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TURQUOISE-I OBV/PTV/r + DSV + RBV Randomisation* 1 : 1 Open-label 18-70 years HCV genotype 1 HCV RNA ≥ 10,000 IU/ml Naïve or pre-treated with PEG-IFN + RBV HIV infection, on ATV/r or RAL HIV RNA < 40 c/ml and CD4 ≥ 200/mm 3 Cirrhosis Child-Pugh A allowed No HBV co-infection Design N = 32 N = 31 W12W24 * Randomisation stratified on prior PEG-IFN + RBV therapy, and cirrhosis ; naïve patients also stratified on IL-28B (CC vs non-CC); experienced patients also stratified on prior response (null, partial, relapse) Treatment regimens –Co-formulated ombitasvir (OBV)/paritaprevir (PTV)/rironavir (r) : 25/150/100 mg qd = 2 tablets –Dasabuvir (DSV) : 250 mg bid –RBV : 1000 or 1200 mg/day (bid dosing) according to body weight (< or ≥ 75 kg) Primary efficacy endpoint –SVR 12 (HCV RNA < 25 IU/ml), with 2-sided 95% CI, comparison between groups TURQUOISE-I Study: ombitasvir/paritaprevir/ritonavir + dasabuvir + ribavirin for HCV in HIV co-infected patients Sulkowski MS, JAMA 2015;315:1223-31
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Baseline characteristics and patient disposition 12 weeks N = 31 24 weeks N = 32 Mean age, years50.9 Female6%9% Body mass index, mean26.427.2 Genotype : 1a / 1b87% / 13%91% / 9% IL28B non-CC genotype84 %78 % HCV RNA log 10 IU/ml, mean (SD) 6.54 ± 0.576.60 ± 0.78 Fibrosis score F0-F1 / F2 / F3 / F4 (%)52 / 16 / 13 / 1963 / 16 / 3 / 19 Prior treatment with PEG-IFN + RBV, N (%)11 (35%)10 (31%) Null response55 Partial response52 Relapse13 CD4/mm 3, mean633625 ARV regimen : ATV/r / RAL52% / 48%38% / 63% Discontinued treatment, N 1 (withdrew consent) 1 (virologic breakthrough) TURQUOISE-I TURQUOISE-I Study: ombitasvir/paritaprevir/ritonavir + dasabuvir + ribavirin for HCV in HIV co-infected patients Sulkowski MS, JAMA 2015;315:1223-31
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Virologic Outcome 12 weeks N = 31 24 weeks N = 32 SVR 12 (HCV RNA < 25 IU/ml)94% (95% CI: 79 - 98)91 % (95% CI : 76 - 97) Failure*, N Reasons 2 1 consent withdrawn 1 relapse 3 1 virologic breakthrough 2 re-infection Mutations detected Relapse NS3 : D168V NS5A : M28T NS5B : S556G Breakthrough NS3 : R155K NS5A : Q30R NS5B : S556G Prior PEG-IFN + RBV therapy in failures Naïve = 1, Null response = 1Naïve = 2, Null response = 1 Fibrosis stage in failuresF3 / F4F4 / F0-F1 / F0-F1 * All 5 = genotype 1a No HIV RNA failure (3 blips in W12-group and 5 blips in W24-group) Decrease in absolute but not relative CD4 cell counts TURQUOISE-I TURQUOISE-I Study: ombitasvir/paritaprevir/ritonavir + dasabuvir + ribavirin for HCV in HIV co-infected patients Sulkowski MS, JAMA 2015;315:1223-31
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12 weeks, N = 3124 weeks, N = 32 AE leading to treatment discontinuation00 AE leading to RBV dose reduction56 Serious adverse event00 AE occurring in > 10% in either group Fatigue58%38% Insomnia16%22% Nausea16%19% Headache19%13% Upper respiratory tract infection13%16% Pruritus19%6% Cough7%16% Ocular icterus16%3% Diarrhea3%13% Hyperbilrubinemia13%3% ALT > 5 x ULN / AST > 5 x ULN0 / 00 / 1 Total bilirubin > 3 x ULN35%19% Adverse events, n (%) TURQUOISE-I TURQUOISE-I Study: ombitasvir/paritaprevir/ritonavir + dasabuvir + ribavirin for HCV in HIV co-infected patients Sulkowski MS, JAMA 2015;315:1223-31
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TURQUOISE-I Study: ombitasvir/paritaprevir/ritonavir + dasabuvir + ribavirin for HCV in HIV co-infected patients Summary –In this open-label, randomised uncontrolled study, treatment with the all-oral, IFN-free 3D plus ribavirin regimen resulted in high SVR 12 rates among patients co-infected with HCV genotype 1 and HIV-1 whether treated for 12 or 24 weeks No discontinuation for AE The 2 failures (1 virologic breakthrough and 1 relapse) were observed in patients with genotype 1a and F4 fibrosis –Limitations Small sample size ARV therapy limited to ATV/r- or RAL-containing regimens Role of RBV not addressed Sulkowski MS, JAMA 2015;315:1223-31 TURQUOISE-I
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