The Safety and Efficacy of Sequential Treatment of Ropeginterferon Alfa-2b (P1101) and Anti-PD1 in Interferon-Naive Adults With Chronic Hepatitis B or D Infection

A Phase Ib, Open Label Study to Assess the Safety and Efficacy of Sequential Administration of P1101 and Anti-PD1 in Interferon-Naive Adults With Chronic Hepatitis B or D Infection

Primary objective:

To evaluate the safety and tolerability of sequential administration of P1101 and anti-PD1 in patient with chronic hepatitis B or D infection

Secondary objectives:

1. To explore HBsAg loss and kinetics during the study period
2. To assess the anti-viral effect during the study period
3. To evaluate the rate of ALT normalization

Study Overview

• Status: Recruiting
• Conditions: Chronic Hepatitis B Infection; Chronic Hepatitis D Infection
• Intervention / Treatment: Drug: P1101 + Nivolumab + Entecavir

Detailed Description

There are 20 scheduled visits (screening, treatment weeks & follow-up weeks) for patients with > 0.5 log10 decline in HBsAg at TW12, which include screening visit, TW0 (baseline), TW2, TW4, TW6, TW8, TW10, TW12, TW13, TW15, TW17, TW19, TW21, TW23 (EOT), FW4, FW8, FW12, FW16, FW20 and FW24.

There are 22 scheduled visits for patients with ≤ 0.5 log10 decline in HBsAg at TW12. These visits include screening visit, TW0 (baseline), TW2, TW4, TW6, TW8, TW10, TW12, TW13, TW16, TW17, TW19, TW21, TW23, TW25, TW27 (EOT), FW4, FW8, FW12, FW16, FW20 and FW24.

• Study Type: Interventional
• Enrollment (Anticipated): 20
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Wendy Hung, MS; Phone Number: 1397 +886-2-2655-7688; Email: Wanchu_Hung@pharmaessentia.com
• Study Contact Backup: Name: Erwin Teng, MS; Phone Number: 1374 +886-2-2655-7688; Email: erwin_teng@pharmaessentia.com

Study Locations

• Taiwan
  • Taipei City, Taiwan
    • Recruiting
    • National Taiwan University Hospital
  • Taipei city, Taiwan
    • Not yet recruiting
    • Taipei Medical University Hospital
    • Contact: Yi-Wen Huang, Ph.D.; Email: yiwenhuang@tmu.edu.tw
  • Taipei city, Taiwan
    • Recruiting
    • Taipei Veterans General Hospital
  • Taoyuan city, Taiwan
    • Recruiting
    • Chang Gung Memorial Hospital, Linkou

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Positive for HBsAg for at least 6 months, either HBeAg (+) or HBeAg (-), and ALT ≥ULN to ≤ 10X ULN at screening;
2. Interferon naïve;
3. Quantitative HBsAg Level < 1,500 IU/mL at screening; Undetectable HBV DNA (either under NUC treatment or not)
4. Adults ≥20 years of age; patients who are over 70 years of age must be in generally good health depending upon the Investigator's judgment;
5. Laboratory test results before study entry: WBC ≥ 3,000/mm3; ANC ≥ 1,500/mm3; Platelet ≥ 90,000/mm3; Hemoglobin ≥ 10g/dL; e-GFR ≥ 60mL/min;
6. ECG without clinically significant abnormalities before study entry;
7. Be able to attend all scheduled visits and to comply with all study procedures;
8. Patients with anti-HDV (+) can be enrolled;
9. Patients with fibrosis stage < F4 can be enrolled;
10. Willing to provide written informed consent;

Exclusion Criteria:

