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Adefovir Dipivoxil For The Treatment Of Patients With Chronic Hepatitis B Related Advanced Fibrosis Or Cirrhosis
This study is ongoing, but not recruiting participants.
Sponsored by: GlaxoSmithKline
Information provided by: GlaxoSmithKline
ClinicalTrials.gov Identifier: NCT00347009
  Purpose

This 36-month open-label study of adefovir dipivoxil investigates the clinical benefits of the therapy in chronic hepatitis B patients with advanced fibrosis or cirrhosis confirmed with biopsy. Primary endpoint is histological improvement defined as a decrease of Ishak Fibrosis Score by one point or more from baseline at Month 36 of adefovir dipivoxil treatment. Approximately 150 patients will be recruited in study centres in the Asia Pacific area. The patients are offered 36 months of open label adefovir dipivoxil treatment, with assessments every three months, after which there is a 6-month post study treatment follow-up prior to study completion. After the 36 months of study treatment, it is likely that the patient will benefit from continued treatment with adefovir dipivoxil. If this is the case in the investigators clinical judgement, the investigator should ensure that a routine prescription is available in a timely manner, and that no unnecessary interruption in treatment occurs.


Condition Intervention Phase
Chronic Hepatitis B
Fibrosis
Cirrhosis
Drug: adefovir dipivoxil
Phase IV

MedlinePlus related topics: Cirrhosis Hepatitis Hepatitis B
Drug Information available for: Hepatitis B Vaccines Adefovir dipivoxil Adefovir
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Single Group Assignment, Efficacy Study
Official Title: An Open Label Study of Adefovir Dipivoxil for the Treatment of Patients With Chronic Hepatitis B Related Advanced Fibrosis or Cirrhosis.

Further study details as provided by GlaxoSmithKline:

Primary Outcome Measures:
  • Histologic improvement at Month 36 (defined as a reduction of > or = 1 point in Ishak Fibrosis Score.

Secondary Outcome Measures:
  • Child-Pugh & Knodell scores Viral Response Alanine Aminotransferase Hepatitis B envelope and surface antigen seroconversion Adverse events and laboratory abnormalities
  • Proportion of patients with reduction from baseline in Child-Pugh score by 2 points or more.
  • Proportion of patients with reduction of at least 2 points in Knodell necroinflammation score at month 36
  • Change in serum HBV DNA level from baseline at Month 12, Month 24 and Month 36 in log 10 copies/mL.
  • Proportion of patients achieving virological response at Month 12, Month 24 and Month 36 (HBV DNA level ≤ 10³ copies mL)
  • Proportion of patients achieving virological response at Month 12, Month 24 and Month 36 (HBV DNA level ≤ 10^4 copies mL)
  • Proportion of patients with undetectable HBV DNA at Month 12, Month 24 and Month 36 (Roche COBAS AMPLICOR™ HIBV MONITOR Test, LLOD < 300 copies/mL)
  • Proportion of patients with virological breakthrough (defined as increase of HBV DNA by 1 log10 copies/mL from treatment nadir, ie the lowest HBV DNA value during the study) at Month 12, Month 24 and Month 36.
  • Proportion of patients with ALT normalization at Month 12, Month 24 and Month 36.
  • Proportion of patients, HBeAg positive at baseline, with the development of undetectable levels of HBeAg at Month 12, Month 24 and Month 36.
  • Proportion of patients, HBeAg positive at baseline, with HBeAg seroconversion defined as a decrease in HBeAg to undetectable levels an a gain of detectable levels of HBeAb at Month 12, Month 24 and Month 36.
  • Proportion of patients with the development of undetectable levels of hepatitis B surface antigen (HBsAg) at Month 12, Month 24 and Month 36.
  • Proportion of patients with HBsAg seroconversion defined as a decrease in HBsAg to undetectable levels and a gain of detectable levels of HBsAb at Month 12, Month 24 and Month 36.

Estimated Enrollment: 150
Study Start Date: May 2005
Estimated Study Completion Date: June 2009
Estimated Primary Completion Date: June 2009 (Final data collection date for primary outcome measure)
  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Male or female patients ≥ 18 years of age
  • A female is eligible to enter and participate in this study if she is of: a) non-childbearing potential (ie. Physiologically incapable of becoming pregnant, including any female who is pre-menarchal or post-menopausal); b) child-bearing potential with a negative serum pregnancy test at screen, and agrees to one of the following: -complete abstinence from intercourse from 2 weeks prior to administration of the study drug, throughout the study, and for a time interval after completion or premature discontinuation from the study to account for elimination of the investigational drug, (a minimum of 5 half-lives or longer if the pharmacodynamic profile of the investigational drug warrants a longer time period); or, -Female sterilization; or -Sterilization of male partner; or -Implants of levonorgestrel; or, -Injectable progestogen; or -Oral contraceptive (combined or progestogen only); or, -Any intrauterine device (IUD) with published data showing that the lowest expected failure rate is less that 1% per year (not all IUDs meet this criterion); or, -Any other methods with published data showing that the lowest expected failure rate for that method is less than 1% per year; or, -Barrier method only if used in combination with any of the above acceptable methods.
  • Documented chronic hepatitis B infection determined by presence of serum HBsAg for at least 6 months (positive once at least 6 months before screening and at time of screening visit.)
  • Positive HBV DNA plasma assay with screening value ≥ 1 x 10^5 copies /mL. (Roche COBAS AMPLICOR TM HBV Monitor Test, LLOD <300 copies/mL )
  • Adequate renal function defined as serum creatinine ≤1.5 mg/dL (≤130 µmol/L).
  • Willing and able to undergo two liver biopsies (prior to dosing, and after 36 months of therapy). The study baseline liver biopsy can be the most recent liver biopsy taken within 6 months of enrollment, as long as the biopsy was taken 6 months or more after the completion of any interferon or 3 months or more after completion of any antiviral treatment (eg. famciclovir, lamivudine etc.), and the patient has not had interferon therapy or any antiviral therapy between the biopsy and screening.
  • Liver biopsy showing advance fibrosis/cirrhosis (Ishak fibrosis score ≥4). The slides must be available for review by an independent histopathologist.
  • Availability and willingness of the subject to provide written informed consent per ICH/GCP and local Guidelines.

