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An Exploratory Study of RGT Strategy on Optimal NUC-experienced Patients

Primary Purpose

Chronic Hepatitis B

Status
Unknown status
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
Peginterferon alfa-2a plus Entecavir
Peginterferon alfa-2a plus Lamivudine
Peginterferon alfa-2a plus Adefovir
Peginterferon alfa-2a plus Tenofovir
Entecavir
Lamivudine
Adefovir
Tenofovir disoproxil
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 nucleoside analogue(NUC) (except of telbivudine);
  3. Treated with NUC (except of telbivudine)for more than 24 weeks and achieve HBV DNA<1000copies/ml and HBsAg<5000IU/ml;&HBeAg<100PEIU/ml(470s/co);
  4. Without contra-indications to Peginterferon alfa-2a therapy as detailed in the label;
  5. Without co-infection with hepatitis C, hepatitis D and HIV;
  6. Women without ongoing pregnancy or breast feeding and willing to take an effective contraceptive measure during the treatment
  7. Agree to participate in the study and sign the patient informed consent form.

Exclusion criteria

  1. Co-infection with active hepatitis A, hepatitis C, hepatitis D and/or human immunodeficiency virus (HIV)
  2. AFP(alpha fetoprotein)>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:

    • Serum albumin <35 g/L
    • Prothrombin time prolonged≥ 4 seconds or PTA(prothrombin activity) < 60%
    • Serum bilirubin > 34 µmol/L
    • History of encephalopathy
    • 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(absolute neutrophil count)<1.5x 10^9/L or PLT(platelet count)<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(telbivudine) 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

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Experimental

    Active Comparator

    Active Comparator

    Arm Label

    A:PEG+NUC (HBsAg<200IU/ml at week 24)

    B:PEG+NUC(HBsAg>200IU/ml at week 24)

    C:NUC(HBsAg>200IU/ml at week 24)

    Arm Description

    Peginterferon alfa-2a 180μg /wk plus nucleoside analogue(NUC): HBsAg<200IU/ml at week 24 (Following treatment with Peginterferon alfa-2a plus nucleoside analogue(NUC) for 24 weeks)

    Peginterferon alfa-2a 180μg /wk plus+nucleoside analogue(NUC): HBsAg>200IU/ml at week 24 (Following treatment with Peginterferon alfa-2a plus nucleoside analogue(NUC) for 24 weeks)

    nucleoside analogue(NUC): HBsAg>200IU/ml at week 24 (Following treatment with Peginterferon alfa-2a plus nucleoside analogue(NUC) for 24 weeks)

    Outcomes

    Primary Outcome Measures

    Number of participants who achieve HBsAg clearance
    To investigate whether HBsAg clearance rate can be improved at week 48 following applying RGT strategy(week 24) in NUC-experience subjects will be measured by the number of participants who achieve HBsAg clearance

