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A Phase II Study to Determine the Safety and Efficacy of Interferon-gamma in Patients With Chronic Hepatitis B

Primary Purpose

Hepatitis B

Status
Unknown status
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
IFN-γ 1b (Actimmune)
Adefovir dipivoxil
IFN-γ 1b and Adefovir dipivoxil combination
Sponsored by
Huntington Medical Research Institutes
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatitis B focused on measuring HBV, Treatment, Interferon-gamma, combination, Hepsera, Actimmune, HBV DNA

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Patients must fulfill all of the following criteria to be eligible for enrollment into the study:

  1. Men or women age 18 to 75 years
  2. Chronic hepatitis B infection based on a history of positive anti-HBsAg and positive for HBV DNA and with or without elevations in liver tests (test to be repeated on screening)

Exclusion Criteria:

Patients with any of the following will be excluded from randomization:

  1. Presence of clinically evident cirrhosis including: ascites requiring active diuretic therapy, history of or therapy for hepatic encephalopathy, or history of GI variceal bleeding
  2. Platelet count < 50,000/mm3
  3. Serum ALT level > 10 times upper limit of normal
  4. Alpha-fetoprotein level ≥ 200 ng/mL or alpha-fetoprotein level between 50-200 ng/mL in association with liver ultrasound or other radiographic abnormality suspicious for hepatic neoplasm
  5. Serum creatinine level > 1.6 mg/dL
  6. Hematology outside of specified limits: neutrophil count <1000/mm3, hemoglobin <10 g/dL in males and <9 g/dL in females
  7. Unstable or uncontrolled thyroid disease
  8. Treatment with any interferon-α or nucleoside/tide analog within the previous 4 weeks
  9. Presence of clinically significant cryoglobulinemia (e.g., skin rash, arthritis, or renal insufficiency due to cryoglobuliemia)
  10. Presence or history of autoimmune hepatitis, alpha-1 anti-trypsin deficiency, hemochromatosis, Wilson's disease, drug- or toxin-induced liver disease, alcohol-related liver disease, primary biliary cirrhosis, or sclerosing cholangitis (mild-to-moderate steatosis is acceptable)
  11. Chronic hepatitis C infection
  12. Hepatits Delta infection (HDV)
  13. Known history of HIV infection or positive HIV antibody test by Western Blot (test performed within 60 days of screening can be used to determine eligibility)
  14. A disease known to cause significant alteration in immunologic function including hematological malignancy or autoimmune disorder (e.g. rheumatoid arthritis, systemic lupus erythematosis, autoimmune thyroid disease, leukemia, lymphoma, etc)
  15. Concurrent therapy with immunosuppressive drugs or cytotoxic agents such as oral prednisone, cyclosporine, azathioprine, or chemotherapeutic agent(s) (e.g., cyclophosphamide, methotrexate, or cancer chemotherapy) or radiation therapy
  16. Behavior that suggests a significant risk of poor compliance including, but not limited to:

    1. Illicit drug abuse within the past 3 years
    2. Current or history of alcohol abuse within the past 2 years
  17. Prior treatment with IFN-γ 1b
  18. History of unstable or deteriorating cardiac disease, including but not limited to:

    1. Myocardial infarction, coronary artery bypass surgery, or angioplasty within the past 6 months
    2. Congestive heart failure requiring hospitalization within the past 6 months
    3. Uncontrolled arrhythmias
    4. Transient ischemic attacks (TIAs)
    5. Any cardiac condition that, in the opinion of the site PI, might be significantly exacerbated by flu-like symptoms associated with the administration of IFN γ 1b
  19. Preexisting (within last two years) or active psychiatric condition including severe depression, major psychoses, suicidal ideation or suicidal attempts
  20. History of (within last two years) or current neurologic or psychiatric disorder that, in the opinion of the site PI, might be exacerbated by flu-like symptoms associated with the administration of IFN γ 1b. In addition, patients with the following conditions should be excluded:

