Monitoring SOF/VEL in Treatment Naïve, HCV Participants With Active Infection (MINMON)

A Single-arm Study to Evaluate the Feasibility and Efficacy of a Minimal Monitoring Strategy to Deliver Pan-genotypic Ribavirin-free HCV Therapy to HCV Infected Populations Who Are HCV Treatment Naïve With Evidence of Active HCV Infection: The MINMON Study

To achieve global hepatitis C virus (HCV) elimination by 2030, 80% of the ~71 million people with chronic HCV infection will need to be treated, necessitating simplification of treatment delivery and associated laboratory monitoring without compromising efficacy or safety. The COVID-19 pandemic has further highlighted the need for innovative models of health care delivery that minimize face-to-face patient-provider contact. The purpose of this study was to evaluate the feasibility, safety, and efficacy of a minimal monitoring (MINMON) strategy to deliver interferon- and RBV-free, pan-genotypic DAA therapy to treat active HCV in HCV treatment naïve participants.

Study Overview

• Status: Completed
• Conditions: Liver Diseases; Hepatitis C; HIV-1-infection
• Intervention / Treatment: Drug: Sofosbuvir/Velpatasvir (SOF/VEL); Other: Minimal Monitoring (MINMON) Strategy

Detailed Description

This study evaluated the feasibility, safety, and efficacy of a minimal monitoring (MINMON) strategy of delivering interferon- and ribavirin (RBV)-free, pan-genotypic direct-acting antiviral (DAA) therapy to treat active hepatitis C virus (HCV) in HCV treatment naïve participants, with or without HIV-1 co-infection, and with no evidence of decompensated cirrhosis.

The MINMON intervention included four components: 1) No pre-treatment HCV genotyping; 2) Entire 12-week treatment course (84 tablets) dispensed to participants at study entry; 3) No scheduled on-treatment laboratory monitoring or clinic visits prior to SVR evaluation scheduled 24 weeks following entry; 4) Remote contact with participants at week 4 for adherence counseling and locator update, and week 22 for scheduling of SVR visit and locator update.

At study entry, all participants received a single-tablet, fixed-dose combination (FDC) of sofosbuvir/velpatasvir (SOF/VEL) for 12 weeks.

The trial was designed to accrue 400 adult participants who may be co-infected with HIV-1 (limited to no more than 200 participants), and whose liver disease state is either no cirrhosis (defined by Fibrosis-4 score) or compensated cirrhosis (defined by Fibrosis-4 and Child-Turcotte-Pugh (CTP) scores, and limited to no more than 80 participants). Accrual from research sites in the United States was limited to no more than 132 participants.

The study proceeded in two steps: Step 1: MINMON intervention and Step 2: post-MINMON follow up.

During Step 1 (MINMON intervention), participants were contacted remotely at week 4 to inquire about study medication adherence and confirm locator information, and again at week 22 to schedule the sustained virologic response (SVR) evaluation and confirm locator information. Unplanned in-person clinic visits before week 22 were permissible to address common treatment toxicities that could not be managed remotely. The primary efficacy outcome measure, sustained virologic response (SVR), was evaluated starting at the week 24 study visit. Early discontinuation of treatment did not alter the timing of the SVR evaluation. If the week 24 visit was missed, SVR could be evaluated at any time up to 76 weeks following study entry.

Following SVR evaluation, participants entered Step 2 for two additional post-SVR evaluation study visits at weeks 48 and 72. Participants were contacted remotely at weeks 42 and 68 to schedule such visits. The schedule of additional post-MINMON evaluation visits were dependent on the week of Step 2 entry.

In version 1 of the study, total study duration was up to 76 weeks. Due to the COVID-19 Pandemic, the window of the week 72 visit was extended for participants who completed SVR evaluations and registered to Step 2 to October 31, 2020 for US sites and to February 28, 2021 for non-US sites. This extension did not alter the window for SVR evaluation.

All scheduled in-clinic study visits included a physical exam, blood collection, and collection of plasma samples. For participants able to become pregnant, pregnancy testing was conducted at screening, entry, and at any in-clinic visit during Step 1 if pregnancy was suspected. Liver Elastography was an optional evaluation.

