Combination Therapy of Pegylated Interferon Alfa-2a and Tenofovir Versus Tenofovir Monotherapy in Chronic Hepatitis B

NCT ID: NCT01369212

Last Updated: 2023-04-28

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

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

201 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-11-30

Study Completion Date

2021-03-08

Brief Summary

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This clinical trial compares the efficacy of peginterferon plus tenofovir for 24 weeks followed by monotherapy with tenofovir for a further 3.5 years to the efficacy of tenofovir alone given for 4 years in patients with chronic hepatitis B. The primary measure of outcome will be HBsAg loss in serum at 48 weeks after stopping all antiviral therapy (sustained off-treatment response).

Detailed Description

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The objective of this study is to compare the long-term efficacy of treatment with combination therapy with peginterferon plus tenofovir versus tenofovir monotherapy in the treatment of chronic hepatitis B.

This is a randomized (1:1) parallel group design trial comparing (i) tenofovir disoproxil fumarate (TDF) 300 mg daily for 192 weeks (4 years) and (ii) peginterferon alfa-2a 180 µg weekly for 24 weeks plus Tenofovir DF 300 mg daily for 192 weeks (4 years). Enrolled participants will be stratified by HBeAg status (positive/negative), genotype (A vs. all others) and cirrhosis (present vs. absent). After 192 weeks of treatment, participants meeting criteria for treatment discontinuation will stop treatment and be followed for 48 weeks (total duration of treatment and follow up is 240 weeks). Emtricitabine/tenofovir coformulated as Truvada, approved for treatment of HIV but not for treatment of hepatitis B virus (HBV) infection, will be offered to patients with primary nonresponse, partial virological response or confirmed virologic breakthrough.

Conditions

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Hepatitis B

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Tenofovir

Tenofovir 192 weeks

Group Type EXPERIMENTAL

Tenofovir

Intervention Type DRUG

300 mg daily for 192 weeks (4 years)

Peginterferon-alfa 2a and tenofovir

A combination of peginterferon-alfa 2a plus tenofovir for 24 weeks and then tenofovir only for 168 weeks

Group Type EXPERIMENTAL

Peginterferon-alfa 2a and tenofovir

Intervention Type DRUG

A combination of peginterferon-alfa 2a 180 µg weekly plus tenofovir 300 mg daily for 24 weeks and then only tenofovir 300 mg daily for 168 weeks (3.5 years).

Interventions

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Tenofovir

300 mg daily for 192 weeks (4 years)

Intervention Type DRUG

Peginterferon-alfa 2a and tenofovir

A combination of peginterferon-alfa 2a 180 µg weekly plus tenofovir 300 mg daily for 24 weeks and then only tenofovir 300 mg daily for 168 weeks (3.5 years).

Intervention Type DRUG

Other Intervention Names

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Hepatitis B Viread Hepatitis B PEGASYS Viread tenofovir

Eligibility Criteria

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Inclusion Criteria

* Participant is enrolled in the HBRN Cohort Study (NCT01263587) or completed the necessary components of the cohort baseline evaluation by the end of the baseline visit for this study
* 18 years or older
* Chronic hepatitis B infection as evidenced by at least one of the following:

1. HBsAg positive result within 8 weeks prior to randomization and another time at least 24 weeks prior to randomization with no HBsAg negative result in between.
2. HBsAg positive within 8 weeks prior to randomization and HBV DNA ≥1000 IU/mL on 2 occasions at least 24 weeks apart (can include result from screening visit within 8 weeks of randomization)
* Hepatitis B e antigen positive or negative
* Serum HBV DNA ≥1000 IU/mL on 2 occasions at least 4 weeks apart within the 32 weeks prior to randomization (can include result from screening visit within 8 weeks of randomization)
* At least 2 elevated serum alanine aminotransferase (ALT) levels (\> 30 U/L for males, \>20 U/L for females) 4 weeks apart, and no more than 32 weeks apart, with the second being within 8 weeks of randomization
* Compensated liver disease
* No evidence of hepatocellular carcinoma (HCC)
* Liver biopsy done that shows findings consistent with chronic hepatitis B with histology activity index (HAI) ≥3 (necroinflammatory component only) or Ishak fibrosis score ≥1 or both, as assessed by the local study pathologist on review of a liver biopsy done within 144 weeks of randomization
* Females of child bearing potential must agree to use an adequate method of contraception throughout the study and must have a negative pregnancy test immediately prior to the start of treatment

