2020
Last Update Posted: December 17, 2020
Last Verified: November 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Peter Gorevic, Icahn School of Medicine at Mount Sinai:
Hepatitis C
Additional relevant MeSH terms:
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Hepatitis A
Hepatitis C
Virus Diseases
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
Flaviviridae Infections
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Immunoproliferative Disorders
Immune System Diseases
Ledipasvir, sofosbuvir drug combination
Sofosbuvir-velpatasvir drug combination
Antiviral Agents
Anti-Infective Agents