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Adefovir Dipivoxil For The Treatment Of Chinese Compensated Chronic Hepatitis B(CHB)Patients

Primary Purpose

Chronic Hepatitis B

Status
Completed
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
adefovir dipivoxil
Sponsored by
GlaxoSmithKline
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Hepatitis B focused on measuring adefovir dipivoxil, compensated, chronic hepatitis B, Chinese

Eligibility Criteria

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

Inclusion Criteria:

  • Male or female subjects aged 18-65 years inclusive
  • Documented chronic hepatitis B infection determined by the presence of serum HBsAg for a least 6 months
  • Serum HBV DNA ≥105 copies/ml for HBeAg positive subjects or ≥104 copies/ml for HBeAg negative subjects (Real-time PCR, LLQ=1000cp/ml) at study screening (within 2 weeks before baseline), respectively.
  • ALT value ≥2 times the upper limit of normal (ULN) at the time of screening, as determined using laboratory ranges and documented ALT abnormal within 6 month prior the study screening.
  • Compensated liver disease with the following laboratory and clinical parameters study screening:
  • prothrombin time ≤ 2 seconds above normal direct bilirubin
  • Albumin≥35g/L
  • Total bilirubin ≤2.5mg/dL (≤ 43 µmol/L) or normal direct bilirubin
  • No history of variceal bleeding
  • No history of encephalopathy
  • No history of ascites
  • Willing and able to undergo two liver biopsies (prior to dosing, and after 48 weeks of therapy; only apply to subjects who are enrolled to the sites where liver biopsy is required).
  • Agree not to participate in any other investigational trials or to undertake other HBV systemic antiviral regimens during participation in this study

Exclusion Criteria:

A subject will not be eligible for inclusion in this study if any of the following criteria apply:

  • Any serious or active medical or psychiatric illnesses other than hepatitis B which, in the opinion of the investigator, would interfere with patient treatment, assessment or compliance with the protocol. This would include, may not limit to, renal, cardiac, pulmonary, vascular, neurogenic, digestive, metabolic (diabetes, thyroid disorders, adrenal disease), immunodeficiency disorders, active infection or cancer.
  • Documented evidence of active liver disease due to other causes including
  • co-infection hepatitis C (HCV), Subjects who are anti-HCV positive and in whom HCV RNA is undetectable are considered to be HCV seropositive and will not be eligible
  • co-infection with hepatitis delta (HDV)
  • co-infection with HIV
  • autoimmune hepatitis (antinuclear antibody titre>1:160)
  • Alanine aminotransferase(ALT) > 10 times ULN at screening or history of acute exacerbation leading to transient decompensation
  • Serum alpha fetoprotein (AFP) >50 ng/mL.
  • Hepatocellular carcinoma as evidenced by one of the following:
  • suspicious foci on ultrasound or radiological examination
  • where no positive ultrasound finding, but serum alpha-fetoprotein > 100ng/ml
  • Adequate renal function defined as serum creatinine >1.5 mg/dL (>130 µmol/L)
  • Adequate hematological function defined as:
  • Absolute neutrophil count <1 x 10³/mm³ (1 x 10^9/L)
  • Platelets<80 x 10³/mm³ (80 x 10^9/L); platelets<100 x 10³/mm³ (100 x 10^9/L)
  • Hemoglobin<12g/dL (120 g/L)(males) or <10 g/dL (100 g/L) (females)
  • Active alcohol or drug abuse or history of alcohol or drug abuse considered by the investigator to be sufficient to hinder compliance with treatment, participation in the study or interpretation of results.
  • Use of immunosuppressive therapy, immunomodulatory therapy (including interferon or thymosin), systemic cytotoxic agents within the previous 6 months or during the study.
  • Use of chronic anti-viral agents(e.g. lamivudine, adefovir dipivoxil, entecavir, famciclovir, tenofovir, FTC, ganciclovir, DAPD, LfMA, HBIg, etc.), Chinese herbal medicines known to have activity against HBV within the previous 3 months or during the study; use of agents with effect of ALT reduction (e.g. schisandra agents) during the study.
  • Received nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, vancomycin, cidofovir, foscarnet, cis-platinum, pentamidine etc.) or competitors of renal excretion (e.g., probenecid within 2 months prior to study screening or the expectation that patient will receive any of these during the course of the study.
  • Received hepatotoxic drugs (e.g., anabolic steroids, ketaconazole, itraconazole, isoniazid, rifampin, rifabutin) within 2 months prior to study screening or expected to receive these during the course of the study.
  • Previous (or planned) participation in an investigational trial involving administration of investigational compound within 2 months prior to the study screening.

