Design Randomisation 1 : 1 Double-blind W8 W12

Slides:



Advertisements
Similar presentations
ALLY-2  Design  Objective –SVR 12 (HCV RNA < 25 IU/ml), with 95% CI, in treatment-naïve genotype 1 treated for 12 weeks DCV + SOF 400 mg QD DCV + SOF.
Advertisements

C-EDGE co-infection study: grazoprevir/ elbasvir in HIV coinfection GZR/EBR 100/50 mg qd N = 218  Design W12 W24 C-EDGE co-infection Rockstroh JK. Lancet.
SMV 150 mg QD + SOF 400 mg QD Randomisation 1 : years HCV genotype 1 Naïve or pre-treated with IFN-based regimen No cirrhosis HCV RNA ≥
UNITY-1 DCV/ASV/BCB No randomisation Open-label UNITY-1 Study: daclatasvir/asunaprevir/beclabuvir in genotype 1 without cirrhosis  Design W12 ≥ 18 years.
NIAID ERADICATE Open-label W12 ≥ 18 years Chronic HCV infection Genotype 1 Treatment naïve HIV infection on stable ART ≥ 8 weeks and HIV RNA < 50 c/ml.
OBV/PTV/r Placebo Randomisation** 2 : years Chronic HCV Genotype 1b HCV RNA ≥ 10,000 IU/ml Naïve or pre-treated, no prior failure with DAA Without.
No randomization N = 59 W12W24 Arm B : compensated cirrhosis N = 31 N = 29 Arm C : compensated cirrhosis Arm A : No cirrhosis AGATE-II Study: OBV/PTV/r.
ALLY-3  Design  Objective –SVR 12 (HCV RNA < 25 IU/ml), with 95% CI DCV 60 mg qd + SOF 400 mg qd Not randomised Open-label ALLY-3 Study: DCV + SOF for.
> 18 years Chronic HCV infection Genotype 1 Failure (relapse) to 4, 6 or 8 weeks of GZR/EBR + SOF in C-SWIFT Part A Compensated cirrhosis assessed by liver.
SOF/VEL 400/100 mg qd N = 500 N = 100 W12 Placebo > 18 years Chronic HCV infection Genotype 1, 2, 4, 5 or 6 Naïve or pre-treatment with IFN-based regimen.
Asselah T. AASLD 2015, Abs. 714 Randomisation 1:1 Open-label years HCV genotype 4 HCV RNA ≥ 1,000 IU/ml Naïve or pre-treated with PEG-IFN + RBV (Part.
OBV/PTV/r + DSV Open label Chronic HCV infection Genotype 1 Treatment-naïve HCV RNA > 1,000 IU/ml Chronic kidney disease with eGFR < 30 ml/min/1.73m 2.
No randomisation Open-label years HCV genotype 1 Naïve or null-response to PEG-IFN + RBV HCV RNA > 10,000 IU/ml No cirrhosis No HBV or HIV co-infection.
 Objective –SVR 12 (HCV RNA < 25 IU/ml), with 95% CI, next observation carried backward DCV + SOF + RBV Randomised* 1:1 Open-label ALLY-3+ study: DCV.
LDV/SOF Failure Open-label W24 Chronic HCV infection Genotype 1 Failure to achieve SVR on LDV/SOF-containing regimen Compensated cirrhosis (liver biopsy.
SOF/VEL 400/100 mg qd N = 120 W12 SOF + RBV > 18 years Chronic HCV infection Genotype 2 Naïve or pre-treatment with IFN-based regimen Compensated cirrhosis.
Dore G. J Hepatol 2016; 64:19-28 MALACHITE TVR + PEG-IFN + RBV Randomisation Open-label years HCV genotype 1 HCV RNA > 10,000 IU/ml Naïve (MALACHITE-I)
GZR/EBR 100/50 mg qd N = 107 N = 52 W12W24W16 PlaceboGZR/EBR W28 > 18 years HCV infection Genotype 1, 4, 6 IBLD: sickle cell anemia,  -thalassemia, hemophilia.
SOF/VEL 400/100 mg qd N = 106 W12 > 18 years Chronic HCV infection Genotype 1-6 Naïve or pre-treatment with IFN-based regimen Compensated cirrhosis allowed*
 Objective –SVR 12 (HCV RNA < 25 IU/ml), by ITT OBV/PTV/r + SOF + RBV OBV/PTV/r + SOF Not randomised Open-label QUARTZ-II Study: OBV/PTV/r + SOF for HCV.
No cirrhosis or compensated cirrhosis * No HBV or HIV coinfection
Design Randomisation* 1 : 1 Open-label W8 W12
ARV-trial.com RUBY-II Study: ombitasvir/paritaprevir/ritonavir + dasabuvir for HCV genotype 1a or 4 with severe renal impairment Design Open label W12.
