Evaluation of Tenofovir Disoproxil Fumarate in Adolescents With Chronic Hepatitis B Infection

A Randomized, Double-Blind Evaluation of the Antiviral Efficacy, Safety, and Tolerability of Tenofovir Disoproxil Fumarate Versus Placebo in Adolescents With Chronic Hepatitis B Infection

The primary purpose of the study is to evaluate the effectiveness, safety, and tolerability of tenofovir disoproxil fumarate (TDF) in adolescents (aged 12-17 years) with chronic hepatitis B virus (HBV) infection.

The optimal treatment for adolescents with chronic HBV infection is currently unknown. Treatment with interferon alfa, lamivudine, and adefovir dipivoxil in pediatric populations has been shown to be less than optimal. Further, the safety and efficacy of entecavir and telbivudine have not been established in patients < 16 years of age. A study evaluating TDF in adolescents (ages 12-17) was needed to assess the safety and efficacy of this agent in the treatment of chronic hepatitis B in this patient population. In addition, the study will help to further elucidate the pharmacokinetic (PK) and resistance profiles of TDF. Through their participation, study participants will help generate critical new information to help guide the most optimal treatment of chronic HBV infection in adolescents.

This is a randomized, double-blind study to evaluate the antiviral efficacy, safety, and tolerability of TDF versus placebo in adolescents with chronic HBV infection. TDF treatment-naive participants were randomized in a 1:1 ratio to TDF or placebo. After 72 weeks of blinded treatment, participants were to switch to open-label TDF for an additional 2.5 years of treatment, provided that no safety concerns are identified by the Independent Data Monitoring Committee monitoring the study.

Study Overview

• Status: Completed
• Conditions: Hepatitis B Virus (HBV)
• Intervention / Treatment: Drug: Tenofovir disoproxil fumarate (TDF); Drug: Placebo

• Study Type: Interventional
• Enrollment (Actual): 106
• Phase: Phase 3

Contacts and Locations

Study Locations

• Bulgaria
  • Plovdiv, Bulgaria, 4002
    • Multiprofile Hospital for Active Treatment Sveti Georgi
  • Sofia, Bulgaria, 1606
    • Clinic of Gastroenterology, Specialized Hospital for Active Treatment of Pediatric Diseases, Sofia
• France
  • Bron Cedex, France, 69677
    • Hopital Femmes Meres Enfants
  • Lille Cedex, France, 59037
    • Hopital Claude Huriez
• Poland
  • Białystok, Poland, 15-274
    • Samodzielny Publiczny Dzieciecy Szpital Kliniczny Akademii Medycznej w Bialymstoku
  • Bydgoszcz, Poland, 85-030
    • Wojewodzki Szpital Obserwacyjno-Zakazny im. T. Browicza
  • Bydgoszcz, Poland, 85-030
    • Wojewodzki Specjalistyczny Szpital im Bieganskiego
  • Kraków, Poland, 31-202
    • Krakowski Szpital Specjalistyczny Im. Jana Pawla Ii
  • Poznan, Poland, 60-572
    • Samodzielny Publiczny Szpital Kliniczny im. Karola Johschera
  • Poznań, Poland, 61-734
    • Specjalistyczny Zespol Opieki Zdrowotnej nad Matka i Dzieckiem
  • Warszawa, Poland, 01-201
    • Wojewodzki Szpital Zakazny
  • Wrocław, Poland, 50-368
    • Samodzielny Publiczny Szpital Kliniczny Nr 1
• Romania
  • Bucharest, Romania, 022328
    • Fundeni Clinical Institute
  • Bucharest, Romania, 21105
    • Institute for Infectious Diseases
  • Napaco, Romania, 400217
    • Cluj Childrens Emergency Hospital
• Spain
  • Madrid, Spain, 28046
    • Hosp Univ y Politecnico La Fe de Valencia
  • Madrid, Spain, 46009
    • Hospital Universitario de Getafe
• Turkey
  • Izmir, Turkey, 35100
    • Ege Universitesi Tip Fakultesi Hastanesi
• United States
  • California
    • Oakland, California, United States, 94609
      • Children'S Hospital & Research Center At Oakland
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • Riley Hospital for Children
  • Washington
    • Seattle, Washington, United States, 98105
      • Children's Hospital & Regional Medical Center, d/b/a Seattle Children's Research Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 17 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria

