HCV Prophylaxis Strategies for Kidney Transplant Recipients

(PREVENT-HCV Trial)

Recruiting in Palo Alto (17 mi)

+8 other locations

Overseen by Christine Durand, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Johns Hopkins University

Disqualifiers: Active HCV, Cirrhosis, HIV, others

No Placebo Group

Breakthrough Therapy

Trial Summary

What is the purpose of this trial?

This study is being done to find out the best time to start medication for Hepatitis C Virus (HCV) in HCV-negative recipients of HCV-positive (HCV D+/R-) kidney transplants. Participants will be randomized into one of two groups: Arm 1 - Prophylaxis: This group will start the HCV medication before transplant and will take a shorter course of HCV medication for 2 weeks. Arm 2 - Transmit and Treat: This group will start the HCV medication after transplant and will take the full course (12 weeks) of HCV medication.

Will I have to stop taking my current medications?

The trial does not specify if you must stop taking your current medications, but you cannot participate if you are unable to safely stop or switch a medication that conflicts with the study medication.

What data supports the effectiveness of the drug Sofosbuvir/Velpatasvir for kidney transplant recipients?

Research shows that using Sofosbuvir/Velpatasvir for 7 days significantly reduced hepatitis C transmission in kidney transplant recipients compared to shorter treatments. Additionally, other studies found that Sofosbuvir-based treatments are effective and safe for treating hepatitis C in kidney transplant patients, with high rates of virus clearance and no major side effects. ^{1 2 3 4 5}

Is Sofosbuvir/Velpatasvir safe for kidney transplant recipients?

Sofosbuvir/Velpatasvir has been shown to be safe for kidney transplant recipients, with no adverse events related to the medication reported in a study of patients who received kidneys from HCV-infected donors. The treatment was well-tolerated, and renal function remained stable in all patients. ^{2 6 7 8 9}

How is the drug Sofosbuvir/Velpatasvir used in kidney transplant recipients unique?

Sofosbuvir/Velpatasvir is unique for kidney transplant recipients as it is used as a short-term prophylactic (preventive) treatment to reduce the risk of hepatitis C virus (HCV) transmission from infected donors to uninfected recipients, with a 7-day regimen showing a significant reduction in transmission rates compared to shorter durations. ^{2 3 5 7 9}

Research Team

Christine Durand, MD

Principal Investigator

Johns Hopkins University

Eligibility Criteria

This trial is for adults over 18 who need a kidney transplant and can give informed consent. They must meet standard criteria for transplantation, have normal liver function (AST or ALT within safe limits), and not be infected with HIV, active hepatitis B, or have had hepatitis C. Pregnant or breastfeeding individuals are excluded.

Inclusion Criteria

I meet the kidney transplant criteria at my local center.

I understand the study and can give my consent.

I am 18 years old or older.

Exclusion Criteria

I have a history of hepatitis C.

I have a liver condition with a FIB-4 score of 1.45 or higher, or a history of severe liver scarring.

I cannot stop or change a medication I'm taking that's not allowed with the study drug.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive sofosbuvir/velpatasvir (SOF/VEL) for either 2 weeks starting pre-transplant (prophylaxis) or 12 weeks starting post-transplant (transmit-and-treat)

2-12 weeks

Follow-up

Participants are monitored for safety, effectiveness, and various health outcomes post-transplant

At least 6 months, up to 3 years

Treatment Details

Interventions

• Prophylaxis (P2W) (Direct-acting Antivirals)
• Transmit and Treat (T&T) (Direct-acting Antivirals)

Trial Overview The study compares two timings to start Hepatitis C medication in patients receiving kidneys from HCV-positive donors: 'Prophylaxis' starts treatment before the transplant with a shorter course of medication; 'Transmit and Treat' begins after the transplant with a full course.

Participant Groups

Group I: Transmit and Treat (T&T) Experimental Treatment 1 Intervention

T\&T is study-supplied SOF/VEL for 12 weeks starting on post-HCV D+/R- kidney transplant day participant's insurance approves standard of care DAAs, or post-KT day 14, whichever comes first.

