Hepatitis B Infection Clinical Trial
Official title:
Tenofovir Disoproxil Fumarate in Combination of Hepatitis B Vaccine With the Omission of Immune Globulin to Prevent Hepatitis B Transmission in Mother With High Viral Load: A Multi-Center, Prospective, Randomized and Open-Label Study
Immunoprophylaxis with two hepatitis B vaccinations following the hepatitis B immune globulin (HBIg) and hepatitis B vaccine at birth is largely effective in protecting infants from hepatitis B virus (HBV) infection. However, hepatitis B infection due to immunoprophylaxis failure often occurs in approximately 10% of infants who are born to highly viremic mothers with HBeAg-positive. Maternal HBV DNA > 200,000 IU/mL is the major independent risk for mother-to-child transmission (MTCT). A recent randomized controlled trial has shown that Tenofovir Disoproxil Fumarate (TDF) use during the third trimester of pregnancy could safely reduce the rate of MTCT with few adverse effects when combined with the administration of the standard immunoprophylaxis to the infants. However, HBIg is expensive and not available in many developing countries, resulting approximately 30% of infant infection when they received only HBV vaccination. The present study aims to investigate if highly viremic mothers who are treated with TDF from the second trimester to delivery in combination of infant's standard series of HBV vaccinations (omission of HBIg) have a comparable MTCT rates, when compared to those of mothers who receive TDF at the third trimester in combination of infant's standard HBV vaccinations and a birth dose of HBIg.
This is a multicenter, prospective, randomized, open-label and parallel two arm study
starting from week 14-16 of pregnancy to post-partum week 28. The enrollment from
approximately 7 centers will be in blocks for sample balance. By using the randomized table,
280 HBeAg-positive pregnant women with chronic hepatitis B (CHB) will be randomized in a 1:1
ratio in to two arms. Group assignments will be also stratified by the maternal HBV DNA
levels >9 log10 versus ≤ 9 log10 IU/mL.
Group A: This is the experimental group. Participating mothers will receive TDF (oral 300 mg
tablet daily) starting at gestational weeks 14-16 and continue until delivery. The mothers
will be followed together with their infants until postpartum week 28. Infants will receive
hepatitis B vaccine at birth (within 12 hours) and additional hepatitis B vaccine at the age
of week 4 and week 24. HBIg will be omitted for the infants in this group. However, the birth
dose of HBIg will be provided to infants born to mothers who have poor control of maternal
viremia (i.e. the levels of HBV DNA >200,000 IU/mL before delivery). Group B: This is the
comparative group. Participating mothers will receive TDF (oral 300 mg tablet daily) starting
at gestational weeks 28 and continue until delivery. Patients in group B will have similar
follow-up schedules as those in the experimental group. Infants will receive hepatitis B
vaccine plus HBIg at birth (within 12 hours) and additional hepatitis B vaccine at the age of
week 4 and week 24.
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