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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
Hepatera Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Hepatitis D Infection

Eligibility Criteria

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

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:

    1. Be menopausal for at least 2 years, or
    2. Be surgically sterile (total hysterectomy or bilateral ovariectomy or bilateral tubal ligation/clips or otherwise be incapable of pregnancy), or
    3. Not be heterosexually active during the study, or
    4. 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

    First Posted
    December 17, 2015
    Last Updated
    April 10, 2018
    Sponsor
    Hepatera Ltd.
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    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
    Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat. 2004 Mar;11(2):97-107. doi: 10.1046/j.1365-2893.2003.00487.x.
    Results Reference
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    PubMed Identifier
    23150796
    Citation
    Yan H, Zhong G, Xu G, He W, Jing Z, Gao Z, Huang Y, Qi Y, Peng B, Wang H, Fu L, Song M, Chen P, Gao W, Ren B, Sun Y, Cai T, Feng X, Sui J, Li W. Sodium taurocholate cotransporting polypeptide is a functional receptor for human hepatitis B and D virus. Elife. 2012 Nov 13;1:e00049. doi: 10.7554/eLife.00049. Erratum In: Elife. 2014;3:e05570.
    Results Reference
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    PubMed Identifier
    12663868
    Citation
    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.
    Results Reference
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    PubMed Identifier
    19208358
    Citation
    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.
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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.
    Results Reference
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    PubMed Identifier
    27132172
    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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