    Secondary Outcome Measures

    Number of participants who achieve HBsAg seroconversion
    To investigate the HBsAg seroconversion rate at week 48 can be improved following applying RGT strategy in NUC-experience subjects will be measured by the number of participants who achieve HBsAg seroconversion
    Number of participants who achieve HBeAg loss
    To investigate the HBeAg loss rate at week 48 can be improved following applying RGT strategy in NUC-experience subjects will be measured by the number of participants who achieve HBeAg loss
    Number of participants who achieve HBeAg seroconversion
    To investigate the HBeAg seroconversion rate at week 48 will be improved following applying RGT strategy in NUC-experience subjects will be measured by the number of participants who achieve HBeAg seroconversion
    Percentage of of participants who achieve HBsAg decline >2log from baseline(0 week)
    To investigate HBsAg decline from baseline at week 48 following applying RGT strategy in NUC-experience subjects by measured the percentage of of participants who achieve HBsAg decline>2log from baseline(0 week)
    Percentage of of participants who achieve HBsAg <10IU/mL
    To investigate the percentage of of participants who achieve HBsAg <100IU/mLat week 48 following applying RGT strategy in NUC-experience subjects
    Percentage of of participants who achieve combined response(defined as HBeAg seroconversion and HBVDNA<300copies/mL)
    To investigate the percentage of of participants who achieve combined response at week 48 following applying RGT strategy in NUC-experience subjects will be measured by number of participants who achieve combined response
    Percentage of of participants who achieve dural response I (defined as HBeAg seroconversion and HBsAg<100IU/mL)
    To investigate the percentage of of participants who achieve dural response I at week 48 following applying RGT strategy in NUC-experience subjects will be measured by number of participants who achieve dural response
    Percentage of of participants who achieve dural response II (defined as HBeAg seroconversion and HBsAg<10IU/mL)
    To investigate the percentage of of participants who achieve dural response II at week 48 following applying RGT strategy in NUC-experience subjects will be measured by number of participants who achieve dural response
    Number of participants who relapses (HBVDNA>1000copies/ml)
    To investigate the number of participants who relapses following applying RGT strategy in NUC-experience subjects
    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
    September 22, 2015
    Last Updated
    September 23, 2015
    Sponsor
    Ruijin Hospital
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02560649
    Brief Title
    An Exploratory Study of RGT Strategy on Optimal NUC-experienced Patients
    Official Title
    A Prospective, Randomized, Multicenter, Open-label, Exploratory Study of Utilizing of "Response-Guided-Therapy (RGT)" Strategy on Optimal Nucleoside Analogue (NUC)-Experienced Patients
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    September 2015
    Overall Recruitment Status
    Unknown status
    Study Start Date
    May 2015 (undefined)
    Primary Completion Date
    August 2016 (Anticipated)
    Study Completion Date
    February 2017 (Anticipated)

    3. Sponsor/Collaborators

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

    4. Oversight

    5. Study Description

    Brief Summary
    The aim of current study is to investigate whether the HBsAg clearance rate can be improved if applying RGT((Response-Guided Therapy) strategy in HBeAg positive CHB(chronic hepatitis B) patients treated by nucleoside analogue(NUC) achieved HBVDNA<1000copies/ml,and HBsAg<5000IU/ml; &HBeAg<100PEIU/ml (or470s/co), combined with PEG-IFN a-2a for 24 weeks.
    Detailed Description
    The current study is a prospective, randomized, open, multi-center investigation. The aim of current study is to investigate whether the HBsAg clearance rate can be improved if applying RGT strategy in HBeAg positive CHB patients treated by NUC achieved HBVDNA<1000copies/ml,and HBsAg<5000IU/ml; &HBeAg<100PEIU/ml (or470s/co), combined with PEG-IFN a-2a for 24 weeks. Then the subjects will be divided into three groups according to qHBsAg levels of week 24 (RGT). For the subjects who qHBsAg<200IU/ml of week 24, they are defined in Group A; the subjects in Group A will continue to be treated by NUC combined with PEG-IFN a-2a 180μg for another 24 weeks(total will be 48 weeks). If the qHBsAg at week 24 did not achieve minor 200IU/ml, the subjects will be randomized to 2 groups: Group B: the subjects will continue to be treated by NUC combined with PEG-IFN a-2a 180μg for another 24 weeks (total will be 48 weeks); Group C: the subjects will be treated by NUC until 48 weeks.