1. Clinically significant illness or surgery that might interfere with study participation;
2. Clinically significant vital sign abnormalities or fever [body temperature >38℃]);
3. History of significant alcohol or drug abuse within 6 months prior to the screening visit (alcohol consumption of more than 14 units of alcohol per week [1 Unit = 150 mL of wine, 360 mL of beer, or 45 mL of 40% alcohol]) or refusal to abstain from alcohol or illicit drugs throughout the study;
4. Any history or presence of poorly controlled or clinically significant medical conditions that are not suitable to receive interferon-based treatment, at the discretion of the investigator: major psychiatric (including but not limited to those with severe depression, severe bi-polar disorder, schizophrenia, suicidal ideation or history of suicidal attempt), neurological, cardiovascular (i.e. uncontrolled hypertension, congestive heart failure (≥ NYHA class 2), serious cardiac arrhythmia, significant coronary artery stenosis, unstable angina) or recent stroke or myocardial infarction), pulmonary, hematologic, immunologic, autoimmune diseases, thyroid or other endocrine diseases, metabolic (e.g. diabetes mellitus with HbA1C > 8.0%) or other uncontrolled systemic disease, coagulation disorders or blood dyscrasias;
5. Pregnant patient, female patient or the spouse of male patient, with child-bearing potential who is unwilling or unable to practice adequate contraception, defined as vasectomy in men, tubal ligation in women, or use of condoms and spermicides, or birth control pills, or intrauterine devices throughout the study;
6. History of severe allergic or hypersensitivity reactions, e.g. hypersensitivity to the active substance or to any of the excipients of Ropeginterferon alfa-2b (P1101), bronchospasm, angioedema, asthma, or anaphylaxis;
7. Therapy with any systemic anti-viral treatment, anti-neoplastic, or immunomodulatory treatment (including supraphysiologic doses of steroids and radiation) within 1 month (3 months for those with long elimination half-lives) prior to the first dose of study drug;
8. A depot injection or an implant of any drug within 3 months prior to administration of study medication, other than contraception or hyaluronic acid injections in joints for osteoarthritis;
9. Body organ transplant or taking immunosuppressant;
10. Use investigational drug of other clinical trials within 4 weeks prior to the first dose of the study drug;
11. History of malignancy diagnosed or treated within 5 years prior to screening (except for localized treatment of squamous or non-invasive basal cell skin cancers; cervical carcinoma in situ);
12. History of opportunistic infection (e.g., invasive candidiasis or pneumocystis pneumonia);
13. Serious localized infection (e.g., cellulitis, abscess) or systemic and life-threatening infection (e.g., septicemia) within 3 months prior to screening;
14. Clinically significant medical conditions known to interfere absorption, distribution, metabolism or excretion of the study drugs;
15. Decompensated liver disease, which includes but not limited to the following: total bilirubin≥2 mg/dL (except in Gilbert syndrome), direct bilirubin ≥2X ULN, albumin level < 3.5 g/dL, INR ≥1.5; clinical evidence of ascites, liver decompensation, hepatic encephalopathy, oesophageal varices or cirrhosis as identified by ultrasound or any other examination before study entry;
16. Significant steatohepatitis by ultrasound or other examination at the discretion of investigator;
17. Other form of significant chronic liver diseases, except those mentioned above (e.g. HBV, HDV);
18. Significant or major fundoscopic findings at screening including but not limited to retinal exudates, hemorrhage, detachment, neovascularization, papilledema, optic atrophy, microaneurysms and macular changes;
19. Positive for anti-HIV or anti-HCV;
20. Prior therapy with anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint pathway;
21. Any contraindication to receiving anti-PD-1 antibody (e.g. active or a history of life-threatening autoimmune conditions, corticosteroids treatment required) or hypersensitivity to the constituents of anti-PD-1 antibody;
22. Patients under monotherapy by telbivudine or any other combination therapy with telbivudine.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: P1101 + Nivolumab + Entecavir

Drug: P1101 + Nivolumab + Entecavir; P1101 (Ropeginterferon alfa-2b) 450 µg subcutaneously (SC) Q2W for 6 doses (12 weeks) *, followed by 0.3 mg/kg Nivolumab for 6 doses (12 weeks) **, with a follow up of 24 weeks. All patients will also receive Entecavir 0.5 mg QD from Day 1 to Follow-up 24. *: HBsAg will be checked at treatment week 12 (or 16, if applicable). **: Only patients with > 0.5 log10 decline in HBsAg at treatment week 12 or 16 will be sequentially treated with Anti-PD1.; Other Names: P1101 (Ropeginterferon alfa-2b) + Nivolumab + Entecavir