Group II: Prophylaxis (P2W) Experimental Treatment 1 Intervention

Prophylaxis is one dose of sofosbuvir/velpatasvir (SOF/VEL) pre-HCV D+/R- kidney transplant (KT), continued for 2 weeks.

Who Is Running the Clinical Trial?

Johns Hopkins University

Lead Sponsor

Trials

2,366

Recruited

15,160,000+

Theodore DeWeese

Johns Hopkins University

Chief Executive Officer since 2023

MD from an unspecified institution

Allen Kachalia

Johns Hopkins University

Chief Medical Officer since 2023

MD from an unspecified institution

National Institute of Allergy and Infectious Diseases (NIAID)

Collaborator

Trials

3,361

Recruited

5,516,000+

Dr. Jeanne Marrazzo

National Institute of Allergy and Infectious Diseases (NIAID)

Chief Executive Officer since 2023

MD, MPH

Dr. H. Clifford Lane

National Institute of Allergy and Infectious Diseases (NIAID)

Chief Medical Officer

MD

Findings from Research

In a study of 19 kidney transplant recipients treated with sofosbuvir-daclatasvir, 100% achieved a sustained virological response 12 weeks after treatment, indicating the treatment's high efficacy against chronic hepatitis C virus (HCV) infection.

Patients also showed significant improvements in liver function, with notable decreases in liver enzyme levels (ALT and AST), and stable kidney function throughout the therapy, suggesting that the treatment is well-tolerated and safe for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of chronic hepatitis C viral infection with sofosbuvir and daclatasvir in kidney transplant recipients. Huang, H., Tang, H., Deng, H., et al.[2021]

A 7-day prophylaxis with sofosbuvir/velpatasvir (SOF/VEL) significantly reduced hepatitis C virus (HCV) transmission in kidney transplant recipients from infected donors, with only 4% of patients experiencing transmission compared to 13% with a 2- to 4-day protocol.

All patients who developed HCV transmission achieved a sustained virologic response after full-course therapy, indicating effective treatment outcomes, and there were no significant differences in transplant outcomes between HCV-positive and HCV-negative recipients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of short-duration antiviral prophylaxis for hepatitis C positive donor kidney transplants. Gupta, G., Yakubu, I., Zhang, Y., et al.[2023]

In a pilot study involving 25 kidney transplant recipients, a sofosbuvir-based regimen demonstrated high efficacy, with 88% of patients achieving a rapid virological response by week 4 and all patients having undetectable HCV RNA by the end of therapy.

The treatment was well-tolerated with no adverse events reported, indicating that new-generation direct antiviral agents (DAAs) are both effective and safe for treating hepatitis C virus infection in kidney transplant recipients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of Sofosbuvir-Based Antiviral Therapy to Treat Hepatitis C Virus Infection After Kidney Transplantation. Kamar, N., Marion, O., Rostaing, L., et al.[2023]

Sofosbuvir-based therapy demonstrated 100% effectiveness in treating chronic hepatitis C virus infection in 40 stable kidney transplant recipients, with successful virologic responses at all assessed time points.

While the treatment was safe overall, it significantly reduced hemoglobin levels in half of the patients, necessitating careful monitoring and potential dose adjustments of ribavirin, as well as a notable decrease in calcineurin inhibitor levels during therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness and safety of sofosbuvir-based therapy against chronic hepatitis C infection after successful kidney transplantation. Musialik, J., Kolonko, A., Kwiecień, K., et al.[2019]

In a study of 22 HCV-infected renal transplant recipients treated with sofosbuvir-based regimens, there was a remarkable 100% sustained viral response at both 12 and 24 weeks, indicating high efficacy of the treatment.