    1. History of multiple sclerosis
    2. Seizures within the past 2 years
  21. Severe or poorly controlled diabetes
  22. Pregnancy or lactation. Females of childbearing potential are required to have a negative urine pregnancy test prior to treatment and must agree to practice abstinence or prevent pregnancy by at least a barrier method of birth control for the duration of the study
  23. Hemoglobinopthies (e.g. thalassemia, sickle cell disease)
  24. Any serious or chronic disease that, in the opinion of the Principal Investigator (PI), may affect the assessment of safety or efficacy parameters. This includes, but is not limited to, patients with malignancy who are receiving chemotherapy, chronic obstructive pulmonary disease or asthma requiring maintenance oral steroids, or active kidney disease
  25. Any condition which, in the opinion of the site PI, is likely to result in the death of the patient within the next year
  26. Patients who, in the opinion of the site PI, are not suitable candidates for enrollment or would not comply with the requirements of the study
  27. Patients who have had a liver transplant
  28. Patients who have Adefovir mutations on baseline tests

Sites / Locations

  • Huntington Medical Research Institutes

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

1

2

3

Arm Description

IFN-γ 1b monotherapy: 200 micro-grams daily for 30 days

IFN-γ 1b 200 micro-grams daily) combination therapy with Adefovir dipivoxil (10 mg daily) for 30 days

Adefovir dipivoxil monotherapy (10 mg QD) 30 days

Outcomes

Primary Outcome Measures

The primary objective is to evaluate the safety and tolerability of IFN-γ 1b either alone or in combination with Adefovir dipivoxil in patients with chronic Hepatitis B.

Secondary Outcome Measures

Evaluate the changes in serum HBV DNA concentrations following administration of Adefovir dipivoxil alone, IFN-γ 1b either alone or in combination with Adefovir dipivoxil in patients with chronic Hepatitis B.
Evaluate the changes in liver tests and hematology following administration of Adefovir dipivoxil alone, IFN-γ 1b either alone or in combination with Adefovir dipivoxil in patients with chronic Hepatitis B.

Full Information

First Posted
September 15, 2008
Last Updated
October 20, 2010
Sponsor
Huntington Medical Research Institutes
Collaborators
InterMune
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1. Study Identification

Unique Protocol Identification Number
NCT00753467
Brief Title
A Phase II Study to Determine the Safety and Efficacy of Interferon-gamma in Patients With Chronic Hepatitis B
Official Title
Protocol Title: A Phase II Open-labeled Study to Determine the Safety and Preliminary Efficacy of Interferon-gamma 1b (IFN-γ 1b) in Patients With Chronic Hepatitis B Who Are HBV DNA Positive
Study Type
Interventional

2. Study Status

Record Verification Date
September 2008
Overall Recruitment Status
Unknown status
Study Start Date
September 2008 (undefined)
Primary Completion Date
August 2009 (Anticipated)
Study Completion Date
August 2009 (Anticipated)

3. Sponsor/Collaborators

Name of the Sponsor
Huntington Medical Research Institutes
Collaborators
InterMune

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Open-label, prospective, two part study evaluating IFN-γ 1b at a dose of 200μg by subcutaneous injection every day either alone or in combination with Adefovir dipivoxil or Adefovir dipivoxil alone at a dose of 10mg QD in patients with chronic Hepatitis B.
Detailed Description
After signing the informed consent potential patients will undergo a screening medical history, physical examination, and laboratory tests. The study will consist of two parts: Part A: IFN-γ 1b monotherapy Part B: IFN-γ 1b combination therapy with Adefovir dipivoxil or Adefovir dipivoxil monotherapy Patients will be enrolled sequentially into to one of three treatment groups. In Part A, ten patients will be enrolled and will receive IFN-γ 1b 200μg, administered every day by subcutaneous injection for 4 weeks. If HBV DNA is reduced by ≥ 1 log10 copies/ mL in ≥ 30% of patients the protocol will proceed to Part B. In Part B, twenty patients will be enrolled into two cohorts (total of 10 for each cohort) and treated for four weeks. The two cohorts will be administered: IFN-γ 1b 200μg, administered every day combination therapy with Adefovir dipivoxil (10mg QD) or Adefovir dipivoxil (10mg QD) alone On the initial study visit, patients will be given instruction on self injection of IFN-γ 1b (if applicable). Patients will be monitored for safety, tolerability, HBV DNA, clinical chemistries including a standard panel of liver tests and hematologies throughout the study and for the two week post-treatment observation period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatitis B
Keywords
HBV, Treatment, Interferon-gamma, combination, Hepsera, Actimmune, HBV DNA