• Study Type: Interventional
• Enrollment (Actual): 400
• Phase: Phase 4

Contacts and Locations

Study Locations

• Brazil
  • Rio de Janeiro, Brazil, 21045
    • Instituto de Pesquisa Clinica Evandro Chagas (12101)
  • RS
    • Porto Alegre, RS, Brazil, 9043010
      • Hospital Nossa Senhora da Conceicao CRS (12201)
• Puerto Rico
  • San Juan, Puerto Rico, 00931
    • Puerto Rico-AIDS CRS (5401)
• South Africa
  • Gauteng
    • Johannesburg, Gauteng, South Africa, 2193
      • University of the Witwatersrand Helen Joseph (WITS HJH) CRS (11101)
  • West Cape
    • Cape Town, West Cape, South Africa, 7505
      • Family Clinical Research Unit (FAM-CUR) CRS (8950)
• Thailand
  • Chiang Mai, Thailand, 50200
    • Chiang Mai University HIV Treatment CRS (31784)
  • Patumwan
    • Bangkok, Patumwan, Thailand, 10330
      • Thai Red Cross AIDS Research Centre (TRC-ARC) CRS (31802)
• Uganda
  • Kampala, Uganda
    • Joint Clinical Research Centre (JCRC) (12401)
• United States
  • Alabama
    • Birmingham, Alabama, United States, 35294
      • Alabama CRS (31788)
  • California
    • Los Angeles, California, United States, 90033-1079
      • University of Southern California (1201)
    • Los Angeles, California, United States, 90095
      • UCLA CARE Center CRS (601)
    • San Diego, California, United States, 92103
      • Ucsd, Avrc Crs (701)
    • San Francisco, California, United States, 94110
      • Ucsf Aids Crs (801)
  • Colorado
    • Aurora, Colorado, United States, 80045
      • University of Colorado Hospital CRS (6101)
  • District of Columbia
    • Washington, District of Columbia, United States, 20009
      • Whitman Walker Health CRS (31791)
  • Georgia
    • Atlanta, Georgia, United States, 30308
      • The Ponce de Leon Center CRS (5802)
  • Illinois
    • Chicago, Illinois, United States, 60611
      • Northwestern University CRS (2701)
    • Chicago, Illinois, United States, 60612
      • Rush Univ. Med. Ctr. ACTG CRS (2702)
  • Maryland
    • Baltimore, Maryland, United States, 21205
      • Johns Hopkins University CRS (201)
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Brigham and Women's Hosp. ACTG CRS (107)
    • Boston, Massachusetts, United States, 02114
      • Massachusetts General Hospital (MGH) CRS (101)
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • Washington U CRS (2101)
  • New Jersey
    • Newark, New Jersey, United States, 07103
      • New Jersey Medical School Clinical Research Center CRS (31786)
  • New York
    • New York, New York, United States, 10032
      • Columbia Physicians and Surgeons CRS (30329)
    • New York, New York, United States, 10010
      • Weill Cornell Chelsea CRS (7804)
    • New York, New York, United States, 10065
      • Weill Cornell Upton CRS (7803)
    • Rochester, New York, United States, 14642
      • University of Rochester Adult HIV Therapeutic Strategies Network CRS (31787)
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27514
      • Unc Aids Crs (3201)
    • Greensboro, North Carolina, United States, 27401
      • Greensboro CRS (3203)
  • Ohio
    • Cincinnati, Ohio, United States, 45267
      • Univ. of Cincinnati CRS (2401)
    • Cleveland, Ohio, United States, 44106
      • Case CRS (2501)
    • Columbus, Ohio, United States, 43210
      • The Ohio State Univ. AIDS CRS (2301)
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • Hosp. of the Univ. of Pennsylvania CRS (6201)
    • Pittsburgh, Pennsylvania, United States, 15213
      • Pittsburgh CRS (1001)
  • Rhode Island
    • Providence, Rhode Island, United States, 02906
      • The Miriam Hospital ACTG CRS (2951)
  • Tennessee
    • Nashville, Tennessee, United States, 37204
      • Vanderbilt Therapeutics (VT) CRS (3652)
  • Texas
    • Dallas, Texas, United States, 75208
      • Trinity Health and Wellness Center CRS (31443)
    • Houston, Texas, United States, 77030
      • Houston AIDS Research Team CRS (31473)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Active Hepatitis C (HCV) infection, defined by HCV RNA >1000 international units (IU/mL) within 35 days prior to study entry
• HCV treatment naïve
• Liver disease staged as either non-cirrhotic (Fibrosis-4 (FIB-4) Score <3.25) or compensated cirrhotic (FIB-4 Score ≥3.25 and Child-Turcotte-Pugh (CTP) ≤Score 6) within 35 days prior to study entry
• HIV-1 negative, or HIV-1 positive with either a) Non-efavirenz containing antiretroviral therapy (ART) started at least 14 days prior to study entry with plasma HIV-1 RNA <400 copies/mL within 90 days prior to study entry or b) not taking ART and CD4+ cell count >350 cells/uL within 90 days prior to study entry

