Myrcludex B Plus Pegylated Interferon-alpha-2a in Patients With HBeAg Negative HBV/HDV Co-infection
Primary Purpose
Chronic Hepatitis D Infection
Status
Completed
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
PEG IFN alfa-2a
Myrcludex B
Sponsored by
About this trial
This is an interventional treatment trial for Chronic Hepatitis D Infection
Eligibility Criteria
Inclusion Criteria:
- Chronic hepatitis B defined by the presence of HBsAg for at least 6 months prior to screening period. Co-infection with hepatitis D virus defined as positive anti-HDV antibodies for at least 3 months and positive for HDV-RNA within the screening period.
- Liver biopsy performed within one year prior to screening or during screening period.
- HBeAg negative
- All women of childbearing potential must have a negative urine pregnancy test prior to enrolment.
Women must:
- Be menopausal for at least 2 years, or
- Be surgically sterile (total hysterectomy or bilateral ovariectomy or bilateral tubal ligation/clips or otherwise be incapable of pregnancy), or
- Not be heterosexually active during the study, or
- Agree to use a highly effective method of birth control (double barrier method or combination of barrier method with hormonal or intrauterine device) during the study and for 3 month after the last dosing of the investigational medicinal product.
- Men must agree to use a highly effective method of birth control (double barrier methods or combination of barrier method with hormonal or intrauterine device in their women-partner) and not to donate a sperm during the study and for 3 month after the last dosing of the investigational medicinal product.
- An understanding, ability and willingness to fully comply with study procedures and restrictions.
- An ability to provide the written informed consent to participate in the study
Exclusion Criteria:
- Decompensated liver disease (Child-Pugh-Score >6).
- Co-infected with hepatitis C virus (HCV), or HIV.
- Patients with presence of anti-HCV antibody and negative HCV RNA in two separate occasions within 12 months prior to screening could be enrolled into the study after sponsor written permission.
- ALT > 6 ULN.
- Creatinine clearance < 60 mL/min.
- Total bilirubin > 2 mg/dL.
- Confirmed contraindication for treatment with PEG-INF-a.
- History of hepatocellular carcinoma (HCC) or findings suggestive of possible HCC, such as suspicious foci on imaging studies or elevated serum alpha-fetoprotein (AFP) levels. In patients with such findings, HCC will be ruled-out prior to screening for the present study.
- One or more additional known primary or secondary causes of liver disease, other than hepatitis B (e.g., alcoholism, autoimmune hepatitis, malignancy with hepatic involvement, hemochromatosis, alpha-1 antitrypsin deficiency, Wilson's Disease, other congenital or metabolic conditions affecting the liver, e.g. congestive heart failure or other severe cardiopulmonary disease). Patients with Gilbert's syndrome and Dubin-Johnson syndrome, two benign disorders associated with low-grade hyperbilirubinemia can be enrolled into the trial.
- History of clinically evident pancreatitis.
- History of alcohol or drug abuse within the preceding two years. For the purposes of the present study, alcohol abuse is arbitrarily defined as frequent consumption of alcoholic beverages with an average daily intake of more than 40 g of ethanol.
- Participation in another study with an investigational drug within less than one month prior to this study or simultaneously to this study.
- Patients who are unable or unwilling to follow the protocol requirements.
- Patients with a history of seizures, central nervous system disorders or psychiatric disability thought to be clinically significant in the opinion of the investigator.
- Patients with limited mental capacity to the extent that she/he cannot provide informed consent or information regarding adverse events of the study drug.
- Clinically significant renal, respiratory or cardiovascular disease.
- Pregnancy and lactation.
- Patients who have previously participated in this study.
