Subcutaneous Continuous Infusion of Interferon Alfa-2b and Ribavirin in Hepatitis C Genotype 1 Nonresponders (SCIN-C)

For chronic hepatitis C patients unresponsive to previous (PEG-)IFN/RBV combination therapy we propose continuous subcutaneous administration of high-dose IFN-a2b (Intron A®) for 48 weeks in combination with 15 mg/kg/day RBV (Rebetol®) and optimal management of side effects in order to maintain the highest possible dosages of both IFN-a2b and RBV for 48 weeks. We expect improved tolerability with continuous subcutaneous pump delivery of IFN-a2b compared to thrice weekly or daily subcutaneous injection of IFN-a2b, and increased antiviral activity and biologic potency due to sustained and higher levels of a fully potent interferon protein.

Study Overview

• Status: Completed
• Conditions: Chronic Hepatitis C
• Intervention / Treatment: Drug: interferon alfa-2b; Drug: interferon alfa-2b; Drug: interferon alfa-2b

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Phase 2; Phase 3

Contacts and Locations

Study Locations

• Netherlands
  • Rotterdam, Netherlands, 3015 GD
    • Erasmus University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Hepatitis C genotype 1 unresponsive to (peg)interferon /ribavirin therapy
• In the past, peginterferon or conventional interferon plus ribavirin combination therapy for at least 12 weeks and less than 2-log HCV RNA decrease at week 12, HCV RNA positivity at week 24, breakthrough during therapy or relapse after therapy
• At least 12 weeks between end of (peg)interferon/ribavirin therapy and start of high-dose IFN/ribavirin therapy
• Persistent indication for antiviral therapy such as persistently elevated serum ALT or histological evidence of continuing or progressive fibrosis
• Age 18-60 years

Exclusion Criteria:

• Signs of progressive liver disease since end of previous therapy, beyond generally accepted criteria for HCV antiviral therapy:

  • serum bilirubin >35 μmol/l, albumin <36 g/l, prothrombin time >4 sec prolonged or platelets <100,000/mm3
  • decompensated cirrhosis (defined as jaundice in the presence of cirrhosis, ascites, gastric bleeding, esophageal varices or encephalopathy)
• Hepatic imaging (US, CT or MRI) with the evidence of hepatocellular carcinoma (hepatic imaging should be performed within 3 months prior to screening) or an alpha fetoprotein >50 ng/ml
• Other acquired or inherited causes of liver disease that could explain liver disease activity
• Co-infection with hepatitis B virus or human immunodeficiency virus (HIV)
• Other significant medical illness that might interfere with this study: significant cardiovascular, pulmonary or renal dysfunction, malignancy other than skin basocellular carcinoma in previous 5 years, immunodeficiency syndromes (e.g.: HIV positivity, steroid therapy, organ transplants other than cornea and hair transplant)
• History of a severe seizure disorder or current anticonvulsant use
• History of thyroid disease poorly controlled on prescribed medications

• Contra-indications for IFN and/or ribavirin:

  • Severe psychiatric disorder, such as major psychoses, suicidal ideation, suicidal attempt and/or manifest depression during previous (peg)interferon therapy. Severe depression would include the following: (a) subjects who have been hospitalized for depression, (b) subjects who have received electroconvulsive therapy for depression, or (c) subjects whose depression has resulted in a prolonged absence of work and/or significant disruption of daily functions. Subjects with a history of mild depression may be considered for entry into the protocol provided that a pretreatment assessment of the subject's mental status supports that the subject is clinically stable and that there is ongoing evaluation of the patient's mental status during the study
  • Reactivation of immunological disorders during previous therapy
  • Visual symptoms related to retinal abnormalities
  • Pregnancy, breast-feeding or inadequate contraception
  • Thalassemia, spherocytosis
• Substance abuse, such as alcohol (³80 gm/day) and I.V. drugs. If the subject has a history of substance abuse, to be considered for inclusion into the protocol, the subject must have abstained from using the abused substance for at least 2 years
• Any other condition which in the opinion of the investigator would make the patient unsuitable for enrollment, or could interfere with the patient participating in and completing the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1; 12 MU interferon alfa-2b daily continuously subcutaneous in combination with 15 mg/kg/day ribavirin	Drug: interferon alfa-2b; 12 MU daily continuously subcutaneous; Other Names: Intron A; Drug: interferon alfa-2b; 9 MU daily continuously subcutaneous; Other Names: Intron A; Drug: interferon alfa-2b; 6 MU daily continuously subcutaneous; Other Names: Intron A
Experimental: 2; 9 MU interferon alfa-2b daily continuously subcutaneous in combination with 15 mg/kg/day ribavirin	Drug: interferon alfa-2b; 12 MU daily continuously subcutaneous; Other Names: Intron A; Drug: interferon alfa-2b; 9 MU daily continuously subcutaneous; Other Names: Intron A; Drug: interferon alfa-2b; 6 MU daily continuously subcutaneous; Other Names: Intron A
Experimental: 3; 6 MU interferon alfa-2b daily continuously subcutaneous in combination with 15 mg/kg/day ribavirin	Drug: interferon alfa-2b; 12 MU daily continuously subcutaneous; Other Names: Intron A; Drug: interferon alfa-2b; 9 MU daily continuously subcutaneous; Other Names: Intron A; Drug: interferon alfa-2b; 6 MU daily continuously subcutaneous; Other Names: Intron A

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Safety and tolerability of high-dose continuous subcutaneous infused IFN-a2b (serious adverse events, grade 4 NCI toxicity, percentage of patients completing treatment or reasons for dose adjustments).	48 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
HCV RNA negativity at week 48 and 24 weeks after end of treatment	48 weeks
Biological activity of IFN-a2b	48 weeks
Pharmacokinetics by IFN-a2b levels	48 weeks
HCV-specific immune responses	48 weeks
Quality of life assessment using SF-36 and SCL-90 questionnaires	48 weeks

Collaborators and Investigators

• Sponsor: Foundation for Liver Research
• Investigators: Principal Investigator: R.J. de Knegt, MD, PhD, Erasmus Medical Center

Study record dates

Study Major Dates

• Study Start: July 1, 2007
• Primary Completion (Actual): June 1, 2010
• Study Completion (Actual): December 1, 2010

Study Registration Dates

• First Submitted: January 7, 2008
• First Submitted That Met QC Criteria: February 25, 2008
• First Posted (Estimate): February 27, 2008

Study Record Updates

• Last Update Posted (Estimate): March 11, 2011
• Last Update Submitted That Met QC Criteria: March 10, 2011
• Last Verified: March 1, 2011

More Information

Terms related to this study

• Keywords: genotype 1 nonresponders
• Additional Relevant MeSH Terms: Digestive System Diseases; RNA Virus Infections; Virus Diseases; Infections; Blood-Borne Infections; Communicable Diseases; Liver Diseases; Flaviviridae Infections; Hepatitis, Viral, Human; Enterovirus Infections; Picornaviridae Infections; Hepatitis, Chronic; Hepatitis; Hepatitis A; Hepatitis C; Hepatitis C, Chronic; Physiological Effects of Drugs; Anti-Infective Agents; Antiviral Agents; Antineoplastic Agents; Immunologic Factors; Interferons; Interferon-alpha; Interferon alpha-2
• Other Study ID Numbers: HCV 06-01; eudract 2006-000592-15