Sites / Locations

  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Single arm adefovir dipivoxil

Arm Description

adefovir dipivoxil once daily orally 10 mg

Outcomes

Primary Outcome Measures

Number of Participants Achieving HBV DNA (Hepatitis B Virus Deoxyribonucleic Acid) <1000 Copies/Milliliter at Week 48
HBV (Hepatitis B Virus) DNA level was tested by real-time Polymerase Chain Reaction at Week 48.

Secondary Outcome Measures

Number of HBeAg Positive Participants Achieving Histological Improvement at Week 48
Histological improvement (defined as a ≥2 point reduction in the Knodell necroinflammation score without worsening fibrosis) was accessed by two pathologists in HBeAg-positive participants undergoing liver biopsy at baseline and week 48/withdrawal. Knodell/Histological Activity Index (HAI) score = combined scores for necrosis, inflammation, and fibrosis and is the sum of scores for periportal bridging necrosis (0-10: none=0, multilobular necrosis=10), intralobular degeneration and focal necrosis and portal inflammation (0-4: none=0, marked=4), and fibrosis (0-4: none=0, cirrhosis=4).
Ranked Assessment of Liver Histology in HBeAg Positive Participants From Baseline to Week 48
A ranked assessment with the Knodell/HAI scoring system that represents the sum of scores for periportal bridging necrosis (0-10: none=0, moderate piecemeal necrosis plus bridging necrosis=5, multilobular necrosis=10); interlobular degeneration and focal necrosis (0-4: none=0, marked=4); portal inflammation (0-4: none=0, marked=4) and fibrosis (0-4: none=0, fibrous portal expansion=1, bridging fibrosis=3, cirrhosis=4) was carried out by two pathologists in the HBeAg positive participants who underwent liver biopsy at baseline and Week 48/withdrawal.
Change From Screening in Median Serum HBV DNA at Weeks 24 and 48
The HBV DNA level was tested in blood serum by real-time Polymerase Chain Reaction with the LLD (lower limit of detection) as 300 copies/milliliter (cp/mL) at screening, week 24, and week 48 in a central laboratory. The change in HBV DNA from screening to week 24 and week 48 was conducted.
Number of Participants Achieving ALT (Alanine Aminotransferase) Normalization at Week 48
Elevated serum ALT levels are defined as serum ALT levels greater than the upper limit of the normal range (ULN), as determined using local laboratory ranges. ALT normalization was defined as ALT measurements at or below the ULN after a baseline value above the ULN.
Number of HBeAg Positive Participants Achieving HBeAg Loss and HBeAg Seroconversion at Week 48
HBeAg loss and HBeAg seroconversion (HBeAg loss and HBeAb detected) were assessed in participants who were HBeAg positive at Weeks 0 and 48. Confirmed HBeAg loss was defined as undetectable HBeAg.
Number of Participants With ADV-associated Resistance at Week 48
Week 48 serum samples from participants, who reached a HBV DNA breakthrough or have HBV DNA≥5 log copies/mL at Weeks 24 and 48 were assessed for the development of ADV (Adefovir dipivoxil) mutation (N236T and A181V) in the HBV polymerase. Virologic breakthrough was defined as an increase in the level of HBV DNA 1 log10 copy/mL from Week 24 to Week 48. ADV-associated resistance was defined as participants with both virologic breakthrough and ADV mutation.