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
IFN-γ 1b monotherapy: 200 micro-grams daily for 30 days
Arm Title
2
Arm Type
Experimental
Arm Description
IFN-γ 1b 200 micro-grams daily) combination therapy with Adefovir dipivoxil (10 mg daily) for 30 days
Arm Title
3
Arm Type
Active Comparator
Arm Description
Adefovir dipivoxil monotherapy (10 mg QD) 30 days
Intervention Type
Drug
Intervention Name(s)
IFN-γ 1b (Actimmune)
Other Intervention Name(s)
Interferon gamma, Actimmune, Immune Interferon, IFN-gamma
Intervention Description
IFN-γ 1b: 200μg given SC ED = 2 vials of active drug (0.5 mL from each vial) will be mixed for a total volume of 1.0 mL per dose
Intervention Type
Drug
Intervention Name(s)
Adefovir dipivoxil
Other Intervention Name(s)
Hepsera
Intervention Description
Adefovir dipivoxil: 1 tablet of 10mg given orally QD
Intervention Type
Drug
Intervention Name(s)
IFN-γ 1b and Adefovir dipivoxil combination
Other Intervention Name(s)
Actimmune, Interferon gamma, IFN gamma, Immune Interferon, Hepsera
Intervention Description
IFN-γ 1b: 200μg given SC ED = 2 vials of active drug (0.5 mL from each vial) will be mixed for a total volume of 1.0 mL per dose Adefovir dipivoxil: 1 tablet of 10mg given orally QD
Primary Outcome Measure Information:
Title
The primary objective is to evaluate the safety and tolerability of IFN-γ 1b either alone or in combination with Adefovir dipivoxil in patients with chronic Hepatitis B.
Time Frame
30 days
Secondary Outcome Measure Information:
Title
Evaluate the changes in serum HBV DNA concentrations following administration of Adefovir dipivoxil alone, IFN-γ 1b either alone or in combination with Adefovir dipivoxil in patients with chronic Hepatitis B.
Time Frame
30 days
Title
Evaluate the changes in liver tests and hematology following administration of Adefovir dipivoxil alone, IFN-γ 1b either alone or in combination with Adefovir dipivoxil in patients with chronic Hepatitis B.
Time Frame
30 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must fulfill all of the following criteria to be eligible for enrollment into the study: Men or women age 18 to 75 years Chronic hepatitis B infection based on a history of positive anti-HBsAg and positive for HBV DNA and with or without elevations in liver tests (test to be repeated on screening) Exclusion Criteria: Patients with any of the following will be excluded from randomization: Presence of clinically evident cirrhosis including: ascites requiring active diuretic therapy, history of or therapy for hepatic encephalopathy, or history of GI variceal bleeding Platelet count < 50,000/mm3 Serum ALT level > 10 times upper limit of normal Alpha-fetoprotein level ≥ 200 ng/mL or alpha-fetoprotein level between 50-200 ng/mL in association with liver ultrasound or other radiographic abnormality suspicious for hepatic neoplasm Serum creatinine level > 1.6 mg/dL Hematology outside of specified limits: neutrophil count <1000/mm3, hemoglobin <10 g/dL in males and <9 g/dL in females Unstable or uncontrolled thyroid disease Treatment with any interferon-α or nucleoside/tide analog within the previous 4 weeks Presence of clinically significant cryoglobulinemia (e.g., skin rash, arthritis, or renal insufficiency due to cryoglobuliemia) Presence or history of autoimmune hepatitis, alpha-1 anti-trypsin deficiency, hemochromatosis, Wilson's disease, drug- or toxin-induced liver disease, alcohol-related liver disease, primary biliary cirrhosis, or