Effect of Teleprevir in Triple Therapy on Intrahepatic Immunological Mechanisms

Study Overview
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Brief Summary
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Chronic hepatitis C infection (HCV) is a disease that affects worldwide about 170 million people. The previous standard of care therapy of chronic HCV patients consists of pegylated-IFN-α combined with ribavirin, and results in sustained clearance of HCV-RNA in only about 50% of the HCV genotype 1 infected patients. Telaprevir, a NS3A-4A inhibitor, has previously proven to offer therapeutic options to previous non-responders to the standard of care. Although, not all chronic HCV patients benefit from telaprevir and it is still not known why certain patients are also non-responsive to this triple therapy. In this study we try to understand why certain patients are also non-responsive to telaprevir, how triple therapy modulates the responsiveness to IFN-α and what the immunological consequences are of treatment with telaprevir, either directly or as a result of telaprevir-induced reduction of HCV-RNA levels.

Official Title
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Effect of Telaprevir in Triple Therapy on Intrahepatic Immunological Mechanisms.

Conditions
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Chronic Hepatitis C

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients between 18 and 70 years of age, with a chronic hepatitis C - genotype 1 infection Patients are naive, non-responders or relapsers to previous treatment with peginterferon or conventional interferon plus ribavirin combination therapy High viral load (>400,000 IU/ml) Indication for antiviral therapy of hepatitis C according to current clinical guidelines Exclusion Criteria: Decompensated cirrhosis (Child-Pugh Grade B or C) Hepatic imaging (ultrasound, CT or MRI) with the evidence of hepatocellular carcinoma. Females who are pregnant or breast-feeding History or other evidence of severe illness, malignancy or any other condition which would make the patient, in the opinion of the investigators, unsuitable for the study Co-infections with human immunodeficiency virus (HIV) or Hepatitis B virus (HBV) Presence of contra-indications for antiviral therapy with telaprevir: Telaprevir is contraindicated when combined with drugs that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events. Telaprevir in contraindicated when combined with drugs that strongly induce CYP3A and thus may lead to lower exposure and loss of efficacy of Telaprevir. The contraindicated medications include the following: Alfuzosin Rifampicin Dihydroergotamine, ergonovine, ergotamine, methylergonovine Cisapride St John's wort Atorvastatin, lovastatin, simvastatin Pimozide Sildenafil or tadalafil Triazolam Presence of contra-indications for antiviral therapy with peginterferon or ribavirin Severe psychiatric disorder, such as major psychoses, suicidal ideation, suicidal attempt and/or manifest depression. Visual symptoms related to retinal abnormalities Pregnancy, breast-feeding or inadequate contraception Thalassemia, spherocytosis Interfering substance abuse, such as high alcohol intake (indicator: 28 drinks/ week)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Determine functionality of immune cells in the liver and blood in chronic HCV patients before, during and after treatment with telaprevir, pegylated-IFN-a and ribavirin | By looking at T cells, NK cells and monocytes during triple therapy, as well intrahepatic as in peripheral blood, we try to better understand why some patients respond and others do not respond to therapy. | 24 week follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hepatitis C, Liver, Immunology, Genotype 1, Treatment, Chronic, RNA Virus Infections, Ribavirin, Peginterferon alfa-2a, Protease Inhibitors, Telaprevir