Full Information

First Posted
February 28, 2007
Last Updated
October 15, 2009
Sponsor
GlaxoSmithKline
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1. Study Identification

Unique Protocol Identification Number
NCT00441974
Brief Title
Adefovir Dipivoxil For The Treatment Of Chinese Compensated Chronic Hepatitis B(CHB)Patients
Official Title
A 48-week Multi-centre, Open-label, Local Phase IV Study to Demonstrate the Efficacy and Safety of Adefovir Dipivoxil Tablets (10mg) in Chinese Subjects With Compensated Chronic Hepatitis B
Study Type
Interventional

2. Study Status

Record Verification Date
October 2009
Overall Recruitment Status
Completed
Study Start Date
December 2006 (undefined)
Primary Completion Date
September 2008 (Actual)
Study Completion Date
September 2008 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
GlaxoSmithKline

4. Oversight

5. Study Description

Brief Summary
This 48-week open-label study of local manufactured adefovir dipivoxil Tablet evaluates the efficacy and safety of adefovir 10mg once daily in Chinese subjects with compensated CHB. Primary endpoint is proportion of subjects achieving HBV DNA undetectable (<=1000 copies/mL by by Roche COBAS AMPLICOR HBV MONITOR Test) at week 48. Approximately 1250 patients will be recruited in 30 study centers in China. The subjects are offered 48 weeks of open label adefovir dipivoxil treatment, with assessments every three months, after with is a 12-week post study treatment follow-up prior to study completion.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Hepatitis B
Keywords
adefovir dipivoxil, compensated, chronic hepatitis B, Chinese

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
1470 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Single arm adefovir dipivoxil
Arm Type
Experimental
Arm Description
adefovir dipivoxil once daily orally 10 mg
Intervention Type
Drug
Intervention Name(s)
adefovir dipivoxil
Intervention Description
adefovir dipivoxil once daily one tablet 10mg orally
Primary Outcome Measure Information:
Title
Number of Participants Achieving HBV DNA (Hepatitis B Virus Deoxyribonucleic Acid) <1000 Copies/Milliliter at Week 48
Description
HBV (Hepatitis B Virus) DNA level was tested by real-time Polymerase Chain Reaction at Week 48.
Time Frame
Week 48
Secondary Outcome Measure Information:
Title
Number of HBeAg Positive Participants Achieving Histological Improvement at Week 48
Description
Histological improvement (defined as a ≥2 point reduction in the Knodell necroinflammation score without worsening fibrosis) was accessed by two pathologists in HBeAg-positive participants undergoing liver biopsy at baseline and week 48/withdrawal. Knodell/Histological Activity Index (HAI) score = combined scores for necrosis, inflammation, and fibrosis and is the sum of scores for periportal bridging necrosis (0-10: none=0, multilobular necrosis=10), intralobular degeneration and focal necrosis and portal inflammation (0-4: none=0, marked=4), and fibrosis (0-4: none=0, cirrhosis=4).
Time Frame
Week 48
Title
Ranked Assessment of Liver Histology in HBeAg Positive Participants From Baseline to Week 48
Description
A ranked assessment with the Knodell/HAI scoring system that represents the sum of scores for periportal bridging necrosis (0-10: none=0, moderate piecemeal necrosis plus bridging necrosis=5, multilobular necrosis=10); interlobular degeneration and focal necrosis (0-4: none=0, marked=4); portal inflammation (0-4: none=0, marked=4) and fibrosis (0-4: none=0, fibrous portal expansion=1, bridging fibrosis=3, cirrhosis=4) was carried out by two pathologists in the HBeAg positive participants who underwent liver biopsy at baseline and Week 48/withdrawal.
Time Frame
Baseline to Week 48
Title
Change From Screening in Median Serum HBV DNA at Weeks 24 and 48
Description
The HBV DNA level was tested in blood serum by real-time Polymerase Chain Reaction with the LLD (lower limit of detection) as 300 copies/milliliter (cp/mL) at screening, week 24, and week 48 in a central laboratory. The change in HBV DNA from screening to week 24 and week 48 was conducted.
Time Frame
Weeks 24 and 48
Title
Number of Participants Achieving ALT (Alanine Aminotransferase) Normalization at Week 48
Description
Elevated serum ALT levels are defined as serum ALT levels greater than the upper limit of the normal range (ULN), as determined using local laboratory ranges. ALT normalization was defined as ALT measurements at or below the ULN after a baseline value above the ULN.
Time Frame
Week 48
Title
Number of HBeAg Positive Participants Achieving HBeAg Loss and HBeAg Seroconversion at Week 48
Description
HBeAg loss and HBeAg seroconversion (HBeAg loss and HBeAb detected) were assessed in participants who were HBeAg positive at Weeks 0 and 48. Confirmed HBeAg loss was defined as undetectable HBeAg.
Time Frame
Week 48
Title
Number of Participants With ADV-associated Resistance at Week 48
Description
Week 48 serum samples from participants, who reached a HBV DNA breakthrough or have HBV DNA≥5 log copies/mL at Weeks 24 and 48 were assessed for the development of ADV (Adefovir dipivoxil) mutation (N236T and A181V) in the HBV polymerase. Virologic breakthrough was defined as an increase in the level of HBV DNA 1 log10 copy/mL from Week 24 to Week 48. ADV-associated resistance was defined as participants with both virologic breakthrough and ADV mutation.
Time Frame
Week 48

