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Combination Therapy of Pegylated Interferon Alfa-2a and Tenofovir Versus Tenofovir Monotherapy in Chronic Hepatitis B

Combination Therapy of Pegylated Interferon Alfa-2a and Tenofovir Versus Tenofovir Monotherapy in HBeAg-positive and HBeAg-negative Chronic Hepatitis B

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01369212
Acronym
HBRN
Enrollment
201
Registered
2011-06-08
Start date
2012-11-30
Completion date
2021-03-08
Last updated
2023-04-28

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Hepatitis B

Brief summary

This clinical trial compares the efficacy of peginterferon plus tenofovir for 24 weeks followed by monotherapy with tenofovir for a further 3.5 years to the efficacy of tenofovir alone given for 4 years in patients with chronic hepatitis B. The primary measure of outcome will be HBsAg loss in serum at 48 weeks after stopping all antiviral therapy (sustained off-treatment response).

Detailed description

The objective of this study is to compare the long-term efficacy of treatment with combination therapy with peginterferon plus tenofovir versus tenofovir monotherapy in the treatment of chronic hepatitis B. This is a randomized (1:1) parallel group design trial comparing (i) tenofovir disoproxil fumarate (TDF) 300 mg daily for 192 weeks (4 years) and (ii) peginterferon alfa-2a 180 µg weekly for 24 weeks plus Tenofovir DF 300 mg daily for 192 weeks (4 years). Enrolled participants will be stratified by HBeAg status (positive/negative), genotype (A vs. all others) and cirrhosis (present vs. absent). After 192 weeks of treatment, participants meeting criteria for treatment discontinuation will stop treatment and be followed for 48 weeks (total duration of treatment and follow up is 240 weeks). Emtricitabine/tenofovir coformulated as Truvada, approved for treatment of HIV but not for treatment of hepatitis B virus (HBV) infection, will be offered to patients with primary nonresponse, partial virological response or confirmed virologic breakthrough.

Interventions

DRUGTenofovir

300 mg daily for 192 weeks (4 years)

DRUGPeginterferon-alfa 2a and tenofovir

A combination of peginterferon-alfa 2a 180 µg weekly plus tenofovir 300 mg daily for 24 weeks and then only tenofovir 300 mg daily for 168 weeks (3.5 years).

Sponsors

University of Pittsburgh
CollaboratorOTHER
National Center for Research Resources (NCRR)
CollaboratorNIH
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Lead SponsorNIH

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Participant is enrolled in the HBRN Cohort Study (NCT01263587) or completed the necessary components of the cohort baseline evaluation by the end of the baseline visit for this study * 18 years or older * Chronic hepatitis B infection as evidenced by at least one of the following: 1. HBsAg positive result within 8 weeks prior to randomization and another time at least 24 weeks prior to randomization with no HBsAg negative result in between. 2. HBsAg positive within 8 weeks prior to randomization and HBV DNA ≥1000 IU/mL on 2 occasions at least 24 weeks apart (can include result from screening visit within 8 weeks of randomization) * Hepatitis B e antigen positive or negative * Serum HBV DNA ≥1000 IU/mL on 2 occasions at least 4 weeks apart within the 32 weeks prior to randomization (can include result from screening visit within 8 weeks of randomization) * At least 2 elevated serum alanine aminotransferase (ALT) levels (\> 30 U/L for males, \>20 U/L for females) 4 weeks apart, and no more than 32 weeks apart, with the second being within 8 weeks of randomization * Compensated liver disease * No evidence of hepatocellular carcinoma (HCC) * Liver biopsy done that shows findings consistent with chronic hepatitis B with histology activity index (HAI) ≥3 (necroinflammatory component only) or Ishak fibrosis score ≥1 or both, as assessed by the local study pathologist on review of a liver biopsy done within 144 weeks of randomization * Females of child bearing potential must agree to use an adequate method of contraception throughout the study and must have a negative pregnancy test immediately prior to the start of treatment