• The following laboratory values obtained within 35 days prior to study entry:

  • Albumin >3.0 g/L
  • Hemoglobin >8.0 g/dL for women; >9.0 g/dL for men
  • Platelet count >50,000/mm^3
  • Calculated creatinine clearance (CrCl) >30 mL/min
  • Aspartate aminotransferase (AST) <10 times the upper limit of the normal range (ULN)
  • Alanine transaminase (ALT) <10 times the ULN
  • Total bilirubin <1.5 times the ULN for participants not on atazanavir (ATV); <3 times the ULN for participants on ATV
  • International normalized ratio (INR) <1.5 times the ULN
• For females of reproductive potential, a negative serum or urine pregnancy test within 48 hours prior to study entry
• All participants of reproductive potential must have agreed not to participate in conception process (e.g., active attempt to become pregnant or to impregnate, sperm donation, in vitro fertilization) while on study treatment and for 6 weeks after stopping study treatment
• If participating in sexual activity that could lead to pregnancy, the all participants of reproductive potential had to agree to use at least one reliable methods of contraception while on study treatment and for 6 weeks after stopping study treatment
• Participants who were not of reproductive potential were eligible without requiring the use of contraceptives.
• Life expectancy >12 months
• Ability and willingness to be contacted remotely
• Ability and willingness of participant to provide informed consent.

Exclusion Criteria:

• Positive for hepatitis B virus (HBV) surface antigen
• For cirrhotic participants, CTP score >6 corresponding to Class B or C
• Breastfeeding or pregnancy
• Known allergy/sensitivity or any hypersensitivity to components of study drugs or their formulation
• Active drug or alcohol use or dependence and other conditions that, in the opinion of the site investigator, would interfere with adherence to study requirements.
• Acute or serious illness requiring systemic treatment and/or hospitalization within 35 days prior to study entry
• For HIV positive participants, presence of active or acute AIDS-defining opportunistic infections within 35 days prior to study entry
• Any history of hepatic decompensation including ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, and/or bleeding esophageal varices
• Use of prohibited medications within the past 14 days prior to study entry

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: MINMON 24 weeks with SOF/VEL 12 Weeks; Participants received Sofosbuvir/Velpatasvir (SOF/VEL [Tradename: Epclusa®]) tablet for 12 weeks with a minimal monitoring (MINMON) strategy for 24 weeks

Drug: Sofosbuvir/Velpatasvir (SOF/VEL); 400/100 mg fixed-dose combination (FDC) tablet administered orally once daily with or without food.; Other Names: Epclusa; Other: Minimal Monitoring (MINMON) Strategy; MINMON Strategy: No pre-treatment HCV genotyping; Entire treatment course (84) tablets of SOF/VEL administered to participants at study entry; No scheduled on-treatment laboratory monitoring or clinic visits; Remote contact with participants at week 4 and week 22

