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Combined Therapy With Peginterferon Alfa-2a With NA in NA-treated HBeAg Positive Patients

Primary Purpose

Chronic Hepatitis B

Status
Unknown status
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Peginterferon alfa-2a
nucleos(t)ide analgoue
Sponsored by
Ruijin Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Hepatitis B

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria:

  1. Male and female patients with age ≥18 and ≤65 years;
  2. There should be evidences that HBsAg and HBeAg have been positive for more than 6 months with HBsAb and HBeAb negative before treated with Entecavir;
  3. Treated with NA for more than 24 weeks and achieve HBV DNA<1000copies/ml with HBeAb negative;
  4. Women without ongoing pregnancy or breast feeding and willing to take an effective contraceptive measure during the treatment
  5. Agree to participate in the study and sign the patient informed consent.

Exclusion Criteria:

  1. Co-infection with active hepatitisA, hepatitisC, hepatitisD and/or human immunodeficiency virus (HIV)
  2. AFP>50ng/ml and/or evidence of hepatocellular carcinoma
  3. Evidence of decompensated liver disease (Child-Pugh scores >5). Child-Pugh >5 means that, if one of the following 6 conditions is met, the patient has to be excluded:

    1. Serum albumin <35 g/L;
    2. Prothrombine time prolonged≥ 4 seconds or PTA < 60%;
    3. Serum bilirubin > 34 µmol/L;
    4. History of encephalopathy;
    5. Ascites
  4. History or other evidence of a medical condition associated with chronic liver disease other than viral hepatitis (e.g., hemochromatosis, autoimmune hepatitis, metabolic liver disease, alcoholic liver disease, toxin exposures, thalassemia)
  5. Pregnant or breast-feeding Women
  6. ANC<1.5x 10^9/L or PLT<90x 10^9/L
  7. Consuming alcohol in excess of 20g/day for women and 30g/day for men within 6 months prior to enrollment
  8. History of severe psychiatric disease, especially depression. Severe psychiatric disease is defined as major depression or psychosis that treated with antidepressant medication or a major tranquilizer at therapeutic doses respectively at any time prior to 3 months or any history of the following: a suicidal attempt hospitalization for psychiatric disease, or a period of disability due to a psychiatric disease
  9. History of immunologically mediated disease, (e.g., inflammatory bowel disease, idiopathic thrombocytopenic purpura, lupus erythematosus, autoimmune hemolytic anemia, scleroderma, rheumatoid arthritis etc.)
  10. History of esophageal varices bleeding or other evidence of esophageal varices bleeding or other symptoms consistent with decompensated liver disease
  11. History of chronic pulmonary disease associated with functional limitation
  12. History of severe cardiac disease (e.g., NYHA Functional Class III or IV, myocardial infarction within 6 months, ventricular tachyarrhythmias requiring ongoing treatment, unstable angina or other significant cardiovascular diseases)
  13. Hemodialysis patients or patients with renal insufficiency
  14. History of a severe seizure disorder or current anticonvulsant use
  15. Major organ transplantation or other evidence of severe illness, malignancy, or any other conditions, which would make the patient, in the opinion of the investigator, unsuitable for the study
  16. History of thyroid disease poorly controlled on prescribed medications
  17. Evidence of severe retinopathy or clinically relevant ophthalmologic disorder
  18. History of other severe disease or evidence of other severe disease or any other illness or conditions that the investigator believe that patients are not suitable to join in the study
  19. Immunomodulatory treatment (including interferon) or LDT within 1 year prior to the first dose of treatment
  20. Patients included in another trial or having been given investigational drugs within 12 weeks prior to screening

Sites / Locations

  • The Third People's Hospital of GuilinRecruiting
  • Ruijin HospitalRecruiting
  • Shanghai Public Health Clinical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

PegINF plus nucleos(i)de analgoue

nucleos(t)ide analgoue

Arm Description

Peginterferon alfa-2a 180μg /wk plus nucleos(t)ide analgoue (NA) 1 piece qd for 48 weeks

nucleos(t)ide analgoue (NA) 1 piece qd for 48 weeks

Outcomes

Primary Outcome Measures

Number of participants who achieve HBeAg seroconversion
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the HBeAg seroconversion in HBeAg positive CHB patients on treatment with Entecavir and with HBV DNA <1000copies/ml which will be measured by the number of participants who achieve HBeAg seroconversion

