Chronic Viral Hepatitis B Without Delta-agent Clinical Trial
Official title:
A Multicenter Randomized Controlled Open-label Trial of Tenofovir vs. Tenofovir Plus Entecavir in Chronic Hepatitis B Patients With Genotypic Resistance to Entecavir and Partial Virologic Response to Ongoing Treatment
With the availability of potent nucloes(t)ide analogues (NA), such as tenofovir disoproxil
fumarate (TDF) and entecavir (ETV), suppression of serum HBV DNA to undetectable levels by
polymerase chain reaction (PCR) assays became achievable in most NA treatment-naïve patients.
Until recently, however, many patients commenced antiviral treatment with inferior NAs prior
to the availability of TDF or ETV, such as lamivudine (LAM) which has a low genetic barrier
to resistance.
ETV resistance increase up to 51% of patients after 5 years of ETV treatment in
lamivudine-refractory patients. Resistance to ETV appears to occur through a two-hit
mechanism with initial selection of M204V/I mutation followed by amino acid substitutions at
rtT184, rtS202, or rtM250.
In vitro studies showed that ETV-resistant mutations are susceptible to TDF, but there are
little clinical data on the efficacy of TDF monotherapy in patients with ETV-resistance.
On the other hand, there was a retrospective cohort study reporting that, with the
combination of TDF and ETV, most of patients became HBV DNA undetectable after median 6
months of treatment. Probability of reaching complete HBV DNA suppression was not decreased
in patients with ADV or ETV-resistance.
Thus, there is no consistent treatment recommendation for patients with ETV-resistance.
In this clinical trial, the investigators will clarify whether tenofovir monotherapy is as
effective as tenofovir plus entecavir in inducing complete virologic response in CHB patients
with genotypic resistance to ETV and partial virologic response to ongoing treatment.
A multi-center randomized active-controlled open-label trial
- Patients will be randomly assigned 1:1 to receive tenofovir (300 mg/day) or tenofovir
(300 mg/day) plus entecavir (1 mg/day) for 48 weeks.
- Because over 98% of Korean patients with CHB have HBV genotype C, HBV genotype will not
determined or be regarded as a stratification factor.
- Patients' treatment information before randomization will be retrospectively
collected.(DNA change, HBeAg status, HBsAg titre, ALT, and treatment duration. etc)
- Patients will be screened within 4 weeks before randomization to determine study
eligibility.
;
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT01639066 -
Tenofovir Plus Entecavir vs. Tenofovir in Adefovir-Resistant Chronic Hepatitis B
|
Phase 4 | |
| Completed |
NCT01595685 -
Telbivudine Versus Entecavir in Reducing Serum HBsAg Levels in Patients With HBeAg-positive Chronic Hepatitis B
|
Phase 3 |