ANRS HC 33 is a pilot study to assess efficacy and safety of a DCV 3DAA therapy with Asunaprevir, Daclatasvir and BMS-791325 in HCV genotype 4-infected patients after failure of pegylated Interferon-Ribavirin regimen. Proportion of patients with cirrhosis will be limited to 50% of all patients included, cirrhosis being defined as a METAVIR score of F4 on the liver biopsy or an hepatic impulse elastometry ≥ 14 kPa or a Fibrotest® result \> 0,75.
The clinical trial is multi-centre, national, Phase 2, open-label, single-arm. The primary objective of this study is to assess, in HCV genotype 4-infected patients in failure to prior treatment with pegylated Interferon and Ribavirin bitherapy, the rate of sustained virological response (SVR) 12 weeks after 12 weeks of treatment with an all-oral combination of 3 DAAs in a Fixed-Dose-Combination (Asunaprevir 200 mg, Daclatasvir 30 mg and BMS - 791325 75 mg) twice a day. Estimated enrollment is 60 patients during the enrolment period (9 months). Schedule of assessments: w4-w8 : screening D0 : Start of anti-HCV tritherapy (Asunaprevir + Daclatasvir + BMS-791325) w12: stop tritherapy w24: Sustained virological response SVR12 assessment (12 weeks post treatment) w36 : Sustained virological response SVR24 assessment (24 weeks post treatment)
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
All patients will receive an all-oral HCV tritherapy with Asunaprevir (200mg), Daclatasvir (30mg) and BMS-791325 (75mg) in a fixed-dose combination (FDC) tablet, twice a day (1 tablet in the morning and 1 tablet in the evening) for 12 weeks.
France
All the Regions of the Country, France
HCV sustained virological response rate
The primary endpoint is the Sustained Virological Response Rate defined by an undetectable HCV RNA at W24, that is to say 12 weeks after the end of the DCV 3DAA therapy associating Asunaprevir, Daclatasvir and BMS - 791325 (SVR12). In case of premature total or partial interruption of HCV treatment, the primary endpoint will also be assessed at week 24.
Time frame: week 24
Number of patients with adverse events
Time frame: up to week 36
Treatment interruptions
Number of patients who totally or partially interrupt,treatment
Time frame: from day 0 to week12
Causes of treatment discontinuation
toxicity or side effects
Time frame: form day 0 to week 12
Self-reported symptoms
self-questionnaire (ANRS AC24 perceived symptoms scale)
Time frame: Day 0, week 12, week 36
Patients adherence rate
measured using the (ANRS) self -questionnaire
Time frame: week 4, week 12
HCV viral load
Time frame: day 0, week 1, week 2, week 4, week 8, week 12, week 16, week 20, week 24, week 36.
Evaluation of the relationship between HCV subtypic distribution at baseline (by sequencing of the HCV NS5B domain) and the virological kinetics and response
Time frame: at screening
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Proportion of patients with resistance mutations to Asunaprevir and/or Daclatasvir and/or BMS in case of virological failure
Time frame: up to week 12
Child-Pugh score (composite measure)
For cirrhotic patients Encephalopathy None+1 Mild to moderate (grade 1 or 2)+2 Severe (grade 3 or 4)+3 Ascites None+1 Mild to moderate (diuretic responsive)+2 Severe (diuretic refractory)+3 Bilirubin (mg/dL) \< 2+1 2-3+2 \> 3+3 Albumin (g/dL) \> 3.5+1 2.8-3.5+2 \< 2.8+3 International normalized ratio \< 1.7+1 1.7-2.3+2 \> 2.3+3 Total score of 5-6 = Grade A (well compensated disease) Total score of 7-9 = Grade B (disease with significant functional compromise) Total score of 10-15 = Grade C (decompensated liver disease)
Time frame: at screening
Insulin resistance measured using the HOMA-IR score
Time frame: Day 0, week 36
Parameters that define metabolic syndrome
Time frame: Day 0, week 36
Evolution of liver fibrosis
Fibrotest® or imaging Fibroscan®. Fibrosis will be evaluated with the same method (Fibroscan® or Fibrotest®) at baseline and week 36.
Time frame: Day 0, week 36
MELD score (composite measure)
For cirrhotic patients MELDScore = 10 \* ((0.957 \* ln(Creatinine)) + (0.378 \* ln(Bilirubin)) + (1.12 \* ln(INR))) + 6.43
Time frame: at screening