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety: AE/SAE	Number of patients with adverse events, including SAEs	Through study Follow-up Week 24 (up to 330 or 358 days)
Safety: clinically significant abnormalities	Number of patients with clinically significant abnormalities, including vital sign, physical examination, electrocardiogram (ECG) and laboratory data	Through study Follow-up Week 24 (up to 330 or 358 days)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Subjects with HBsAg loss	The percentage of subjects with HBsAg loss at treatment week 12, 23/27 and follow up week 12, 24 in the treatment group	Treatment Week 12, Treatment Week 23 or 27, Follow-up Week 12 and Follow-up Week 24
Subjects with HBsAg reduction from baseline	The percentage of subjects with HBsAg reduction from baseline at treatment week 12, 23/27 and follow up week 12, 24 in the treatment group	Treatment Week 12, Treatment Week 23 or 27, Follow-up Week 12 and Follow-up Week 24
Subjects with HBsAg seroconversion	The percentage of subjects with HBsAg seroconversion at treatment week 12, 23/27 and follow up week 12, 24 in the treatment group	Treatment Week 12, Treatment Week 23 or 27, Follow-up Week 12 and Follow-up Week 24
Subjects with undetectable HBV DNA	The percentage of subjects with undetectable HBV DNA at treatment week 12, 23/27 and follow up week 12, 24 in the treatment group	Treatment Week 12, Treatment Week 23 or 27, Follow-up Week 12 and Follow-up Week 24
Subjects with ≥ 2 log10 decline from baseline in HDV RNA	The percentage of subjects with ≥ 2 log10 decline from baseline in HDV RNA at treatment week 12, 23/27 and follow up week 12, 24 in the treatment group	Treatment Week 12, Treatment Week 23 or 27, Follow-up Week 12 and Follow-up Week 24
Subjects with undetectable HDV RNA	The percentage of subjects with undetectable HDV RNA at treatment week 12, 23/27 and follow up week 12, 24 in the treatment group	Treatment Week 12, Treatment Week 23 or 27, Follow-up Week 12 and Follow-up Week 24
Subjects with ALT normalization	The percentage of subjects with ALT normalization at treatment week 12, 23/27 and follow up week 12, 24 in the treatment group	Treatment Week 12, Treatment Week 23 or 27, Follow-up Week 12 and Follow-up Week 24

Collaborators and Investigators

• Sponsor: PharmaEssentia

Study record dates

Study Major Dates

• Study Start (Anticipated): December 1, 2021
• Primary Completion (Anticipated): March 1, 2023
• Study Completion (Anticipated): March 1, 2023

Study Registration Dates

• First Submitted: November 6, 2020
• First Submitted That Met QC Criteria: November 16, 2020
• First Posted (Actual): November 20, 2020

Study Record Updates

• Last Update Posted (Actual): September 22, 2021
• Last Update Submitted That Met QC Criteria: September 15, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: P1101; HBV; Anti-PD1; HDV
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; RNA Virus Infections; Virus Diseases; Blood-Borne Infections; Disease Attributes; Liver Diseases; Hepatitis, Viral, Human; Hepadnaviridae Infections; DNA Virus Infections; Enterovirus Infections; Picornaviridae Infections; Infections; Communicable Diseases; Hepatitis B; Hepatitis; Hepatitis A; Hepatitis D; Hepatitis D, Chronic; Hepatitis B, Chronic; Hepatitis, Chronic; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Antineoplastic Agents; Antineoplastic Agents, Immunological; Immune Checkpoint Inhibitors; Entecavir; Nivolumab
• Other Study ID Numbers: A20-101

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No