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HBV Vaccine in Renal Failure Patients

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ClinicalTrials.gov Identifier: NCT02621112
Recruitment Status : Completed
First Posted : December 3, 2015
Last Update Posted : October 22, 2019
Sponsor:
Information provided by (Responsible Party):
The University of Hong Kong

Brief Summary:
Hepatitis B virus infection remains an important clinical issue among patients on renal replacement therapy. Seroconversion rate as defined by an anti-HBs Ab titer > 10 IU/L after intramuscular hepatitis B vaccination (HBVv) remains poor in this cohort. Factors associated with inadequate anti-HBs response include older age, diabetes mellitus, obesity and low hepatitis B vaccine dose. Various small-scale studies including multiple high dose intramuscular vaccination or multiple small dose intradermal vaccination were attempted with variable response. Recent study on dose sparing seasonal influenza vaccine delivered via a novel intradermal microneedle has demonstrated good immunogenic responses similar to full-dose intramuscular vaccination. Imiquimod, a synthetic TLR7 agonist useful for the treatment of DNA virus infection, has been shown to improve vaccine immunogenicity. The investigators therefore propose a prospective, randomized study to compare the safety and immunogenicity of intradermal hepatitis B vaccination with this novel device with intramuscular in patients on renal replacement therapy.

Condition or disease Intervention/treatment Phase
Renal Failure Biological: Intradermal HBVv with imiquimod Biological: Intradermal HBVv with aqueous cream Biological: Intramuscular HBVv with aqueous cream Phase 2 Phase 3

Detailed Description:

The investigators aim to recruit at least 120 subjects on renal replacement therapy in this prospective double blind randomized controlled trial. All recruited subjects have to be HBsAg and anti-HBs negative before recruitment. Subjects were randomly assigned to three groups.

All patients received 4 doses of hepatitis B vaccine at 0,1,3 and 6 months: Group 1: to receive intradermal 10mcg of recombinant hepatitis B vaccine at two separate sites (5mcg) with topical imiquimod ointment pretreatment 5 minutes before injection. Group 2: to receive intradermal 10mcg of recombinant hepatitis B vaccine at two separate sites (5mcg) with topical placebo aqueous cream pretreatment 5 minutes before injection. Group 3: to receive intramuscular 10mcg (1mL) of recombinant hepatitis B vaccine at two separate sites (5mcg) with topical placebo aqueous cream pretreatment 5 minutes before injection.

Subjects will be advised not to wash the topical treatment for 8 hours after vaccination. Patients and investigators will be blinded to the type of topical treatment applied. Anti-HBs titre will be measured at baseline, before each vaccination, and at 12 and 18 months after the first dose of vaccination.

The primary end point is the seroprotection rate of the HBVv at 12 months after the first dose of vaccination. The secondary end points are the seroprotection rate of HBVv and the geometric mean titre (GMT) fold increase of the anti-HBs at 1, 3, 6, 12 (GMT only) and 18 months after the first dose of vaccination. Adverse reactions of the vaccine will also be assessed immediately and for 1 month after vaccination.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 94 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Efficacy of Intradermal Hepatitis B Vaccine in Renal Failure Patients
Study Start Date : January 2016
Actual Primary Completion Date : December 2018
Actual Study Completion Date : March 2019

Resource links provided by the National Library of Medicine

Drug Information available for: Imiquimod

Arm Intervention/treatment
Experimental: Intradermal HBVv with imiquimod
Intradermal hepatitis B vaccination with topical imiquimod pretreatment. Subjects to receive intradermal 10mcg of recombinant hepatitis B vaccine at two separate sites (5mcg) with topical imiquimod ointment pretreatment 5 minutes before injection at 0, 1, 3, 6 months
Biological: Intradermal HBVv with imiquimod
Intradermal hepatitis B vaccine with imiquimod pretreatment

