Antiviral Therapy in Hepatitis B Virus (HBV)-Related Advanced Liver Disease Patients

Hepatitis B, Chronic Clinical Trial

Official title:

A Randomized, Open Label, Phase IV, Multicenter Study for Efficacy and Safety of Lamivudine Versus Entecarvir Therapy in HBV-related Advanced Liver Disease Patients With High Viral Load and Normal or Slightly Elevated Transaminase

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT00823550
• Other study ID #: 4-2008-0296
• Status: Active, not recruiting
• Phase: Phase 4
• First received: January 14, 2009
• Last updated: December 15, 2010
• Start date: January 2009
• Est. completion date: July 2015

Study information

• Verified date: January 2009
• Source: Yonsei University
• Contact: n/a
• Is FDA regulated: No
• Health authority: Korea: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

This is a randomized, open label, phase IV, multicenter study for efficacy and safety of lamivudine versus entecarvir therapy in HBV-related advanced liver disease patients with high viral load and normal or slightly elevated transaminase.

Description:

Currently, treatment guidelines for the management of chronic hepatitis B (CHB) recommend that patients with serum HBV DNA > 105 copies/ml and elevated ALT levels greater than two times the upper limit of normal (ULN) are obvious candidates for antiviral therapy. Guidelines also suggest that antiviral therapy be considered in CHB patients with high viral load, if a biopsy shows significant liver disease despite ALT ≤ 2× ULN. Data from recent trials in hepatitis B patients who present with normal to minimally elevated ALT (≤ 2× ULN) indicate that significant hepatic pathology could still be found. Serum ALT level may not accurately predict activity of liver damage. ALT is a poor predictor of outcome and therefore is not a suitable criterion for antiviral therapy in chronic hepatitis B infection. Also, a recent large randomized controlled clinical trial comparing lamivudine maintenance and placebo in advanced fibrosis (Ishak fibrosis score ≥ 4) suggests that sustained viral suppression with antiviral therapy is linked to reduced risk for disease progression. (Liaw YF et al. NEJM 2004;351:1521-1531)

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 462
• Est. completion date: July 2015
• Est. primary completion date: July 2014
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion criteria

• Male and female, 18 years of age or older

• HBsAg positive for more than 6 months

• Serum HBV DNA > 2,000 IU/ml

• Serum ALT < 2 X ULN on two consecutive occasions at least 3 months apart

• Naïve to nucleoside or nucleotide therapy

• On liver biopsy, fibrosis score = 3 according to METAVIR scoring system (within 2 years of Day 0)

• If liver biopsy is not available, subjects must have two of the following items

• Overt findings of cirrhosis by radiologic evidence (MRI, CT, US)

• Gastrointestinal varices

• Platelet count < 100,000,Splenomegaly (Spleen size - 12cm)

• The patient who is willing and able to provide written informed consent to participate in this study

Exclusion criteria

• A history of SBP, variceal bleeding, HEP, HCC

• Decompensated liver disease (Child-Pugh score > 10)

• Co-infected with HCV or HIV

• History of any other forms of liver disease.

• Patient who is pregnant or breastfeeding

• Treatment with immunosuppressive, immunomodulatory agents or antiviral agents within 6 months prior to study entry

• A history of liver transplantation or planned for liver transplantation

• A history of any other medical disease or condition that would make the patients unsuitable for the study.

• Patient is currently abusing alcohol or illicit drugs or has a history of alcohol abuse or illicit substance abuse within the preceding 2 years.

• Patient is enrolled or plans to enroll in another clinical trial of an investigational agent while participating in this study.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Hepatitis
• Hepatitis A
• Hepatitis B
• Hepatitis B, Chronic
• Liver Diseases

Intervention

Drug:
• Entecavir
entecavir 0.5 mg QD
• Lamivudine
lamivudine 100 mg QD

Locations

Country	Name	City	State
Korea, Republic of	Severance Hospital	Seoul

Sponsors (18)

Lead Sponsor

Collaborator

Yonsei University

Ajou University, Bristol-Myers Squibb, Chung-Ang University, Hallym University Medical Center, Hanyang University, Inha University Hospital, Inje University, Kangbuk Samsung Hospital, Keimyung University, Konkuk University Hospital, Korea University, Korea University Anam Hospital, Kyungpook National University, Pusan National University Hospital, Severance Hospital, Soonchunhyang University Hospital, The Catholic University of Korea

Country where clinical trial is conducted

Korea, Republic of, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Time to disease progression as defined by the first occurrence of any of the cirrhosis compolications		5 years	Yes
Secondary	Proportion of patients achieving either HBV DNA level = 60 IU/mL Proportion of patients with ALT normalization Proportion of patients with HBeAg loss and seronconversion Proportion of patients with virologic breakthrough		at months 12, 24, 36, 48, and 60	No