• Male or female, 12 through 17 years of age, inclusive (consent of parent/legal guardian required)
• Documented chronic HBV infection
• HBeAg positive or HBeAg negative
• Weight > 35 kg
• Able to swallow oral tablets
• HBV DNA > 100,000 copies/mL (polymerase chain reaction (PCR) method)
• Alanine aminotransferase (ALT) > 2 × upper limit of normal (ULN) at screening, OR any history of ALT > 2 × ULN over the past 24 months
• Willing and able to provide written informed consent/assent (child and parent/legal guardian)
• Negative serum pregnancy test (for postmenarchal females only)
• Estimated glomerular filtration rate (creatinine clearance [using the Schwartz formula]) > 80 mL/min/1.73m^2
• Adequate hematologic function (absolute neutrophil count ≥ 1,500/mm^3; hemoglobin ≥ 10.0 g/dL)
• No prior TDF therapy (participants may have received prior interferon or oral anti-HBV nucleoside/nucleotide therapy; participants must have discontinued interferon therapy ≥ 6 months prior to screening; participants experienced on anti-HBV nucleoside/nucleotide therapy must have discontinued therapy ≥ 16 weeks prior to screening to avoid flare if randomized to the placebo arm)

Exclusion Criteria

• Pregnant women, women who are breast feeding or who believe they may wish to become pregnant during the course of the study
• Males and females of reproductive potential who are not willing to use an effective method of contraception during the study
• Decompensated liver disease
• Receipt of interferon (pegylated or not) therapy within 6 months of the Screening Visit
• Receipt of anti-HBV nucleoside/nucleotide therapy within 16 weeks of the Screening Visit
• Alpha fetoprotein > 50 ng/mL
• Evidence of hepatocellular carcinoma (HCC)
• Coinfection with HIV, hepatitis C virus (HCV), or hepatitis D virus (HDV)
• History of significant renal disease (eg, nephrotic syndrome, renal dysgenesis, polycystic kidney disease, congenital nephrosis, acute tubular necrosis, other renal disease)
• History of significant bone disease (eg, osteomalacia, chronic osteomyelitis, osteogenesis imperfecta, osteochondroses, multiple bone fractures)
• Significant cardiovascular, pulmonary, or neurological disease
• Evidence of a gastrointestinal malabsorption syndrome that may interfere with absorption of orally administered medications
• History of solid organ or bone marrow transplantation
• Ongoing therapy with nephrotoxic agents, competitors of renal excretion, systemic chemotherapeutic agents, systemic corticosteroids, interleukin-2 (IL-2), or other immunomodulating or investigational agents
• Known hypersensitivity to the study drugs, the metabolites or formulation excipients
• Any other condition (including alcohol or substance abuse) or prior therapy that, in the opinion of the Investigator, would make the participants unsuitable for the study or unable to comply with dosing requirements

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo	Drug: Placebo; TDF placebo tablet once daily
Experimental: Tenofovir disoproxil fumarate (TDF)	Drug: Tenofovir disoproxil fumarate (TDF); TDF administered as a 300-mg tablet once daily; Other Names: Viread®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With HBV DNA < 400 Copies/mL at Week 72	The percentage of participants with HBV DNA < 400 copies/mL at Week 72 was summarized by treatment and age group (grouped by baseline age for analysis), using the missing = failure (M = F) analysis with the double-blind efficacy evaluation (DBEE) algorithm. In the M = F analysis method, all missing data were considered as failure to meet the outcome measure threshold. This method was combined with the DBEE algorithm, which included all available data for the double-blind period, and any data for the open-label period were not included; data generated during treatment-free follow-up from subjects who achieved HBsAg loss and entered treatment-free follow-up during double-blind treatment period were included.	Week 72
Percentage of Participants With at Least a 6% Decrease From Baseline in Bone Mineral Density (BMD) of the Spine at Week 72	Data were summarized by treatment and age group (grouped by baseline age for analysis). In contrast with what was previously reported in the interim results posting, 1 participant met the primary safety endpoint of at least a 6% decrease from baseline in spine BMD at Week 72, based on the final BMD data analysis. The apparent discrepancy was due to the correction factor applied to the subject-specific BMD calculations performed at the time of the Interim Week 72 clinical study report that could not take into account the actual Week 72 phantom data (ie, calibration test used in longitudinal clinical trials to monitor and adjust for shifts in the dual-energy x-ray absorptiometry (DXA) scanner calibration over time), which were not provided by the site at that time. The correction factor applied to the final analysis has been properly based on all phantom data through the end of Week 72, as well as through the end of Week 192.	Baseline to Week 72

