Entecavir for Chronic Hepatitis B

March 24, 2011 updated by: Foundation for Liver Research

The Antiviral Efficacy of Entecavir in Chronic Hepatitis B Within the European Network of Excellence (VIRGIL)

The primary aim of this study is to asses the efficacy (both virological and clinical) and safety of ETV in both NA-naïve and NA-experienced chronic hepatitis B patients, and to explore baseline factors associated with virologic reponse (VR) to ETV.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Chronic hepatitis B is a major health problem, affecting more than 350 million people worldwide. (1) First line treatment consists of pegylated IFN once weekly or oral nucleos(t)ide analogues (NA) once daily. (2) NA target the reverse transcriptase of hepatitis B virus (HBV), and are potent inhibitors of viral replication. In the absence of antiviral drug resistance, continued NA therapy is able to suppress viral replication over prolonged periods, and can prevent clinical progression to liver cirrhosis and hepatocellular carcinoma. (3) Currently approved agents include the nucleoside analogues lamivudine (LAM), telbivudine (LdT), and entecavir (ETV), and the nucleotide analogues adefovir dipivoxil (ADV), and tenofovir disiproxil fumarate (TDF).

Entecavir ETV is a cyclopentyl guanosine analogue, and a potent and selective inhibitor of HBV replication in vitro.(4) In the phase III registration trials it resulted in superior virologic, biochemical and histological efficacy after one year of therapy compared to LAM in both HBeAg-positive and HBeAg-negative chronic HBV patients. (5, 6) Moreover, ETV proved to have a high genetic barrier to resistance with only 1.2% of NA-naïve HBV patients demonstrating genotypic resistance to ETV after five years of ETV monotherapy.(7) In LAM-refractory chronic HBV patients ETV appeared to be less potent and the frequency of resistance was increased. (8, 9) After five years of treatment 51% of LAM-refractory patients showed genotypic ETV resistance, and in 43% a virologic breakthrough was observed as well. (7) Recently we presented the promising results of a large European cohort of patients treated with ETV for a median period of 12 months. We concluded that ETV should not be used in patients with a prior history of LAM-resistance. However, prior treatment with ADV did not influence the efficacy of ETV in these patients.(10)

HBeAg loss or seroconversion In HBeAg positive patients, HBeAg loss or seroconversion is the major objective of NA treatment regimes according to current guidelines. HBeAg loss or seroconversion is usually associated with sustained remission and a very low risk for the development of cirrhosis and hepatocellular carcinoma. (11-13) PEG-IFN induced HBeAg seroconversion was shown to be sustained in 70% after a 3 year follow up. (14) There are some contradictory results concerning NA induced durability of HBeAg loss or seroconversion. First reports on lamuvidine induced HBeAg loss or seroconversion were rather promising.(15-17) However, more recent and also larger studies report much higher relapse rates and predictors of sustainability were proposed. (18-21) The registration trial of entecavir showed a 82% durability after 24 weeks without consolidation therapy.(6) Recently we showed that the durability of HBeAg seroconversion was very poor with 42%, 58% and 74% seroreversion respectively 1,2 and 3 years after seroconversion on different NA treatment regimes. However, only a minority of these patients was treated with the newer and more potent NA. (22)

As the increasing number of patients who experienced treatment failure to different NA treatment regimens poses a growing problem for the clinician, data on the efficacy of ETV in these NA-experienced patient groups is warranted. Furthermore, current guidelines are subject of discussion as durability of NA induced HBeAg loss or seroconversion seems less sustained then expected, and prolonged or maybe infinite therapy may be necessary to prevent long term complications.

Study Type

Observational

Enrollment (Actual)

418

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Netherlands
      • Rotterdam, Netherlands, 3015 CE
        • Erasmus MC

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Probability Sample

Study Population

all consecutive adult CHB patients treated with ETV monotherapy in 10 large European referral centers

Description

Inclusion Criteria:

  • HBsAg positive for at least 6 months
  • Entecavir therapy for at least 3 months

Exclusion Criteria:

  • viral co infections
  • concomitant antiviral therapy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Retrospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Chronic HBV patients
Patients with chronic hepatitis B Treated for at least 3 months No HIV, HCV or HDV.
Drug: Entecavir
once daily

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Virological response
Time Frame: 144 weeks after starting Entecavir
Cumulative probability (%) of patients achieving HBV DNA negativity at week 144
144 weeks after starting Entecavir

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Foundation for Liver Research

Investigators

  • Principal Investigator: Harry LA Janssen, MD, PhD, Erasmus MC

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2010

Primary Completion (Actual)

January 1, 2011

Study Completion (Actual)

March 1, 2011

Study Registration Dates

First Submitted

March 21, 2011

First Submitted That Met QC Criteria

March 24, 2011

First Posted (Estimate)

March 25, 2011

Study Record Updates

Last Update Posted (Estimate)

March 25, 2011

Last Update Submitted That Met QC Criteria

March 24, 2011

Last Verified

March 1, 2011

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • VIRGIL

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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