Efficacy of Telbivudine With or Without add-on Tenofovir According to Roadmap Strategy Compare With Entecavir (TETRA)
Recruitment status was Recruiting
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Purpose
Oral antiviral drugs which can be given to patients with HBeAg-positive chronic hepatitis B include Lamivudine, Clevudine, Adefovir, Telbivudine, Entecavir and Tenofovir. 2009 American Association for the Study of Liver Disease (AASLD) Treatment Guidelines and 2009 European association for the Study of the Liver (EASL) Treatment Guidelines recommend the administration of Entecavir or Tenofovir with high potency and low resistance. Lamivudine has low antiviral potency and high incidence of mutation in long-term administration compared to Entecavir or Tenofovir. Clevudine causes the elevated creatinine kinase (CK), side effects including myositis/myopathy and much mutation in the long-term administration. Globe study demonstrated Telbivudine had more excellent antiviral potency than Lamivudine, which was also comparable to or higher than Entecavir or Tenofovir. Nevertheless, the choice of treatment drugs can be limited due to the mutation rate of 25% for 2 years. However, the analysis of Globe study results showed that 2-year treatment progress was very good in patient who showed virologic response at 24 weeks after the initiation of treatment and that high antiviral potency and low mutation rate were observed when the Telbivudine roadmap strategy (in the event that virologic response is shown at 24 weeks, telbivudine monotherapy is maintained and in the event that virologic response is not shown, tenofovir add-on therapy is done) recently implemented and announced in 2011 Asian Pacific Association for the Study of the Liver (APASL) was applied. However, the study was single arm study, which restricted the comparison between Entecavir and Tenofovir monotherapy groups. Therefore, this study intends to compare the anti-viral effect and mutation rate between Entecavir 0.5mg monotherapy group and Telbivudine roadmap strategy group in patients with HBeAg-positive chronic hepatitis B through a randomized study.
| Condition | Intervention | Phase |
|---|---|---|
|
Chronic Hepatitis B |
Drug: Telbivudine Drug: Tenofovir Drug: Entecavir |
Phase 4 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Randomized, Prospective, Multicenter, Open-label Study to Evaluate the Efficacy of Telbivudine With or Without add-on Tenofovir According to Roadmap Strategy Compare With Entecavir in HBeAg-positive Chronic Hepatitis B Patients |
- HBV DNA non-detectability [ Time Frame: Week 48 ] [ Designated as safety issue: No ]Low detection limit of HBV DNA is 50 IU/mL
- HBV DNA non-detectability [ Time Frame: Week 96 ] [ Designated as safety issue: No ]Low detection limit of HBV DNA is 50 IU/mL
- Reduction of HBV DNA from baseline [ Time Frame: Week 12, 24, 36, 48, 60, 72, 84 & 96 ] [ Designated as safety issue: No ]
- HBeAg loss or HBeAg seroconversion [ Time Frame: Week 48 & 96 ] [ Designated as safety issue: No ]
- HBsAg loss or HBsAg seroconversion [ Time Frame: Week 48 & 96 ] [ Designated as safety issue: No ]
- ALT normalization [ Time Frame: Week 48 & 96 ] [ Designated as safety issue: No ]
- Accumulate rate of Viral breakthrough [ Time Frame: Week 48 & 96 ] [ Designated as safety issue: No ]
- Accumulate rate of Biochemical Breakthrough [ Time Frame: Week 48 & 96 ] [ Designated as safety issue: No ]
- Accumulate rate of genotypic mutation in HBV [ Time Frame: Week 48 & 96 ] [ Designated as safety issue: No ]
- Change of eGFR from baseline [ Time Frame: Week 12, 24, 36, 48, 60, 72, 84 & 96 ] [ Designated as safety issue: No ]
- Accumulate rate of CK abnormal elevation [ Time Frame: Week 48 & 96 ] [ Designated as safety issue: Yes ]
- Accumulate rate of symptom related muscular disease [ Time Frame: Week 48 & 96 ] [ Designated as safety issue: Yes ]
- Accumulate rate of Adverse event or serious adverse event [ Time Frame: Week 48 & 96 ] [ Designated as safety issue: Yes ]
| Estimated Enrollment: | 104 |
| Study Start Date: | April 2012 |
| Estimated Study Completion Date: | December 2014 |
| Estimated Primary Completion Date: | December 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Experimental: Telbivudine-Tenofovir roadmap |
Drug: Telbivudine
If virologic response, which means HBV DNA < 50 IU/mL, is shown at 24 weeks, telbivudine monotherapy is maintained and in the event that virologic response is not shown, tenofovir add-on therapy is done
Other Name: Sebivo
Drug: Tenofovir
If virologic response, which means HBV DNA < 50 IU/mL, is shown at 24 weeks, telbivudine monotherapy is maintained and in the event that virologic response is not shown, tenofovir add-on therapy is done
Other Name: Viread
|
| Active Comparator: Entecavir |
Drug: Entecavir
Maintain the entecavir through the study period
Other Name: Baraclude
|
Detailed Description:
