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Addition of PegIFN Alfa-2a to CHB Patients Treated With Nucleot(s)Ides

Primary Purpose

Hepatitis B

Status
Unknown status
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
PegIFN alfa-2a
Sponsored by
The Second Affiliated Hospital of Chongqing Medical University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatitis B focused on measuring HBsAg clearance

Eligibility Criteria

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

Inclusion Criteria:

  1. Male and female subjects,18-65 years
  2. positive for hepatitis B surface antigen (HBsAg) and negative for antibodies to HBsAg (anti-HBs antibodies) for at least 6 months before NAs treated
  3. nucleot(s)ides monotherapy (including lamivudine, adefovir, entecavir, tenofovir) and achieved HBV DNA<1000 copies/mL with HBsAg <3000 IU/mL, positive or negative for HBeAg, and negative for anti-HBs antibodies
  4. Subjects with no contra-indications to Peginterferon alfa therapy as detailed in the label (Hypersensitivity to the active substance, to alpha interferon, or to any of the excipients; Autoimmune hepatitis; Severe hepatic dysfunction or decompensated cirrhosis of the liver; A history of severe pre-existing cardiac disease, including unstable or uncontrolled cardiac disease in the previous six months)
  5. Subjects who are not co-infected with Hepatitis A Virus, Hepatitis C Virus or HIV
  6. Female subjects not pregnant or breast feeding when Peginterferon alfa treatment commenced, and aware of the requirement to use an effective method of contraception during therapy
  7. Written informed consent signed.

Exclusion Criteria:

  1. positive for Hepatitis A Virus Ab, HCV-RNA or positive for Hepatitis C Virus Ab, HDV Ab, HEV Ab or positive for HIV Ab in screening period
  2. Hepatocellular carcinoma(HCC) or alpha feto protein(AFP) levels more than 100 ng/ml and Hepatic malignant potential of Imaging examination or AFP levels more than 100 ng/ml for 3 months
  3. Compensated or Decompensated liver cirrhosis: with history of cirrhosis before nucleot(s)ides treatment or Child-Pugh score ≥ 5 or Complications of liver cirrhosis such as ascites, hepatic encephalopathy, esophageal gastric varices bleeding
  4. Autoimmune disease including Autoimmune hepatitis and Psoriasis and so on
  5. Pregnant women and lactating women or patients with pregnancy plans and not willing to use contraception during the study period
  6. A history of immunoregulation drug therapy within one year before entry including IFN and so on
  7. Have a history of alcohol abuse
  8. With severe psychiatric condition or nervous disease such as epilepsy, depression, mania, epilepsy, schizophrenia and so on
  9. A neutrophil count of less than 1500 per cubic millimeter or a platelet count of less than 90,000 per cubic millimeter
  10. Severe organ dysfunction
  11. With other malignant tumors(exclude the cured ones)
  12. Uncontrolled diabetes, hypertension or thyroid disease
  13. A serum creatinine level that was more than 1.5 times the upper limit of the normal range
  14. Hypersensitivity to interferon(IFN) or its active substance, and ineligible to IFN
  15. Participate in other clinical studies at the same time
  16. Patients unsuitable for the research -

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    No Intervention

    Active Comparator

    Arm Label

    nucleot(s)ides treated

    PegIFN alfa-2a + nucleot(s)ides treated

    Arm Description

    patients who treated with nucleot(s)ides (including lamivudine, adefovir, entecavir, tenofovir) are still using the original treatment for 72 weeks

    patients who treated with nucleot(s)ides (including lamivudine, adefovir, entecavir, tenofovir), then will add PegIFN alfa-2a to the original nucleot(s)ides for 48 weeks, then follow up for 24 weeks

    Outcomes

    Primary Outcome Measures

    Number of participants who achieve HBsAg clearance
    To investigate whether Peg-IFN alfa-2a add on treatment can improve the HBsAg clearance in CHB patients at the end of the treatment (48 week).

    Secondary Outcome Measures

    Number of participants who achieve HBsAg seroconversion
    To investigate whether Peg-IFN alfa-2a add on treatment can improve the HBsAg seroconversion in CHB patients at the end of the treatment (48 week).
    Number of participants who achieve HBeAg clearance and seroconversion
    To investigate whether Peg-IFN alfa-2a add on treatment can improve HBeAg clearance and seroconversion at the end of the treatment (48 week).
    HBsAg changes from Baseline
    Pegasys 24 weeks Group:12,24 weeks and Pegasys 48 weeks Group:12,24,48 weeks
    Number of participants who achieve HBV DNA<1000 copies/ml
    To investigate whether Peg-IFN alfa-2a add on treatment can improve HBV DNA<1000 copies/ml