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subjects aged 18-65 years inclusive Documented chronic hepatitis B infection determined by the presence of serum HBsAg for a least 6 months Serum HBV DNA ≥105 copies/ml for HBeAg positive subjects or ≥104 copies/ml for HBeAg negative subjects (Real-time PCR, LLQ=1000cp/ml) at study screening (within 2 weeks before baseline), respectively. ALT value ≥2 times the upper limit of normal (ULN) at the time of screening, as determined using laboratory ranges and documented ALT abnormal within 6 month prior the study screening. Compensated liver disease with the following laboratory and clinical parameters study screening: prothrombin time ≤ 2 seconds above normal direct bilirubin Albumin≥35g/L Total bilirubin ≤2.5mg/dL (≤ 43 µmol/L) or normal direct bilirubin No history of variceal bleeding No history of encephalopathy No history of ascites Willing and able to undergo two liver biopsies (prior to dosing, and after 48 weeks of therapy; only apply to subjects who are enrolled to the sites where liver biopsy is required). Agree not to participate in any other investigational trials or to undertake other HBV systemic antiviral regimens during participation in this study Exclusion Criteria: A subject will not be eligible for inclusion in this study if any of the following criteria apply: Any serious or active medical or psychiatric illnesses other than hepatitis B which, in the opinion of the investigator, would interfere with patient treatment, assessment or compliance with the protocol. This would include, may not limit to, renal, cardiac, pulmonary, vascular, neurogenic, digestive, metabolic (diabetes, thyroid disorders, adrenal disease), immunodeficiency disorders, active infection or cancer. Documented evidence of active liver disease due to other causes including co-infection hepatitis C (HCV), Subjects who are anti-HCV positive and in whom HCV RNA is undetectable are considered to be HCV seropositive and will not be eligible co-infection with hepatitis delta (HDV) co-infection with HIV autoimmune hepatitis (antinuclear antibody titre>1:160) Alanine aminotransferase(ALT) > 10 times ULN at screening or history of acute exacerbation leading to transient decompensation Serum alpha fetoprotein (AFP) >50 ng/mL. Hepatocellular carcinoma as evidenced by one of the following: suspicious foci on ultrasound or radiological examination where no positive ultrasound finding, but serum alpha-fetoprotein > 100ng/ml Adequate renal function defined as serum creatinine >1.5 mg/dL (>130 µmol/L) Adequate hematological function defined as: Absolute neutrophil count <1 x 10³/mm³ (1 x 10^9/L) Platelets<80 x 10³/mm³ (80 x 10^9/L); platelets<100 x 10³/mm³ (100 x 10^9/L) Hemoglobin<12g/dL (120 g/L)(males) or <10 g/dL (100 g/L) (females) Active alcohol or drug abuse or history of alcohol or drug abuse considered by the investigator to be sufficient to hinder compliance with treatment, participation in the study or interpretation of results. Use of immunosuppressive therapy, immunomodulatory therapy (including interferon or thymosin), systemic cytotoxic agents within the previous 6 months or during the study. Use of chronic anti-viral agents(e.g. lamivudine, adefovir dipivoxil, entecavir, famciclovir, tenofovir, FTC, ganciclovir, DAPD, LfMA, HBIg, etc.), Chinese herbal medicines known to have activity against HBV within the previous 3 months or during the study; use of agents with effect of ALT reduction (e.g. schisandra agents) during the