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Experimental
Active Comparator
Arm Label
MXB then PEG IFN
MXB + PEG IFN then PEG IFN
PEG IFN
Arm Description
Myrcludex B 2mg daily for 24 weeks, followed by PEG IFN alfa-2a 180 µg/0.5 mL weekly for 48 weeks
Myrcludex B 2mg daily and PEG IFN alfa-2a 180 µg/0.5 mL weekly for 24 weeks, followed by PEG IFN alfa-2a 180 µg/0.5 mL weekly for 24 weeks
PEG IFN alfa-2a 180 µg/0.5 mL once weekly for 48 weeks
Outcomes
Primary Outcome Measures
Number of Participants With Hepatitis B Surface Antigen (HBsAg) Response at Week 12 of Therapy
HBsAg response was defined as serum HBsAg decline of at least 0.5 log IU/mL (or HBsAg negativation) at week 12 compared to baseline (including the patient with negative baseline level)
Secondary Outcome Measures
Number of Participants With Hepatitis B Surface Antigen (HBsAg) Response at Week 24 of Therapy
HBsAg response was defined as serum HBsAg decline of at least 0.5 log IU/mL (or HBsAg negativation) at week 24 compared to baseline (including the patient with negative baseline level)
Number of Participants With Hepatitis B Virus Deoxyribonucleic Acid (HBV DNA) Response at Week 24 of Therapy
HBV DNA response was defined as persistent reduction of HBV DNA by > 1 log IU/mL or negativation (including the patient with negative baseline level)
Number of Participants With Hepatitis B Virus Deoxyribonucleic Acid (HBV DNA) Response at Week 12 of Therapy
HBV DNA response was defined as persistent reduction of HBV DNA by > 1 log IU/mL or negativation (including the patient with negative baseline level)
Number of Participants With Hepatitis D Virus Ribonucleic Acid (HDV RNA) Response at Week 12 of Therapy
HDV RNA response was defined as persistent reduction of HDV RNA by > 1 log IU/mL or negativation (including the patient with negative baseline level)
Number of Participants With Hepatitis D Virus Ribonucleic Acid (HDV RNA) Response at Week 24 of Therapy
HDV RNA response was defined as persistent reduction of HDV RNA by > 1 log IU/mL or negativation (including the patient with negative baseline level)
Number of Participants With Biochemical Response at Week 12 of Therapy
Biochemical response was defined as normalization of ALT level as compared to baseline.
Number of Participants With Biochemical Response at Week 24 of Therapy
Biochemical response was defined as normalization of ALT level as compared to baseline.
Number of Participants With Covalently Closed Circular Deoxyribonucleic Acid (cccDNA) Response at Week 72 of Therapy
Virological cccDNA response was defined as reduction of intrahepatic cccDNA by 0.5 log in comparison to baseline at the end of follow up.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02637999
Brief Title
Myrcludex B Plus Pegylated Interferon-alpha-2a in Patients With HBeAg Negative HBV/HDV Co-infection
Official Title
Randomized Open-label Substudy of Daily Myrcludex B Plus Pegylated Interferon-alpha-2a in Patients With HBeAg Negative Chronic Hepatitis B Co-infected With Hepatitis Delta
Study Type
Interventional
2. Study Status
Record Verification Date
April 2018
Overall Recruitment Status
Completed
Study Start Date
February 13, 2014 (Actual)
Primary Completion Date
January 21, 2016 (Actual)
Study Completion Date
January 21, 2016 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hepatera Ltd.
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Randomized open-label substudy of daily Myrcludex B (MXB) plus pegylated interferon-alpha-2a (PEG-INF-a) in patients with hepatitis B e antigen (HBeAg) negative chronic hepatitis B virus (HBV) co-infected with hepatitis delta virus (HDV).
Detailed Description
The study is designed to evaluate safety and efficacy of MXB in a subset of HBV infected patients who are co-infected with HDV. Hepatitis delta represents the most severe form of chronic viral hepatitis and there is no approved treatment option available for patients infected with both HBV and HDV.
24 patients will be randomised into 3 arms: pre-treatment with MXB followed by PEG-INF-a treatment versus a combination of both drugs versus PEG-INF-a.
