Hepatitis B, Chronic Clinical Trial
Official title:
Long-Term Lamivudine Therapy for Chronic Hepatitis B
Verified date | March 31, 2007 |
Source | National Institutes of Health Clinical Center (CC) |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This study will evaluate the long-term safety and effectiveness of lamivudine therapy and the
possibility of stopping therapy in patients whose hepatitis B is chronic, that is, long
lasting, and which has responded to treatment. Chronic hepatitis B, caused by a virus, is a
common form of liver disease affecting about 1 million Americans and about 5 percent of the
world's population. Health effects include a continuous state of being infectious and the
risk of transmitting hepatitis to other people, symptoms of liver disease, and development of
cirrhosis-that is, severe damage to the liver-and liver cancer. Lamivudine is a medication
that blocks hepatitis B effectively but does not make it disappear completely. Scientists
believe that the immune system must also be active to rid the body of the last traces of
hepatitis B.
Patients ages 18 and older who have chronic hepatitis B and are being treated with lamivudine
may be eligible to participate in this study. They will undergo a medical history and
physical examination and will be given lamivudine in 100 mg tablets to be taken as one
tablet, once each day. Patients will be asked to return to the outpatient clinic every 3
months, when they will undergo a brief interview and measurement of vital signs-such as blood
pressure, pulse, and body weight. During the visits, they will fill out questionnaires about
any symptoms or side effects they have, and they will be seen by a doctor and have a brief
medical history and examination. There will be a collection of blood for complete blood
counts, liver enzymes, and hepatitis B virus. Extra blood tests may be done to analyze
patients' immune reactions to hepatitis B. Patients will also receive refills of their
lamivudine tablets. They will continue to be treated with lamivudine as long as it seems to
control the hepatitis infection and liver disease.
At intervals of about 1 year, patients will have ultrasound examinations, lasting about 1
hour, of the liver and abdomen. Then at intervals of about 5 years, patients will undergo
liver biopsies, which require a hospital stay of 2 to 3 days. A liver biopsy is done by
passing a needle through the skin into the liver to obtain a piece of liver about 2 inches
long and 1/16-inch in diameter. A small amount of bleeding probably occurs with most liver
biopsies. Internal bleeding is a risk, which may require that the patient stay in the
hospital a few days longer, for rest, observation and pain medicine. The biopsy provides
information that proves whether lamivudine is controlling the liver disease and preventing it
from worsening or progressing to cirrhosis.
Side effects of lamivudine include fatigue, muscle aches, fever and chills, sore throat,
nausea, stomach pain or cramps, and diarrhea. Serious side effects are rare, occurring in
less than 1% of people taking lamivudine. They include inflammation of the pancreas, nerve
damage, and buildup of lactic acid in the blood. About 25% of patients experience a temporary
worsening, or flare, of hepatitis during the first few months of treatment. If flares are
severe, it is important for researchers to determine whether they are caused by resistance to
lamivudine or by the immune system acting against the hepatitis B virus or another liver
condition. A flare of hepatitis can also occur when lamivudine is stopped, that is, a
withdrawal. In such situations, testing for hepatitis B virus levels and other liver
conditions is important. It may lead to other treatments or stopping lamivudine and taking
another medication instead. While patients are participating in the study, they will have a
careful evaluation of their hepatitis and general condition. They may have an improvement in
their disease as a result of long-term lamivudine therapy.
Status | Completed |
Enrollment | 50 |
Est. completion date | March 31, 2007 |
Est. primary completion date | |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
- INCLUSION CRITERIA: - Age 18 years or above, male or female - Presence of HBsAg in serum for at least 6 months. - Previous liver biopsy histology showing chronic hepatitis with or without cirrhosis. - Long-term (greater than 1 year) lamivudine therapy in doses of 100 mg daily. - Normal or near normal (less than twice the upper limit of normal) serum aminotransferase levels. - HBV DNA levels below 10(5) copies per ml while on lamivudine. - Written informed consent. EXCLUSION CRITERIA: - In women, pregnancy, breast feeding, and, in those capable of bearing children, inability to practice adequate contraception. - Significant systemic illnesses other than liver disease, including congestive heart failure, renal failure, chronic pancreatitis, or diabetes mellitus with poor control. - Serum creatinine greater than 1.5 mg/dL and creatinine clearance less than 50 cc/min. - A history of clinically apparent pancreatitis or evidence of subclinical pancreatitis as shown by serum amylase values twice the upper limits of the normal range and abnormalities of the pancreas on computerized tomography or other imaging studies of the abdomen. - Severe cirrhosis as defined by Child's stage C (Child-Pugh score of 7 or above). - HIV infection as indicated by presence of anti-HIV in serum. - Chronic hepatitis C as shown by the presence of anti-HCV and HCV RNA in serum. - Immunosuppressive therapy requiring use of more than 10 mg of prednisone (or its equivalent) per day. - Other antiviral therapy for chronic hepatitis B within the previous 3 months. - Sensory or motor neuropathy apparent from medical history and physical examination. |
Country | Name | City | State |
---|---|---|---|
United States | National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda | Maryland |
Lead Sponsor | Collaborator |
---|---|
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) |
United States,
Lok AS, McMahon BJ; Practice Guidelines Committee, American Association for the Study of Liver Diseases (AASLD). Chronic hepatitis B: update of recommendations. Hepatology. 2004 Mar;39(3):857-61. — View Citation
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