- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03468907
The Safety of Anti-viral Therapy in Preventing HBV MTCT in Pregnant Women After Discontinuation
August 27, 2018 updated by: Chao-Shuang Lin, Third Affiliated Hospital, Sun Yat-Sen University
The Safety of Anti-viral Therapy in Preventing Mother-to-child Transmission of Hepatitis B Virus in Pregnant Women After Discontinuation
Mother-to-child transmission (MTCT) is the most common mode of perpetuating chronic hepatitis B virus (HBV) infection in endemic countries.
Many studies have demonstrated antepartum anti-viral therapy (AVT) is a advisable option to reduce mother-to-child transmission and the risk of vaccination breakthrough in infants who received passive-active immunoprophylaxis.
However, several controversies over antiviral treatment have not been resolved, that is, optimal duration, effect of postpartum therapy, and risk of postpartum alanine aminotransferase (ALT) flare after withdrawal.
Will the risk of postpartum hepatitis flares increase after short-term AVT in late pregnancy for maternal HBV infection is discontinued?
Is there any correlation between postpartum hepatitis flares and withdrawal time?
Will the proportion of postpartum flares be reduced if extending the duration of AVT after delivery?
There is an urgent need in this area.
This study mainly investigated the safety of antiviral therapy in preventing HBV mother-to-child transmission in pregnant women after discontinuation.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Between June 2015 and December 2017, 111 mothers were enrolled during their visit to the Department of Gynecology and Obstetrics or the Department of Infectious Diseases of the Third Affiliated Hospital of Sun Yat-Sen University in Guangzhou, Guangdong province, China.
Pregnant women fulfilling the inclusion and exclusion criteria were offered participation in the study.
All pregnant women who opted for AVT need to sign a consent form and started on oral telbivudine (LDT) 600 mg or tenofovir disoproxil fumarate (TDF) 300 mg (as per patients' wishes) daily between gestational weeks 24 and 28.
Serum levels of HBV DNA, HBsAg, HBsAb, HBeAg, HBeAb, liver function tests, haematology and renal biochemistry were measured at baseline(i.e. at screening), every 4 weeks after treatment begins, at the time of delivery, and at 1, 2, 3, 6, 12 month postpartum.
After delivery, treatment with LDT or TDF was immediately withdrew to the patients with an intention of breastfeeding, while the other patients, without desire of breastfeeding, would subsequently extend antiviral treatment duration to postpartum 6 weeks.
All infants were vaccinated with genetically engineered HBV vaccine 20 ug according to a standard vaccination regimen (i.e.
within 12h of birth, at week 4 and at week 24) and 200 IU doses of hepatitis B immunoglobulin immediately (within 2h) after birth and at day 15.
The infant's HBV serologic status and HBV DNA were tested at birth (before immunization) and again at 7 months.
The investigators discussed the postpartum liver function after withdrawal and evaluated the impact of extending the postpartum duration of AVT administered for the prevention of perinatal transmission.
Study Type
Interventional
Enrollment (Actual)
111
Phase
- Phase 4
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 45 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
Female
Description
Inclusion Criteria:
- Gestational age between 24 and 28 weeks
- Detectable serum HBsAg at the Screening visit and at least 6 months prior
- Serum HBV DNA level >1,000,000 IU/mL at Screening visit
- Alanine aminotransferase (ALT) below the upper limit of normal (ULN; 40 IU/mL)
Exclusion Criteria:
- Patient is co-infected with hepatitis A virus, hepatitis C virus, hepatitis delta virus, hepatitis E virus or HIV.
- Patient has a history of antiviral treatment or concurrent treatment with immunomodulators, cytotoxic drugs, or steroids.
- Patient has clinical signs of threatened miscarriage in early pregnancy.
- Patient has evidence of hepatocellular carcinoma or cirrhosis.
- Patient has evidence of fetal deformity by 3-dimensional ultrasound examination.
- Patient has a husband infected with HBV.
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
- Primary Purpose: Prevention
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Early cessation
Pregnant mothers who opted for antiviral therapy would start on oral LDT 600 mg or TDF 300 mg (as per patients' wishes) daily between gestational weeks 24 and 28.
Antiviral therapy was discontinued in intrapartum.
|
Pregnant mothers who opted for antiviral therapy would start on oral LDT 600 mg daily between gestational weeks 24 and 28.
Other Names:
Pregnant mothers who opted for antiviral therapy would start on oral TDF 300 mg daily between gestational weeks 24 and 28.
Other Names:
|
Experimental: Late cessation
Pregnant mothers who opted for antiviral therapy would start on oral LDT 600 mg or TDF 300 mg (as per patients' wishes) daily between gestational weeks 24 and 28.
After delivery, mothers ceased antiviral treatment at postpartum 6 weeks.
|
Pregnant mothers who opted for antiviral therapy would start on oral LDT 600 mg daily between gestational weeks 24 and 28.
Other Names:
Pregnant mothers who opted for antiviral therapy would start on oral TDF 300 mg daily between gestational weeks 24 and 28.