104 treatment-naïve patients with HBeAg-positive chronic hepatitis B who fulfill the inclusion criteria will be randomized in a 1:1 ratio to receive either Telbivudine 600mg monotherapy or Entecavir monotherapy with stratification before randomization according to presence of cirrhosis. For Telbivudine group, Telbivudine monotherapy or Tenofovir combined therapy will be done according to virologic response at 24 weeks and the primary study will be completed at Week 48 and treatment response will be analyzed. The treatment will be extended to Week 96 and the secondary analysis will be performed then.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Male or female, at least 18 years of age
- Documented CHB defined by HBsAg or HBeAg positive at least 6 month prior
- HBsAg positive at screening visit
- HBeAg positive and Anti-HBe negative at screening visit
- Serum HBV DNA 20,000~200,000,000 IU/mL as determined by Realtime PCR at screening visit
- Serum ALT 80~400 IU/mL at screening visit
- Patient is willing and able to comply with the study drug regimen and all other study requirements
- Patient is willing and able to provide written informed consent to participate in the study
Exclusion Criteria:
- Patient has received interferon, pegylated interferon, nucleoside or nucleotide drugs at any time
- Patient is co-infected with HCV, HDV, or HIV
- Patient with Child Pugh B or C (Child Pugh score ≥ 7)
- Patient has a history of or clinical signs/symptoms of hepatic decompensation such as ascites, esophageal variceal bleeding, hepatic encephalopathy
- Patient has any of the following laboratory values at screening visit:
- Hemoglobin <10 g/dL
- Absolute neutrophil count (ANC) <1,500/mm3
- Platelet count <70,000/mm3
- Patient has a history of clinical and laboratory evidence of chronic renal insufficiency defined as an estimated serum creatinine clearance < 50 mL/min using the MDRD formula at screening visit
- Patient is pregnant or breastfeeding
- Patient with currently abusing illegal drugs or alcohol sufficient
- Patient has organ transplantation
- History of any other acute or chronic medical condition that in the opinion of the investigator would make the patient unsuitable for inclusion into the study
- Patient has one or more additional known primary or secondary causes of liver disease, other than CHB, including steatohepatitis and autoimmune hepatitis
- Patient, if AFP is >50ng/mL at screening visit, has image findings suggestive of HCC at Liver CT or Liver MRI
- Patient with hypersensitivity for study drug
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT01588912
| Contact: Ki Tae Yoon, M.D. | 82-55-360-2362 | ktyoon@pusan.ac.kr | |
| Contact: Surin Tak | 82-55-360-1738 | surintak@hanmail.net |
| Korea, Republic of | |
| Nae-Yun Heo | Not yet recruiting |
| Busan, Korea, Republic of | |
| Contact: Nae-Yun Heo | |
| Principal Investigator: Nae-Yun Heo | |
| Eun Uk Jung | Not yet recruiting |
| Busan, Korea, Republic of | |
| Contact: Eun Uk Jung | |
| Principal Investigator: Eun Uk Jung | |
| Hyun Young Woo | Not yet recruiting |
| Busan, Korea, Republic of | |
| Contact: Hyun Young Woo | |
| Principal Investigator: Hyun Young Woo | |
| Yang Hyun Baek | Not yet recruiting |
| Busan, Korea, Republic of | |
| Contact: Yang Hyun Baek | |
| Principal Investigator: Yang Hyun Baek | |
| Byung Chul Yoon | Not yet recruiting |
| Busan, Korea, Republic of | |
| Contact: Byung Chul Yoon | |
| Principal Investigator: Byung Chul Yoon | |
| Hyun Jin Jo | Not yet recruiting |
| Changwon, Korea, Republic of | |
| Contact: Hyun Jin Jo | |
| Principal Investigator: Hyun Jin Jo | |
| Byung Seok Kim | Not yet recruiting |
| Daegu, Korea, Republic of | |
| Contact: Byung Seok Kim | |
| Principal Investigator: Byung Seok Kim | |
| Soo Young Park | Not yet recruiting |
| Daegu, Korea, Republic of | |
| Contact: Soo Young Park | |
| Principal Investigator: Soo Young Park | |
| Hyun Ju Min | Not yet recruiting |
| Jinju, Korea, Republic of | |
| Contact: Hyun Ju Min | |
| Principal Investigator: Hyun Ju Min | |
| Ki Tae Yoon | Recruiting |
| Yangsan, Korea, Republic of | |
| Contact: Ki Tae Yoon, M.D. 82-55-360-2362 ktyoon@pusan.ac.kr | |
| Contact: Surin Tak 82-55-360-1738 surintak@hanmail.net | |
| Principal Investigator: Ki Tae Yoon, M.D. | |
| Principal Investigator: | Ki Tae Yoon, M.D. | Pusan National University Yangsan Hospital |
More Information
No publications provided
| Responsible Party: | Ki Tae Yoon, Assistant Professor, Pusan National University Yangsan Hospital |
| ClinicalTrials.gov Identifier: | NCT01588912 History of Changes |
| Other Study ID Numbers: | CLDT600AKR07T |
| Study First Received: | April 27, 2012 |
| Last Updated: | April 30, 2012 |
| Health Authority: | Korea: Food and Drug Administration |
Keywords provided by Pusan National University Yangsan Hospital:
|
chronic hepatitis B HBeAg positive telbivudine |
tenofovir entecavir roadmap |
Additional relevant MeSH terms:
|
Hepatitis B Hepatitis B, Chronic Hepatitis, Chronic DNA Virus Infections Digestive System Diseases Hepadnaviridae Infections Hepatitis Hepatitis, Viral, Human Liver Diseases Virus Diseases Entecavir Telbivudine |
Tenofovir Tenofovir disoproxil Anti-HIV Agents Anti-Infective Agents Anti-Retroviral Agents Antiviral Agents Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Nucleic Acid Synthesis Inhibitors Pharmacologic Actions Reverse Transcriptase Inhibitors Therapeutic Uses |
ClinicalTrials.gov processed this record on March 03, 2015