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Trial record 66 of 82 for:    GRAZOPREVIR ANHYDROUS AND ELBASVIR

ATTIC - Access To Treat in the Community (ATTIC)

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ClinicalTrials.gov Identifier: NCT03797066
Recruitment Status : Not yet recruiting
First Posted : January 8, 2019
Last Update Posted : March 11, 2019
Sponsor:
Collaborators:
Merck Sharp & Dohme Corp.
Hepatitis C Trust
Information provided by (Responsible Party):
King's College Hospital NHS Trust

Brief Summary:
The study is looking at the potential of utilizing a "point of care" test and treat pathway; using the DDA called Zepatier for achieving SVR in an homeless population who have tested positive for genotype 1 or 4 HCV.

Condition or disease Intervention/treatment Phase
Hepatitis C, Chronic Drug: ZEPATIER 50Mg-100Mg Tablet Phase 4

Detailed Description:

Direct acting antivirals (DAA) are new medications that have been approved for the management of HCV. These drugs have proven to be very effective in curing the HCV, without the need for interferon injections; which have always been used in the past. There are many combinations of DAAs, which treat specific types of HCV. Persons who test positive for the virus are typically referred to be seen and treated by a specialist hepatitis service based in hospital. This means that individuals may sometimes not attend the hospital to commence treatment; or follow up on their management.

The study is designed to explore if testing and treating individuals close to their own "local" setting will be an improvement to the current treatment pathway and encourage better involvement with the health care team; as well as looking at what the health care team can do to ensure participants in this test-and-treat trial receive the entire course of drug treatment prescribed to treat their HCV infection.

Participants infected with either genotype 1 or 4 HCV infection will be treated with Zepatier, a DAA which works by stopping the hepatitis C virus from (multiplying). The study medication is taken for 12 or 16 weeks depending on the genotype (or strain of HCV). Some participants will be given an additional drug called ribavirin. The study will examine the effectiveness of Zepatier at clearing the hepatitis C virus from the blood and body; and also what particular effects may be experienced by participants who may also be taking treatment for other conditions. Participants affected with other genotypes (not 1 and 4)will be offered standard NHS treatment with the appropriate antiviral combination for these strains.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 150 participants
Intervention Model: Single Group Assignment
Intervention Model Description: non-randomised, open label
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Localized on -Site Testing and Treatment of Hepatitis C in Homeless Persons in South London: a Pilot Non-randomised Phase 4 Interventional Clinical Trial of Grazoprevir and Elbasvir ± Ribavirin in Participants With Genotype 1a, 1b or 4 to Measure Efficacy and Adherence to Treatment in a Homeless Population
Estimated Study Start Date : April 2019
Estimated Primary Completion Date : December 2020
Estimated Study Completion Date : March 2021

Resource links provided by the National Library of Medicine



Intervention Details:
  • Drug: ZEPATIER 50Mg-100Mg Tablet
    Zepatier 50/100 OD , with addition of Ribavarin in patients with Genotype 1a and 4 with HCV RNA> 800,000 iu/ml or baseline NS5A resistance.


Primary Outcome Measures :
  1. SVR [ Time Frame: 24 months ]
    The percentage of participants achieving an SVR, defined as an HCV RNA evel less than the lower limit of quantification by sensitive PCR; by means of a short directed test and treat program in the homeless community.


Secondary Outcome Measures :
  1. prevalence of HCV infection [ Time Frame: 24 months ]
    Reduction in local prevalence of of viraemic hepatitis C, after a pilot trial of treatment in three to four homeless hostels.

  2. Baseline knowledge evaluation [ Time Frame: 24 months ]
    Participant knowledge of their hepatitis C status (disease, diagnosis, and current available approved treatments) will be assessed by means of a questionnaire completed at baseline. The researchers will also review participants willingness to engage in a test and treat protocol and correlate these findings with demographic and sociological data. This will be done using a questionnaire designed by the researchers; containing simple questions with respect to currently available testing and treatment of HCV infection.

  3. Change From Baseline (BL) to SVR12 timepoint in 36-Item Short-Form Health Survey (SF-36) Scores [ Time Frame: baseline, SVR 12 (twelve weeks post end of active treatment/ last dose of study drug) ]

    The 36-Item Short Form Health Survey (SF-36) is a set of generic, coherent, and easily administered quality-of-life measures. The survey addresses eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. It also includes a single item that provides an indication of perceived change in health. Participants self-report on items in a subscale that have between 2-6 choices per item using Likert-type responses (e.g. none of the time, some of the time, etc.). Summations of item scores of the same subscale give the subscale scores, which are transformed into a range from 0 to 100; zero= worst HRQL, 100=best HRQL.

