The Effects of Oral Hypoglycemic Agents on Chronic Hepatitis C Patients Receiving Peg-Intron Plus Ribavirin
Overview[ - collapse ][ - ]
| Purpose | Pegylated interferon in combination with ribavirin is the current standard treatment of chronic hepatitis C virus infection, but is expensive and has several adverse effects. To modify this standard treatment by optimizing its therapeutic effect and decreasing its adverse events are important. Recent studies have identified a close link between metabolic profiles, insulin resistance and Hepatitis C Virus (HCV) infection. Several pilot studies in western world have have found beneficial effects of oral hypoglycemic agents on chronic Hepatitis C (CHC) genotype 1 infected patients. Whether this concept still holds true in Taiwanese people remains unknown. The objective of this clinical trial is to evaluate the effect of oral hypoglycemic agents (daily for 4 weeks of run-in period and 8 weeks of combination treatment) on CHC genotype 1 infected Taiwanese patients receiving 48 weeks of Peg-IFN plus ribavirin (RBA), and the enrolled subjects will be randomized into 4 treatment groups (including Acarbose, Metformin, Pioglitazone and standard care control groups). During the trial and 24 weeks after the end of treatment, serial serum HCV RNA, alanine aminotransferase (ALT) levels, and other clinical data will be evaluated to determine the therapeutic response and adverse events of the CHC patients. |
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| Condition | Chronic Hepatitis C |
| Intervention | Drug: Pioglitazone Drug: Acarbose Drug: Metformin |
| Phase | Phase 4 |
| Sponsor | National Taiwan University Hospital |
| Responsible Party | National Taiwan University Hospital |
| ClinicalTrials.gov Identifier | NCT01025765 |
| First Received | December 2, 2009 |
| Last Updated | November 23, 2012 |
| Last verified | November 2012 |
Tracking Information[ + expand ][ + ]
| First Received Date | December 2, 2009 |
|---|---|
| Last Updated Date | November 23, 2012 |
| Start Date | November 2009 |
| Estimated Primary Completion Date | December 2012 |
| Current Primary Outcome Measures | Sustained Virologic Response [Time Frame: at the end of 24 weeks post-treatment follow-up] [Designated as safety issue: No] |
| Current Secondary Outcome Measures | serum ALT normalization, and histologic improvement [Time Frame: at the end of treatment and 24 weeks after the end of treatment] [Designated as safety issue: No] |
Descriptive Information[ + expand ][ + ]
| Brief Title | The Effects of Oral Hypoglycemic Agents on Chronic Hepatitis C Patients Receiving Peg-Intron Plus Ribavirin |
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| Official Title | An Open-label, Multi-center, Randomized Study Comparing the Effects of Oral Hypoglycemic Agents on Viral Kinetics of Chronic Hepatitis C Patients Receiving Pegylated Interferon Alfa 2b Plus Ribavirin |
| Brief Summary | Pegylated interferon in combination with ribavirin is the current standard treatment of chronic hepatitis C virus infection, but is expensive and has several adverse effects. To modify this standard treatment by optimizing its therapeutic effect and decreasing its adverse events are important. Recent studies have identified a close link between metabolic profiles, insulin resistance and Hepatitis C Virus (HCV) infection. Several pilot studies in western world have have found beneficial effects of oral hypoglycemic agents on chronic Hepatitis C (CHC) genotype 1 infected patients. Whether this concept still holds true in Taiwanese people remains unknown. The objective of this clinical trial is to evaluate the effect of oral hypoglycemic agents (daily for 4 weeks of run-in period and 8 weeks of combination treatment) on CHC genotype 1 infected Taiwanese patients receiving 48 weeks of Peg-IFN plus ribavirin (RBA), and the enrolled subjects will be randomized into 4 treatment groups (including Acarbose, Metformin, Pioglitazone and standard care control groups). During the trial and 24 weeks after the end of treatment, serial serum HCV RNA, alanine aminotransferase (ALT) levels, and other clinical data will be evaluated to determine the therapeutic response and adverse events of the CHC patients. |
| Detailed Description | Pegylated interferon in combination with ribavirin is the current standard treatment of chronic hepatitis C virus infection, but is expensive and has several adverse effects. To modify this standard treatment by optimizing its therapeutic effect and decreasing its adverse events are important. Recent studies have identified a close link between metabolic profiles, insulin resistance and HCV infection. Chronic hepatitis C (CHC) patients with higher pretreatment HOMA-IR (insulin resistance) index have poor therapeutic response than the ones with lower HOMA-IR index. Thus, it is reasonable to increase the therapeutic response of CHC patients by lowering insulin resistance. Several pilot studies in western world have been conducted to evaluate this concept by adding oral hypoglycemic agents into pegylated interferon plus ribavirin treatment, and have found beneficial