Active Comparator: Intradermal HBVv with aqueous cream
Intradermal hepatitis B vaccination with topical aqueous cream. Subjects to receive intradermal 10mcg of recombinant hepatitis B vaccine at two separate sites (5mcg) with topical aqueous cream pretreatment 5 minutes before injection at 0, 1, 3, 6 months
Biological: Intradermal HBVv with aqueous cream
Intradermal hepatitis B vaccine with aqueous cream pretreatment

Active Comparator: Intramuscular HBVv with aqueous cream
Intramuscular hepatitis B vaccination with topical aqueous cream. Subjects to receive intramuscular 10mcg of recombinant hepatitis B vaccine at two separate sites (5mcg) with topical aqueous cream pretreatment 5 minutes before injection at 0, 1, 3, 6 months
Biological: Intramuscular HBVv with aqueous cream
Intramuscular hepatitis B vaccine with aqueous cream pretreatment




Primary Outcome Measures :
  1. Seroprotection rate to HBV [ Time Frame: 12 months after first dose of hepatitis B vaccine ]
    percentage of recruited subjects with anti-HBs >10 mIU/mL


Secondary Outcome Measures :
  1. Adverse reaction to hepatitis B vaccine [ Time Frame: 1 month ]
  2. Seroprotection rate to HBV [ Time Frame: 1, 3, 6 and 18 months after first dose of hepatitis B vaccine ]
    percentage of recruited subjects with anti-HBs >10 mIU/mL

  3. GMT fold increase of anti-HBs [ Time Frame: 1, 3, 6, 12 and 18 months after first dose of hepatitis B vaccine ]


Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients recruited have to be aged ≥ 21 years, with history of chronic renal failure and on renal replacement therapy (continuous ambulatory peritoneal dialysis or hemodialysis).
  • All patients have to give written informed consent and will have up to 1 week period to decide.
  • Subjects must be available to complete the study and comply with study procedures.
  • Patients are willing to allow for serum samples to be stored beyond the study period, for potential additional future testing to better characterize immune response.
  • All recruited subjects have to be HBsAg, anti-HBs and anti-HIV negative before recruitment.

Exclusion Criteria:

  • Inability to comprehend and to follow all required study procedures
  • History or any illness that might interfere with the results of the study or pose additional risk to the subjects due to participation in the study.
  • Have a recent history (documented, confirmed or suspected) of a flu-like disease within a week of vaccination.
  • Have a known allergy to components of the Study Vaccines.
  • Have a positive urine or serum pregnancy test within 24 hours prior to vaccination, or women who are breastfeeding.
  • Have an active neoplastic disease or a history of any hematologic malignancy.
  • Have known chronic active hepatitis B and hepatitis C (HBsAg+ve and anti-HCV+ve).
  • Have known active human immunodeficiency virus (HIV).
  • Received an experimental agent (vaccine, drug, biologic, device, blood product, or medication) within 1 month prior to vaccination in this study or expect to receive an experimental agent during this study.
  • Unwilling to refuse participation in another clinical study through the end of this study.
  • Axillary temperature ≥ 38°C or oral temperature ≥ 38.5°C within 3 days of intended study vaccination.
  • Have a history of alcohol or drug abuse in the last 5 years.
  • Have any condition that the investigator believes may interfere with successful completion of the study.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02621112


Locations
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Hong Kong
University of Hong Kong, Queen Mary Hospital
Hong Kong, Hong Kong
Sponsors and Collaborators
The University of Hong Kong
Investigators
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Principal Investigator: Ivan FN Hung, MD FRCP The University of Hong Kong
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: The University of Hong Kong
ClinicalTrials.gov Identifier: NCT02621112    
Other Study ID Numbers: UW 11-209
First Posted: December 3, 2015    Key Record Dates
Last Update Posted: October 22, 2019
Last Verified: October 2019
Additional relevant MeSH terms:
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Renal Insufficiency
Kidney Diseases
Urologic Diseases
Imiquimod
Adjuvants, Immunologic
Immunologic Factors
Physiological Effects of Drugs
Antineoplastic Agents
Interferon Inducers