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Sperl J, Horvath G, Halota W, Ruiz-Tapiador JA, Streinu-Cercel A, Jancoriene L, Werling K, Kileng H, Koklu S, Gerstoft J, Urbanek P, Flisiak R, Leiva R, Kazenaite E, Prinzing R, Patel S, Qiu J, Asante-Appiah E, Wahl J, Nguyen BY, Barr E, Platt HL. Efficacy and safety of elbasvir/grazoprevir and sofosbuvir/pegylated interferon/ribavirin: A phase III randomized controlled trial. J Hepatol 2016; 65:1112-1119. [PMID: 27542322 DOI: 10.1016/j.jhep.2016.07.050] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/27/2016] [Accepted: 07/30/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Direct-acting antiviral agents have improved treatment outcomes for patients with hepatitis C virus (HCV) infection; however, head-to-head comparisons are limited. The C-EDGE Head-2-Head Study compared the safety and efficacy of elbasvir/grazoprevir (EBR/GZR) with sofosbuvir plus pegylated interferon/ribavirin (SOF/PR) in patients with HCV infection. METHODS This was a randomized, open-label, phase III trial. Two hundred fifty-seven patients with HCV genotype (GT)1 or 4 infection and baseline viral load >10,000IU/ml were randomized to receive 12weeks of EBR/GZR 50mg/100mg once daily (n=129) or sofosbuvir (400mg once daily) plus PR (n=128). Primary efficacy objective was sustained virologic response 12weeks after the end of therapy (SVR12, HCV RNA <15IU/ml). The primary safety objective was the proportion of patients experiencing a tier 1 safety event. RESULTS The majority of patients were non-cirrhotic (83.1%), treatment-naïve (74.9%) and had HCV GT1b infection (82.0%). SVR12 rates were 99.2% (128/129) and 90.5% (114/126) in the EBR/GZR and SOF/PR groups, respectively. The estimated adjusted difference in SVR12 was 8.8% (95% confidence interval [CI], 3.6-15.3%). Because the lower bound of the 1-sided 1-sample exact test was greater than -10% and greater than zero, both non-inferiority and superiority of EBR/GZR vs. SOF/PR were established. The frequency of tier 1 safety events was lower among patients receiving EBR/GZR than SOF/PR (0.8% vs. 27.8%, between group difference, 27.0% [95% CI, -35.5% to -19.6%; p<0.001]). CONCLUSIONS EBR/GZR has a superior efficacy and safety profile in patients with HCV GT1 or 4 infection compared with SOF/PR. LAY SUMMARY The combination of elbasvir/grazoprevir for 12weeks was highly effective in treating patients with chronic hepatitis C, genotypes 1 or 4 infection. This regimen was more effective than sofosbuvir/pegylated interferon/ribavirin for 12weeks, and was notably superior in patients regarded as difficult to treat, including those with previous treatment failure, cirrhosis, or a high baseline viral load. The combination of elbasvir/grazoprevir also demonstrated a superior safety and tolerability profile based on fewer serious adverse events, no serious drug-related adverse events, and no treatment discontinuations. CLINICAL TRIAL REGISTRATION Clinical trials.gov Identifier: NCT02358044.
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Affiliation(s)
- Jan Sperl
- Institut Klinické a Experimentální Medicíny (IKEM), Prague, Czech Republic.