effects of oral hypoglycemic agents on CHC genotype 1 infected patients. Whether this concept still holds true in Taiwanese people remains unknown. To evaluate the effect of oral hypoglycemic agents on CHC genotype 1 infected Taiwanese patients, we design this study and evaluate the virologic, biochemical and histological responses of CHC patients receiving pegylated interferon plus ribavirin treatment, and hope to identify similar beneficial effects of oral hypoglycemic agents in CHC Taiwanese patients. We plan to enroll about 80 chronic hepatitis C genotype 1 infected patients from the clinics into this study. All patients should have informed consent, not receive any interferon-based therapy or anti-viral medication, abstinence from alcohol beverage for more than 6 months and conformed to the regulations of Bureau of National Health Insurance, Taiwan. All patients will be randomly assigned into 4 different treatment arms. The patients assigned into the first 3 arms will receive one kind of the following oral hypoglycemic agents, such as Acarbose, Metformin, or Pioglitazone for 12 weeks (including 4 weeks of run-in period and 8 weeks of combination treatment with pegylated interferon alfa plus ribavirin). From week 13, all the patients of the first 3 arms will receive pegylated interferon alfa plus ribavirin for 40 weeks. The last arm is the control group; all the patients in the last arm will receive standard pegylated interferon alfa plus ribavirin treatment for 48 weeks. During the trial and 24 weeks after the end of treatment, the serum HCV RNA levels, clinical and biochemical data will be evaluated to determine the therapeutic response and adverse events of the patients. |
| Study Type | Interventional |
| Study Phase | Phase 4 |
| Study Design | Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment |
| Condition | Chronic Hepatitis C |
| Intervention | Drug: Pioglitazone Pioglitazone(30mg qd) for 4 weeks of run-in period and 8 weeks of combination treatment with Peginterferon alfa-2b (1.5/μg per kg) per week plus Ribavirin 1000-1200 mg/day (≥ 75 kg, 1200 mg; < 75 kg, 1000mg). Other Names: PioglitazoneDrug: Acarbose Acarbose (50 mg/per meal) for 4 weeks of run-in period and 8 weeks of combination treatment with Peginterferon alfa-2b (1.5/μg per kg) per week plus Ribavirin 1000-1200 mg/day (≥ 75 kg, 1200 mg; < 75 kg, 1000mg). Other Names: AcarboseDrug: Metformin Metformin (500 mg tid) 4 weeks of run-in period and 8 weeks of combination treatment with Peginterferon alfa-2b (1.5/μg per kg) per week plus Ribavirin 1000-1200 mg/day (≥ 75 kg, 1200 mg; < 75 kg, 1000mg). From week 13, all the subjects will receive pegylated interferon alfa plus ribavirin for 40 weeks. Other Names: Metformin |
| Study Arm (s) |
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Recruitment Information[ + expand ][ + ]
| Recruitment Status | Active, not recruiting |
|---|---|
| Estimated Enrollment | 80 |
| Estimated Completion Date | December 2012 |
| Estimated Primary Completion Date | December 2012 |
| Eligibility Criteria | Inclusion Criteria: 1. Treatment naïve 2. Age old than 18 years old 3. Anti-HCV positive > 6 months 4. Detectable serum quantitative HCV-RNA 5. HCV genotype 1 6. Serum alanine aminotransferase levels above the upper limit of normal with 6 months of enrollment 7. Pre-treatment HOMA-IR ≧ 2.0. (HOMA-IR = fasting insulin (mU/L) x fasting glucose (mg/dL) x 0.05551/22.5) Exclusion Criteria: 1. Anemia (hemoglobin < 13 gram per deciliter for men and < 12 gram per deciliter for women) 2. Neutropenia (neutrophil count <1,500 per cubic milliliter) 3. Thrombocytopenia (platelet <90,000 per cubic milliliter) 4. Co-infection with hepatitis B virus (HBV) or human immunodeficiency virus (HIV) 5. Chronic alcohol abuse (daily consumption > 20 gram per day in male and >10gram per day in female). 6. Diabetes Mellitus history or under oral hypoglycemic agents therapy Liver cirrhosis 7. Serum creatinine level more than 1.5 times the upper limit of normal Autoimmune liver disease 8. Neoplastic disease 9. An organ transplant 10. Immunosuppressive therapy 11. Poorly controlled autoimmune diseases, pulmonary diseases, cardiac diseases, psychiatric diseases, neurological diseases, diabetes mellitus 12. Evidence of drug abuse 13. Unwilling to have contraception |
| Gender | Both |
| Ages | 18 Years |
| Accepts Healthy Volunteers | No |
| Contacts | Not Provided |
| Location Countries | Taiwan |
Administrative Information[ + expand ][ + ]
| NCT Number | NCT01025765 |
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| Other Study ID Numbers | 200905056M |
| Has Data Monitoring Committee | No |
| Information Provided By | National Taiwan University Hospital |
| Study Sponsor | National Taiwan University Hospital |
| Collaborators | Schering-Plough Merck Sharp & Dohme Corp. |
| Investigators | Principal Investigator: Jia-Horng Kao, M.D., PhD. National Taiwan University Hospital |
| Verification Date | November 2012 |
Locations[ + expand ][ + ]
| National Taiwan University Hospital Department of Internal Medicine, | Taipei, Taiwan, 10002 |
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