eGFR (MDRD) > 50 mL/min
Design Single arm Open label W12 ≥ 18 years, HCV genotype 1 to 6
No HBV or HIV co-infection
No HBV or HIV co-infection
TOPAZ-II Study: OBV/PTV/r + DSV + RBV for genotype 1
ARV-trial.com SURVEYOR-II study – Part 3: glecaprevir/pibrentasvir + RBV in genotype 3 with treatment experience and/or cirrhosis Design Randomisation.
C-ISLE study: EBR/GZR + SOF + RBV in genotype 3 and cirrhosis
Design No randomisation Open-label W12 W years HCV genotype 1
PHOTON-2 Study: SOF + RBV in HCV-HIV co-infection
> 18 years Chronic HCV infection Compensated cirrhosis **
ARV-trial.com C-CREST study, Part B: uprifosbuvir (MK-3682)/GZR/ruzasvir (MK-8408) fixed-dose combination + RBV for genotypes 1, 2 and 3 - Phase II Randomisation.
Compensated cirrhosis No HBV or HIV co-infection
Design Randomisation 2 : 1 Double-blind W12 ≥ 18 years, HCV genotype 3
C-CORAL Study: elbasvir/grazoprevir for genotype 1, 4, 6
GEODE-II Study: OBV/PTV/r + DSV + low dose RBV in genotype 1a
GARNET Study: OBV/PTV/r + DSV 8 weeks in genotype 1b
No cirrhosis or compensated cirrhosis** No HBV or HIV co-infection
AL study: AL ODV + SMV in naïve patients, phase II
Creatinine clearance ≥ 50 ml/min No HBV or HIV co-infection
Design Randomisation* 1 : 1 Open-label W12
ARV-trial.com RUBY-I Study, cohort 2: ombitasvir/paritaprevir/ritonavir + dasabuvir + RBV for HCV genotype 1 with renal impairment Design Open label W12.
QUARTZ II-III : OBV/PTV/r + SOF RBV in genotype 2 or 3
Glecaprevir-Pibrentasvir in Non-Cirrhotic Genotype 2 ENDURANCE-2
C-BREEZE-2 Study: ruzasvir + uprifosbuvir for 12 weeks in genotype 1-6
Design W12 W16 Randomisation Open-label ≥ 18 years HCV genotype 1 or 4
Design Randomisation* 1 : 1 Double blind W12
SOF/VEL + GS-9857 in genotypes 1-6 Phase II
LEAGUE-1 study: daclatasvir + SMV + RBV for genotype 1
ARV-trial.com SURVEYOR-II study – Part 3: glecaprevir/pibrentasvir ± RBV in genotype 3 with treatment experience and/or cirrhosis Design Randomisation.
Phase 3 Treatment-Naïve and Treatment-Experienced
Phase 3 Treatment-Naïve and Treatment-Experienced
ARV-trial.com IMPACT Study: SMV + DCV + SOF in HCV genotype 1 with decompensated liver disease Design Open label ≥ 18 years Chronic HCV infection Genotype.
ION-3 Study: LDV/SOF + RBV for naïve genotype 1
GS-US Study: SOF/VEL + GS in genotype 2, 3, 4 or 6 - Phase II
EXPEDITION-V Study: GLE/PIB in patients with renal impairment
ARV-trial.com TURQUOISE-I Study: ombitasvir/paritaprevir/ritonavir + dasabuvir + ribavirin for HCV in HIV co-infected patients Randomisation 1 : 1 Open-label.
MAGELLAN-3 Study: GLE/PIB + SOF + RBV in patients who failed GLE/PIB
LDV/SOF ± RBV in genotype 3 or 6 – Phase 2
ARV-trial.com C-CREST study, Part B: uprifosbuvir (MK-3682)/GZR/ruzasvir (MK-8408) fixed-dose combination + RBV for genotypes 1, 2 and 3 - Phase II Randomisation.
No HBV or HIV co-infection
Design W12 W16 Randomisation Open-label ≥ 18 years HCV genotype 1 or 4
SOF/VEL ± RBV in genotype 3 with compensated cirrhosis
ENDURANCE-4 Study: glecaprevir/pibrentasvir in genotype 4, 5 or 6
ARV-trial.com CORAL-I study cohorts 3 to 6: OBV/PTV/r + DSV + RBV in transplant recipients and genotype 1 or 4 Design W12 W24 No randomisation Open-label.
Sequencing cohorts Open-label Design W8 W12 ≥ 18 years
Design W12 Open-label Liver transplant recipients
Glecaprevir-Pibrentasvir in Non-Cirrhotic Genotype 2 ENDURANCE-2
Presentation transcript:

ENDURANCE-1 Study: glecaprevir/pibrentasvir in genotype 1 without cirrhosis Design Randomisation 1 : 1 Double-blind W8 W12 ≥ 18 years, HCV genotype 1 Treatment-naïve or treatment-experienced with IFN or PEG-IFN + RBV or SOF + RBV ± PEG-IFN (exclusion of DAA other than SOF) HCV RNA > 1 000 IU/mL No cirrhosis ** No HBV co-infection HIV co-infection allowed if ARV-naive (HIV RNA < 1000 c/ml and CD4 ≥ 500/mm3) or on stable ART with HIV RNA below detection and CD4 ≥ 200/mm3 (ARV allowed : TDF, 3TC, FTC, ABC, ZDV, RAL, DTG, RPV) N = 351 GLE/PIB SVR12 GLE/PIB SVR12 N = 352 * Fibroscan® < 12.5 kPa or FibroTest® ≤ 0.48 + APRI < 1 GLE/PIB: 100/40 mg 3 tablets QD ENDURANCE-1 Zeuzem S. AASLD 2016, Abs. 253 1

ENDURANCE-1 Study: glecaprevir/pibrentasvir in genotype 1 without cirrhosis Objectives (SVR12) Non-inferiority of the 12-week regimen, by ITT-PS (exclusion of HIV and prior SOF), with lower margin of the 2-sided CI > 91% (historical rate) Non-inferiority of the 12-week regimen, by ITT-PS-PP (ITT-PS + exclusion of premature discontinuation or virologic failure prior to W8 and missing data in the SVR12 window), with lower margin of the 95% CI for the difference = 5% Non-inferiority of the 8-week regimen, by ITT-PS, with a lower margin of the 95% CI for the difference = 5% Secondary endpoints Efficacy in HIV-co-infection and in patients with prior SOF treatment, by ITT Virologic failure and relapse Resistance analysis (15% detection threshold) Safety ENDURANCE-1 Zeuzem S. AASLD 2016, Abs. 253 2

Baseline characteristics ENDURANCE-1 Study: glecaprevir/pibrentasvir in genotype 1 without cirrhosis Baseline characteristics GLE/PIB 8W N = 351 GLE/PIB 12W N = 352 Median age, years 53 52 Female, % 50 Race : White , % 82 86 Median BMI, kg/m2 25 Genotype 1a, % 43 42 Median HCV RNA, log10 IU/mL 6.11 6.14 Fibrosis stage (%) : F0-F1 / F2 / F3 85 / 6 / 9 85 / 7 / 8 IL28B CC, % 29 24 Treatment-experienced, % IFN-based SOF-based 38 99 0.8 1 HIV co-infection, % CD4/mm3, median 4 644 5 801 PPI use, % 6 10 ENDURANCE-1 Zeuzem S. AASLD 2016, Abs. 253 3