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With HBV DNA < 400 Copies/mL at Weeks 48, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis) using the missing = failure method.	Weeks 48, 96, 144, and 192
Percentage of Participants With Normal Alanine Aminotransferase (ALT) at Weeks 48, 72, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis) using the missing = failure method.	Weeks 48, 72, 96, 144, and 192
Percentage of Participants With HBV DNA < 400 Copies/mL and Normal ALT at Weeks 48, 72, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis) using the missing = failure method.	Weeks 48, 72, 96, 144, and 192
Percentage of Participants With HBV DNA < 169 Copies/mL at Weeks 48, 72, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis) using the missing = failure method.	Weeks 48, 72, 96, 144, and 192
Percentage of Participants With Hepatitis B Surface Antigen (HBsAg) Loss at Weeks 48, 72, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis), using the M = F.	Baseline; Weeks 48, 72, 96, 144, and 192
Percentage of Participants With HBsAg Seroconversion at Weeks 48, 72, 96, 144, and 192	HBsAg seroconversion was defined as change of detectable antibody to HBsAg from negative to positive. Data were summarized by treatment and age group (grouped by baseline age for analysis), using the M = F.	Baseline; Weeks 48, 72, 96, 144, and 192
Percentage of Participants With at Least a 6% Decrease From Baseline in Spine BMD at Weeks 48, 96, 144, and 192	The percentage of participants reported is the cumulative incidence from baseline to the respective time point. Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Weeks 48, 96, 144, and 192
Percentage of Participants With at Least a 6% Decrease From Baseline in Whole Body BMD at Weeks 48, 72, 96, 144, and 192	The percentage of participants reported is the cumulative incidence from baseline to the respective time point. Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Weeks 48, 72, 96, 144, and 192
Percent Change From Baseline in Spine Bone Mineral Density (BMD) at Week 48	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 48
Percent Change From Baseline in Spine BMD at Week 72	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 72
Percent Change From Baseline in Spine BMD at Week 96	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 96
Percent Change From Baseline in Spine BMD at Week 144	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 144
Percent Change From Baseline in Spine BMD at Week 192	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 192
Percent Change From Baseline in Whole Body BMD at Week 48	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 48
Percent Change From Baseline in Whole Body BMD at Week 72	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 72
Percent Change From Baseline in Whole Body BMD at Week 96	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 96
Percent Change From Baseline in Whole Body BMD at Week 144	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 144
Percent Change From Baseline in Whole Body BMD at Week 192	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 192
Change From Baseline in Z-score for Spine BMD at Week 48	To assess any effect of treatment on growth, Z-scores were used to express the deviation from a reference population for lumbar spine BMD. A Z-score of 0 indicated that a subject was typical of the population for their age, ethnicity, and gender. A negative Z-score indicated that the subject's recorded value was lower than typical for their age, ethnicity, and gender. A positive Z-score indicates that the subject's recorded value was higher than typical for their age, ethnicity, and gender. Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 48
Change From Baseline in Z-score for Spine BMD at Week 72	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 72
Change From Baseline in Z-score for Spine BMD at Week 96	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 96
Change From Baseline in Z-score for Spine BMD at Week 144	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 144
Change From Baseline in Z-score for Spine BMD at Week 192	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 192
Change From Baseline in Z-score for Whole Body BMD at Week 48	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 48
Change From Baseline in Z-score for Whole Body BMD at Week 72	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 72
Change From Baseline in Z-score for Whole Body BMD at Week 96	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 96
Change From Baseline in Z-score for Whole Body BMD at Week 144	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 144
Change From Baseline in Z-score for Whole Body BMD at Week 192	Data were summarized by treatment and age group (grouped by baseline age for analysis).	Baseline; Week 192
Number of Participants With Changes in Drug-Resistant Mutations During the Study	The number of participants with changes in drug-resistant mutations during the study was summarized.	Baseline through Week 192
Percentage of Participants Who Were HBeAg-Positive at Baseline and Who Had HBeAg Loss at Weeks 48, 72, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis) using the missing = failure method.	Baseline; Weeks 48, 72, 96, 144, and 192
Percentage of Participants Who Were HBeAg-Positive at Baseline and Who Had HBeAg Seroconversion at Weeks 48, 72, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis) using the missing = failure method.	Baseline; Weeks 48, 72, 96, 144, and 192
Percentage of Participants Who Were HBeAg-Positive at Baseline Who Had HBV DNA < 400 Copies/mL, Normal ALT, and HBeAg Loss/Seroconversion at Weeks 48, 72, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis) using the missing = failure method.	Baseline; Weeks 48, 72, 96, 144, and 192
Percentage of Participants With Abnormal ALT at Baseline Who Had Normalized ALT at Weeks 48, 72, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis) using the missing = failure method.	Baseline; Weeks 48, 72, 96, 144, and 192
Percentage of Participants With Abnormal ALT at Baseline Who Had HBV DNA < 400 Copies/mL and Normalized ALT at Weeks 48, 72, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis) using the missing = failure method.	Baseline; Weeks 48, 72, 96, 144, and 192
Percentage of Participants Who Were HBeAg-Positive With Abnormal ALT at Baseline Who Had HBV DNA < 400 Copies/mL, Normalized ALT, and HBeAg Loss/Seroconversion at Weeks 48, 72, 96, 144, and 192	Data were summarized by treatment and age group (grouped by baseline age for analysis) using the missing = failure method.	Baseline; Weeks 48, 72, 96, 144, and 192

