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Study on an Optimal Antiviral Treatment in HBeAg Positive Chronic Hepatitis B Patients

Primary Purpose

Chronic Hepatitis

Status
Unknown status
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Group A, TDF
Group B:TDF then TDF and Peginterferon alfa-2a
Group C:TDF and Peginterferon alfa-2a then TDF
Sponsored by
Ruijin Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Hepatitis focused on measuring HBeAg positive

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;HBsAg≤50000IU/ml, ALT≥ 2ULN,Liver histology above G2S2 and HBV DNA≥10*5 copies/mL;
  3. Women without ongoing pregnancy or breast feeding and both women and men willing to take an effective contraceptive measure during the treatment;
  4. Agree to participate in the study and sign the patient informed consent form.

Exclusion Criteria:

  1. Treated by immunosuppressant,immunomodulator,Systemic cytotoxic drug,herbs or HBIg within 6 months prior to the first dose of treatment;
  2. ALT≥10 X ULN or total bilirubin ≥2 X ULN;
  3. Allergic history to interferon;
  4. Co-infection with active hepatitis A, hepatitis C, hepatitis D and/or human immunodeficiency virus (HIV);
  5. Child-Pugh scores >7;
  6. 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);
  7. Pregnant or breast-feeding Women;
  8. Consuming alcohol in excess of 20g/day for women and 30g/day for men within 6 months prior to enrollment or drug taking history;
  9. ANC(absolute neutrophil count)<1.5x 10^9/L or PLT(platelet count)<90x 10^9/L
  10. Creatinine over upper limit of normal;
  11. 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;
  12. History of immunologically mediated disease, (e.g., inflammatory bowel disease, idiopathic thrombocytopenic purpura, lupus erythematosus, autoimmune hemolytic anemia, scleroderma, rheumatoid arthritis etc.);
  13. History of esophageal varices bleeding or other evidence of esophageal varices bleeding or other symptoms consistent with decompensated liver disease;
  14. History of severe cardiac disease (e.g., New York Heart Association Functional Class III or IV, myocardial infarction within 6 months, ventricular tachyarrhythmias requiring ongoing treatment, unstable angina or other significant cardiovascular diseases);
  15. Hemodialysis patients or patients with renal insufficiency;
  16. History of a severe seizure disorder or current anticonvulsant use;
  17. 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;
  18. History of thyroid disease poorly controlled on prescribed medications;
  19. Evidence of severe retinopathy or clinically relevant ophthalmologic disorder;
  20. 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;
  21. Patients included in another trial or having been given investigational drugs within 12 weeks prior to screening;
  22. AFP(alpha feto protein)>50ng/ml and/or evidence of hepatocellular carcinoma;
  23. Other disease should exclusive considered by the investigator.

Sites / Locations

  • Xixi Hospital of HangzhouRecruiting
  • Changhai HospitalRecruiting
  • Hua shan Hospital,Fudan UniversityRecruiting
  • Infectious diesease hospital of Huangpu district in ShanghaiRecruiting
  • No.9 hospital of shanghaiRecruiting
  • Shanghai public health clinical centerRecruiting
  • Shuguang Hospital of Shanghai T.C.MRecruiting
  • Tongren hospital Shanghai Jiaotong University School of medicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Experimental

Experimental

Arm Label

Group A,TDF

Group B,TDF+PEG

Group C,TDF+PEG

Arm Description

The subjects in group A will be treated by TDF for 96 weeks

The subjects in group B will be treated by TDF in the first 48 weeks, then will be treated by the combination of TDF and Peginterferon alfa-2a for another 48 weeks

The subjects in group C will be treated by the combination of TDF and Peginterferon alfa-2a for the first 48 weeks, then will be treated by TDF for another 48 weeks

Outcomes

Primary Outcome Measures

Number of subjects who achieve HBeAg seroconversion
The number of subjects with HBeAg seroconversion at week 96 will be measured

Secondary Outcome Measures

Number of participants who achieve HBeAg seroconversion
The number of subjects with HBeAg seroconversion at week 48 and 72 will be measured
The percentage decrease of HBsAg level at group A,B,C
The level of HBsAg in group A,B,C at week 48 ,72 and 96 will be measured,changing from baseline
Number of participants who achieve HBeAg loss
The number of subjects with HBeAg loss at week48.72 and 96 will be measured
The number of subjects who achieve HBVDNA undetectable
The number of subjects with HBVDNA undetectable at week 24,48,72 and 96 will be measured
The factor such as HBsAg level related to responsible rate
The HBsAg level at week 48,72,96 will be measured, to assess whether the quantitative HBsAg level related to the responsible rate
The number of subjects who achieve ALT back to normal
The number of subjects with normal ALT at week 48,72 and 96 will be measured