sclerosing cholangitis (mild-to-moderate steatosis is acceptable) Chronic hepatitis C infection Hepatits Delta infection (HDV) Known history of HIV infection or positive HIV antibody test by Western Blot (test performed within 60 days of screening can be used to determine eligibility) A disease known to cause significant alteration in immunologic function including hematological malignancy or autoimmune disorder (e.g. rheumatoid arthritis, systemic lupus erythematosis, autoimmune thyroid disease, leukemia, lymphoma, etc) Concurrent therapy with immunosuppressive drugs or cytotoxic agents such as oral prednisone, cyclosporine, azathioprine, or chemotherapeutic agent(s) (e.g., cyclophosphamide, methotrexate, or cancer chemotherapy) or radiation therapy Behavior that suggests a significant risk of poor compliance including, but not limited to: Illicit drug abuse within the past 3 years Current or history of alcohol abuse within the past 2 years Prior treatment with IFN-γ 1b History of unstable or deteriorating cardiac disease, including but not limited to: Myocardial infarction, coronary artery bypass surgery, or angioplasty within the past 6 months Congestive heart failure requiring hospitalization within the past 6 months Uncontrolled arrhythmias Transient ischemic attacks (TIAs) Any cardiac condition that, in the opinion of the site PI, might be significantly exacerbated by flu-like symptoms associated with the administration of IFN γ 1b Preexisting (within last two years) or active psychiatric condition including severe depression, major psychoses, suicidal ideation or suicidal attempts History of (within last two years) or current neurologic or psychiatric disorder that, in the opinion of the site PI, might be exacerbated by flu-like symptoms associated with the administration of IFN γ 1b. In addition, patients with the following conditions should be excluded: History of multiple sclerosis Seizures within the past 2 years Severe or poorly controlled diabetes Pregnancy or lactation. Females of childbearing potential are required to have a negative urine pregnancy test prior to treatment and must agree to practice abstinence or prevent pregnancy by at least a barrier method of birth control for the duration of the study Hemoglobinopthies (e.g. thalassemia, sickle cell disease) Any serious or chronic disease that, in the opinion of the Principal Investigator (PI), may affect the assessment of safety or efficacy parameters. This includes, but is not limited to, patients with malignancy who are receiving chemotherapy, chronic obstructive pulmonary disease or asthma requiring maintenance oral steroids, or active kidney disease Any condition which, in the opinion of the site PI, is likely to result in the death of the patient within the next year Patients who, in the opinion of the site PI, are not suitable candidates for enrollment or would not comply with the requirements of the study Patients who have had a liver transplant Patients who have Adefovir mutations on baseline tests
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Myron J Tong, Phd, MD
Organizational Affiliation
HMRI
Official's Role
Study Chair
Facility Information:
Facility Name
Huntington Medical Research Institutes
City
Pasadena
State/Province
California
ZIP/Postal Code
91105
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lori Tong, RN
Phone
626-397-5827
Email
ltong@hmri.org
First Name & Middle Initial & Last Name & Degree
Myron J Tong, PhD, MD

