Premium
Vaniprevir with pegylated interferon alpha‐2a and ribavirin in treatment‐naïve patients with chronic hepatitis C: A randomized phase II study
Author(s) -
Manns Michael P.,
Gane Edward,
RodriguezTorres Maribel,
Stoehr Albrecht,
Yeh ChauTing,
Marcellin Patrick,
Wiedmann Richard T.,
Hwang Peggy M.,
Caro Luzelena,
Barnard Richard J.O.,
Lee Andrew W.
Publication year - 2012
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.25743
Subject(s) - ribavirin , medicine , gastroenterology , pegylated interferon , placebo , regimen , hepatitis c virus , hepatitis c , viral load , alpha interferon , clinical endpoint , combination therapy , randomized controlled trial , immunology , interferon , virus , pathology , alternative medicine
Vaniprevir (MK‐7009) is a macrocyclic hepatitis C virus (HCV) nonstructural protein 3/4A protease inhibitor. The aim of the present phase II study was to examine virologic response rates with vaniprevir in combination with pegylated interferon alpha‐2a (Peg‐IFN‐α‐2a) plus ribavirin (RBV). In this double‐blind, placebo‐controlled, dose‐ranging study, treatment‐naïve patients with HCV genotype 1 infection (n = 94) were randomized to receive open‐label Peg‐IFN‐α‐2a (180 μg/week) and RBV (1,000‐1,200 mg/day) in combination with blinded placebo or vaniprevir (300 mg twice‐daily [BID], 600 mg BID, 600 mg once‐daily [QD], or 800 mg QD) for 28 days, then open‐label Peg‐IFN‐α‐2a and RBV for an additional 44 weeks. The primary efficacy endpoint was rapid viral response (RVR), defined as undetectable plasma HCV RNA at week 4. Across all doses, vaniprevir was associated with a rapid two‐phase decline in viral load, with HCV RNA levels approximately 3log 10 IU/mL lower in vaniprevir‐treated patients, compared to placebo recipients. Rates of RVR were significantly higher in each of the vaniprevir dose groups, compared to the control regimen (68.8%‐83.3% versus 5.6%; P < 0.001 for all comparisons). There were numerically higher, but not statistically significant, early and sustained virologic response rates with vaniprevir, as compared to placebo. Resistance profile was predictable, with variants at R155 and D168 detected in a small number of patients. No relationship between interleukin‐28B genotype and treatment outcomes was demonstrated in this study. The incidence of adverse events was generally comparable between vaniprevir and placebo recipients; however, vomiting appeared to be more common at higher vaniprevir doses. Conclusion : Vaniprevir is a potent HCV protease inhibitor with a predictable resistance profile and favorable safety profile that is suitable for QD or BID administration. (H EPATOLOGY 2012;56:884–893)