Primary Endpoints (SVR12) ENDURANCE-1 Study: glecaprevir/pibrentasvir in genotype 1 without cirrhosis Primary Endpoints (SVR12) 12 Weeks GLE/PIB 8 Weeks GLE/PIB % 100 100 99,7 99,1 * 100 91% (historical rate) 80 60 - 0,6% 40 20 332 331 335 332 ITT-PS ITT-PS-PP ITT-PS ITT-PS-PP ITT-PS: ITT population, excluding HIV co-infected and SOF-experienced patients ITT-PS-PP: ITT-PS population excluding patients with premature discontinuation or virologic failure prior to W8, and missing data in the SVR12 window * 1 patient with genotype 1a in the 8W treatment arm experienced on-treatment virologic failure at D29 ENDURANCE-1 Zeuzem S. AASLD 2016, Abs. 253

Secondary efficacy endpoints (SVR12): ITT population ENDURANCE-1 Study: glecaprevir/pibrentasvir in genotype 1 without cirrhosis Secondary efficacy endpoints (SVR12): ITT population 8 Weeks 12 Weeks 99,7 ** 100 80 60 40 20 99 * 99,7 99 351 336 15 1 352 334 18 2 Overall Mono-infected HIV co-infected SOF-experienced % ITT population: all patients receiving study drug ; none excluded * 1 patient experienced on-treatment virologic failure, 1 patient discontinued on D2 due to non-compliance, 1 patient missing SVR12 data ** 1 patient missing SVR12 data ENDURANCE-1 Zeuzem S. AASLD 2016, Abs. 253

Adverse events and laboratory abnormalities, N (%) ENDURANCE-1 Study: glecaprevir/pibrentasvir in genotype 1 without cirrhosis Adverse events and laboratory abnormalities, N (%) GLE/PIB 8W N = 351 GLE/PIB 12W N = 352 Any adverse event 216 (62%) 234 (66%) Serious adverse event * 5 (1%) 4 (1%) Adverse event leading to discontinuation 1 (0.3) ** Adverse events in > 10% of patients, % Headache Fatigue 19 9 18 12 Laboratory abnormalities AST grade ≥ 3 (5 x ULN) AST grade 4 ALT grade ≥ 3 (5 x ULN) ALT grade 4 Total bilirubin grade 3 (3-10 x ULN) 2 (0.6%) 1 (0.3%) * On treatment: pneumonia aspiration, atrial fibrillation, angina unstable, radius fracture, transient ischemic attack, irritable bowel syndrome. Post-treatment: bronchitis, uterine myoma, suicide attempt. ** dandruff, anxiety and amnesia, all deemed not related to therapy. 1 death occurred during post-treatment period due to an unknown cause considered unrelated to study drug ENDURANCE-1 Zeuzem S. AASLD 2016, Abs. 253 6

ENDURANCE-1 Study: glecaprevir/pibrentasvir in genotype 1 without cirrhosis Summary 99-100% of genotype 1-infected patients without cirrhosis achieved SVR12 with 8 or 12 weeks of glecaprevir/pibrentasvir (GLE/PIB) 8-week treatment was non-inferior to 12-week treatment (all 3 primary endpoints were met) SVR12 rates were high regardless of HIV-1 co-infection (limitation: 5% of the study population) prior treatment experience baseline HCV RNA presence of baseline polymorphisms or other factors GLE/PIB was well tolerated Only 1 patient (0.1%) discontinued study drugs for adverse event No significant laboratory abnormalities ENDURANCE-1 Zeuzem S. AASLD 2016, Abs. 253 7