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Study Comparing the Safety of Switching From Lamivudine to Adefovir Dipivoxil Versus Overlapping Lamivudine and Adefovir Before Adefovir Dipivoxil Monotherapy in Patients With Chronic Hepatitis B

Primary Purpose

Chronic Hepatitis B

Status
Completed
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
Adefovir Dipivoxil
Sponsored by
Thomas Jefferson University
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, Lamivudine, Hepatitis B

Eligibility Criteria

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

Inclusion Criteria: Males and females ≥ 18 years of age with chronic hepatitis B Hepatitis B surface antigen (HBsAg)(+) for a minimum of 6 months prior to entry Hepatitis B envelope antigen (HBeAg)(+) or (-) at baseline Patients having previously received LAM for at least 24 weeks Patients with compensated liver function (Child-Pugh score ≤ 6) Exclusion Criteria: Any serious or active medical or psychiatric illness which, in the opinion of the investigator, would interfere with patient treatment, assessment or compliance with the protocol. Received immunoglobulins, interferon or other immune or cytokine-based therapies with possible activity in hepatitis B disease within 6 months prior to study screening. Organ or bone marrow transplant recipients. Evidence of active liver disease due to other causes (e.g., Wilson's disease, hemochromatosis, autoimmune hepatitis, hepatitis C or hepatitis D co-infection) Patients taking parenteral (intravenous or intramuscular or subcutaneous) or oral steroids, immuno-suppressant therapies or chemotherapeutic agents within 2 months of study screening or expected to receive these agents during the course of the study. Previous participation in an investigational trial involving administration of any investigational compound within 2 months prior to the study screening or those who received anti-HBV therapy other than lamivudine within the previous 3 months (e.g. anabolic steroids, ketaconazole, itraconazole, isoniazid, rifampin, rifabutin, simvastatin, lovastatin) Clinically relevant alcohol or drug use or history of alcohol or drug use considered by the investigator to be sufficient to hinder compliance with treatment, follow up procedures or evaluation of adverse events Lactating females or females with a positive serum pregnancy test. Females of childbearing potential (post-puberty) unwilling or unable to have pregnancy testing at any study visit Therapy with nephrotoxic drugs (e.g. aminoglycosides, amphotericin B, vancomycin, cidofovir, foscarnet, cisplatin pentamidine, tacrolimus, cyclosporine) or competitors of renal excretion (e.g. probenecid) within 2 months prior to study screening or the expectation that subject will receive these during the course of the study. The use of antiviral therapy with agents demonstrating potential anti-HBV activity other than lamivudine within the previous 3 months (e.g. famciclovir, lobucavir, emtricitabine, DAPD, L-FMAU, entecavir, ganciclovir or others). History of hypersensitivity to nucleoside and/or nucleotide analogues. Clinical, ultrasonographic or radiologic evidence of hepatic mass suggestive of hepatocellular carcinoma. Serum alphafetoprotein (AFP) > 50 ng/mL at the first screening visit. However, if the AFP level is > 50 ng/mL at the first screening visit, but has remained stable or decreased over the 6 months preceding the first screening visit, and if there is no radiologic or ultrasonic evidence of hepatic mass(es) suggestive of hepatocellular carcinoma, the patient will be allowed to enroll. Inability to comply with study requirements.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Active Comparator

    Active Comparator

    Arm Label

    Direct switch to Adefovir Dipivoxil from Lamivudine

    Overlapping Lamivudine and Adefovir Dipivoxil for 3 months followed by ADV monotherapy

    Arm Description

    Outcomes

    Primary Outcome Measures

    Observe the proportion of patients with ALT elevations (> 10 x ULN) at any time over the course of the switch
    Study serum HBV DNA levels over time
    Study serum ALT levels over time
    Study the proportion of patients with YMDD variants at entry
    Study the safety during the switching period

    Secondary Outcome Measures

    Full Information

    First Posted
    March 24, 2006
    Last Updated
    November 5, 2021
    Sponsor
    Thomas Jefferson University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00307242
    Brief Title
    Study Comparing the Safety of Switching From Lamivudine to Adefovir Dipivoxil Versus Overlapping Lamivudine and Adefovir Before Adefovir Dipivoxil Monotherapy in Patients With Chronic Hepatitis B
    Official Title
    A Single Center Open-Label, Randomized Study Comparing the Safety of Immediately Switching From Lamivudine to Adefovir Dipivoxil Versus Overlapping Lamivudine and Adefovir for 12 Weeks Before Instituting Adefovir Dipivoxil Monotherapy in Patients With Chronic Hepatitis B
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    November 2021
    Overall Recruitment Status
    Completed
    Study Start Date
    June 17, 2005 (Actual)
    Primary Completion Date
    February 2009 (Actual)
    Study Completion Date
    February 5, 2009 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Thomas Jefferson University