Secondary Outcome Measures

Number of participants who achieve HBeAg loss
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve HBeAg seroconversion which will be measured by number of participants who achieve HBeAg loss
Number of participants who achieve HBsAg loss
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve HBsAg loss which will be measured by number of participants who achieve HBsAg loss
Number of participants who achieve HBsAg seroconversion
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve HBsAg seroconversion which will be measured by number of participants who achieve HBsAg seroconversion
HBsAg decline from baseline
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve HBsAg decline from baseline
Percentage of participants who achieve HBsAg <1000IU/mL
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the percentage of participants who achieve HBsAg<1000IU/mL
Percentage of of participants who achieve HBsAg <100IU/mL
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the percentage of of participants who achieve HBsAg<100IU/mL
Number of participants who achieve combined response I (defined as HBeAg seroconversion and HBV DNA<100000copies/mL)
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the combined response I which will be measured by number of participants who achieve combined response I
Number of participants who achieve combined response II (defined as HBeAg seroconversion and HBV DNA<1000copies/mL)
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the combined response II which will be measured by number of participants who achieve combined response II
Number of participants who achieve dural response I (defined as HBeAg seroconversion and HBsAg<1000IU/mL)
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the dural response I which will be measured by number of participants who achieve dural response I
Number of participants who achieve dural response II (defined as HBeAg seroconversion and HBsAg<100IU/mL)
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the dural response II which will be measured by number of participants who achieve dural response II
Number of Participants with AE
Number of participants with adverse events as a measure of safety and tolerability
Number of Participants with SAE
Number of participants with SAEs as a measure of safety and tolerability

Full Information

First Posted
March 25, 2015
Last Updated
December 2, 2015
Sponsor
Ruijin Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02474316
Brief Title
Combined Therapy With Peginterferon Alfa-2a With NA in NA-treated HBeAg Positive Patients
Official Title
A Prospective, Randomized, Multicenter, Open-label Study Evaluating HBeAg Seroconversion in HBeAg Positive CHB Patients on Treatment With NA Switched to Combined Therapy With Peginterferon Alfa-2a and NA for 48 Weeks
Study Type
Interventional

2. Study Status

Record Verification Date
June 2015
Overall Recruitment Status
Unknown status
Study Start Date
August 2014 (undefined)
Primary Completion Date
December 2017 (Anticipated)
Study Completion Date
December 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ruijin Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a prospective, randomized, multicenter, open-label study. After more than 24 weeks NA treatment, HBeAg positive CHB patients who achieved HBV DNA<1000copies/ml but HBeAb negative, will be randomized (1:1) into 2 study arms as follows: Arm A: Peginterferon alfa-2a 180μg /wk plus NA 1 piece qd for 48 weeks Arm B: Entecavir 0.5mg qd for 48 weeks
Detailed Description
This is a prospective, randomized, multicenter, open-label study. After more than 24 weeks NA treatment, HBeAg positive CHB patients who achieved HBV DNA<1000copies/ml but HBeAb negative, will be randomized (1:1) into 2 study arms as follows: Arm A: Peginterferon alfa-2a 180μg /wk plus NA 1piece qd for 48 weeks Arm B:NA 1 piece qd for 48 weeks The primary endpoint: HBeAg seroconversion at week 48