Other Names:
|
No Intervention: Control
Eligible patients who refused antiviral therapy but consented to the study were assigned to the control arm.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Postpartum flare incidence
Time Frame: From baseline to postpartum 12 months.
|
Time-to-event measures.
Postpartum flare was defined as an alanine aminotransferase (ALT) rise to three times baseline level or five times ULN (40U/L) within 12 months post-delivery.
Maternal would be recorded if postpartum flare occured.
At the end of postpartum 12-month follow-up period, postpartum flare incidence was measured.
|
From baseline to postpartum 12 months.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time of flare onset
Time Frame: Baseline (i.e. at screening); at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Time-to-event measures.
Time of the onset of postpartum liver damage.
|
Baseline (i.e. at screening); at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Proportion of severe flares
Time Frame: Baseline (i.e. at screening); at the time of delivery; at 1,2,3,6,12 month postpartum.
|
As per protocol, ALT flares (>5 times baseline level or >10 times ULN) were considered severe adverse events (SAEs).
|
Baseline (i.e. at screening); at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Peak ALT during flare
Time Frame: Baseline (i.e. at screening); at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Peak ALT during postpartum flare.
|
Baseline (i.e. at screening); at the time of delivery; at 1,2,3,6,12 month postpartum.
|
The rate of perinatal transmission
Time Frame: 7 months after birth.
|
Perinatal transmission was established by detectable HBV DNA and HBsAg levels in the peripheral blood of infants at 7 months.
|
7 months after birth.
|
HBV kinetics in patients
Time Frame: Baseline (i.e. at screening); at 4-week intervals after treatment was begun up to delivery; at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Changes of HBV viral load in patients treated and not treated with antiviral agents.
|
Baseline (i.e. at screening); at 4-week intervals after treatment was begun up to delivery; at the time of delivery; at 1,2,3,6,12 month postpartum.
|
The liver function normalization rate
Time Frame: Baseline (i.e. at screening); at 4-week intervals after treatment was begun up to delivery; at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Normal liver function was defined as the value of ALT level lower 40U/L.
|
Baseline (i.e. at screening); at 4-week intervals after treatment was begun up to delivery; at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Maternal HBsAg loss/seroconversion rate
Time Frame: Baseline (i.e. at screening); at 4-week intervals after treatment was begun up to delivery; at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Measurement of the proportion of maternal hepatitis B surface antigen loss and seroconversion.
|
Baseline (i.e. at screening); at 4-week intervals after treatment was begun up to delivery; at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Incidence of perinatal and partum complications
Time Frame: Baseline (i.e. at screening); at 4-week intervals after treatment was begun up to delivery; at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Perinatal and partum complications included hypertensive disorders in pregnancy, gestational diabetes mellitus, fetal growth retardation, premature delivery, premature rupture of membrane, and postpartum hemorrhage.
|
Baseline (i.e. at screening); at 4-week intervals after treatment was begun up to delivery; at the time of delivery; at 1,2,3,6,12 month postpartum.
|
Birth height
Time Frame: At the time of delivery.
|
Measurement of infants' height at the time of delivery.
|
At the time of delivery.
|
Birth weight
Time Frame: At the time of delivery.
|
Measurement of infants' weight at the time of delivery.
|
At the time of delivery.
|
Neonate apgar score at 1 minute
Time Frame: At 1 minute after birth.
|
Apgar scores of neonates included activity, pulse, grimace, appearance and respiration.
|
At 1 minute after birth.
|
Neonate apgar score at 5 minutes
Time Frame: At 5 minutes after birth.
|
Apgar scores of neonates included activity, pulse, grimace, appearance and respiration.
|
At 5 minutes after birth.
|
Incidence of deformity
Time Frame: At the time of delivery; at 1, 7, 12 month postpartum.
|
The incidence of baby deformity was recorded during the postpartum follow-up period.
|
At the time of delivery; at 1, 7, 12 month postpartum.
|
Breastfeeding rate
Time Frame: At birth, at 1 and 7 month follow-up.
|
Breast feeding status was assessed in all infants during the postpartum follow-up period.
|
At birth, at 1 and 7 month follow-up.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Study Chair: Zhi-liang Gao, PhD, Third Affiliated Hospital, Sun Yat-Sen University
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 (Actual)
June 1, 2015
Primary Completion (Actual)
December 31, 2017
Study Completion (Actual)
December 31, 2017
Study Registration Dates
First Submitted
January 21, 2018
First Submitted That Met QC Criteria
March 12, 2018
First Posted (Actual)
March 19, 2018
Study Record Updates
Last Update Posted (Actual)
August 29, 2018
Last Update Submitted That Met QC Criteria
August 27, 2018
Last Verified
August 1, 2018
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, Chronic
- Hepatitis B
- Hepatitis
- Hepatitis A
- Hepatitis B, 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
- Telbivudine
Other Study ID Numbers
- Safety of anti-viral agents
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
IPD Plan Description
Individual participant data (IPD) is not available to other researchers.
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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