Combination Entecavir and Peginterferon Therapy in HBeAg-Positive Immune-Tolerant Adults With Chronic Hepatitis B

NCT ID: NCT01369199

Last Updated: 2022-05-26

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE3

Total Enrollment

28 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-05-31

Study Completion Date

2017-02-14

Brief Summary

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The investigators evaluated the safety and efficacy of a short lead-in course (8 weeks) of entecavir followed by combination of entecavir plus peginterferon alfa-2a for 40 weeks.

Detailed Description

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To determine the efficacy of treatment with 8 weeks of entecavir followed by 40 weeks of both entecavir and peginterferon in the treatment of chronic hepatitis B in hepatitis B "e" antigen (HBeAg) positive adults who are in the immune tolerant phase.

To evaluate safety and sustained responses after treatment with entecavir and peginterferon alfa-2a in the treatment of chronic hepatitis B in HBeAg positive adults who are in the immune tolerant phase.

A single arm treatment study of 8 weeks of entecavir followed by 40 weeks of both entecavir and peginterferon alfa-2a in adults with HBeAg-positive chronic hepatitis B with normal or near normal alanine aminotransferase (ALT) levels and high serum levels of hepatitis B virus (HBV) DNA ("immune tolerant" HBeAg-positive chronic hepatitis B). All participants followed for 48 weeks after treatment discontinuation (week 96 for those who completed treatment).

Conditions

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Hepatitis B

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Peginterferon and entecavir

A combination of 8 weeks of entecavir followed by 40 weeks of both entecavir and peginterferon.

Group Type EXPERIMENTAL

Entecavir and peginterferon

Intervention Type DRUG

Entecavir 0.5 mg daily orally for 48 weeks plus peginterferon 180 µg sq weekly during weeks 9-48 of treatment.

Interventions

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Entecavir and peginterferon

Entecavir 0.5 mg daily orally for 48 weeks plus peginterferon 180 µg sq weekly during weeks 9-48 of treatment.

Intervention Type DRUG

Other Intervention Names

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PEGASYS, peginterferon alfa 2a, Baraclude

Eligibility Criteria

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Inclusion Criteria

* Enrolled in \& completed the baseline evaluation for NCT01263587 or completed the necessary components of NCT01263587 by the end of baseline visit.
* \>18 years of age at the baseline visit (day 0). Patients \>50 years of age at baseline will need to have a liver biopsy as standard of care with hepatic activity index (HAI) ≤3 \& Ishak fibrosis score ≤1 within 96 weeks prior to baseline visit.
* Documented chronic HBV infection as evidenced by detection of HBsAg in serum for ≥24 weeks prior to baseline visit OR at least one positive HBsAg \& negative anti-hepatitis B core (HBc) immunoglobulin (IgM) within 24 weeks prior to baseline visit OR at least one positive HBsAg \& two positive HBV DNA over a period of ≥24 weeks prior to baseline visit.
* Presence of HBeAg in serum at last screening visit within 6 weeks of baseline visit.
* Serum HBV DNA level \>10˄7 IU/mL on at least two occasions at least 12 weeks apart during the 52 weeks before baseline visit. One of the two HBV DNA levels must be within 6 weeks of baseline visit.
* ALT levels persistently ≤45 U/L in males, ≤30 U/L in females (approx. 1.5 times the upper limit of normal (ULN) range) as documented by at least three values: one taken 28-52 weeks before baseline visit, one taken 6 to 24 weeks before the baseline visit, \& the final value within 6 weeks prior to baseline visit.
* No evidence of hepatocellular carcinoma (HCC) based upon alpha-fetoprotein (AFP) ≤20 ng/mL at screening visit (up to 6 weeks prior to baseline visit). a. Participants who meet American Association for the Study of Liver Diseases (AASLD) criteria for HCC surveillance must have negative liver imaging as shown by ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI) within 28 weeks prior to baseline visit. b. Participants with AFP \>20 ng/mL must be evaluated clinically with additional imaging \& shown not to have HCC on CT or MRI before they can be enrolled.

