Myrcludex B vs Entecavir in Patients With HBeAg Negative Chronic Hepatitis B

A Phase 1b/2a Randomized, Open-label Clinical Trial of Daily Myrcludex B Versus Entecavir in Patients With HBeAg Negative Chronic Hepatitis B

A randomized, open-label multicentre clinical trial of daily Myrcludex B versus entecavir in patients with HBeAg negative chronic hepatitis B.

Study Overview

• Status: Completed
• Conditions: Chronic Hepatitis B
• Intervention / Treatment: Drug: Entecavir; Drug: Myrcludex B

Detailed Description

This is a randomized, open-label multicentre clinical trial of daily Myrcludex B versus entecavir in patients with HBeAg negative chronic hepatitis B. Accounting for screen-outs about 76 patients will be screened and 48 of them will be randomized into 6 treatment groups:

Arm A (8 patients): Myrcludex B 0.5 mg / day / sc / 12 weeks Arm B (8 patients): Myrcludex B 1 mg / day / sc / 12 weeks Arm C (8 patients): Myrcludex B 2 mg / day / sc / 12 weeks Arm D (8 patients): Entecavir 0.5 mg / day / orally / 24 weeks Arm E (8 patients): Myrcludex B 5 mg / day / sc / 12 weeks Arm F (8 patients): Myrcludex B 10 mg / day / sc / 24 weeks

The study consists of screening period up to 28 days (Day -28 -1); baseline visit (Day 0), treatment period up to 12 weeks for groups A-C, E and 24 weeks for groups D, F; follow-up period up to 12 weeks for groups A-C, E, F.

• Study Type: Interventional
• Enrollment (Actual): 48
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• Russian Federation
  • Chelyabinsk, Russian Federation, 454052
    • SBEI of Higher Professional Education "South Ural State Medical university" of the MoH of the RF
  • Moscow, Russian Federation, 105275
    • 1-st MMU n.a. I.M. Sechenov based in Moscow State-Owned Health Care Institution "Infectious Clinical Hospital № 2 of Moscow Healthcare Department"
  • Moscow, Russian Federation, 117198
    • FSBI of Higher Education "People's Friendship University"
  • Moscow, Russian Federation, 119333
    • FSBHI "Central Clinical Hospital RAS"
  • Moscow, Russian Federation, 129110
    • LLC "Clinical Hospital of Tsentrosoyuz"
  • Saint Petersburg, Russian Federation, 190103
    • SPb SBHI "The Center for Prevention and Control of AIDS and Infectious Diseases"
  • Saint Petersburg, Russian Federation, 191167
    • SPb SIH "Clinical Centre of Infectious Diseases Named After S.P. Botkin"
  • Samara, Russian Federation, 430063
    • Medical Company "Hepatolog" LLC
  • Stavropol', Russian Federation, 355000
    • SBIH "Stavropol Regional Clinical Hospital"

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Age 18-65 years inclusive at the time of giving of written informed consent for study participation.
2. Chronic hepatitis B defined by the presence of HBsAg for at least 6 months prior to screening period.
3. Liver biopsy performed within one year prior to screening or during screening period.

4. Alanine aminotransferase (ALT) ≥1.5 x ULN and ≤ 6 x ULN. If ALT level during screening period is ≥1 ULN the patient can be included in the study after obtaining the sponsor's approval and if the following conditions are met :

   • evidence of inflammation such as lymphocyte infiltration confirmed by liver biopsy performed within the 6 months prior to the inclusion in the study,
   • and/or the patient has a history of elevated ALT levels of ≥1.5 ULN during the 12 months prior to screening period.
5. HBeAg negative and anti-HBeAg positive.
6. HBV DNA ≥ 104 copies/mL.
7. All women of childbearing potential must have a negative urine pregnancy test prior to enrolment.