    Full Information

    First Posted
    December 28, 2015
    Last Updated
    December 30, 2015
    Sponsor
    The Second Affiliated Hospital of Chongqing Medical University
    Collaborators
    People's Hospital of Anshun City of Guizhou Province, The First Affiliated Hospital of Nanchang University, First Affiliated Hospital of Xinjiang Medical University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02644538
    Brief Title
    Addition of PegIFN Alfa-2a to CHB Patients Treated With Nucleot(s)Ides
    Official Title
    A Randomized, Controlled, Open-label, Multicenter Clinical Trial to Evaluate the Addition of PegIFN Alfa-2a to CHB Patients Treated With Nucleot(s)Ides
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    December 2015
    Overall Recruitment Status
    Unknown status
    Study Start Date
    December 2015 (undefined)
    Primary Completion Date
    December 2017 (Anticipated)
    Study Completion Date
    December 2018 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    The Second Affiliated Hospital of Chongqing Medical University
    Collaborators
    People's Hospital of Anshun City of Guizhou Province, The First Affiliated Hospital of Nanchang University, First Affiliated Hospital of Xinjiang Medical University

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This study evaluates whether PegIFN alfa-2a add on can improve CHB patients HBsAg clearance at the end of 48 weeks treatment. The CHB patients who received nucleot(s)ides anti-virus treatment and reached HBV DNA<1000 copies/ml and HBsAg<3000 IU/ml, were randomly assigned into two groups: One group continue the nucleot(s)ides treatment for 72 weeks, the other add on PegIFN alfa-2a on the basis of the original treatment for 48 weeks, and follow up for 24 weeks.
    Detailed Description
    nucleot(s)ides is a potent inhibitor of hepatitis B viral(HBV) replication, but long-term therapy may be required, and it is difficult for CHB patients to achieve HBsAg clearance by using nucleot(s)ides. Therefore, it is need take long-term therapy if chronic hepatitis B (CHB) choose to use nucleot(s)ides, and in another way, nucleot(s)ides resistance is an important clinical risk. More and more young patients want to stop treating, and discontinuation of nucleot(s)ides is a feasible strategy to reduce resistance. However, it is really easy to relapse if patients did not arrive HBsAg clearance. PegIFN alfa-2a can clear HBV by direct anti-viral and immune regulation mechanisms including enhancing natural killer cell response, increased cluster of differentiation 8(CD8 +) T lymphocytes and other mechanisms to restore and enhance the immune response in patients with CHB; and what's more, patients are safety after discontinuing.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Hepatitis B
    Keywords
    HBsAg clearance

    7. Study Design

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

    8. Arms, Groups, and Interventions

    Arm Title
    nucleot(s)ides treated
    Arm Type
    No Intervention
    Arm Description
    patients who treated with nucleot(s)ides (including lamivudine, adefovir, entecavir, tenofovir) are still using the original treatment for 72 weeks
    Arm Title
    PegIFN alfa-2a + nucleot(s)ides treated
    Arm Type
    Active Comparator
    Arm Description
    patients who treated with nucleot(s)ides (including lamivudine, adefovir, entecavir, tenofovir), then will add PegIFN alfa-2a to the original nucleot(s)ides for 48 weeks, then follow up for 24 weeks
    Intervention Type
    Drug
    Intervention Name(s)
    PegIFN alfa-2a
    Other Intervention Name(s)
    Pegasys
    Intervention Description
    chronic hepatitis B patients who treated with nucleot(s)ides (including lamivudine, adefovir, entecavir, tenofovir) arrived HBV DNA <1000copies/ml, and HBsAg<3000IU/ml, then change the treatment to original nucleot(s)ides add on PegIFN alfa-2a, the combined treatment is for 48 weeks, and follow up for 24 weeks
    Primary Outcome Measure Information:
    Title
    Number of participants who achieve HBsAg clearance
    Description
    To investigate whether Peg-IFN alfa-2a add on treatment can improve the HBsAg clearance in CHB patients at the end of the treatment (48 week).
    Time Frame
    treat for 48 weeks
    Secondary Outcome Measure Information:
    Title
    Number of participants who achieve HBsAg seroconversion
    Description
    To investigate whether Peg-IFN alfa-2a add on treatment can improve the HBsAg seroconversion in CHB patients at the end of the treatment (48 week).
    Time Frame
    48 weeks
    Title
    Number of participants who achieve HBeAg clearance and seroconversion
    Description
    To investigate whether Peg-IFN alfa-2a add on treatment can improve HBeAg clearance and seroconversion at the end of the treatment (48 week).
    Time Frame
    48 weeks
    Title
    HBsAg changes from Baseline
    Description
    Pegasys 24 weeks Group:12,24 weeks and Pegasys 48 weeks Group:12,24,48 weeks
    Time Frame
    12,24 and 48 weeks
    Title
    Number of participants who achieve HBV DNA<1000 copies/ml
    Description
    To investigate whether Peg-IFN alfa-2a add on treatment can improve HBV DNA<1000 copies/ml
    Time Frame
    12,24 and 48 weeks

