Serum Hepatitis B Surface Antigen Levels to Guide the Stopping of Entecavir in HBeAg-negative Chronic Hepatitis B

February 20, 2014 updated by: Henry LY Chan, Chinese University of Hong Kong

This will be a multi-center study in Hong Kong. This is a retrospective-prospective study in HBeAg-negative chronic hepatitis B patients. HBeAg-negative patients on entecavir followed up in the liver clinics will be identified from the existing database. All patients had HBV DNA testing every 6 months as a clinic routine. Serum HBsAg levels will be tested in the residual serum samples at the pre-treatment and last follow-up visits. Eligible patients will be discussed on the plan of stopping entecavir therapy. All patients will have written informed consent before recruited into this study. All patients will be followed up for 12 months after stopping entecavir treatment. As entecavir is most commonly used antiviral drug in Hong Kong and in the Western countries, the investigators aim to investigate and validate the use of serum HBsAg quantification to guide the timing of stopping entecavir in HBeAg-negative patients. The results of this study will provide scientific evidence on the use of this new serum marker to predict sustained remission after stopping entecavir. In the long-run, it can improve patient compliance, reduce the need of long-term antiviral and reduce the drug cost in the management of HBeAg-negative chronic hepatitis B.

All patients will stop entecavir according to the Asian Pacific guideline with written informed consent and close subsequent monitoring. In the protocol, there is a safety net for re-treatment. There will not be any invasive procedure. There is no major ethical issue.

Study Overview

Status

Completed

Conditions

Detailed Description

Chronic hepatitis B is the commonest cause of liver cirrhosis and hepatocellular carcinoma in Hong Kong. Approximately 50% of patients had negative hepatitis B e antigen (HBeAg), which indicates an escape of host immune clearance by the host. Oral antiviral drugs are very effective in suppressing viral replication and inducing biochemical remission [1]. However, the timing to stop oral antiviral agents is controversial. Hepatitis B surface antigen (HBsAg) seroclearance has been recommended as the best time for drug cessation for HBeAg-negative patients [2,3], but its occurrence is very uncommon especially among Asian patients. The Asian Pacific guideline recommended stopping treatment when serum HBV DNA became undetectable for three times within 12 months [4], but approximately 50% of patients will experience virologic relapse post-treatment [5,6].

HBsAg quantification has been shown to correlate with the concentration of covalently closed circular DNA in the liver [7]. In a Hong Kong study among 53 HBeAg-negative patients who stopped lamivudine, HBsAg ≤ 100 IU/ml and/or reduction of > 1 log at the end of treatment could predict sustained response up to 5 years post-treatment [8]. In other words, it is probable that patients who have a lower serum HBsAg level, which may reflect a lower concentration of virus inside the liver, have a lower risk of viral relapse after stopping antiviral therapy.

Study Type

Observational

Enrollment (Actual)

82

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

  • Hong Kong
      • Hong Kong, Hong Kong
        • Cheng Suen Man Shook Hepatitis Center, Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital

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 to 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

HBeAg-negative patients on entecavir followed up in the liver clinics will be identified from the existing database. All patients had HBV DNA testing every 6 months as a clinic routine. Serum HBsAg levels will be tested in the residual serum samples at the pre-treatment and last follow-up visits. Eligible patients will be discussed on the plan of stopping entecavir therapy. All patients will have written informed consent before recruited into this study. All patients will be followed up for 12 months after stopping entecavir treatment.

Description

Inclusion Criteria:

  1. HBeAg-negative patients on entecavir monotherapy for at least 24 months
  2. Undetectable HBV DNA by PCR-based assay on 3 separate occasions 6 months apart (as per Asian Pacific guideline in 2008).
  3. Normal ALT levels according to the local laboratory reference value on 2 separate occasions 6 months apart

Exclusion Criteria:

  1. Patients previously or currently on interferon therapy
  2. Patients who have experienced another antiviral agent besides entecavir
  3. Patients with hepatitis C virus infection as indicated by a positive anti-HCV serology test
  4. Patients with Child's B liver cirrhosis, cirrhotic complications or hepatocellular carcinoma
  5. Patients with organ transplantation
  6. Serious medical illnesses or malignancy
  7. Age < 18 years or > 65 years
  8. No patient consent

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: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
sustained response, defined as HBV DNA persistently ≤ 200 IU/ml
Time Frame: 12 months after stopping Entecavir
12 months after stopping Entecavir

Secondary Outcome Measures

Outcome Measure
Time Frame
HBsAg < 1000 IU/ml and 100 IU/ml
Time Frame: 12 months post-treatment
12 months post-treatment
HBV DNA < 200 IU/ml and 20 IU/ml
Time Frame: 12 months post-treatment
12 months post-treatment
virological relapse
Time Frame: 5 years post-treastment
5 years post-treastment
HBsAg clearance
Time Frame: 5 years post-treatment
5 years post-treatment

Collaborators and Investigators

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

Sponsor

Chinese University of Hong Kong

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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

March 1, 2012

Primary Completion (Actual)

September 1, 2013

Study Completion (Actual)

September 1, 2013

Study Registration Dates

First Submitted

January 28, 2014

First Submitted That Met QC Criteria

February 20, 2014

First Posted (Estimate)

February 24, 2014

Study Record Updates

Last Update Posted (Estimate)

February 24, 2014

Last Update Submitted That Met QC Criteria

February 20, 2014

Last Verified

February 1, 2014

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Stop Nuc

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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