| | | | - Waldemar Halota
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Anca Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Ligita Jancoriene
- Vilnius University, Department of Infectious and Chest Diseases, Dermatovenerology and Alergology, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania
| | | | - Hege Kileng
- UNN Universitetssykehuset Nord Norge, Tromsø, Norway
| | | | - Jan Gerstoft
- Klinik for Infektionsmedicin, Rigshospitalet, University of Copenhagen, Denmark
| | - Petr Urbanek
- Department of Internal Medicine, 1st Medical Faculty Charles University and Central Military Hospital, Prague, Czech Republic
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | | | - Edita Kazenaite
- Vilnius University, Faculty of Medicine, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania
| | | | - Sushma Patel
- Merck & Co., Inc., Kenilworth, NJ, United States
| | - Jingjun Qiu
- Merck & Co., Inc., Kenilworth, NJ, United States
| | | | - Janice Wahl
- Merck & Co., Inc., Kenilworth, NJ, United States
| | | | - Eliav Barr
- Merck & Co., Inc., Kenilworth, NJ, United States
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Dore GJ, Altice F, Litwin AH, Dalgard O, Gane EJ, Shibolet O, Luetkemeyer A, Nahass R, Peng CY, Conway B, Grebely J, Howe AYM, Gendrano IN, Chen E, Huang HC, Dutko FJ, Nickle DC, Nguyen BY, Wahl J, Barr E, Robertson MN, Platt HL. Elbasvir-Grazoprevir to Treat Hepatitis C Virus Infection in Persons Receiving Opioid Agonist Therapy: A Randomized Trial. Ann Intern Med 2016; 165:625-634. [PMID: 27537841 DOI: 10.7326/m16-0816] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is common in persons who inject drugs (PWID). OBJECTIVE To evaluate elbasvir-grazoprevir in treating HCV infection in PWID. DESIGN Randomized, placebo-controlled, double-blind trial. (ClinicalTrials.gov: NCT02105688). SETTING Australia, Canada, France, Germany, Israel, the Netherlands, New Zealand, Norway, Spain, Taiwan, the United Kingdom, and the United States. PATIENTS 301 treatment-naive patients with chronic HCV genotype 1, 4, or 6 infection who were at least 80% adherent to visits for opioid agonist therapy (OAT). INTERVENTION The immediate-treatment group (ITG) received elbasvir-grazoprevir for 12 weeks; the deferred-treatment group (DTG) received placebo for 12 weeks, no treatment for 4 weeks, then open-label elbasvir-grazoprevir for 12 weeks. MEASUREMENTS The primary outcome was sustained virologic response at 12 weeks (SVR12), evaluated separately in the ITG and DTG. Other outcomes included SVR24, viral recurrence or reinfection, and adverse events. RESULTS The SVR12 was 91.5% (95% CI, 86.8% to 95.0%) in the ITG and 89.5% (95% CI, 81.5% to 94.8%) in the active phase of the DTG. Drug use at baseline and during treatment did not affect SVR12 or adherence to HCV therapy. Among 18 patients with posttreatment viral recurrence through 24-week follow-up, 6 had probable reinfection. If the probable reinfections were assumed to be responses, SVR12 was 94.0% (CI, 89.8% to 96.9%) in the ITG. One patient in the ITG (1 of 201) and 1 in the placebo-phase DTG (1 of 100) discontinued treatment because of an adverse event. LIMITATION These findings may not be generalizable to PWID who are not receiving OAT, nor do they apply to persons with genotype 3 infection, a common strain in PWID. CONCLUSION Patients with HCV infection who were receiving OAT and treated with elbasvir-grazoprevir had high rates of SVR12, regardless of ongoing drug use. These results support the removal of drug use as a barrier to interferon-free HCV treatment for patients receiving OAT. PRIMARY FUNDING SOURCE Merck & Co.
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Affiliation(s)
- Gregory J Dore
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Frederick Altice
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Alain H Litwin
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Olav Dalgard
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Edward J Gane
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Oren Shibolet
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Anne Luetkemeyer
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Ronald Nahass
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Cheng-Yuan Peng
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Brian Conway
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Jason Grebely
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Anita Y M Howe
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Isaias N Gendrano
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Erluo Chen
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Hsueh-Cheng Huang
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Frank J Dutko
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - David C Nickle
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Bach-Yen Nguyen
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Janice Wahl
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Eliav Barr
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Michael N Robertson
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
| | - Heather L Platt
- From The Kirby Institute, UNSW Australia, Sydney, Australia; Yale School of Medicine, New Haven, Connecticut; Montefiore Medical Center, Bronx, New York; Akershus University Hospital, Lorenskog, Norway; Auckland Clinical Studies, Auckland, New Zealand; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; University of California, San Francisco, San Francisco, California; ID Care, Hillsborough, New Jersey; China Medical University, Taichung, Taiwan; Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada; and Merck & Co., Kenilworth, New Jersey
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