Exclusion Criteria

* Serum ALT ≥450 U/L for males and ≥300 U/L for females
* Treatment with interferon or nucleos(t)ide analogues for hepatitis B within 48 weeks of randomization
* More than 48 weeks of therapy with nucleos(t)ide analogues for hepatitis B at any time in the past
* History of hepatic decompensation including but not limited to ascites, variceal bleeding, or hepatic encephalopathy
* Known allergy or intolerance to any of the study medications
* Females who are pregnant or breastfeeding
* Previous organ transplantation including engrafted bone marrow transplant
* Any other concomitant liver disease, including hemochromatosis, hepatitis C or D; Participants with severe steatohepatitis will be excluded (participants with non-alcoholic fatty liver disease \[NAFLD\] with steatosis only and/or mild to moderate steatohepatitis are acceptable)
* Positive anti-HIV
* Renal insufficiency with calculated (by Modification of Diet in Renal Disease (MDRD) method) creatinine clearance \<60 mL/min within 8 weeks prior to randomization
* Platelet count \<90,000 /mm3, hemoglobin \<13 g/dL (males) or \<12 g/dL (females), absolute neutrophil count \<1500 /mm\^3 (\<1000/mm\^3 for African-Americans) within 8 weeks prior to randomization
* History of active alcohol or drug abuse within 48 weeks of screening.
* Pre-existing psychiatric condition(s), including but not limited to: Current moderate or severe depression as determined by the study physician, history of depression requiring hospitalization within past 10 years, history of suicidal or homicidal attempt within the past 10 years, or history of severe psychiatric disorders including but not limited to schizophrenia, psychosis, bipolar disorder
* History of immune-mediated disease, or cerebrovascular, chronic pulmonary or cardiac disease associated with functional limitation, retinopathy, uncontrolled thyroid disease, poorly controlled diabetes or uncontrolled seizure disorder
* Any medical condition that would 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 last 144 weeks (except adequately treated carcinoma in situ or basal cell carcinoma of the skin)
* Need for ongoing use of any antivirals with activity against HBV during the course of the study
* Any other condition that in the opinion of the investigator would make the participant unsuitable for enrollment or could interfere with the participant participating in and completing the study.
* Participation in any other clinical trial involving investigational drugs within 30 days of randomization or intention to participate in another clinical trial during 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)

Edward Doo, 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

Plymouth, 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 Western Hospital

Toronto, Ontario, Canada

Site Status

Countries

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United States Canada

References

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Terrault NA, Sterling R, Lok AS, Ghany MG, Feld JJ, Cloherty G, Wahed AS, Yang X. Hepatitis B Virus RNA as a Biomarker for Safe Antiviral Discontinuation: A Prospective Study of Nucleos(t)ide Analogue Withdrawal. J Infect Dis. 2025 Jun 2;231(5):1290-1298. doi: 10.1093/infdis/jiae541.

Reference Type DERIVED
PMID: 39478672 (View on PubMed)

Feld JJ, Wahed AS, Fried M, Ghany MG, Di Bisceglie AM, Perrillo RP, Khalili M, Yang X, Belle SH, Janssen HLA, Terrault N, Lok AS; Hepatitis B Research Network (HBRN). Withdrawal of Long-Term Nucleotide Analog Therapy in Chronic Hepatitis B: Outcomes From the Withdrawal Phase of the HBRN Immune Active Treatment Trial. Am J Gastroenterol. 2023 Jul 1;118(7):1226-1236. doi: 10.14309/ajg.0000000000002176. Epub 2023 Jan 13.

Reference Type DERIVED
PMID: 36728214 (View on PubMed)

Terrault NA, Lok AS, Wahed AS, Ghany MG, Perrillo RP, Fried MW, Wong DK, Khalili M, Lau DTY, Sterling RK, Di Bisceglie AM, Lisker-Melman M, Cooper SL, Chung RT, Patel K, Roberts LR, Belle SH, Janssen HLA; Hepatitis B Research Network. Randomized Trial of Tenofovir With or Without Peginterferon Alfa Followed by Protocolized Treatment Withdrawal in Adults With Chronic Hepatitis B. Am J Gastroenterol. 2023 Jul 1;118(7):1214-1225. doi: 10.14309/ajg.0000000000002125. Epub 2022 Dec 23.

Reference Type DERIVED
PMID: 36599136 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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U01DK082864

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

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

UL1TR000004

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UL1TR001111

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UL1TR000058

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

UL1RR024986

Identifier Type: NIH

Identifier Source: secondary_id

View Link

DK082864 HBRN Immune Active

Identifier Type: -

Identifier Source: org_study_id

NCT01821794

Identifier Type: -

Identifier Source: nct_alias

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