Full Information

First Posted
December 16, 2016
Last Updated
September 21, 2021
Sponsor
Ruijin Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT03013556
Brief Title
Study on an Optimal Antiviral Treatment in HBeAg Positive Chronic Hepatitis B Patients
Official Title
A Prospective, Randomized, Multicenter, Open-label Study of Optimal Antiviral Treatment in HBeAg Positive Chronic Hepatitis B Patients
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Unknown status
Study Start Date
November 2016 (undefined)
Primary Completion Date
December 30, 2021 (Anticipated)
Study Completion Date
December 31, 2021 (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 current study is a prospective, randomized, open, multi-center investigation. The aim of the study is to investigate whether the HBeAg seroconversion rate can be improved if applying combination therapy in HBeAg positive CHB patients who has achieved HBVDNA<105copies/ml,HBsAg≤5000IU/ml, ALT≥ 2ULN or Liver histology G2S2.
Detailed Description
The HBeAg positive chronic hepatitis B(CHB) subjects who has achieved HBV DNA<10*5copies/ml,HBsAg≤5000IU/ml, ALT≥ 2ULN or Liver histology G2S2 will be randomized to three groups. The subjects who go into group A will be treated by tenofovir disoproxil fumarate (TDF) for 96 weeks; The subjects who go into group B will be treated by TDF in the first 48 weeks, then will be treated by the combination of TDF and Peginterferon alfa-2a for another 48 weeks; The subjects who go into group C will be treated by the combination of TDF and Peginterferon alfa-2a for the first 48 weeks, then will be treated by TDF for another 48 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Hepatitis
Keywords
HBeAg positive

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Group A,TDF
Arm Type
Active Comparator
Arm Description
The subjects in group A will be treated by TDF for 96 weeks
Arm Title
Group B,TDF+PEG
Arm Type
Experimental
Arm Description
The subjects in group B will be treated by TDF in the first 48 weeks, then will be treated by the combination of TDF and Peginterferon alfa-2a for another 48 weeks
Arm Title
Group C,TDF+PEG
Arm Type
Experimental
Arm Description
The subjects in group C will be treated by the combination of TDF and Peginterferon alfa-2a for the first 48 weeks, then will be treated by TDF for another 48 weeks
Intervention Type
Drug
Intervention Name(s)
Group A, TDF
Other Intervention Name(s)
tenofovir
Intervention Description
TDF for 96 weeks
Intervention Type
Drug
Intervention Name(s)
Group B:TDF then TDF and Peginterferon alfa-2a
Other Intervention Name(s)
tenofovir,pegasys
Intervention Description
Subjects will be treated by TDF in the first 48 weeks, then will be treated by the combination of TDF and Peginterferon alfa-2a for another 48 weeks
Intervention Type
Drug
Intervention Name(s)
Group C:TDF and Peginterferon alfa-2a then TDF
Other Intervention Name(s)
tenofovir,pegasys
Intervention Description
Subjects will be treated by the combination of TDF and Peginterferon alfa-2a for the first 48 weeks, then will be treated by TDF for another 48 weeks.
Primary Outcome Measure Information:
Title
Number of subjects who achieve HBeAg seroconversion
Description
The number of subjects with HBeAg seroconversion at week 96 will be measured
Time Frame
at 96 week
Secondary Outcome Measure Information:
Title
Number of participants who achieve HBeAg seroconversion
Description
The number of subjects with HBeAg seroconversion at week 48 and 72 will be measured
Time Frame
at 48 week;at 72 week
Title
The percentage decrease of HBsAg level at group A,B,C
Description
The level of HBsAg in group A,B,C at week 48 ,72 and 96 will be measured,changing from baseline
Time Frame
at 48 week;at 72 week;at 96 week
Title
Number of participants who achieve HBeAg loss
Description
The number of subjects with HBeAg loss at week48.72 and 96 will be measured
Time Frame
at 48 week;at 72 week;at 96 week
Title
The number of subjects who achieve HBVDNA undetectable
Description
The number of subjects with HBVDNA undetectable at week 24,48,72 and 96 will be measured
Time Frame
at 24 week;48 week;at 72 week;at 96 week
Title
The factor such as HBsAg level related to responsible rate
Description
The HBsAg level at week 48,72,96 will be measured, to assess whether the quantitative HBsAg level related to the responsible rate
Time Frame
at week 48,72,96
Title
The number of subjects who achieve ALT back to normal
Description
The number of subjects with normal ALT at week 48,72 and 96 will be measured
Time Frame
at 48 week;at 72 week;at 96 week

