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Chronic Hepatitis BNCT02069678

Serum Hepatitis B Surface Antigen Levels to Guide the Stopping of Entecavir in HBeAg-negative Chronic Hepatitis B

An observational study of Chronic Hepatitis B, run by Chinese University of Hong Kong at 1 site in Hong Kong.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This will be a multi-center study in Hong Kong. This is a retrospective-prospective study in HBeAg-negative chronic hepatitis B patients. HBeAg-negative patients on entecavir followed up in the liver clinics will be identified from the existing database. Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Chronic Hepatitis B
How many people
82 participants
Where
1 siteHong Kong
Study dates
Mar 2012to Sep 2013
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: HBeAg-negative patients on entecavir followed up in the liver clinics will be identified from the existing database. All patients had HBV DNA testing every 6 months as a clinic routine. Serum HBsAg levels will be tested in the residual serum samples at the pre-treatment and last follow-up visits. Eligible patients will be discussed on the plan of stopping entecavir therapy. All patients will have written informed consent before recruited into this study. All patients will be followed up for 12 months after stopping entecavir treatment.

Who may be able to join

  • HBeAg-negative patients on entecavir monotherapy for at least 24 months
  • Undetectable HBV DNA by PCR-based assay on 3 separate occasions 6 months apart (as per Asian Pacific guideline in 2008).
  • Normal ALT levels according to the local laboratory reference value on 2 separate occasions 6 months apart

Who cannot join

  • Patients previously or currently on interferon therapy
  • Patients who have experienced another antiviral agent besides entecavir
  • Patients with hepatitis C virus infection as indicated by a positive anti-HCV serology test
  • Patients with Child's B liver cirrhosis, cirrhotic complications or hepatocellular carcinoma
  • Patients with organ transplantation
  • Serious medical illnesses or malignancy
  • Age < 18 years or > 65 years
  • No patient consent

Trial locations and contacts

1 site in 1 country.

Hong Kong1 site

  • Cheng Suen Man Shook Hepatitis Center, Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital

    Hong Kong

Other trials in Hong Kong

About this study

This will be a multi-center study in Hong Kong. This is a retrospective-prospective study in HBeAg-negative chronic hepatitis B patients. HBeAg-negative patients on entecavir followed up in the liver clinics will be identified from the existing database. All patients had HBV DNA testing every 6 months as a clinic routine. Serum HBsAg levels will be tested in the residual serum samples at the pre-treatment and last follow-up visits. Eligible patients will be discussed on the plan of stopping entecavir therapy. All patients will have written informed consent before recruited into this study. All patients will be followed up for 12 months after stopping entecavir treatment. As entecavir is most commonly used antiviral drug in Hong Kong and in the Western countries, the investigators aim to investigate and validate the use of serum HBsAg quantification to guide the timing of stopping entecavir in HBeAg-negative patients. The results of this study will provide scientific evidence on the use of this new serum marker to predict sustained remission after stopping entecavir. In the long-run, it can improve patient compliance, reduce the need of long-term antiviral and reduce the drug cost in the management of HBeAg-negative chronic hepatitis B.

All patients will stop entecavir according to the Asian Pacific guideline with written informed consent and close subsequent monitoring. In the protocol, there is a safety net for re-treatment. There will not be any invasive procedure. There is no major ethical issue.

Read the detailed description

Chronic hepatitis B is the commonest cause of liver cirrhosis and hepatocellular carcinoma in Hong Kong. Approximately 50% of patients had negative hepatitis B e antigen (HBeAg), which indicates an escape of host immune clearance by the host. Oral antiviral drugs are very effective in suppressing viral replication and inducing biochemical remission [1]. However, the timing to stop oral antiviral agents is controversial. Hepatitis B surface antigen (HBsAg) seroclearance has been recommended as the best time for drug cessation for HBeAg-negative patients [2,3], but its occurrence is very uncommon especially among Asian patients. The Asian Pacific guideline recommended stopping treatment when serum HBV DNA became undetectable for three times within 12 months [4], but approximately 50% of patients will experience virologic relapse post-treatment [5,6].