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With Sustained Virologic Response 12 (SVR12)	SVR12 was defined as plasma HCV RNA less than the lower limit of quantification (LLOQ) from the earliest sample drawn at least 22 weeks following study treatment initiation (i.e. at a visit scheduled at least 10 weeks after scheduled end of study treatment). Participants without any HCV RNA result at least 22 weeks after treatment initiation will be considered as having HCV RNA greater than the LLOQ. LLOQ was defined as <15 IU/mL for results tested at USA centralized testing laboratory Quest using the "Roche COBAS® HCV Quantitative nucleic acid test for use on the COBAS® 6800/8800" assays for quantitation (and detection) of HCV, and <12 IU/mL for results tested at regional international labs using "Abbott RealTime HCV" assay for quantitation (and detection) of HCV. A two-sided 95%, confidence interval was calculated for this percentage using the Wilson (score) method.	From at least 22 weeks and up to 76 weeks from treatment initiation
Percentage of Participants With an Occurrence of Serious Adverse Events According to International Council for Harmonization (ICH) Criteria	Serious adverse events (SAEs) as defined by ICH guidelines. A two-sided, 95% confidence interval was calculated for the percentage using the Wilson (score) method.	From treatment initiation to 28 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With at Least One Unplanned Clinic Visit Prior to SVR12 Evaluation	According to the study minimal monitoring intervention, there were no planned clinic visits prior to study week 24, when SVR12 was scheduled to be evaluated. An unplanned clinic visit was defined as an in-clinic visit occurring from treatment initiation to up to week 22. A two-sided, 95% confidence interval was calculated for the percentage using the Wilson (score) method.	From treatment initiation to 22 weeks
Percentage of Participants With an Occurrence of One or More Non-serious, Grade >= 3 Adverse Event (AE), or Treatment Limiting AE.	AEs included all primary diagnoses, primary signs/symptoms, and primary laboratory abnormalities that either had severity grade ≥ 3 or led to a change in study medication. Serious Adverse Events (SAE) by International Council for Harmonization (ICH) criteria were excluded as they contributed to the primary safety outcome measure. Severity grading was based on DAIDS AE Grading Table, Corrected Version 2.1. A two-sided, 95% confidence interval was calculated for the percentage using the Wilson (score) method.	From treatment initiation to 28 weeks
Percentage of Participants Who Prematurely Discontinued HCV Study Medications	Since there were no planned clinic visits during the 12 week study medication period, the last dose of study treatment was self-reported by participants, and recorded at the SVR evaluation visit at 24 weeks. Premature treatment discontinuation was defined when the self-reported final dose date was <11 weeks (<77 days) after the date of initial dose (accounting for any reported treatment holds). Participants discontinuing study follow up without information about completion of HCV study medications were counted as having prematurely discontinued medications. A two-sided, 95% confidence interval was calculated for the percentage using the Wilson (score) method.	From at least 22 weeks and up to 76 weeks from treatment initiation

Collaborators and Investigators

• Sponsor: AIDS Clinical Trials Group
• Collaborators: National Institute of Allergy and Infectious Diseases (NIAID)
• Investigators: Study Chair: Sunil Solomon, MBBS, PhD, MPH, Johns Hopkins University

Publications and helpful links

General Publications

• Solomon SS, Wagner-Cardoso S, Smeaton L, Sowah LA, Wimbish C, Robbins G, Brates I, Scello C, Son A, Avihingsanon A, Linas B, Anthony D, Nunes EP, Kliemann DA, Supparatpinyo K, Kityo C, Tebas P, Bennet JA, Santana-Bagur J, Benson CA, Van Schalkwyk M, Cheinquer N, Naggie S, Wyles D, Sulkowski M. A minimal monitoring approach for the treatment of hepatitis C virus infection (ACTG A5360 [MINMON]): a phase 4, open-label, single-arm trial. Lancet Gastroenterol Hepatol. 2022 Apr;7(4):307-317. doi: 10.1016/S2468-1253(21)00397-6. Epub 2022 Jan 10.

Helpful Links

• Manual for Expedited Reporting of Adverse Events to DAIDS (DAIDS EAE Manual), Version 2.0, January 2010
• DAIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1
• NIH. BLAST® Basic Local Alignment Search Tool. US National Library of Medicine, National Center for Biotechnology Information, NIH; 2021

Study record dates

Study Major Dates

• Study Start (Actual): October 22, 2018
• Primary Completion (Actual): July 30, 2020
• Study Completion (Actual): February 28, 2021

Study Registration Dates

• First Submitted: April 19, 2018
• First Submitted That Met QC Criteria: April 19, 2018
• First Posted (Actual): April 30, 2018

Study Record Updates

• Last Update Posted (Actual): February 4, 2022
• Last Update Submitted That Met QC Criteria: January 27, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; RNA Virus Infections; Virus Diseases; Blood-Borne Infections; Disease Attributes; Flaviviridae Infections; Hepatitis, Viral, Human; Hepatitis; Liver Diseases; Infections; Communicable Diseases; Hepatitis C; Anti-Infective Agents; Antiviral Agents; Sofosbuvir; Sofosbuvir-velpatasvir drug combination; Velpatasvir
• Other Study ID Numbers: ACTG A5360; UM1AI068636 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No