8. Women must:

   • Be menopausal for at least 2 years, or
   • Be surgically sterile (total hysterectomy or bilateral ovariectomy or bilateral tubal ligation/clips or otherwise be incapable of pregnancy), or
   • Not be heterosexually active during the study, or
   • Agree to use a highly effective method of birth control (double barrier method or combination of barrier method with hormonal or intrauterine device) during the study and for 3 month after the last dosing of the investigational medicinal product.
9. Men must agree to use a highly effective method of birth control (double barrier methods or combination of barrier method with hormonal or intrauterine device in their women-partner) and not to donate a sperm during the study and for 3 month after the last dosing of the investigational medicinal product.
10. An understanding, ability and willingness to fully comply with study procedures and restrictions.
11. An ability to provide the written informed consent to participate in the study.

Exclusion Criteria:

1. Decompensated liver disease (Child-Pugh-Score >6).
2. Any sign of liver cirrhosis (histological, ultra sound, biochemical).
3. Co-infected with hepatitis C virus (HCV), hepatitis D virus (HDV), or HIV.
4. ALT > 6 ULN.
5. Creatinine clearance < 60 mL/min.
6. Total bilirubin > 2 mg/dL.
7. Pre-treatment with nucleoside-analogues (lamivudine, telbivudine, entecavir) less than 6 months prior to the first dosing of the investigational medicinal products. Pre-treatment with nucleotide-analogues and interferons is allowed.
8. History of hepatocellular carcinoma (HCC) or findings suggestive of possible HCC, such as suspicious foci on imaging studies or elevated serum alpha-fetoprotein (AFP) levels. In patients with such findings, HCC will be ruled-out prior to screening for the present study.
9. One or more additional known primary or secondary causes of liver disease, other than hepatitis B (e.g., alcoholism, autoimmune hepatitis, malignancy with hepatic involvement, hemochromatosis, alpha-1 antitrypsin deficiency, Wilson's Disease, other congenital or metabolic conditions affecting the liver, e.g. congestive heart failure or other severe cardiopulmonary disease). Patients with Gilbert's syndrome and Dubin-Johnson syndrome, two benign disorders associated with low-grade hyperbilirubinemia can be enrolled into the trial.
10. History of clinically evident pancreatitis.
11. History of alcohol or drug abuse within the preceding two years. For the purposes of the present study, alcohol abuse is arbitrarily defined as frequent consumption of alcoholic beverages with an average daily intake of more than 40 g of ethanol.
12. Participation in another study with an investigational drug within less than one month prior to this study or simultaneously to this study.
13. Patients who are unable or unwilling to follow the protocol requirements.
14. Patients with a history of seizures, central nervous system disorders or psychiatric disability thought to be clinically significant in the opinion of the investigator.
15. Patients with limited mental capacity to the extent that she/he cannot provide informed consent or information regarding adverse events of the study drug.
16. Clinically significant renal, respiratory or cardiovascular disease.
17. Pregnancy and lactation.
18. Patients who have previously participated in this study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm A; Myrcludex B 0.5 mg daily for 12 weeks, followed by 12 weeks follow-up period	Drug: Myrcludex B; Other Names: Myrcludex
Experimental: Arm B; Myrcludex B 1 mg daily for 12 weeks, followed by 12 weeks follow-up period	Drug: Myrcludex B; Other Names: Myrcludex
Experimental: Arm C; Myrcludex B 2 mg daily for 12 weeks, followed by 12 weeks follow-up period	Drug: Myrcludex B; Other Names: Myrcludex
Active Comparator: Arm D; Entecavir 0.5 mg daily for 24 weeks	Drug: Entecavir; Other Names: Baraclude®
Experimental: Arm E; Myrcludex B 5 mg daily for 12 weeks, followed by 12 weeks follow-up period	Drug: Myrcludex B; Other Names: Myrcludex
Experimental: Arm F; Myrcludex B 10 mg daily for 24 weeks, followed by 12 weeks follow-up period	Drug: Myrcludex B; Other Names: Myrcludex

