ViZIR: Efficacy and Safety of the Combination Vitamin D With Standard of Care in Egyptian Patients With Untreated Chronic Hepatitis C
Study Details
Study Description
Brief Summary
The purpose of this study is to show the superiority of a 4 weeks lead-in phase of Vitamin D followed by a 48 weeks combination of Vitamin D with PEG-IFN plus RBV in comparison with standard PEG-IFN + RBV in untreated Egyptian patients with chronic hepatitis C, on the sustained virological response (SVR) at 3 months after end of treatment (week 60).
Condition or Disease | Intervention/Treatment | Phase |
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Phase 3 |
Detailed Description
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Method: Phase III, randomized, open-label superiority clinical trial, among Egyptian patients with chronic hepatitis C.
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Treatment strategy: Vitamin D Arm: Vitamin D over a 4 weeks lead-in phase followed by Vitamin D in combination with PEG-INF plus RBV during 48 weeks. Standard of Care Arm: PEG-INF plus RBV during 48 weeks.
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Main outcome: Proportion of patients with Sustained Virological Response (SVR) as defined by HCV RNA below the detection limit based on quantitative PCR 12 weeks after stopping treatment.
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Sample Size: 520 patients (260 per arm)
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Enrollment period: 12 months
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Patient's participation duration: 62 weeks (SOC Arm), 66 weeks (Vit-D Arm)
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Statistical analysis:
The superiority of the vitamin D arm will be tested against the standard PEG IFN + RBV combination. 260 patients in each arm will give 80% power to document a 12% difference in the SVR rates between the experimental (Vitamin D) and the control (standard treatment) arms..
A futility analysis is planned for this study, in order to be able to interrupt the trial prematurely in case preliminary results show a lack of efficacy of vitamin D.
This analysis will be performed on half of the patients, thus 260 patients (130 patients per arm), on a week 12/14 week criterion (HCV RNA viral load at W12/W14).
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Vitamin D Vitamin D + Pegylated Interferon Alpha 2b + Ribavirin |
Drug: Vitamin D + Pegylated Interferon Alpha 2b + Ribavirin
Vitamin D ARM: 28000UI/week during 4 weeks (lead in phase) then 28000 UI/week associated with PegIFN/RBV during 48 weeks
Other Names:
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No Intervention: Standard of Care Pegylated Interferon Alpha 2b + Ribavirin |
Outcome Measures
Primary Outcome Measures
- Proportion of patients with Sustained Virological Response (SVR). [60 Weeks after peg-IFN/RBV initiation]
Proportion of patients with Sustained Virological Response (SVR) as defined by HCV RNA below the detection limit based on quantitative PCR 12 weeks after stopping treatment.
Secondary Outcome Measures
- Rapid Virological Response (RVR) [4 Weeks after peg-IFN/RBV initiation]
HCV RNA at 4 weeks post initiation of combination therapy (PEG IFN + RBV)
- Early Virological Response (EVR) [12 Weeks after peg-IFN/RBV initiation]
HCV RNA at 12 weeks post initiation of combination therapy
- End of Treatment Response (ETR) [48 Weeks after peg-IFN/RBV initiation]
HCV RNA at end of treatment (week 48)
- Normalization of ALT during treatment and 12 weeks after the end of treatment [From 2 Weeks after peg-IFN/RBV initiation to End of Follow-up (Week 60)]
- Incidence of serious adverse events (SAE) grade 3 and 4 (ANRS scale) [From Lead-in phase (Week -4) to End of Follow-up (Week 60)]
incidence of SAE leading to dosage reduction or treatment cessation, percentage of patients treated by EPO and G-CSF
- Evolution of FibroScan values between pre-inclusion and week 60 [At Screening Visit 2 (S2) and at End of Follow-up (Week 60)]
Eligibility Criteria
Criteria
Inclusion Criteria:
Common with National Program for Viral Hepatitis
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Age: 18 years to 60 years
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Positive HCV antibodies using a third generation test
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Detectable HCV RNA by PCR
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Liver biopsy showing chronic hepatitis with either a METAVIR score F1 with elevated liver enzymes or scores F2/F3
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Naïve to treatment with PEG-IFN and RBV
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HBs antigen negative
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Prothrombin time ≥60 %, normal bilirubin, alpha-foeto protein < 3*normal range of the laboratory, anti-nuclear antibodies<1/160 Effective contraception during the treatment period; no breast-feeding
Specific to the trial
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Prior approval from the Ministry of Health to be treated as part of the National Program with allocation to Peg-IFN α2b treatment
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Living <100 km from Cairo and able to come to the centre every week for the treatment
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Signed informed consent and willingness to participate in the trial
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Naïve to treatment with vitamin D (received vitamin D less than 30 consecutive days in the 3 months preceding inclusion)
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Biopsy slide validated by NHTMRI pathologist
Exclusion Criteria:
Common with National program for Viral Hepatitis
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Serious co-morbid conditions such as severe hypertension, heart failure, significant coronary heart disease, poorly controlled diabetes (HbA1C>8%) , chronic obstructive pulmonary disease
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Major uncontrolled depressive illness
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Solid transplant organ (renal, heart, or lung)
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Untreated thyroid disease
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History of previous anti-HCV therapy
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Body mass index (BMI) greater than 30 kg/m²
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Known human immunodeficiency virus (HIV) coinfection: although HIV testing will not be proposed or done, patients with known HIV coinfection will not be included in the trial
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Anti-HCV therapy contraindications:
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hypersensitivity to one of the two drugs (PEG-IFN, RBV)
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pregnancy or unwilling to comply with adequate contraception
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breast-feeding
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neutropenia (<1500/mm3)
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anaemia (<11g/dL for women ; <12g/dL for men)
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thrombocytopenia (<100,000/mm3)
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elevated creatinin (>1.5mg/dL)
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concomitant liver disease other than hepatitis C (immuno-active chronic hepatitis B, autoimmune hepatitis, alcoholic liver disease, hemochromatosis, alpha-1 antitrypsin deficiency, Wilson disease)
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liver biopsy showing severe steatosis (>66%) and steatohepatitis; decompensated cirrhosis (Child Pugh>A); hepatocellular carcinoma, METAVIR score F4.
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TSH>5 mU/L
Specific to the trial
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Patients allocated to Peg-IFN alpha 2a treatment
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Hypersensitivity to vitamin D
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Vitamin D contraindications:
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hypercalcaemia (fasting calcaemia >105 mg/L or 2.62 mmol/L)
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ratio calciuria / creatininuria (fasting ratio >1 mmol Ca/mmol creatinin)
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hyperphosphatemia (>1.5 mmol/L)
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calcium lithiasis
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patients being treated with thiazide diuretics (risk of hypercalcaemia with vitamin D treatment)
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patients being treated with glucocorticoïds (decrease in vitamin D efficacy)
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postmenopausal women treated by vitamin D and calcium for osteoporosis
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Treatment by vitamin D more than 30 consecutive days in the 3 months preceding inclusion in the trial.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | NHTMRI | Cairo | Egypt |
Sponsors and Collaborators
- ANRS, Emerging Infectious Diseases
- Institut Pasteur
Investigators
- Study Chair: Gamal Esmat, MD, PhD, NHTMRI, Cairo, Egypt
- Study Chair: Arnaud Fontanet, MD, PhD, Institut Pasteur, Paris France
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- ANRS 12226 ViZIR