Prolonged blockade of HBV entry into hepatocytes should also block infection with HDV particles (which uses hepatitis B surface antigen (HBsAg) as its envelope) and thus provide a therapeutic option for this otherwise hardly treatable disease. PEG-INF-a is used for the treatment of chronic hepatitis delta. The study endpoints are virological response (HBsAg, hepatitis delta virus ribonucleic acid (HDV RNA), hepatitis B virus deoxyribonucleic acid (HBV DNA)), as well as safety and tolerability and drug immunogenicity.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Hepatitis D Infection
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
24 (Actual)
8. Arms, Groups, and Interventions
Arm Title
MXB then PEG IFN
Arm Type
Experimental
Arm Description
Myrcludex B 2mg daily for 24 weeks, followed by PEG IFN alfa-2a 180 µg/0.5 mL weekly for 48 weeks
Arm Title
MXB + PEG IFN then PEG IFN
Arm Type
Experimental
Arm Description
Myrcludex B 2mg daily and PEG IFN alfa-2a 180 µg/0.5 mL weekly for 24 weeks, followed by PEG IFN alfa-2a 180 µg/0.5 mL weekly for 24 weeks
Arm Title
PEG IFN
Arm Type
Active Comparator
Arm Description
PEG IFN alfa-2a 180 µg/0.5 mL once weekly for 48 weeks
Intervention Type
Drug
Intervention Name(s)
PEG IFN alfa-2a
Other Intervention Name(s)
Pegasys
Intervention Type
Drug
Intervention Name(s)
Myrcludex B
Other Intervention Name(s)
Myrcludex
Primary Outcome Measure Information:
Title
Number of Participants With Hepatitis B Surface Antigen (HBsAg) Response at Week 12 of Therapy
Description
HBsAg response was defined as serum HBsAg decline of at least 0.5 log IU/mL (or HBsAg negativation) at week 12 compared to baseline (including the patient with negative baseline level)
Time Frame
Baseline and 12 weeks
Secondary Outcome Measure Information:
Title
Number of Participants With Hepatitis B Surface Antigen (HBsAg) Response at Week 24 of Therapy
Description
HBsAg response was defined as serum HBsAg decline of at least 0.5 log IU/mL (or HBsAg negativation) at week 24 compared to baseline (including the patient with negative baseline level)
Time Frame
Baseline and 24 weeks
Title
Number of Participants With Hepatitis B Virus Deoxyribonucleic Acid (HBV DNA) Response at Week 24 of Therapy
Description
HBV DNA response was defined as persistent reduction of HBV DNA by > 1 log IU/mL or negativation (including the patient with negative baseline level)
Time Frame
Baseline and 24 weeks
Title
Number of Participants With Hepatitis B Virus Deoxyribonucleic Acid (HBV DNA) Response at Week 12 of Therapy
Description
HBV DNA response was defined as persistent reduction of HBV DNA by > 1 log IU/mL or negativation (including the patient with negative baseline level)
Time Frame
Baseline and 12 weeks
Title
Number of Participants With Hepatitis D Virus Ribonucleic Acid (HDV RNA) Response at Week 12 of Therapy
Description
HDV RNA response was defined as persistent reduction of HDV RNA by > 1 log IU/mL or negativation (including the patient with negative baseline level)
Time Frame
Baseline and 12 weeks
Title
Number of Participants With Hepatitis D Virus Ribonucleic Acid (HDV RNA) Response at Week 24 of Therapy
Description
HDV RNA response was defined as persistent reduction of HDV RNA by > 1 log IU/mL or negativation (including the patient with negative baseline level)
Time Frame
Baseline and 24 weeks
Title
Number of Participants With Biochemical Response at Week 12 of Therapy
Description
Biochemical response was defined as normalization of ALT level as compared to baseline.
Time Frame
Baseline and 12 weeks
Title
Number of Participants With Biochemical Response at Week 24 of Therapy
Description
Biochemical response was defined as normalization of ALT level as compared to baseline.
Time Frame
Baseline and 24 weeks
Title
Number of Participants With Covalently Closed Circular Deoxyribonucleic Acid (cccDNA) Response at Week 72 of Therapy
Description
Virological cccDNA response was defined as reduction of intrahepatic cccDNA by 0.5 log in comparison to baseline at the end of follow up.
Time Frame
Baseline and 72 weeks for arm A and 48 weeks for arms B and C
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:
Chronic hepatitis B defined by the presence of HBsAg for at least 6 months prior to screening period. Co-infection with hepatitis D virus defined as positive anti-HDV antibodies for at least 3 months and positive for HDV-RNA within the screening period.
Liver biopsy performed within one year prior to screening or during screening period.
HBeAg negative
All women of childbearing potential must have a negative urine pregnancy test prior to enrolment.
Women must:
Be menopausal for at least 2 years, or
Be surgically sterile (total hysterectomy or bilateral ovariectomy or bilateral tubal ligation/clips or otherwise be incapable of pregnancy), or
Not be heterosexually active during the study, or
Agree to use a highly effective method of birth control (double barrier method or combination of barrier method with hormonal or intrauterine device) during the study and for 3 month after the last dosing of the investigational medicinal product.