study. Received nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, vancomycin, cidofovir, foscarnet, cis-platinum, pentamidine etc.) or competitors of renal excretion (e.g., probenecid within 2 months prior to study screening or the expectation that patient will receive any of these during the course of the study. Received hepatotoxic drugs (e.g., anabolic steroids, ketaconazole, itraconazole, isoniazid, rifampin, rifabutin) within 2 months prior to study screening or expected to receive these during the course of the study. Previous (or planned) participation in an investigational trial involving administration of investigational compound within 2 months prior to the study screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
GSK Clinical Trials
Organizational Affiliation
GlaxoSmithKline
Official's Role
Study Director
Facility Information:
Facility Name
GSK Investigational Site
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510515
Country
China
Facility Name
GSK Investigational Site
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510630
Country
China
Facility Name
GSK Investigational Site
City
Wuhan
State/Province
Hubei
ZIP/Postal Code
430030
Country
China
Facility Name
GSK Investigational Site
City
Nanjing
State/Province
Jiangsu
ZIP/Postal Code
210002
Country
China
Facility Name
GSK Investigational Site
City
Nanjing
State/Province
Jiangsu
ZIP/Postal Code
210003
Country
China
Facility Name
GSK Investigational Site
City
Nanjing
State/Province
Jiangsu
ZIP/Postal Code
210029
Country
China
Facility Name
GSK Investigational Site
City
Changchun
State/Province
Jilin
ZIP/Postal Code
130021
Country
China
Facility Name
GSK Investigational Site
City
Chengdu
State/Province
Sichuan
ZIP/Postal Code
610041
Country
China
Facility Name
GSK Investigational Site
City
Hangzhou
State/Province
Zhejiang
ZIP/Postal Code
310003
Country
China
Facility Name
GSK Investigational Site
City
Beijing
ZIP/Postal Code
100011
Country
China
Facility Name
GSK Investigational Site
City
Beijing
ZIP/Postal Code
100044
Country
China
Facility Name
GSK Investigational Site
City
Beijing
ZIP/Postal Code
100050
Country
China
Facility Name
GSK Investigational Site
City
Beijing
ZIP/Postal Code
100069
Country
China
Facility Name
GSK Investigational Site
City
Changsha
ZIP/Postal Code
410008
Country
China
Facility Name
GSK Investigational Site
City
Changsha
ZIP/Postal Code
410011
Country
China
Facility Name
GSK Investigational Site
City
Chongqing
ZIP/Postal Code
400038
Country
China
Facility Name
GSK Investigational Site
City
Chongquin
ZIP/Postal Code
400038
Country
China
Facility Name
GSK Investigational Site
City
Fuzhou
ZIP/Postal Code
350025
Country
China
Facility Name
GSK Investigational Site
City
Jinan
ZIP/Postal Code
250021
Country
China
Facility Name
GSK Investigational Site
City
Shanghai
ZIP/Postal Code
200001
Country
China
Facility Name
GSK Investigational Site
City
Shanghai
ZIP/Postal Code
200003
Country
China
Facility Name
GSK Investigational Site
City
Shanghai
ZIP/Postal Code
200025
Country
China
Facility Name
GSK Investigational Site
City
Shanghai
ZIP/Postal Code
200040
Country
China
Facility Name
GSK Investigational Site
City
Shanghai
ZIP/Postal Code
200433
Country
China
Facility Name
GSK Investigational Site
City
Tianjin
ZIP/Postal Code
300192
Country
China

12. IPD Sharing Statement

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Adefovir Dipivoxil For The Treatment Of Chinese Compensated Chronic Hepatitis B(CHB)Patients

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