Glecaprevir-Pibrentasvir in Non-Cirrhotic Genotype 2 ENDURANCE-2

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Presentation transcript:

Glecaprevir-Pibrentasvir in Non-Cirrhotic Genotype 2 ENDURANCE-2 Phase 3 Treatment Naïve or Experienced Glecaprevir-Pibrentasvir in Non-Cirrhotic Genotype 2 ENDURANCE-2 Source: Asselah T, et al. Clin Gastroenterol Hepatol. 2018;16:417-26.

Glecaprevir-Pibrentasvir in Non-Cirrhotic GT 2 Glecaprevir-Pibrentasvir in Non-Cirrhotic GT 2 *ENDURANCE-2: Study Features ENDURANCE-2 Trial Design: Randomized, double-blind, placebo-controlled phase 3 trial to evaluate the safety and efficacy of the fixed-dose combination of glecaprevir- pibrentasvir for 12 weeks in treatment-naïve or treatment-experienced adults with GT 2 chronic HCV infection without cirrhosis. Setting: Multiple centers in US, Europe and Asia Key Eligibility Criteria - Chronic HCV genotype 2 - Age ≥18 years - HCV RNA ≥1,000 IU/mL at screening - Naïve or treated with (1) PEG (or IFN) +/- RBV or (2) SOF + RBV +/- PEG - Absence of cirrhosis - HIV or HBV coinfection excluded Primary End-Point: SVR12 *Note: ENDURANCE-2 was published in conjunction with ENDURANCE-4 and SURVEYOR-II (Part 4) Source: Asselah T, et al. Clin Gastroenterol Hepatol. 2018;16:417-26.

GLE-PIB (data not included) Glecaprevir-Pibrentasvir in Non-Cirrhotic GT 2 ENDURANCE-2: Study Design Week 36 12 24 GLE-PIB n = 202 SVR12 Placebo GLE-PIB (data not included) n = 100 SVR12 Note: Four patients enrolled in GT2 arm later determined to be infected with GT1 by phylogenetic analysis Abbreviations: GLE-PIB= Glecaprevir-pibrentasvir Drug Dosing Glecaprevir-pibrentasvir (100/40 mg) fixed-dose combination: three pills (300/120 mg) once daily Source: Asselah T, et al. Clin Gastroenterol Hepatol. 2018;16:417-26.

Glecaprevir-Pibrentasvir in Non-Cirrhotic GT 2 ENDURANCE-2: Baseline Characteristics GLE-PIB (n = 202) Placebo (n = 100) Age, mean ± SD, years 57 ± 12.8 58 ± 12.0 Male, n (%) 98 (49) 45 (45) Race, n (%) White Black Asian 121 (60) 7 (3) 69 (34) 60 (60) 7 (7) 32 (32) BMI, mean, ± SD kg/m2 25.8 ± 4.7 26.4 ± 4.1 HCV RNA, median (range), log10 IU/mL 6.25 (2.5-7.3) 6.39 (3.4-7.2) IL28B non-CC, n (%) 111 (55) 50 (50) Former IDU, n (%) 32 (16) 18 (18) *One patient in active arm with subtype 2i. Source: Asselah T, et al. Clin Gastroenterol Hepatol. 2018;16:417-26.

Glecaprevir-Pibrentasvir in Non-Cirrhotic GT 2 ENDURANCE-2: Baseline Characteristics GLE-PIB (n = 202) Placebo (n = 100) Fibrosis Stage, n (%) F0-1 F2 F3 154 (76) 18 (9) 30 (15) 85 (85) 9 (9) 6 (6) Treatment-naïve, n (%) 141 (70) 71 (71) Treatment-experienced, n (%) IFN or PEG ± RBV, n (%) SOF + RBV ± PEG, n (%) 61 (30) 55 (27) 6 (3) 29 (29) 27 (27) 2 (2) Concomitant PPI use, n (%) 22 (11) 11 (11) Source: Asselah T, et al. Clin Gastroenterol Hepatol. 2018;16:417-26.

Glecaprevir-Pibrentasvir in Non-Cirrhotic GT 2 ENDURANCE-2: Baseline Polymorphisms Prevalence of Baseline Polymorphism*, n (%)* Genotype 2 (n = 160) None 28 (18) NS3 only NS5A only 132 (83) Both NS3 + NS5A *Baseline polymorphisms detected by next generation sequencing at a 15% threshold in samples that had sequences available for both targets (N) at the following amino acid positions: - NS3: 155, 156, 168 - NS5A: 24, 28, 30, 31, 58, 92, 93 Source: Asselah T, et al. Clin Gastroenterol Hepatol. 2018;16:417-26.

Glecaprevir-Pibrentasvir in Non-Cirrhotic GT 2 ENDURANCE-2: Results ENDURANCE-2: Overall SVR, by Analysis 195/196 192/192 ITT, intent-to-treat: excludes 6 sofosbuvir-experienced patients, all of whom achieved SVR12 mITT, modified intent-to-treat: xcludes patients with non-virologic failure and those with ineligible genotype Source: Asselah T, et al. Clin Gastroenterol Hepatol. 2018;16:417-26.

Glecaprevir-Pibrentasvir in Non-Cirrhotic GT 2 ENDURANCE-2: Adverse Events Adverse Event (AE), n (%) GLE-PIB 12 weeks (n = 202) Placebo (n = 100) Discontinuation due to AE Serious AEs§ 3 (1) 1 (1) Deaths Any AE in >10% of patients Headache Fatigue 24 (12) 23 (11) 12 (12) 10 (10) Laboratory AEs AST elevation, grade 3-4 (>5x ULN) ALT elevation, grade 3-4 (>5x ULN)* Total bilirubin, grade 3 (3-10x ULN)⋕ 2 (1) 1 (0.5) 2 (2) AST, aspartate aminotransferase; ALT, alanine aminotransferase; ULN, upper limit normal § No serious AEs were deemed to be DAA-related; no SAEs led to drug discontinuation. Event occurred with grade 3 AST and grade 3 alkaline phosphatase elevation in context of cholelithiasis. ⋕Indirect hyperbilirubinemia; no associated ALT elevation. Declined with treatment. Source: Asselah T, et al. Clin Gastroenterol Hepatol. 2018;16:417-26.

Glecaprevir-Pibrentasvir in Non-Cirrhotic GT 2 Glecaprevir-Pibrentasvir in Non-Cirrhotic GT 2 *ENDURANCE-2: Conclusions Conclusion: “The SVR12 rate in all genotype 2-infected patients treated for 12 weeks (including those with sofosbuvir experience) was 99.5%, with no virologic failures.” *Note: ENDURANCE-2 was published in conjunction with ENDURANCE-4 and SURVEYOR-II (Part 4) Source: Asselah T, et al. Clin Gastroenterol Hepatol. 2018;16:417-26.

This slide deck is from the University of Washington’s Hepatitis C Online and Hepatitis Web Study projects. Hepatitis C Online www.hepatitisc.uw.edu Hepatitis Web Study http://depts.washington.edu/hepstudy/ Funded by a grant from the Centers for Disease Control and Prevention.