Men must agree to use a highly effective method of birth control (double barrier methods or combination of barrier method with hormonal or intrauterine device in their women-partner) and not to donate a sperm during the study and for 3 month after the last dosing of the investigational medicinal product.
An understanding, ability and willingness to fully comply with study procedures and restrictions.
An ability to provide the written informed consent to participate in the study
Exclusion Criteria:
Decompensated liver disease (Child-Pugh-Score >6).
Co-infected with hepatitis C virus (HCV), or HIV.
Patients with presence of anti-HCV antibody and negative HCV RNA in two separate occasions within 12 months prior to screening could be enrolled into the study after sponsor written permission.
ALT > 6 ULN.
Creatinine clearance < 60 mL/min.
Total bilirubin > 2 mg/dL.
Confirmed contraindication for treatment with PEG-INF-a.
History of hepatocellular carcinoma (HCC) or findings suggestive of possible HCC, such as suspicious foci on imaging studies or elevated serum alpha-fetoprotein (AFP) levels. In patients with such findings, HCC will be ruled-out prior to screening for the present study.
One or more additional known primary or secondary causes of liver disease, other than hepatitis B (e.g., alcoholism, autoimmune hepatitis, malignancy with hepatic involvement, hemochromatosis, alpha-1 antitrypsin deficiency, Wilson's Disease, other congenital or metabolic conditions affecting the liver, e.g. congestive heart failure or other severe cardiopulmonary disease). Patients with Gilbert's syndrome and Dubin-Johnson syndrome, two benign disorders associated with low-grade hyperbilirubinemia can be enrolled into the trial.
History of clinically evident pancreatitis.
History of alcohol or drug abuse within the preceding two years. For the purposes of the present study, alcohol abuse is arbitrarily defined as frequent consumption of alcoholic beverages with an average daily intake of more than 40 g of ethanol.
Participation in another study with an investigational drug within less than one month prior to this study or simultaneously to this study.
Patients who are unable or unwilling to follow the protocol requirements.
Patients with a history of seizures, central nervous system disorders or psychiatric disability thought to be clinically significant in the opinion of the investigator.
Patients with limited mental capacity to the extent that she/he cannot provide informed consent or information regarding adverse events of the study drug.
Clinically significant renal, respiratory or cardiovascular disease.
Pregnancy and lactation.
Patients who have previously participated in this study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Pavel Bogomolov, PhD
Organizational Affiliation
LLC "Clinical Hospital of Tsentrosoyuz"
Official's Role
Principal Investigator
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
14996343
Citation
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Results Reference
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12663868
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Trauner M, Boyer JL. Bile salt transporters: molecular characterization, function, and regulation. Physiol Rev. 2003 Apr;83(2):633-71. doi: 10.1152/physrev.00027.2002.
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PubMed Identifier
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Romeo R, Del Ninno E, Rumi M, Russo A, Sangiovanni A, de Franchis R, Ronchi G, Colombo M. A 28-year study of the course of hepatitis Delta infection: a risk factor for cirrhosis and hepatocellular carcinoma. Gastroenterology. 2009 May;136(5):1629-38. doi: 10.1053/j.gastro.2009.01.052. Epub 2009 Jan 29.
Results Reference
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PubMed Identifier
18080231
Citation
Cornberg M, Protzer U, Dollinger MM, Petersen J, Wedemeyer H, Berg T, Jilg W, Erhardt A, Wirth S, Schirmacher P, Fleig WE, Manns MP. Prophylaxis, diagnosis and therapy of hepatitis B virus (HBV) infection: the German guidelines for the management of HBV infection. Z Gastroenterol. 2007 Dec;45(12):1281-328. doi: 10.1055/s-2007-963714. No abstract available.
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Citation
Blank A, Markert C, Hohmann N, Carls A, Mikus G, Lehr T, Alexandrov A, Haag M, Schwab M, Urban S, Haefeli WE. First-in-human application of the novel hepatitis B and hepatitis D virus entry inhibitor myrcludex B. J Hepatol. 2016 Sep;65(3):483-9. doi: 10.1016/j.jhep.2016.04.013. Epub 2016 Apr 27.
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Myrcludex B Plus Pegylated Interferon-alpha-2a in Patients With HBeAg Negative HBV/HDV Co-infection
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