eltrombopag to initiate and maintain interferon antiviral treatment to subjects with hepatitis c related liver disease

Conditions: Hepatitis C, Chronic

Summary: the purpose of this study is to assess the ability of eltrombopag to maintain a platelet count sufficient to facilitate initiation of antiviral therapy, to minimise antiviral therapy dose reductions and to avoid permanent discontinuation of antiviral therapy. the clinical benefit of eltrombopag will be measured by the proportion of subjects who are able to achieve a sustained virological response (svr).


Eligibility criteria:
inclusion criteria: male and female subjects, \>18 years evidence of chronic hepatitis c virus (hcv) infection subjects who are appropriate candidates for peginterferon (pegifn) and ribavirin antiviral therapy a platelet count of \ 11.0g/dl for men or \>10.0g/dl for women absolute neutrophil count (anc) \>750/mm3 and no history of infections associated with neutropenia creatinine clearance \>50ml/minute all fertile males and females must use two forms of effective contraception between them during treatment and during the 24 weeks after treatment end subject is able to understand, consent and comply with protocol requirements and instructions and is likely to complete the study as planned exclusion criteria: non-responders to previous treatment with pegifn and ribavirin who failed to achieve a sustained virologic response (svr) for reasons other than thrombocytopenia, despite an optimal course (dose and duration) of combination therapy with pegifn and ribavirin decompensated liver disease, e.g. child-pugh score \>6 or history of ascites or hepatic encephalopathy or current evidence of ascites known hypersensitivity, intolerance or allergy to interferon (ifn), ribavirin, eltrombopag or any of their ingredients serious cardiac, cerebrovascular, or pulmonary disease that would preclude treatment with pegifn and ribavirin subjects with a history of any one of the following: suicide attempt or hospitalisation for depression in the past 5 years any current severe or poorly controlled psychiatric disorder the following subjects are eligible for study participation, but must be assessed and followed (if recommended) by a mental health professional: * subjects who have had a severe or poorly controlled psychiatric disorder more than 6 months ago but less than 5 years ago * seizure disorder that has not been well controlled history of clinically significant bleeding from oesophageal or gastric varices subjects with haemoglobinopathies, e.g. sickle cell anaemia, thalassemia major any prior history of arterial or venous thrombosis and two or more of the following risk factors: hereditary thrombophilic disorders (e.g. factor v leiden, antithrombin iii (atiii) deficiency, etc), hormone replacement therapy, systemic contraception (containing estrogen), smoking, diabetes, hypercholesterolemia, medication for hypertension or cancer pre-existing cardiac disease (new york heart association (nyha) grade iii/iv), or arrhythmias known to involve the risk of thromboembolic events, or corrected qt interval (qtc) \>450 msec evidence of hepatocellular carcinoma laboratory evidence of infection with human immunodeficiency virus (hiv) or active hepatitis b virus (hbv) infection any disease condition associated with active bleeding or requiring anticoagulation with heparin or warfarin therapy with any anti-neoplastic or immuno-modulatory treatment \<6 months prior to the first dose of eltrombopag subjects who have had a malignancy diagnosed and/or treated within the past 5 years, except for subjects with localised basal or squamous cell carcinoma treated by local excision or subjects with malignancies who have been adequately treated and, in the opinion of the oncologist, have an excellent chance of cancer-free survival pregnant or nursing women males with a female partner who is pregnant history of alcohol/drug abuse or dependence within 6 months of the study start (unless participating in a controlled rehabilitation programme) treatment with an investigational drug or ifn within 30 days or 5 half-lives (whichever is longer) of the screening visit history of platelet clumping that prevents reliable measurement of platelet counts history of major organ transplantation with an existing functional graft thyroid dysfunction not adequately controlled subjects planning to have cataract surgery evidence of portal vein thrombosis on abdominal imaging within 3 months of the baseline visit

Keywords: thrombopoietin hepatitis c ribavirin platelets hepatitis c-related thrombocytopenia peginterferon alfa-2a