    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 subjects,18-65 years positive for hepatitis B surface antigen (HBsAg) and negative for antibodies to HBsAg (anti-HBs antibodies) for at least 6 months before NAs treated nucleot(s)ides monotherapy (including lamivudine, adefovir, entecavir, tenofovir) and achieved HBV DNA<1000 copies/mL with HBsAg <3000 IU/mL, positive or negative for HBeAg, and negative for anti-HBs antibodies Subjects with no contra-indications to Peginterferon alfa therapy as detailed in the label (Hypersensitivity to the active substance, to alpha interferon, or to any of the excipients; Autoimmune hepatitis; Severe hepatic dysfunction or decompensated cirrhosis of the liver; A history of severe pre-existing cardiac disease, including unstable or uncontrolled cardiac disease in the previous six months) Subjects who are not co-infected with Hepatitis A Virus, Hepatitis C Virus or HIV Female subjects not pregnant or breast feeding when Peginterferon alfa treatment commenced, and aware of the requirement to use an effective method of contraception during therapy Written informed consent signed. Exclusion Criteria: positive for Hepatitis A Virus Ab, HCV-RNA or positive for Hepatitis C Virus Ab, HDV Ab, HEV Ab or positive for HIV Ab in screening period Hepatocellular carcinoma(HCC) or alpha feto protein(AFP) levels more than 100 ng/ml and Hepatic malignant potential of Imaging examination or AFP levels more than 100 ng/ml for 3 months Compensated or Decompensated liver cirrhosis: with history of cirrhosis before nucleot(s)ides treatment or Child-Pugh score ≥ 5 or Complications of liver cirrhosis such as ascites, hepatic encephalopathy, esophageal gastric varices bleeding Autoimmune disease including Autoimmune hepatitis and Psoriasis and so on Pregnant women and lactating women or patients with pregnancy plans and not willing to use contraception during the study period A history of immunoregulation drug therapy within one year before entry including IFN and so on Have a history of alcohol abuse With severe psychiatric condition or nervous disease such as epilepsy, depression, mania, epilepsy, schizophrenia and so on A neutrophil count of less than 1500 per cubic millimeter or a platelet count of less than 90,000 per cubic millimeter Severe organ dysfunction With other malignant tumors(exclude the cured ones) Uncontrolled diabetes, hypertension or thyroid disease A serum creatinine level that was more than 1.5 times the upper limit of the normal range Hypersensitivity to interferon(IFN) or its active substance, and ineligible to IFN Participate in other clinical studies at the same time Patients unsuitable for the research -

    12. IPD Sharing Statement

    Plan to Share IPD
    Undecided
    IPD Sharing Plan Description
    still undecided
    Citations:
    PubMed Identifier
    15014185
    Citation
    Ganem D, Prince AM. Hepatitis B virus infection--natural history and clinical consequences. N Engl J Med. 2004 Mar 11;350(11):1118-29. doi: 10.1056/NEJMra031087. No abstract available. Erratum In: N Engl J Med. 2004 Sep 16;351(12):351.
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    Liang X, Bi S, Yang W, Wang L, Cui G, Cui F, Zhang Y, Liu J, Gong X, Chen Y, Wang F, Zheng H, Wang F, Guo J, Jia Z, Ma J, Wang H, Luo H, Li L, Jin S, Hadler SC, Wang Y. Epidemiological serosurvey of hepatitis B in China--declining HBV prevalence due to hepatitis B vaccination. Vaccine. 2009 Nov 5;27(47):6550-7. doi: 10.1016/j.vaccine.2009.08.048. Epub 2009 Sep 1.
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    Citation
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    European Association For The Study Of The Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol. 2012 Jul;57(1):167-85. doi: 10.1016/j.jhep.2012.02.010. Epub 2012 Mar 20. No abstract available. Erratum In: J Hepatol. 2013 Jan;58(1):201. Janssen, Harry [corrected to Janssen, Harry L A].
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    Citation
    Micco L, Peppa D, Loggi E, Schurich A, Jefferson L, Cursaro C, Panno AM, Bernardi M, Brander C, Bihl F, Andreone P, Maini MK. Differential boosting of innate and adaptive antiviral responses during pegylated-interferon-alpha therapy of chronic hepatitis B. J Hepatol. 2013 Feb;58(2):225-33. doi: 10.1016/j.jhep.2012.09.029. Epub 2012 Oct 6.
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    PubMed Identifier
    21182232
    Citation
    Chen J, Wang Y, Wu XJ, Li J, Hou FQ, Wang GQ. Pegylated interferon alpha-2b up-regulates specific CD8+ T cells in patients with chronic hepatitis B. World J Gastroenterol. 2010 Dec 28;16(48):6145-50. doi: 10.3748/wjg.v16.i48.6145.
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    Marcellin P, Bonino F, Yurdaydin C, Hadziyannis S, Moucari R, Kapprell HP, Rothe V, Popescu M, Brunetto MR. Hepatitis B surface antigen levels: association with 5-year response to peginterferon alfa-2a in hepatitis B e-antigen-negative patients. Hepatol Int. 2013 Mar;7(1):88-97. doi: 10.1007/s12072-012-9343-x. Epub 2012 Mar 23.
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    Piratvisuth T, Marcellin P, Popescu M, Kapprell HP, Rothe V, Lu ZM. Hepatitis B surface antigen: association with sustained response to peginterferon alfa-2a in hepatitis B e antigen-positive patients. Hepatol Int. 2013 Jun;7(2):429-36. doi: 10.1007/s12072-011-9280-0. Epub 2011 Jun 24.
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    Addition of PegIFN Alfa-2a to CHB Patients Treated With Nucleot(s)Ides

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