    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
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    324 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    A:PEG+NUC (HBsAg<200IU/ml at week 24)
    Arm Type
    Experimental
    Arm Description
    Peginterferon alfa-2a 180μg /wk plus nucleoside analogue(NUC): HBsAg<200IU/ml at week 24 (Following treatment with Peginterferon alfa-2a plus nucleoside analogue(NUC) for 24 weeks)
    Arm Title
    B:PEG+NUC(HBsAg>200IU/ml at week 24)
    Arm Type
    Active Comparator
    Arm Description
    Peginterferon alfa-2a 180μg /wk plus+nucleoside analogue(NUC): HBsAg>200IU/ml at week 24 (Following treatment with Peginterferon alfa-2a plus nucleoside analogue(NUC) for 24 weeks)
    Arm Title
    C:NUC(HBsAg>200IU/ml at week 24)
    Arm Type
    Active Comparator
    Arm Description
    nucleoside analogue(NUC): HBsAg>200IU/ml at week 24 (Following treatment with Peginterferon alfa-2a plus nucleoside analogue(NUC) for 24 weeks)
    Intervention Type
    Drug
    Intervention Name(s)
    Peginterferon alfa-2a plus Entecavir
    Other Intervention Name(s)
    Pegasys; ETV
    Intervention Description
    Peginterferon alfa-2a 180μg /wk plus Entecavir 0.5mg qd for 48 weeks(Arm A and B)
    Intervention Type
    Drug
    Intervention Name(s)
    Peginterferon alfa-2a plus Lamivudine
    Other Intervention Name(s)
    Pegasys; LAM
    Intervention Description
    Peginterferon alfa-2a 180μg /wk plus Lamivudine 0.1g qd for 48 weeks(Arm A and B)
    Intervention Type
    Drug
    Intervention Name(s)
    Peginterferon alfa-2a plus Adefovir
    Other Intervention Name(s)
    Pegasys;ADV
    Intervention Description
    Peginterferon alfa-2a 180μg /wk plus Adefovir 10mg qd for 48 weeks(Arm A and B)
    Intervention Type
    Drug
    Intervention Name(s)
    Peginterferon alfa-2a plus Tenofovir
    Other Intervention Name(s)
    Pegasys;TDF
    Intervention Description
    Peginterferon alfa-2a 180μg /wk plus Tenofovir 300mg qd for 48 weeks(Arm A and B)
    Intervention Type
    Drug
    Intervention Name(s)
    Entecavir
    Other Intervention Name(s)
    ETV
    Intervention Description
    Entecavir 0.5mg qd for 24 weeks(Arm C)
    Intervention Type
    Drug
    Intervention Name(s)
    Lamivudine
    Other Intervention Name(s)
    LAM
    Intervention Description
    Lamivudine 0.1g qd for 24 weeks(Arm C)
    Intervention Type
    Drug
    Intervention Name(s)
    Adefovir
    Other Intervention Name(s)
    Adefovir dipivoxil;ADV
    Intervention Description
    Adefovir 10mg qd for 24 weeks(ArmC)
    Intervention Type
    Drug
    Intervention Name(s)
    Tenofovir disoproxil
    Other Intervention Name(s)
    Tenofovir disoproxil;TDF
    Intervention Description
    Tenofovir 300mg qd for 24 weeks(Arm C)
    Primary Outcome Measure Information:
    Title
    Number of participants who achieve HBsAg clearance
    Description
    To investigate whether HBsAg clearance rate can be improved at week 48 following applying RGT strategy(week 24) in NUC-experience subjects will be measured by the number of participants who achieve HBsAg clearance
    Time Frame
    Week 48
    Secondary Outcome Measure Information:
    Title
    Number of participants who achieve HBsAg seroconversion
    Description
    To investigate the HBsAg seroconversion rate at week 48 can be improved following applying RGT strategy in NUC-experience subjects will be measured by the number of participants who achieve HBsAg seroconversion
    Time Frame
    Week 48
    Title
    Number of participants who achieve HBeAg loss
    Description
    To investigate the HBeAg loss rate at week 48 can be improved following applying RGT strategy in NUC-experience subjects will be measured by the number of participants who achieve HBeAg loss
    Time Frame
    Week 48
    Title
    Number of participants who achieve HBeAg seroconversion
    Description
    To investigate the HBeAg seroconversion rate at week 48 will be improved following applying RGT strategy in NUC-experience subjects will be measured by the number of participants who achieve HBeAg seroconversion
    Time Frame
    Week 48
    Title
    Percentage of of participants who achieve HBsAg decline >2log from baseline(0 week)