    Data will be analysed ffg the guidelines suggested by the developers https://www.rand.org/health/surveys_tools/mos/36-item-short-form/scoring.html


  4. Change From Baseline (BL) to SVR 12 in Chronic Liver Disease Questionnaire-Hepatitis C Virus (CLDQ-HCV) [ Time Frame: baseline , SVR 12 (twelve weeks post end of active treatment/last dose of study drug) ]
    Impact of a localized test and treat protocol on health related quality of life will be assessed using the CLDQ-HCV instruments. The CLDQ-HCV is a disease-specific questionnaire measuring HRQL that contains 29 items divided into 4 domains: emotional function (9 items), worry (6 items), systemic symptoms (8 items) and activity/energy (6 items). All items refer to the previous 2 weeks and are rated on a 7 point Likert scale, with 1 corresponding to the maximum frequency ("all of the time") and 7 to the minimum ("none of the time"). Domain scores are the means of the items contained. A summary score is calculated by the mean of all domain scores (CLDQ-HCV Global). Higher scores indicate better health-related quality of life

  5. Percentage of Participants Who Were Compliant With Treatment According To Moriskey, Green And Levine Adherence Scale (MAS4)(Subset Analysis) [ Time Frame: 12 or 16 weeks ]
    Adherence to treatment measured by Moriskey, Green and Levine Adherence scale. This is a 4 item questionnaire that is easy to administer and score (using a yes/no format); and quickly identifies barriers to adherence.An answer of yes to zero questions indicates high adherence behavior, answering yes to one or two questions indicates medium adherence behavior, and answering yes to three or four questions indicates low adherence behavior

  6. Percentage of Participants Who Were Compliant With Treatment According To Medication Count (Subset Analysis) [ Time Frame: 12 or 16 weeks ]
    Compliance will be calculated as the amount of dispensed medication minus the amount of medication returned by participants at each visit.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 90 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Participants 18 years or older with chronic hepatitis C genotype 1 or 4 will be eligible.
  2. Able and wiling to provide written informed consent.
  3. Both interferon treatment naïve and experienced participants will be included.
  4. Participants without cirrhosis will be eligible if HCV RNA positive, documented chronic hepatitis C and a FibroScan of ≤ 12.5.
  5. Participants with cirrhosis (Fibroscan > 12.5 or APRI > 2) will be eligible if the serum albumin is > 3.5 g/dl, platelets > 100,000 and INR < 1.5 and there is no prior history of hepatic decompensation.
  6. Participants with well controlled HIV coinfection will be included, but should be stabilized on antiretrovirals for which no clinically significant interaction is expected.
  7. Participants who are HBsAg positive will be included, but will require antiviral prophylaxis for HepB. Anti- HbC positive participants will be included. Prophylaxis will not be given, but these participants will require careful monitoring of their ALT levels.

Exclusion Criteria:

  • Persons with prior HCV DAA treatment
  • Individuals younger than 18 years of age
  • Individuals infected with genotypes other than 1a or 1b or 4 HCV identified on screening; however such participants identified on screening will be offered appropriate NHS England standard of treatment for the genotype.
  • Unable or unwilling to give informed consent
  • Active tuberculosis
  • Females who are pregnant, planning pregnancy or breastfeeding
  • Concurrent and/or recent involvement in other research that is likely to interfere with the intervention within three months of study enrolment
  • Clinically-significant medical or psychiatric illness (other than chronic HCV) in the past, present, or being evaluated, that may interfere with participant treatment, safety, assessment or compliance with the protocol
  • Participants with cirrhosis (Fibroscan > 12.5 or APRI > 2) and serum albumin is < 3.5 g/dl, platelets <100,000 and INR > 1.5 or a prior history of hepatic decompensation
  • Severe renal impairment with eGFR <30 mL/min/1.73m2 or requiring dialysis

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 ClinicalTrials.gov identifier (NCT number): NCT03797066


Contacts
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Contact: Vernie Ramalingam +442032992038 vernie.ramalingam@nhs.net
Contact: Sarah Montague +442032995030 sarah.montague@nhs.net

Locations
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United Kingdom
Kings College Hospital NHS Trust Not yet recruiting
London, United Kingdom, SE5 9RS
Contact: Sarah Montague    +442032992038    sarah.montague@nhs.net   
Principal Investigator: Kosh Dr Agarwal         
Sponsors and Collaborators
King's College Hospital NHS Trust
Merck Sharp & Dohme Corp.
Hepatitis C Trust

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Responsible Party: King's College Hospital NHS Trust
ClinicalTrials.gov Identifier: NCT03797066     History of Changes
Other Study ID Numbers: KCHATTIC01
First Posted: January 8, 2019    Key Record Dates
Last Update Posted: March 11, 2019
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: anonymised data sharing only, via publications

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes
Keywords provided by King's College Hospital NHS Trust:
hepatitis C virus
homeless
Additional relevant MeSH terms:
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Elbasvir-grazoprevir drug combination
Hepatitis A
Hepatitis C
Hepatitis C, Chronic
Hepatitis
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Virus Diseases
Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
Flaviviridae Infections
Hepatitis, Chronic
Antiviral Agents
Anti-Infective Agents