Exclusion Criteria:

  1. ALT >10XULN at screening
  2. Child-Pugh Score ≥ 7
  3. History of acute exacerbation leading to transient decompensation
  4. Co-infections with HIV, HCV or HDV. Note: Patients who are anti-HCV seropositive and in whom HCV RNA is undetectable are considered to be HCV seropositive and will not be eligible for enrollment.
  5. Any of the following laboratory parameter within 4 weeks prior to study entry: -Haemoglobin <8.0 g/dL, -Absolute neutrophil count (ANC) < 1.5 x 10^9/L, -Platelet count ≤50 x 10^9/L, -Pancreatic amylase and/or lipase >2 x ULN

    • Screening alpha-fetoprotein (AFP) value >50 ng/mL
    • Clinical, ultrasonographic or radiologic evidence of hepatic mass suggestive of hepatocellular carcinoma.
    • Significant concurrent medical and/or psychiatric conditions other than hepatitis B that in the opinion of the investigators might interfere with patient's treatment, assessment or compliance according to study requirement, such as malignancy, congestive heart failure, renal failure, chronic pancreatitis, diabetes mellitus with poor control and alcoholism.
    • Any of the following medications with 2 months prior to study entry (or the expectation that subject will receive these during the course of the study): -Nephrotoxic medication (eg aminoglycosides, amphotericin B, vancomycin, cidofovir, foscarnet, cisplatin, pentamidine) or competitors or renal excretion (eg probenecid, sulfinpyrazone), -Hepatotoxic medication (eg anabolic steroids,ketoconazole, itraconazole, isoniazid, rifampin, rifabutin).
    • Treatment with immunosuppressive/immunomodulatory agents (including interferon and corticosteroids) within 6 months prior to study entry.
    • Presence of other causes of liver disease (ie. hemochromatosis, Wilson's disease, alcoholic liver disease, non-alcoholic steatohepatitis, autoimmune hepatitis, alpha-1 antitrypsin deficiency).
    • A history of liver transplantation /planned for liver transplantation.
    • Pregnancy (or lactation) or , in subjects capable of bearing children, inability/unwillingness to practice adequate contraception.
    • Females of child-bearing potential (post-puberty) willing or unable to have pregnancy testing at any study visit.
    • History of hypersensitivity to nucleoside and/or nucleotide analogues.
    • Concurrent participation in another clinical trial in which the subject is or will be exposed to another investigational or a non-investigational drug or device within 30 days of the screening visit.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00347009

Locations
Hong Kong
GSK Investigational Site
Pokfulam, Hong Kong
Korea, Republic of
GSK Investigational Site
Sungnam-City, Korea, Republic of, 463-712
GSK Investigational Site
Seoul, Korea, Republic of, 135-710
GSK Investigational Site
Daegu, Korea, Republic of, 700-712
GSK Investigational Site
Pusan, Korea, Republic of, 602-739
GSK Investigational Site
Seoul, Korea, Republic of, 137-701
GSK Investigational Site
Seoul, Korea, Republic of, 120-752
Singapore
GSK Investigational Site
Singapore, Singapore, 169608
Taiwan
GSK Investigational Site
Taipei, Taiwan, 114
GSK Investigational Site
Kaohsiung, Taiwan, 833
GSK Investigational Site
Taipei, Taiwan, 100
Vietnam
GSK Investigational Site
Ho Chi Minh City, Vietnam
Sponsors and Collaborators
GlaxoSmithKline
Investigators
Study Director: GSK Clinical Trials, MD GlaxoSmithKline
  More Information

Responsible Party: GSK ( Study Director )
Study ID Numbers: ADF104070
Study First Received: June 30, 2006
Last Updated: October 9, 2008
ClinicalTrials.gov Identifier: NCT00347009  
Health Authority: Taiwan: Department of Health

Keywords provided by GlaxoSmithKline:
Chronic Hepatitis B
Cirrhosis
Advanced Fibrosis
Adefovir Dipivoxil

Study placed in the following topic categories:
Liver Diseases
Hepatitis, Chronic
Fibrosis
Hepatitis, Viral, Human
Liver Cirrhosis
Hepatitis
Virus Diseases
Digestive System Diseases
Hepatitis B, Chronic
Hepatitis B
DNA Virus Infections
Adefovir dipivoxil
Adefovir

Additional relevant MeSH terms:
Anti-Infective Agents
Pathologic Processes
Anti-Retroviral Agents
Molecular Mechanisms of Pharmacological Action
Therapeutic Uses
Enzyme Inhibitors
Antiviral Agents
Hepadnaviridae Infections
Nucleic Acid Synthesis Inhibitors
Pharmacologic Actions
Reverse Transcriptase Inhibitors

ClinicalTrials.gov processed this record on January 14, 2009