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;HBsAg≤50000IU/ml, ALT≥ 2ULN,Liver histology above G2S2 and HBV DNA≥10*5 copies/mL; Women without ongoing pregnancy or breast feeding and both women and men 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: Treated by immunosuppressant,immunomodulator,Systemic cytotoxic drug,herbs or HBIg within 6 months prior to the first dose of treatment; ALT≥10 X ULN or total bilirubin ≥2 X ULN; Allergic history to interferon; Co-infection with active hepatitis A, hepatitis C, hepatitis D and/or human immunodeficiency virus (HIV); Child-Pugh scores >7; 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; Consuming alcohol in excess of 20g/day for women and 30g/day for men within 6 months prior to enrollment or drug taking history; ANC(absolute neutrophil count)<1.5x 10^9/L or PLT(platelet count)<90x 10^9/L Creatinine over upper limit of normal; 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 severe cardiac disease (e.g., New York Heart Association 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; Patients included in another trial or having been given investigational drugs within 12 weeks prior to screening; AFP(alpha feto protein)>50ng/ml and/or evidence of hepatocellular carcinoma; Other disease should exclusive considered by the investigator.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Xinxin Zhang
Email
zhangx@shsmu.edu.cn
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Xinxin Zhang
Organizational Affiliation
Ruijin Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Xixi Hospital of Hangzhou
City
Hangzhou
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Xiaoqing Fu
Facility Name
Changhai Hospital
City
Shanghai
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mobin Wan
Email
mobinwan@aliyun.com
Facility Name
Hua shan Hospital,Fudan University
City
Shanghai
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jiming Zhang
Email
jmzhang@vip.126.com
Facility Name
Infectious diesease hospital of Huangpu district in Shanghai
City
Shanghai
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hailin Liang
Facility Name
No.9 hospital of shanghai
City
Shanghai
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jie Xu
Email
dr.xu@aliyun.com
Facility Name
Shanghai public health clinical center
City
Shanghai
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Liang Chen
Email
chenliang@shaphc.org
Facility Name
Shuguang Hospital of Shanghai T.C.M
City
Shanghai
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
yueqiu Gao
Email
gaoyueqiu@hotmail.com
Facility Name
Tongren hospital Shanghai Jiaotong University School of medicine
City
Shanghai
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Qin Zhang

12. IPD Sharing Statement

Citations:
PubMed Identifier
26453773
Citation
Marcellin P, Ahn SH, Ma X, Caruntu FA, Tak WY, Elkashab M, Chuang WL, Lim SG, Tabak F, Mehta R, Petersen J, Foster GR, Lou L, Martins EB, Dinh P, Lin L, Corsa A, Charuworn P, Subramanian GM, Reiser H, Reesink HW, Fung S, Strasser SI, Trinh H, Buti M, Gaeta GB, Hui AJ, Papatheodoridis G, Flisiak R, Chan HL; Study 149 Investigators. Combination of Tenofovir Disoproxil Fumarate and Peginterferon alpha-2a Increases Loss of Hepatitis B Surface Antigen in Patients With Chronic Hepatitis B. Gastroenterology. 2016 Jan;150(1):134-144.e10. doi: 10.1053/j.gastro.2015.09.043. Epub 2015 Oct 8.
Results Reference
result
PubMed Identifier
25190434
Citation
Xie Q, Zhou H, Bai X, Wu S, Chen JJ, Sheng J, Xie Y, Chen C, Chan HL, Zhao M. A randomized, open-label clinical study of combined pegylated interferon Alfa-2a (40KD) and entecavir treatment for hepatitis B "e" antigen-positive chronic hepatitis B. Clin Infect Dis. 2014 Dec 15;59(12):1714-23. doi: 10.1093/cid/ciu702. Epub 2014 Sep 4.
Results Reference
result
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
result

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Study on an Optimal Antiviral Treatment in HBeAg Positive Chronic Hepatitis B Patients

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