Collaborators and Investigators

• Sponsor: Gilead Sciences
• Investigators: Study Director: Benedetta Massetto, MD, PhD, Gilead Sciences

Publications and helpful links

General Publications

• Murray KF, Szenborn L, Wysocki J, Rossi S, Corsa AC, Dinh P, McHutchison J, Pang PS, Luminos LM, Pawlowska M, Mizerski J. Randomized, placebo-controlled trial of tenofovir disoproxil fumarate in adolescents with chronic hepatitis B. Hepatology. 2012 Dec;56(6):2018-26. doi: 10.1002/hep.25818. Epub 2012 Aug 27.

Study record dates

Study Major Dates

• Study Start: December 1, 2008
• Primary Completion (Actual): March 1, 2011
• Study Completion (Actual): December 1, 2015

Study Registration Dates

• First Submitted: August 13, 2008
• First Submitted That Met QC Criteria: August 13, 2008
• First Posted (Estimate): August 14, 2008

Study Record Updates

• Last Update Posted (Estimate): September 1, 2016
• Last Update Submitted That Met QC Criteria: July 20, 2016
• Last Verified: July 1, 2016

More Information

Terms related to this study

• Keywords: tenofovir; adolescents; chronic hepatitis B
• Additional Relevant MeSH Terms: Digestive System Diseases; RNA Virus Infections; Virus Diseases; Infections; Blood-Borne Infections; Communicable Diseases; Liver Diseases; Hepatitis, Viral, Human; Hepadnaviridae Infections; DNA Virus Infections; Enterovirus Infections; Picornaviridae Infections; Hepatitis B; Hepatitis; Hepatitis A; Hepatitis B, Chronic; Hepatitis, Chronic; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Reverse Transcriptase Inhibitors; Nucleic Acid Synthesis Inhibitors; Enzyme Inhibitors; Anti-HIV Agents; Anti-Retroviral Agents; Tenofovir
• Other Study ID Numbers: GS-US-174-0115