    Description
    To investigate HBsAg decline from baseline at week 48 following applying RGT strategy in NUC-experience subjects by measured the percentage of of participants who achieve HBsAg decline>2log from baseline(0 week)
    Time Frame
    Week 48
    Title
    Percentage of of participants who achieve HBsAg <10IU/mL
    Description
    To investigate the percentage of of participants who achieve HBsAg <100IU/mLat week 48 following applying RGT strategy in NUC-experience subjects
    Time Frame
    Week 48
    Title
    Percentage of of participants who achieve combined response(defined as HBeAg seroconversion and HBVDNA<300copies/mL)
    Description
    To investigate the percentage of of participants who achieve combined response at week 48 following applying RGT strategy in NUC-experience subjects will be measured by number of participants who achieve combined response
    Time Frame
    Week 48
    Title
    Percentage of of participants who achieve dural response I (defined as HBeAg seroconversion and HBsAg<100IU/mL)
    Description
    To investigate the percentage of of participants who achieve dural response I at week 48 following applying RGT strategy in NUC-experience subjects will be measured by number of participants who achieve dural response
    Time Frame
    Week 48
    Title
    Percentage of of participants who achieve dural response II (defined as HBeAg seroconversion and HBsAg<10IU/mL)
    Description
    To investigate the percentage of of participants who achieve dural response II at week 48 following applying RGT strategy in NUC-experience subjects will be measured by number of participants who achieve dural response
    Time Frame
    Week 48
    Title
    Number of participants who relapses (HBVDNA>1000copies/ml)
    Description
    To investigate the number of participants who relapses following applying RGT strategy in NUC-experience subjects
    Time Frame
    Week 48
    Title
    Number of Participants with AE
    Description
    Number of participants with adverse events as a measure of safety and tolerability
    Time Frame
    Week 48
    Title
    Number of Participants with SAE
    Description
    Number of participants with SAEs as a measure of safety and tolerability
    Time Frame
    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 nucleoside analogue(NUC) (except of telbivudine); Treated with NUC (except of telbivudine)for more than 24 weeks and achieve HBV DNA<1000copies/ml and HBsAg<5000IU/ml;&HBeAg<100PEIU/ml(470s/co); Without contra-indications to Peginterferon alfa-2a therapy as detailed in the label; Without co-infection with hepatitis C, hepatitis D and HIV; 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 form. Exclusion criteria Co-infection with active hepatitis A, hepatitis C, hepatitis D and/or human immunodeficiency virus (HIV) AFP(alpha fetoprotein)>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 Prothrombin time prolonged≥ 4 seconds or PTA(prothrombin activity) < 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(absolute neutrophil count)<1.5x 10^9/L or PLT(platelet count)<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(telbivudine) 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

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    24915612
    Citation
    Ning Q, Han M, Sun Y, Jiang J, Tan D, Hou J, Tang H, Sheng J, Zhao M. Switching from entecavir to PegIFN alfa-2a in patients with HBeAg-positive chronic hepatitis B: a randomised open-label trial (OSST trial). J Hepatol. 2014 Oct;61(4):777-84. doi: 10.1016/j.jhep.2014.05.044. Epub 2014 Jun 7.
    Results Reference
    background
    Citation
    P. Hu et al. 2015 EASL abstract O116. PREDICTIVE VALUE OF BASELINE AND ON-TREATMENT qHBsAg LEVEL IN HBeAg POSITIVE CHB PATIENTS WHO SWITCHED FROM NUCS TO PEGYLATED INTERFERON A-2A: A FURTHER ANALYSIS FROM NEW SWITCH STUDY
    Results Reference
    background
    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
    background

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    An Exploratory Study of RGT Strategy on Optimal NUC-experienced Patients

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