The treatment was generally safe, although ribavirin caused anemia in some patients, and there was a notable decrease in tacrolimus levels, necessitating dose adjustments for many participants.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Direct-acting Antiviral Agents in Hepatitis C Virus-infected Renal Allograft Recipients: Treatment and Outcome Experience from Single Center. Prasad, N., Patel, MR., Pandey, A., et al.[2020]

The sofosbuvir-velpatasvir regimen achieved a high sustained virological response (SVR12) rate of 94.2% in 1277 patients with chronic hepatitis C virus (HCV) infection, indicating its strong efficacy.

Adding ribavirin did not significantly improve SVR12 rates for HCV genotypes 1 and 2, but it did enhance the response for genotype 3 patients, suggesting that ribavirin may be beneficial for specific HCV genotypes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and efficacy of sofosbuvir-velpatasvir: A meta-analysis. Ren, XD., Fu, X., He, YQ., et al.[2022]

In a study of 26 HCV-negative kidney transplant recipients from HCV-infected donors, treatment with Sofosbuvir/Velpatasvir for 12 weeks was effective, with all patients maintaining negative HCV RNA levels post-treatment.

The treatment was deemed safe, as adverse events occurred in 57.7% of patients, but none were related to the medication, and renal function remained stable throughout the study.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sofosbuvir/Velpatasvir Prophylaxis for 12 Weeks in Hepatitis C Virus (HCV)-Negative Recipients Receiving Kidney Transplantation from HCV-Positive Donors. Chen, R., Li, D., Zhang, M., et al.[2021]

In a study of 30 patients with chronic hepatitis C genotype 1, treatment with generic sofosbuvir/ledipasvir (SOF/LDV) resulted in a 100% sustained virologic response, indicating its high efficacy in clearing the virus.

The treatment was found to be safe, with no severe adverse events reported, although 20% of patients experienced mild to moderate side effects, demonstrating that generic SOF/LDV is a viable option even for patients with cirrhosis or previous interferon treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Real-life efficacy of generic sofosbuvir/ledipasvir for treatment of Iranian patients with chronic hepatitis C: A cohort study. Sharafi, H., Alavian, SH., Behnava, B., et al.[2022]

In a study of 6 male kidney transplant patients with hepatitis C, treatment with sofosbuvir and daclatasvir resulted in a 100% sustained virological response rate after 12 weeks, indicating high efficacy in clearing the virus.

The treatment was generally safe, with no serious adverse events reported, although two patients required a reduced dose of sofosbuvir due to elevated serum creatinine levels, suggesting careful monitoring of kidney function is necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and safety of sofosbuvir and daclatasvir in treatment of kidney transplantation recipients with hepatitis C virus infection. Xue, Y., Zhang, LX., Wang, L., et al.[2021]

References

1. Denmark pubmed.ncbi.nlm.nih.gov

Treatment of chronic hepatitis C viral infection with sofosbuvir and daclatasvir in kidney transplant recipients. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Outcomes of short-duration antiviral prophylaxis for hepatitis C positive donor kidney transplants. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of Sofosbuvir-Based Antiviral Therapy to Treat Hepatitis C Virus Infection After Kidney Transplantation. [2023]

4. Denmark pubmed.ncbi.nlm.nih.gov

Effectiveness and safety of sofosbuvir-based therapy against chronic hepatitis C infection after successful kidney transplantation. [2019]

5. India pubmed.ncbi.nlm.nih.gov

Direct-acting Antiviral Agents in Hepatitis C Virus-infected Renal Allograft Recipients: Treatment and Outcome Experience from Single Center. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Safety and efficacy of sofosbuvir-velpatasvir: A meta-analysis. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Sofosbuvir/Velpatasvir Prophylaxis for 12 Weeks in Hepatitis C Virus (HCV)-Negative Recipients Receiving Kidney Transplantation from HCV-Positive Donors. [2021]

8. Iran pubmed.ncbi.nlm.nih.gov

Real-life efficacy of generic sofosbuvir/ledipasvir for treatment of Iranian patients with chronic hepatitis C: A cohort study. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Efficacy and safety of sofosbuvir and daclatasvir in treatment of kidney transplantation recipients with hepatitis C virus infection. [2021]