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Hepatitis B

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
366 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
PegINF plus nucleos(i)de analgoue
Arm Type
Experimental
Arm Description
Peginterferon alfa-2a 180μg /wk plus nucleos(t)ide analgoue (NA) 1 piece qd for 48 weeks
Arm Title
nucleos(t)ide analgoue
Arm Type
Active Comparator
Arm Description
nucleos(t)ide analgoue (NA) 1 piece qd for 48 weeks
Intervention Type
Drug
Intervention Name(s)
Peginterferon alfa-2a
Other Intervention Name(s)
Pegasys
Intervention Description
Peginterferon alfa-2a 180ug/wk s.c for 48 weeks
Intervention Type
Drug
Intervention Name(s)
nucleos(t)ide analgoue
Intervention Description
nucleos(t)ide analgoue (NA) 1 piece p.o for 48 weeks
Primary Outcome Measure Information:
Title
Number of participants who achieve HBeAg seroconversion
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the HBeAg seroconversion in HBeAg positive CHB patients on treatment with Entecavir and with HBV DNA <1000copies/ml which will be measured by the number of participants who achieve HBeAg seroconversion
Time Frame
at week 48
Secondary Outcome Measure Information:
Title
Number of participants who achieve HBeAg loss
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve HBeAg seroconversion which will be measured by number of participants who achieve HBeAg loss
Time Frame
at week 48
Title
Number of participants who achieve HBsAg loss
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve HBsAg loss which will be measured by number of participants who achieve HBsAg loss
Time Frame
at week 48
Title
Number of participants who achieve HBsAg seroconversion
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve HBsAg seroconversion which will be measured by number of participants who achieve HBsAg seroconversion
Time Frame
at week 48
Title
HBsAg decline from baseline
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve HBsAg decline from baseline
Time Frame
at week 48
Title
Percentage of participants who achieve HBsAg <1000IU/mL
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the percentage of participants who achieve HBsAg<1000IU/mL
Time Frame
at week 48
Title
Percentage of of participants who achieve HBsAg <100IU/mL
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the percentage of of participants who achieve HBsAg<100IU/mL
Time Frame
at week 48
Title
Number of participants who achieve combined response I (defined as HBeAg seroconversion and HBV DNA<100000copies/mL)
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the combined response I which will be measured by number of participants who achieve combined response I
Time Frame
at week 48
Title
Number of participants who achieve combined response II (defined as HBeAg seroconversion and HBV DNA<1000copies/mL)
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the combined response II which will be measured by number of participants who achieve combined response II
Time Frame
at week 48
Title
Number of participants who achieve dural response I (defined as HBeAg seroconversion and HBsAg<1000IU/mL)
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the dural response I which will be measured by number of participants who achieve dural response I
Time Frame
at week 48
Title
Number of participants who achieve dural response II (defined as HBeAg seroconversion and HBsAg<100IU/mL)
Description
To investigate whether the combined therapy with Peginterferon alfa-2a with Entecavir can improve the dural response II which will be measured by number of participants who achieve dural response II
Time Frame
at week 48
Title
Number of Participants with AE
Description
Number of participants with adverse events as a measure of safety and tolerability
Time Frame
at week 48
Title
Number of Participants with SAE
Description
Number of participants with SAEs as a measure of safety and tolerability
Time Frame
at week 48

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Male and female patients with age ≥18 and ≤65 years; There should be evidences that HBsAg and HBeAg have been positive for more than 6 months with HBsAb and HBeAb negative before treated with Entecavir; Treated with NA for more than 24 weeks and achieve HBV DNA<1000copies/ml with HBeAb negative; Women without ongoing pregnancy or breast feeding and willing to take an effective contraceptive measure during the treatment Agree to participate in the study and sign the patient informed consent. Exclusion Criteria: Co-infection with active hepatitisA, hepatitisC, hepatitisD and/or human immunodeficiency virus (HIV) AFP>50ng/ml and/or evidence of hepatocellular carcinoma Evidence of decompensated liver disease (Child-Pugh scores >5). Child-Pugh >5 means that, if one of the following 6 conditions is met, the patient has to be excluded: Serum albumin <35 g/L; Prothrombine time prolonged≥ 4 seconds or PTA < 60%; Serum bilirubin > 34 µmol/L; History of encephalopathy; Ascites History or other evidence of a medical condition associated with chronic liver disease other than viral hepatitis (e.g., hemochromatosis, autoimmune hepatitis, metabolic liver disease, alcoholic liver disease, toxin exposures, thalassemia) Pregnant or breast-feeding Women ANC<1.5x 10^9/L or PLT<90x 10^9/L Consuming alcohol in excess of 20g/day for women and 30g/day for men within 6 months prior to enrollment History of severe psychiatric disease, especially depression. Severe psychiatric disease is defined as major depression or psychosis that treated with antidepressant medication or a major tranquilizer at therapeutic doses respectively at any time prior to 3 months or any history of the following: a suicidal attempt hospitalization for psychiatric disease, or a period of disability due to a psychiatric disease History of immunologically mediated disease, (e.g., inflammatory bowel disease, idiopathic thrombocytopenic purpura, lupus erythematosus, autoimmune hemolytic anemia, scleroderma, rheumatoid arthritis etc.) History of esophageal varices bleeding or other evidence of esophageal varices bleeding or other symptoms consistent with decompensated liver disease History of chronic pulmonary disease associated with functional limitation History of severe cardiac disease (e.g., NYHA Functional Class III or IV, myocardial infarction within 6 months, ventricular tachyarrhythmias requiring ongoing treatment, unstable angina or other significant cardiovascular diseases) Hemodialysis patients or patients with renal insufficiency History of a severe seizure disorder or current anticonvulsant use Major organ transplantation or other evidence of severe illness, malignancy, or any other conditions, which would make the patient, in the opinion of the investigator, unsuitable for the study History of thyroid disease poorly controlled on prescribed medications Evidence of severe retinopathy or clinically relevant ophthalmologic disorder History of other severe disease or evidence of other severe disease or any other illness or conditions that the investigator believe that patients are not suitable to join in the study Immunomodulatory treatment (including interferon) or LDT within 1 year prior to the first dose of treatment Patients included in another trial or having been given investigational drugs within 12 weeks prior to screening
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Qing Xie
Phone
86-13651804273
Email
xieqingrjh2015@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Qing Xie
Organizational Affiliation
Ruijin Hospital
Official's Role
Study Chair
Facility Information:
Facility Name
The Third People's Hospital of Guilin
City
Guilin
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shuquan Chen, doctor
Facility Name
Ruijin Hospital
City
Shanghai
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Qing Xie, doctor
First Name & Middle Initial & Last Name & Degree
Wei Cai, doctor
Facility Name
Shanghai Public Health Clinical Center
City
Shanghai
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Liang Chen, doctor