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    In earlier clinical studies, when patients who have been on lamivudine (LAM) were switched to adefovir dipivoxil (ADV), some patients developed ALT flares with an elevation of ALT > 10 x the upper limits of normal (ULN). There were no cases of hepatic decompensation with the flares, however. The transition methods were varied among physicians from no overlapping to overlapping for 1 to 3 months with LAM and ADV. There is still some uncertainty about the optimal approach to switching from LAM to ADV. This study will compare the safety of directly switching to ADV to a protocolled switch after a period of overlap of 12 weeks. This will facilitate pro-active switching in patients on LAM and will also highlight genotypic resistance ahead of phenotypic resistance as a reason to switch patients. Data to date have only been presented as part of a controlled study in patients with clinically evident LAM-resistance. This study will enroll patients who still have serum hepatitis B virus (HBV) DNA suppression whilst receiving LAM.
    Detailed Description
    Chronic HBV infection is an important worldwide cause of morbidity, mortality and source of potential new infections. There are an estimated 350 million carriers of HBV in the world. In China, Southeast Asia and sub-Saharan Africa, as many as 10-15% of the population are chronically infected. In North America and Northern Europe, infection and carrier rates are much lower, usually below 1%. Intermediate carrier rates of 1-5% are found in Southern Europe (e.g., Italy, Greece and Spain), parts of South and Central America, the Middle East and Japan. Persistent infection develops in over 90% of perinatally infected children and in 3-10% of people who become infected after the age of 6 years. Worldwide, it has been estimated that more than one million people die annually due to HBV-related end stage diseases such as cirrhosis and hepatocellular carcinoma. The goal of antiviral therapy for hepatitis B is to reduce a patient's risks for progressive liver disease through prolonged suppression or eradication of HBV infection and to arrest or ameliorate HBV-related liver damage.

    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, Lamivudine, Hepatitis B

    7. Study Design

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

    8. Arms, Groups, and Interventions

    Arm Title
    Direct switch to Adefovir Dipivoxil from Lamivudine
    Arm Type
    Active Comparator
    Arm Title
    Overlapping Lamivudine and Adefovir Dipivoxil for 3 months followed by ADV monotherapy
    Arm Type
    Active Comparator
    Intervention Type
    Drug
    Intervention Name(s)
    Adefovir Dipivoxil
    Primary Outcome Measure Information:
    Title
    Observe the proportion of patients with ALT elevations (> 10 x ULN) at any time over the course of the switch
    Time Frame
    baseline, 3, 6, 9, and 12 months
    Title
    Study serum HBV DNA levels over time
    Time Frame
    baseline, 3, 6, 9, and 12 months
    Title
    Study serum ALT levels over time
    Time Frame
    baseline, 3, 6, 9, and 12 months
    Title
    Study the proportion of patients with YMDD variants at entry
    Time Frame
    baseline, 3, 6, 9, and 12 months
    Title
    Study the safety during the switching period
    Time Frame
    baseline, 3, 6, 9, and 12 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Males and females ≥ 18 years of age with chronic hepatitis B Hepatitis B surface antigen (HBsAg)(+) for a minimum of 6 months prior to entry Hepatitis B envelope antigen (HBeAg)(+) or (-) at baseline Patients having previously received LAM for at least 24 weeks Patients with compensated liver function (Child-Pugh score ≤ 6) Exclusion Criteria: Any serious or active medical or psychiatric illness which, in the opinion of the investigator, would interfere with patient treatment, assessment or compliance with the protocol. Received immunoglobulins, interferon or other immune or cytokine-based therapies with possible activity in hepatitis B disease within 6 months prior to study screening. Organ or bone marrow transplant recipients. Evidence of active liver disease due to other causes (e.g., Wilson's disease, hemochromatosis, autoimmune hepatitis, hepatitis C or hepatitis D co-infection) Patients taking parenteral (intravenous or intramuscular or subcutaneous) or oral steroids, immuno-suppressant therapies or chemotherapeutic agents within 2 months of study screening or expected to receive these agents during the course of the study. Previous participation in an investigational trial involving administration of any investigational compound within 2 months prior to the study screening or those who received anti-HBV therapy other than lamivudine within the previous 3 months (e.g. anabolic steroids, ketaconazole, itraconazole, isoniazid, rifampin, rifabutin, simvastatin, lovastatin) Clinically relevant alcohol or drug use or history of alcohol or drug use considered by the investigator to be sufficient to hinder compliance with treatment, follow up procedures or evaluation of adverse events Lactating females or females with a positive serum pregnancy test. Females of childbearing potential (post-puberty) unwilling or unable to have pregnancy testing at any study visit Therapy with nephrotoxic drugs (e.g. aminoglycosides, amphotericin B, vancomycin, cidofovir, foscarnet, cisplatin pentamidine, tacrolimus, cyclosporine) or competitors of renal excretion (e.g. probenecid) within 2 months prior to study screening or the expectation that subject will receive these during the course of the study. The use of antiviral therapy with agents demonstrating potential anti-HBV activity other than lamivudine within the previous 3 months (e.g. famciclovir, lobucavir, emtricitabine, DAPD, L-FMAU, entecavir, ganciclovir or others). History of hypersensitivity to nucleoside and/or nucleotide analogues. Clinical, ultrasonographic or radiologic evidence of hepatic mass suggestive of hepatocellular carcinoma. Serum alphafetoprotein (AFP) > 50 ng/mL at the first screening visit. However, if the AFP level is > 50 ng/mL at the first screening visit, but has remained stable or decreased over the 6 months preceding the first screening visit, and if there is no radiologic or ultrasonic evidence of hepatic mass(es) suggestive of hepatocellular carcinoma, the patient will be allowed to enroll. Inability to comply with study requirements.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Hie-Won Hann, M.D.
    Organizational Affiliation
    Thomas Jefferson University
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Study Comparing the Safety of Switching From Lamivudine to Adefovir Dipivoxil Versus Overlapping Lamivudine and Adefovir Before Adefovir Dipivoxil Monotherapy in Patients With Chronic Hepatitis B

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