12. IPD Sharing Statement

Citations:
PubMed Identifier
16718779
Citation
Parvez MK, Sehgal D, Sarin SK, Basir SF, Jameel S. Inhibition of hepatitis B virus DNA replicative intermediate forms by recombinant interferon-gamma. World J Gastroenterol. 2006 May 21;12(19):3006-14. doi: 10.3748/wjg.v12.i19.3006.
Results Reference
background
PubMed Identifier
1919540
Citation
Lau JY, Lai CL, Wu PC, Chung HT, Lok AS, Lin HJ. A randomised controlled trial of recombinant interferon-gamma in Chinese patients with chronic hepatitis B virus infection. J Med Virol. 1991 Jul;34(3):184-7. doi: 10.1002/jmv.1890340310.
Results Reference
background
PubMed Identifier
2115494
Citation
Marcellin P, Loriot MA, Boyer N, Martinot-Peignoux M, Degott C, Degos F, Brandely M, Lenfant B, Benhamou JP. Recombinant human gamma-interferon in patients with chronic active hepatitis B: pharmacokinetics, tolerance and biological effects. Hepatology. 1990 Jul;12(1):155-8. doi: 10.1002/hep.1840120124.
Results Reference
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PubMed Identifier
17030856
Citation
Narayan R, Buronfosse T, Schultz U, Chevallier-Gueyron P, Guerret S, Chevallier M, Saade F, Ndeboko B, Trepo C, Zoulim F, Cova L. Rise in gamma interferon expression during resolution of duck hepatitis B virus infection. J Gen Virol. 2006 Nov;87(Pt 11):3225-3232. doi: 10.1099/vir.0.82170-0.
Results Reference
result
PubMed Identifier
16912304
Citation
Wang J, Michalak TI. Inhibition by woodchuck hepatitis virus of class I major histocompatibility complex presentation on hepatocytes is mediated by virus envelope pre-S2 protein and can be reversed by treatment with gamma interferon. J Virol. 2006 Sep;80(17):8541-53. doi: 10.1128/JVI.00830-06.
Results Reference
result
PubMed Identifier
15994231
Citation
Wieland SF, Eustaquio A, Whitten-Bauer C, Boyd B, Chisari FV. Interferon prevents formation of replication-competent hepatitis B virus RNA-containing nucleocapsids. Proc Natl Acad Sci U S A. 2005 Jul 12;102(28):9913-7. doi: 10.1073/pnas.0504273102. Epub 2005 Jul 1.
Results Reference
result
PubMed Identifier
15940636
Citation
Park SG, Ryu HM, Lim SO, Kim YI, Hwang SB, Jung G. Interferon-gamma inhibits hepatitis B virus-induced NF-kappaB activation through nuclear localization of NF-kappaB-inducing kinase. Gastroenterology. 2005 Jun;128(7):2042-53. doi: 10.1053/j.gastro.2005.03.002.
Results Reference
result
PubMed Identifier
3129521
Citation
Bissett J, Eisenberg M, Gregory P, Robinson WS, Merigan TC. Recombinant fibroblast interferon and immune interferon for treating chronic hepatitis B virus infection: patients' tolerance and the effect on viral markers. J Infect Dis. 1988 May;157(5):1076-80. doi: 10.1093/infdis/157.5.1076. No abstract available.
Results Reference
result
PubMed Identifier
2452123
Citation
Porres JC, Mora I, Gutiez J, Bartolome J, Quiroga JA, Bas C, Compernolle C, Ordi J, Chocarro A, Carreno V. Antiviral effect of recombinant gamma interferon in chronic hepatitis B virus infection: a pilot study. Hepatogastroenterology. 1988 Feb;35(1):5-9.
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result
PubMed Identifier
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Citation
Di Bisceglie AM, Rustgi VK, Kassianides C, Lisker-Melman M, Park Y, Waggoner JG, Hoofnagle JH. Therapy of chronic hepatitis B with recombinant human alpha and gamma interferon. Hepatology. 1990 Feb;11(2):266-70. doi: 10.1002/hep.1840110217.
Results Reference
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Links:
URL
http://www.hmri.org/
Description
Huntington Medical Research Institutes
URL
http://www.uclahealth.org/body.cfm?xyzpdqabc=0&id=479&action=detail&ref=20715
Description
Myron J. Tong, PhD, MD

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A Phase II Study to Determine the Safety and Efficacy of Interferon-gamma in Patients With Chronic Hepatitis B

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