12. IPD Sharing Statement

Citations:
PubMed Identifier
14697813
Citation
Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet. 2003 Dec 20;362(9401):2089-94. doi: 10.1016/S0140-6736(03)15108-2.
Results Reference
result
PubMed Identifier
24954675
Citation
Trepo C, Chan HL, Lok A. Hepatitis B virus infection. Lancet. 2014 Dec 6;384(9959):2053-63. doi: 10.1016/S0140-6736(14)60220-8. Epub 2014 Jun 18.
Results Reference
result
PubMed Identifier
10051494
Citation
Tassopoulos NC, Volpes R, Pastore G, Heathcote J, Buti M, Goldin RD, Hawley S, Barber J, Condreay L, Gray DF. Efficacy of lamivudine in patients with hepatitis B e antigen-negative/hepatitis B virus DNA-positive (precore mutant) chronic hepatitis B. Lamivudine Precore Mutant Study Group. Hepatology. 1999 Mar;29(3):889-96. doi: 10.1002/hep.510290321.
Results Reference
result
PubMed Identifier
12606735
Citation
Marcellin P, Chang TT, Lim SG, Tong MJ, Sievert W, Shiffman ML, Jeffers L, Goodman Z, Wulfsohn MS, Xiong S, Fry J, Brosgart CL; Adefovir Dipivoxil 437 Study Group. Adefovir dipivoxil for the treatment of hepatitis B e antigen-positive chronic hepatitis B. N Engl J Med. 2003 Feb 27;348(9):808-16. doi: 10.1056/NEJMoa020681.
Results Reference
result
PubMed Identifier
20049753
Citation
Chang TT, Lai CL, Kew Yoon S, Lee SS, Coelho HS, Carrilho FJ, Poordad F, Halota W, Horsmans Y, Tsai N, Zhang H, Tenney DJ, Tamez R, Iloeje U. Entecavir treatment for up to 5 years in patients with hepatitis B e antigen-positive chronic hepatitis B. Hepatology. 2010 Feb;51(2):422-30. doi: 10.1002/hep.23327.
Results Reference
result
PubMed Identifier
25348661
Citation
Brouwer WP, Xie Q, Sonneveld MJ, Zhang N, Zhang Q, Tabak F, Streinu-Cercel A, Wang JY, Idilman R, Reesink HW, Diculescu M, Simon K, Voiculescu M, Akdogan M, Mazur W, Reijnders JG, Verhey E, Hansen BE, Janssen HL; ARES Study Group. Adding pegylated interferon to entecavir for hepatitis B e antigen-positive chronic hepatitis B: A multicenter randomized trial (ARES study). Hepatology. 2015 May;61(5):1512-22. doi: 10.1002/hep.27586. Epub 2015 Feb 27.
Results Reference
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Combined Therapy With Peginterferon Alfa-2a With NA in NA-treated HBeAg Positive Patients

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