HBsAg quantification has been shown to correlate with the concentration of covalently closed circular DNA in the liver [7]. In a Hong Kong study among 53 HBeAg-negative patients who stopped lamivudine, HBsAg ≤ 100 IU/ml and/or reduction of > 1 log at the end of treatment could predict sustained response up to 5 years post-treatment [8]. In other words, it is probable that patients who have a lower serum HBsAg level, which may reflect a lower concentration of virus inside the liver, have a lower risk of viral relapse after stopping antiviral therapy.

Medical subject headings
Hepatitis B, Chronic

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. sustained response, defined as HBV DNA persistently ≤ 200 IU/ml

    Measured: 12 months after stopping Entecavir

Secondary outcomes (4)

  1. HBsAg < 1000 IU/ml and 100 IU/ml

    Measured: 12 months post-treatment

  2. HBV DNA < 200 IU/ml and 20 IU/ml

    Measured: 12 months post-treatment

  3. virological relapse

    Measured: 5 years post-treastment

  4. HBsAg clearance

    Measured: 5 years post-treatment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Feb 2014 (estimated)
  2. Study startMar 2012
  3. Primary completionSep 2013
  4. Study completionSep 2013

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
82 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02069678
Sponsor's protocol ID
Stop Nuc
Status last verified
Feb 2014
First submitted
28 Jan 2014
Last updated
24 Feb 2014
Results posted
No
Data monitoring committee
No

Publications

  • Lai CL, Shouval D, Lok AS, Chang TT, Cheinquer H, Goodman Z, DeHertogh D, Wilber R, Zink RC, Cross A, Colonno R, Fernandes L; BEHoLD AI463027 Study Group. Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B. N Engl J Med. 2006 Mar 9;354(10):1011-20. doi: 10.1056/NEJMoa051287.

    PubMed 16525138

  • Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology. 2007 Feb;45(2):507-39. doi: 10.1002/hep.21513. No abstract available.

    PubMed 17256718

  • European Association For The Study Of The Liver. EASL Clinical Practice Guidelines: management of chronic hepatitis B. J Hepatol. 2009 Feb;50(2):227-42. doi: 10.1016/j.jhep.2008.10.001. Epub 2008 Oct 29. No abstract available.

    PubMed 19054588

  • Liaw YF, Leung N, Kao JH, Piratvisuth T, Gane E, Han KH, Guan R, Lau GK, Locarnini S; Chronic Hepatitis B Guideline Working Party of the Asian-Pacific Association for the Study of the Liver. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int. 2008 Sep;2(3):263-83. doi: 10.1007/s12072-008-9080-3. Epub 2008 May 10.

    PubMed 19669255

  • Chan HL, Wang H, Niu J, Chim AM, Sung JJ. Two-year lamivudine treatment for hepatitis B e antigen-negative chronic hepatitis B: a double-blind, placebo-controlled trial. Antivir Ther. 2007;12(3):345-53.

    PubMed 17591024

  • Chan HL, Wong VW, Tse AM, Tse CH, Chim AM, Chan HY, Wong GL, Sung JJ. Serum hepatitis B surface antigen quantitation can reflect hepatitis B virus in the liver and predict treatment response. Clin Gastroenterol Hepatol. 2007 Dec;5(12):1462-8. doi: 10.1016/j.cgh.2007.09.005.

    PubMed 18054753

  • Chan HL, Wong GL, Chim AM, Chan HY, Chu SH, Wong VW. Prediction of off-treatment response to lamivudine by serum hepatitis B surface antigen quantification in hepatitis B e antigen-negative patients. Antivir Ther. 2011;16(8):1249-57. doi: 10.3851/IMP1921.

    PubMed 22155906

Questions about this trial

What is this clinical trial studying?

An observational study of Chronic Hepatitis B, run by Chinese University of Hong Kong at 1 site in Hong Kong.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 24 Feb 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Hong Kong. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

sustained response, defined as HBV DNA persistently ≤ 200 IU/ml (time frame: 12 months after stopping Entecavir). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02069678, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Feb 2014.

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