UNITY-2 Study
This study, published in JAMA 2015, investigates the efficacy of Daclatasvir-Asunaprevir-Beclabuvir treatment in cirrhotic patients with Hepatitis C genotype 1. The findings of the UNITY-2 study by Muir et al. provide insights into the effectiveness of this regimen in both treatment-naive and treatment-experienced individuals.
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Phase 3 Treatment-Na ve and Treatment-Experienced Daclatasvir-Asunaprevir-Beclabuvir in Genotype 1 Cirrhotics UNITY-2 Study Muir A, et al. JAMA 2015;313:1736-44.
Daclatasvir-Asunaprevir-Beclabuvir +/- RBV for HCV GT 1 UNITY-2 Trial: Study Features Daclatasvir-Asunaprevir-Beclabuvir Trial: Features Design: Multicenter, randomized, double-blind phase 3 trial of daclatasvir- asunaprevir-beclabuvir (fixed-dose combination) +/- ribavirin in treatment- na ve or experienced, chronic HCV GT 1 patients with compensated cirrhosis Setting: Multiple centers in the United States, Canada, Australia, France Entry Criteria - Chronic HCV Genotype 1 - Compensated cirrhosis (METAVIR F4 or equivalent by biopsy, FibroScan >14.6 kPa or FibroTest/FibroSURE 0.75 or APRI >2) - Platelets >50,000 cells/mm3 - Albumin > 3.5 g/dL and INR < 1.7 - Treatment-na ve or treatment-experienced - HCV RNA 10,000 IU/ml End-Points: Primary = SVR12 Source: Muir A, et al. JAMA 2015;313:1736-44.
Daclatasvir-Asunaprevir-Beclabuvir +/- RBV for HCV GT 1 UNITY-2 Trial: Study Design Week 0 12 24 SVR12 n=55 DCV-ASV-BCV + RBV Treatment Na ve GT 1a/1b Cirrhosis n=112 DCV-ASV-BCV + Placebo n=57 SVR12 Treatment Experienced GT 1a/1b Cirrhosis n=90 DCV-ASV-BCV + RBV SVR12 n=45 DCV-ASV-BCV + Placebo n=45 SVR12 Drug Dosing Daclatasvir (DCV)-Asunaprevir (ASV)-Beclabuvir (BCV) (30/200/75 mg): fixed dose combination BID Ribavirin (RBV): weight-based and divided BID (1000 mg/day if < 75kg or 1200 mg/day if 75kg) N =14 Source: Muir A, et al. JAMA 2015;313:1736-44.
Daclatasvir-Asunaprevir-Beclabuvir +/- RBV for HCV GT 1 UNITY-2 Trial: Patient Characteristics Treatment-Naive Characteristic DCV-ASV-BCV + RBV (n=55) DCV-ASV-BCV (n=57) Male 35 (64%) 39 (68%) Median age, years (range) 59 (35-73) 58 (25-75) Race White Black/African American Asian 46 (84%) 6 (11%) 1 (2%) 49 (86%) 6 (11%) 0 HCV RNA 800,000 IU/ml 41 (75%) 93 (90%) HCV subtype 1A 39 (71%) 75 (73%) IL28B non-CC genotype 37 (67%) 43 (75%) Platelets x 103/ l 125 100-<125 50-<100 25-<50 28 (51%) 10 (18%) 16 (29%) 1 (2%) 35 (63%) 13 (23%) 8 (14%) 0 Source: Muir A, et al. JAMA 2015;313:1736-44.
Daclatasvir-Asunaprevir-Beclabuvir +/- RBV for HCV GT 1 UNITY-2 Trial: Patient Characteristics Treatment-Experienced Characteristic DCV-ASV-BCV + RBV (n=45) DCV-ASV-BCV (n=45) Male 27 (60%) 32 (71%) Median age, years (range) 60 (48-73) 59 (19-76) Race White Black/African American Asian 37 (82%) 6 (13%) 1 (2%) 41 (91%) 2 (4%) 2 (4%) HCV RNA 800,000 IU/ml 41 (91%) 43 (96%) HCV subtype 1A 35 (78%) 35 (78%) IL28B non-CC genotype 35 (80%) 30 (67%) Prior Treatment Outcome Relapse Partial Response Null Response Interferon-intolerant 8 (18%) 2 (4%) 16 (36%) 10 (22%) 8 (18%) 6 (13%) 19 (42%) 6 (13%) Source: Muir A, et al. JAMA 2015;313:1736-44.
Daclatasvir-Asunaprevir-Beclabuvir +/- RBV for HCV GT 1 UNITY-2 Trial: Results 100 98 Patients with SVR12 (%) 93 93 87 80 60 40 20 53/57 54/55 39/45 42/45 0 DCV/ASV/BCV DCV/ASV/BCV + RBV DCV/ASV/BCV DCV/ASV/BCV + RBV Treatment-Na ve Treatment-Experienced Abbreviations: DCV=daclatasvir; ASV=asunaprevir; BCV=beclabuvir; RBV=ribavirin Source: Muir A, et al. JAMA 2015;313:1736-44.
Daclatasvir-Asunaprevir-Beclabuvir +/- RBV for HCV GT 1 UNITY-2 Trial: Results UNITY-2: SVR12 by Regimen and Platelet Count DCV/ASV/BCV DCV/ASV/BCV +RBV 100 Patients (%) with SVR12 100 95 91 80 88 60 40 20 69/76 69/73 23/26 27/27 0 Platelets 100,000 cells/ l Platelets <100,000 cells/ l Abbreviations: DCV=daclatasvir; ASV=asunaprevir; BCV=beclabuvir; RBV=ribavirin Source: Muir A, et al. JAMA 2015;313:1736-44.
Daclatasvir-Asunaprevir-Beclabuvir +/- RBV for HCV GT 1 UNITY-2 Trial: Adverse Events NUTRINO: SVR 12 by Liver Disease DCV-ASV-BCV (n=102) DCV-ASV-BCV + RBV (n=100) Event (%) Serious Adverse Events (AEs) AEs leading to discontinuation of all meds Adverse Events, 10% incidence Fatigue Headache Nausea Diarrhea Insomnia Pruritus Grade 3 or 4 Lab Abnormalities Hemoglobin < 9 g/dl ALT >5 x ULN Lipase, total >3 x ULN 2 7 0 1 12 17 14 13 6 6 28 23 17 9 15 15 0 3 5 5 1 1 Abbreviations: DCV=daclatasvir; ASV=asunaprevir; BCV=beclabuvir; RBV=ribavirin; ULN = upper limit of normal Source: Muir A, et al. JAMA 2015;313:1736-44.
Daclatasvir-Asunaprevir-Beclabuvir +/- RBV for HCV GT 1 UNITY-2 Trial: Conclusion Conclusions and Relevance: In this open-label, uncontrolled study, patients with chronic HCV genotype 1 infection and cirrhosis who received a 12-week oral fixed-dose regimen of daclatasvir, asunaprevir, and beclabuvir, with or without ribavirin, achieved high rates of SVR12. Source: Muir A, et al. JAMA 2015;313:1736-44.
This slide deck is from the University of Washingtons 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.
