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OBV/PTV/r Placebo Randomisation** 2 : 1 18-75 years Chronic HCV Genotype 1b HCV RNA ≥ 10,000 IU/ml Naïve or pre-treated, no prior failure with DAA Without cirrhosis or with compensated cirrhosis (Child-Pugh A) No HBV or HIV co-infection N = 106 N = 215 W12W24 * Randomisation was stratified on prior IFN-based therapy (naïve or experienced) ; Naïve patients also stratified on HCV RNA level (< or ≥ 100,000 IU/ml), patients with HCV RNA ≥ 100,000 IU/ml further stratified on eligibility to IFN-based therapy (yes or no) ; Experienced patients also stratified on response to prior IFN therapy (relapse, non response or intolerance) OBV/PTV/r SVR 12 Open label GIFT-I Kumada H. Hepatology 2015; 62:1037-1046 GIFT-I Study: ombitasvir/paritaprevir/ritonavir for genotype 1b japanese patients Treatment regimen –Co-formulated ombitasvir (OBV)/paritaprevir (PTV)/ritonavir (r) : 25/150/100 mg qd = 2 tablets Design No cirrhosis Double-blind OBV/PTV/r Cirrhosis: open-label SVR 12 N = 42
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GIFT-I Kumada H. Hepatology 2015; 62:1037-1046 GIFT-I Study: ombitasvir/paritaprevir/ritonavir for genotype 1b japanese patients Objective –SVR 12 (HCV RNA 100.000 IU/ml, with 95% CI, ITT analysis –Comparison to historical rate with TVR + PEG-IFN + RBV (63%) : superiority if lower bound of the SVR 95% CI > 63%, > 90% power OBV/PTV/r Placebo Randomisation** 2 : 1 18-75 years Chronic HCV Genotype 1b HCV RNA ≥ 10,000 IU/ml Naïve or pre-treated, no prior failure with DAA Without cirrhosis or with compensated cirrhosis (Child-Pugh A) No HBV or HIV co-infection N = 106 N = 215 W12W24 OBV/PTV/r SVR 12 Open label Design No cirrhosis Double-blind OBV/PTV/r Cirrhosis: open-label SVR 12 N = 42 * Randomisation was stratified on prior IFN-based therapy (naïve or experienced) ; Naïve patients also stratified on HCV RNA level (< or ≥ 100,000 IU/ml), patients with HCV RNA ≥ 100,000 IU/ml further stratified on eligibility to IFN-based therapy (yes or no) ; Experienced patients also stratified on response to prior IFN therapy (relapse, non response or intolerance)
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No cirrhosisCirrhosis OBV/PTV/r N = 215 Placebo N = 106 OBV/PTV/r N = 42 Mean age, years61.161.561.8 Female63%56%52% Fibrosis stage F0-F1 / F2 / F3 / F460% / 21% / 20% / 074% / 3% / 23% / 00 / 0 / 2% / 98% IL28B CC genotype56%51%64% HCV RNA log 10 IU/ml, mean6.746.686.64 Prior treatment with IFN-based therapy 35.3%35.8%78.6% Non response37% 58% Relapse29% 24% IFN-intolerance34%234%15% Discontinued treatment, N601 For adverse event / For virologic failure 2121 - 1010 GIFT-I Kumada H. Hepatology 2015; 62:1037-1046 GIFT-I Study: ombitasvir/paritaprevir/ritonavir for genotype 1b Japanese patients Baseline characteristics and patient disposition
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* Treatment-naïve without cirrhosis, IFN-eligible, HCV RNA ≥ 100,000 IU/ml ** 95% CI: 90.5 to 98.8 : superior to the historical SVR 12 with TVR + PEG-IFN + RBV SVR 12 (HCV RNA < 25 IU/ml) OBV/PTV/r (double-blind) OBV/PTV/r (open-label) OBV/PTV/r (cirrhosis) GIFT-I Kumada H. Hepatology 2015; 62:1037-1046 GIFT-I Study: ombitasvir/paritaprevir/ritonavir for genotype 1b Japanese patients 25 50 100 75 94.6** 94.9 94.2 96.1 97.4 Experienced 98.1 98.5 90.5 NaïveAll % 42N Primary Efficacy population* 0 ExperiencedNaïveAll 386810676139215112
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No cirrhosis N = 321 Cirrhosis N = 42 N (%)8 (2.5%)3 (7.1%) On-treatment virologic failure, N21 Relapse, N62 IL28B genotype CC Baseline HCV RNA > 7 log 10 IU/ml 5757 3131 Resistance testing (population sequencing) –At baseline, NS3 resistance-associated variants in 1%, NS5A RAVs in 38% –At failure, 10/11 patients had both NS3 and NS5A RAVs NS3 : D168V alone or + Y56H, N = 8 ; D168A + Y56H, N = 2 NS5A : Y93H alone or + L28M, R30Q, L31M, L31V and/or P58S, N = 10 (in 8/10, Y93H present at baseline) ; L31F, N = 1 GIFT-I Kumada H. Hepatology 2015; 62:1037-1046 GIFT-I Study: ombitasvir/paritaprevir/ritonavir for genotype 1b Japanese patients Patients without SVR 12 on OBV/PTV/r
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OBV/PTV/r N = 215 Placebo N = 106 OBV/PTV/r post placebo N = 106 OBV/PTV/r N = 42 AE leading to treatment discontinuation 2001 Serious adverse event7232 Common adverse event Nasopharyngitis16.7%13.2%7.5%14.3% Headache8.8%9.4%6.6%7.1% Peripheral edema5.1%03.8%7.1% Nausea4.2%3.8%0.9%9.5% Pyrexia1.9%0.9% 9.5% Laboratory abnormalities, N AST > 5 x ULN1100 ALT > 5 x ULN0100 Total bilirubin > 3 x ULN0001 Hemoglobin < 8 g/dl0000 Adverse events and ≥ grade 3 laboratory abnormalities, n (%) GIFT-I Kumada H. Hepatology 2015; 62:1037-1046 GIFT-I Study: ombitasvir/paritaprevir/ritonavir for genotype 1b Japanese patients
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Summary –In this phase III trial in Japanese patients with HCV genotype 1b infection with or without cirrhosis, high SVR 12 rates were achieved with 12 weeks of the IFN-free and RBV-free regimen of OBV/PTV/r –Rate of virologic failure was low (3%) with RAVs observed in both NS3 and NS5A in 10 of 11 patients with virologic failure, including 8 patients with pre-existing NS5A RAV Y93H Y93H is present in 8.2% to 25% Japanese with HCV genotype 1b In this study, Y93H was present at baseline in 14% of patients and SVR 12 was 83% in patients with this RAV at baseline –Among treatment-emergent adverse events, only peripheral edema occurred more frequently with OBV/PTV/r than with placebo All patients who experienced peripheral edema were also taking concurrent calcium channel blockers, with a risk related to the dose of the CCB GIFT-I Kumada H. Hepatology 2015; 62:1037-1046 GIFT-I Study: ombitasvir/paritaprevir/ritonavir for genotype 1b Japanese patients
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