Exclusion Criteria

* History of hepatic decompensation
* Evidence of decompensated liver disease prior to or during screening, including direct bilirubin \>0.5 mg/dL, international normalization ratio (INR) \>1.5, or serum albumin \<3.5 g/dL.
* Platelet count \<120,000/mm3, hemoglobin \<13 g/dL (males) or \<12 g/dL (females), absolute neutrophil count \< 1500 /mm3 (\<1000/mm3 for African-Americans) at last screening visit.
* Previous treatment with medications that have established activity against HBV including interferon \& nucleos(t)ide analogs ≥24 weeks. Patients with \<24 weeks of prior HBV treatment \& a wash-out period \>24 weeks are not excluded.
* Known allergy or intolerance to study medications.
* Females who are pregnant or breastfeeding. Females of childbearing potential unable or unwilling to use a reliable method of contraception during the treatment period.
* Renal insufficiency with calculated creatinine clearance \<50 mL/min at screening.
* History of alcohol or drug abuse within 48 weeks of baseline visit.
* Previous liver or other organ transplantation (including engrafted bone marrow).
* Any other concomitant liver disease, including hepatitis C or D. Non-alcoholic fatty liver disease (NAFLD) with steatosis \&/or mild to moderate steatohepatitis is acceptable but NAFLD with severe steatohepatitis is exclusionary.
* Presence of anti-hepatitis D virus (HDV) or anti-hepatitis C virus (HCV) (unless HCV RNA negative) in serum on any occasion in the 144 weeks prior to baseline visit. Presence of anti-HIV (test completed within 6 weeks prior to baseline visit).
* Pre-existing psychiatric condition(s), including, but not limited to: current moderate or severe depression, history of depression requiring hospitalization within the past 10 years, history of suicidal or homicidal attempt within the past 10 years, history of severe psychiatric disorders as determined by a study physician.
* History of immune-mediated or cerebrovascular disease, chronic pulmonary or cardiac disease associated with functional limitation, retinopathy, uncontrolled thyroid disease, poorly controlled diabetes or uncontrolled seizure disorder, as determined by a study physician.
* Any medical condition that would, in the opinion of a study physician, be predicted to be exacerbated by therapy or that would limit study participation.
* Any medical condition requiring, or likely to require, chronic systemic administration of corticosteroids or other immunosuppressive medications during the course of this study.
* Evidence of active or suspected malignancy, or a history of malignancy within the 144 weeks prior to baseline visit (except adequately treated carcinoma in situ or basal cell carcinoma of the skin).
* Expected need for ongoing use of any antivirals with activity against HBV during the course of the study.
* Concomitant use of complementary or alternative medications purported to have antiviral activity.
* Participation in any other clinical trial involving investigational drugs within 30 days of the baseline visit or intention to participate in another clinical trial involving investigational drugs during participation in this study.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Pittsburgh

OTHER

Sponsor Role collaborator

National Center for Research Resources (NCRR)

NIH

Sponsor Role collaborator

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Averell Sherker, MD

Role: STUDY_CHAIR

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Anna Lok, MD

Role: PRINCIPAL_INVESTIGATOR

University of Michigan

Locations

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Cedars Sinai Medical Center

Los Angeles, California, United States

Site Status

University of California Los Angeles

Los Angeles, California, United States

Site Status

California Pacific Medical Center

San Francisco, California, United States

Site Status

University of California San Francisco

San Francisco, California, United States

Site Status

Queen's Medical Center

Honolulu, Hawaii, United States

Site Status

NIH Clinical Center

Bethesda, Maryland, United States

Site Status

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status

Beth Israel Deaconess Medical Center

Boston, Massachusetts, United States

Site Status

University of Michigan Health System

Ann Arbor, Michigan, United States

Site Status

University of Minnesota

Minneapolis, Minnesota, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

Saint Louis University

St Louis, Missouri, United States

Site Status

Washington University

St Louis, Missouri, United States

Site Status

University of North Carolina

Chapel Hill, North Carolina, United States

Site Status

Duke University Medical Center

Durham, North Carolina, United States

Site Status

Baylor University Medical Center

Dallas, Texas, United States

Site Status

University of Texas Southwestern

Dallas, Texas, United States

Site Status

Virginia Commonwealth University

Richmond, Virginia, United States

Site Status

Virginia Mason Medical Center

Seattle, Washington, United States

Site Status

University of Washington Medical Center

Seattle, Washington, United States

Site Status

University of Toronto

Toronto, Ontario, Canada

Site Status

Countries

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United States Canada

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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U01DK082916

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082843

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082863

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082864

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082866

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082867

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082871

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082872

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082874

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082919

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082923

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082927

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082943

Identifier Type: NIH

Identifier Source: secondary_id

View Link

U01DK082944

Identifier Type: NIH

Identifier Source: secondary_id

View Link

P30DK050306

Identifier Type: NIH

Identifier Source: secondary_id

View Link

A-DK-3002-001

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

M01RR000040

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UL1TR000058

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UL1TR000004

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UL1TR001111

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UL1RR024986

Identifier Type: NIH

Identifier Source: secondary_id

View Link

DK082864 HBRN IT Adult Trial

Identifier Type: -

Identifier Source: org_study_id

NCT01534611

Identifier Type: -

Identifier Source: nct_alias

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