Bioequivalence Study of Crushed Elbasvir/Grazoprevir Compared to the Whole Tablet (CRUSADE-2)

Bioequivalence Study of CRUshed ElbaSvir/GrAzoprevir compareD to the wholE Tablet (CRUSADE-2)/Hep-NED005

Elbasvir/grazoprevir (Zepatier®) is a once-daily tablet for the treatment of chronic hepatitis C virus (HCV) GT1a, 1b or 4 infection containing the NS5A inhibitor elbasvir (ELB) 50 mg and the NS3/4A protease inhibitor grazoprevir (GZR) 100 mg.

For patients with swallowing difficulties, administration of whole tablets can be problematic. In addition, HCV patients that are hospitalized (at intensive care units) due to severe illness (co-infections/ liver failure) might not be able to swallow medication. Therefore it is useful to know whether it is possible to administer ELB/GZR through a different route, like a feeding tube.

In daily practice, information about the safety and efficacy of crushed tablets is lacking which might result in noncompliance, interruption or discontinuation of expensive HCV therapy. However, it is not recommended to interrupt treatment because there is no evidence about the efficacy of the therapy after discontinuation (and restarting).

Currently, patients and healthcare professionals are crushing tablets without information about efficacy and safety. Depending on the biopharmaceutical characteristics of a drug formulation, crushing tablets can lead to altered pharmacokinetics of drugs.

It is important to know whether pharmacokinetic parameters are influenced by crushing of tablets; both a decrease and an increase in exposure may occur. A decrease of the plasma concentrations of ELB and/or GZR potentially reduces the therapeutic effect of the drugs. Higher doses or switching to other HCV-drugs might be needed. In contrast, in case a higher Cmax and/or AUC occurs there might be an increased risk of toxicity.

As a result, crushing the drug is a contra-indication based on the available data. Therefore this study will be conducted to investigate whether a crushed ELB/GZR tablet is bioequivalent to ELB/GZR as a whole tablet.

Study Overview

• Status: Completed
• Conditions: Hepatitis C; Deglutition Disorders
• Intervention / Treatment: Drug: Zepatier whole tablet; Drug: Zepatier crushed tablet

• Study Type: Interventional
• Enrollment (Actual): 11
• Phase: Phase 1

Contacts and Locations

Study Locations

• Netherlands
  • Nijmegen, Netherlands
    • RTCCS Radboudumc

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 55 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Subject is at least 18 and not older than 55 years at screening.
• Subject does not smoke more than 10 cigarettes, 2 cigars, or 2 pipes per day for at least 3 months prior to Day 1.
• Subject weighs at least 40 kg.
• Subject has a Quetelet Index (Body Mass Index) of 18 to 30 kg/m2, extremes included.
• Subject is able and willing to sign the Informed Consent Form prior to screening evaluations.
• Subject is in good age-appropriate health condition as established by medical history, physical examination, and electrocardiography, results of biochemistry, hematology and urinalysis testing within 4 weeks prior to Day 1. Results of biochemistry, hematology and urinalysis testing should be within the laboratory's reference ranges. If laboratory results are not within the reference ranges, the subject is included on condition that the Investigator judges that the deviations are not clinically relevant. This should be clearly recorded.
• Subject has a normal blood pressure and pulse rate, according to the Investigator's judgment.

Exclusion Criteria:

• Creatinine clearance below 60 mL/min.
• Documented history of sensitivity/idiosyncrasy to medicinal products or excipients.
• Positive hepatitis B or C test
• Pregnant female (as confirmed by an hCG test performed less than 4 weeks before day 1) or breast-feeding female. Female subjects of childbearing potential without adequate contra-ception, e.g. hysterectomy, bilateral tubal ligation, (non-hormonal) intrauterine device, total abstinence, double barrier methods, or two years post-menopausal. They must agree to take precautions in order to prevent a pregnancy throughout the entire conduct of the study.
• Therapy with any drug (for two weeks preceding Day 1), except for acetaminophen (max 2 gram/day).
• Relevant history or presence of pulmonary disorders (especially COPD), cardiovascular disorders, neurological disorders (especially seizures and migraine), psychiatric disorders, gastro-intestinal disorders, renal and hepatic disorders (clinically relevant increased ALAT/ASAT or hyperbilirubinemia), hormonal disorders (especially diabetes mellitus), coagulation disorders.
• Relevant history or current condition that might interfere with drug absorption, distribution, metabolism or excretion.
• History of or current abuse of drugs, alcohol or solvents (positive drugs of abuse test).
• Inability to understand the nature and extent of the study and the procedures required.
• Participation in a drug study within 60 days prior to Day 1.
• Donation of blood within 60 days prior to Day 1.
• Febrile illness within 3 days before Day 1.
• Co-worker of Radboud university medical center.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Treatment R (reference); Single-dose ELB/GZR as a whole tablet in a fasted state.	Drug: Zepatier whole tablet; Single-dose ELB/GZR as a whole tablet in a fasted state.
Experimental: Treatment T (test); Single-dose crushed ELB/GZR in a fasted state.	Drug: Zepatier crushed tablet; Single-dose crushed ELB/GZR in a fasted state.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bioequivalence AUC0-72h	Determination of elbasvir/grazoprevir AUC0-72h by noncompartmental analysis. Descriptive statistics for the plasma concentrations of elbasvir/grazoprevir at each sampling time. Descriptive statistics for each PK parameter per treatment (geometric mean + CV%). Geometric Mean Ratios and 90% confidence intervals of pharmacokinetic parameters of treatment T (Test) vs. treatment R (Reference). AUC0-72h geometric mean ratios for elbasvir and grazoprevir with a 90% Cl falling entirely within the range of 0.7 to 1.43 are considered bioequivalent.	72 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bioequivalence (Cmax)	Determination of grazoprevir Cmax by noncompartmental analysis. Geometric Mean Ratios and 90% confidence intervals of pharmacokinetic parameters of T (Test) vs. R (Reference). Cmax geometric mean ratios for elbasvir and grazoprevir with a 90% Cl falling entirely within the range of 0.7 to 1.43 are considered bioequivalent.	18 days
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability])	Adverse events after intake of elbasvir/grazoprevir tablets in healthy adult volunteers.	18 days

Collaborators and Investigators

• Sponsor: Radboud University Medical Center

Publications and helpful links

General Publications

• Pijnenburg DWM, van Seyen M, Abbink EJ, Colbers A, Drenth JPH, Burger DM. Pharmacokinetic similarity demonstrated after crushing of the elbasvir/grazoprevir fixed-dose combination tablet for HCV infection. J Antimicrob Chemother. 2020 Sep 1;75(9):2661-2665. doi: 10.1093/jac/dkaa230.

Helpful Links

• paper

Study record dates

Study Major Dates

• Study Start (Actual): March 28, 2019
• Primary Completion (Actual): July 30, 2019
• Study Completion (Actual): July 30, 2019

Study Registration Dates

• First Submitted: January 21, 2019
• First Submitted That Met QC Criteria: January 23, 2019
• First Posted (Actual): January 25, 2019

Study Record Updates

• Last Update Posted (Actual): October 19, 2020
• Last Update Submitted That Met QC Criteria: October 16, 2020
• Last Verified: August 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; RNA Virus Infections; Virus Diseases; Infections; Blood-Borne Infections; Communicable Diseases; Gastrointestinal Diseases; Liver Diseases; Pharyngeal Diseases; Otorhinolaryngologic Diseases; Flaviviridae Infections; Hepatitis, Viral, Human; Esophageal Diseases; Hepatitis; Hepatitis C; Deglutition Disorders; Anti-Infective Agents; Antiviral Agents; Elbasvir-grazoprevir drug combination
• Other Study ID Numbers: UMCN-AKF 17.01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No