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Patients With HBsAg Response at 12 Week of Therapy	HBsAg response is defined as serum HBsAg decline of at least 0.5 logs IU/ml (or HBsAg negativation) at week 12 compared to baseline.	12 week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Patients With HBsAg Response at 24 Week of Therapy	HBsAg response is defined as serum HBsAg decline of at least 0.5 logs IU/ml (or HBsAg negativation) at week 24 compared to baseline.	24 weeks
Proportion of Patients With HBV DNA Response at Week 12 of Therapy	HBV DNA response is defined as persistent reduction of HBV DNA by >1 log IU/ml or negativation at week 12 compared to baseline.	12 weeks
Proportion of Patients With Biochemical Response at 12 Weeks of Therapy	Biochemical response is defined as normalization of ALT level at week 12 compared to baseline.	12 weeks
Proportion of Patients With cccDNA Response at 24 Week of Therapy	Virological cccDNA response is defined as reduction of intrahepatic cccDNA by 0.5 logs in comparison to baseline at week 24.	24 weeks
Proportion of Patients With HBV DNA Response at Week 24 of Therapy	HBV DNA response is defined as persistent reduction of HBV DNA by >1 log IU/ml or negativation at week 24 compared to baseline.	24 weeks
Proportion of Patients With Biochemical Response at 24 Weeks of Therapy	Biochemical response is defined as normalization of ALT level at week 24 compared to baseline.	24 weeks

Collaborators and Investigators

• Sponsor: Hepatera Ltd.
• Investigators: Principal Investigator: Pavel Bogomolov, PhD, LLC "Clinical Hospital of Tsentrosoyuz"

Publications and helpful links

General Publications

• Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat. 2004 Mar;11(2):97-107. doi: 10.1046/j.1365-2893.2003.00487.x.
• Yan H, Zhong G, Xu G, He W, Jing Z, Gao Z, Huang Y, Qi Y, Peng B, Wang H, Fu L, Song M, Chen P, Gao W, Ren B, Sun Y, Cai T, Feng X, Sui J, Li W. Sodium taurocholate cotransporting polypeptide is a functional receptor for human hepatitis B and D virus. Elife. 2012 Nov 13;1:e00049. doi: 10.7554/eLife.00049. Erratum In: Elife. 2014;3:e05570.
• Trauner M, Boyer JL. Bile salt transporters: molecular characterization, function, and regulation. Physiol Rev. 2003 Apr;83(2):633-71. doi: 10.1152/physrev.00027.2002.
• Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009 Sep;50(3):661-2. doi: 10.1002/hep.23190. No abstract available.
• Nowak MA, Bonhoeffer S, Hill AM, Boehme R, Thomas HC, McDade H. Viral dynamics in hepatitis B virus infection. Proc Natl Acad Sci U S A. 1996 Apr 30;93(9):4398-402. doi: 10.1073/pnas.93.9.4398.
• Yan H, Zhong G, Xu G, He W, Jing Z, Gao Z, Huang Y, Qi Y, Peng B, Wang H, Fu L, Song M, Chen P, Gao W, Ren B, Sun Y, Cai T, Feng X, Sui J, Li W. Sodium taurocholate cotransporting polypeptide is a functional receptor for human hepatitis B and D virus. Elife. 2012 Nov 13;3. doi: 10.7554/eLife.00049.

Study record dates

Study Major Dates

• Study Start (Actual): November 14, 2012
• Primary Completion (Actual): October 4, 2014
• Study Completion (Actual): October 4, 2014

Study Registration Dates

• First Submitted: August 18, 2016
• First Submitted That Met QC Criteria: August 25, 2016
• First Posted (Estimate): August 26, 2016

Study Record Updates

• Last Update Posted (Actual): September 19, 2018
• Last Update Submitted That Met QC Criteria: December 28, 2017
• Last Verified: December 1, 2017

More Information

Terms related to this study

• 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; Anti-Infective Agents; Antiviral Agents; Entecavir
• Other Study ID Numbers: MYR 201 (HBV)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No