Exclusion criteria

* Serum ALT ≥450 U/L for males and ≥300 U/L for females * Treatment with interferon or nucleos(t)ide analogues for hepatitis B within 48 weeks of randomization * More than 48 weeks of therapy with nucleos(t)ide analogues for hepatitis B at any time in the past * History of hepatic decompensation including but not limited to ascites, variceal bleeding, or hepatic encephalopathy * Known allergy or intolerance to any of the study medications * Females who are pregnant or breastfeeding * Previous organ transplantation including engrafted bone marrow transplant * Any other concomitant liver disease, including hemochromatosis, hepatitis C or D; Participants with severe steatohepatitis will be excluded (participants with non-alcoholic fatty liver disease \[NAFLD\] with steatosis only and/or mild to moderate steatohepatitis are acceptable) * Positive anti-HIV * Renal insufficiency with calculated (by Modification of Diet in Renal Disease (MDRD) method) creatinine clearance \<60 mL/min within 8 weeks prior to randomization * Platelet count \<90,000 /mm3, hemoglobin \<13 g/dL (males) or \<12 g/dL (females), absolute neutrophil count \<1500 /mm\^3 (\<1000/mm\^3 for African-Americans) within 8 weeks prior to randomization * History of active alcohol or drug abuse within 48 weeks of screening. * Pre-existing psychiatric condition(s), including but not limited to: Current moderate or severe depression as determined by the study physician, history of depression requiring hospitalization within past 10 years, history of suicidal or homicidal attempt within the past 10 years, or history of severe psychiatric disorders including but not limited to schizophrenia, psychosis, bipolar disorder * History of immune-mediated disease, or cerebrovascular, chronic pulmonary or cardiac disease associated with functional limitation, retinopathy, uncontrolled thyroid disease, poorly controlled diabetes or uncontrolled seizure disorder * Any medical condition that would be predicted to be exacerbated by therapy or that would limit study participation * Any medical condition requiring or likely to require chronic systemic administration of corticosteroids or other immunosuppressive medications during the course of this study * Evidence of active or suspected malignancy, or a history of malignancy within the last 144 weeks (except adequately treated carcinoma in situ or basal cell carcinoma of the skin) * Need for ongoing use of any antivirals with activity against HBV during the course of the study * Any other condition that in the opinion of the investigator would make the participant unsuitable for enrollment or could interfere with the participant participating in and completing the study. * Participation in any other clinical trial involving investigational drugs within 30 days of randomization or intention to participate in another clinical trial during this study.

Design outcomes

Primary

MeasureTime frameDescription
Percent of Participants With Hepatitis B Surface Antigen (HBsAg) Loss by Week 240Week 240Estimated percent of participants who became HBsAg negative by week 240 from randomization

Secondary

MeasureTime frameDescription
Number of Participants With Serious Adverse EventsUp to 240 weeksNumber of participants with at least one serious adverse event between randomization and week 240
Number of Participants With Adverse Eventsup to 240 weeksNumber of participants with at least one adverse event between randomization and week 240
Number of Participants With Hepatitis B e Antigen (HBeAg) Loss at Week 192week 192Number of participants who became Hepatitis B e antigen (HBeAg) negative at week 192 among HBeAg positive participants at randomization (baseline)
Number of Participants With HBeAg Loss at Week 240week 240Number of participants who became HBeAg negative at week 240 among HBeAg positive participants at baseline
Number of Participants With HBsAg Seroconversion at Week 192week 192Number of participants who became with HBsAg negative and developed anti-HBs at week 192
Number of Participants With HBsAg Seroconversion at Week 240week 240Number of participants who became HBsAg negative and developed anti-HBs at week 240
Number of Participants With HBeAg Seroconversion at Week 192week 192Number of participants who became HBeAg negative and developed anti-HBe at week 192 among HBeAg positive participants at baseline
Number of Participants With HBeAg Seroconversion at Week 240week 240Number of participants who became HBeAg negative and developed anti-HBe at week 240 among HBeAg positive participants at baseline
Cumulative Percent of Participants With HBsAg Loss at Week 192Week 192Cumulative percentage of participants with HBsAg loss at week 192 estimated using Kaplan-Meier method
Number of Participants With Normal Alanine Transaminase (ALT) Levels at Week 240week 240Number of participants with normal alanine transaminase (ALT) levels \[males ≤30 U/L, for females ≤20 U/L\] at week 240
Number of Participants With HBV DNA<1000 IU/mL at Week 192week 192Number of participants with HBV DNA \<1000 IU/mL at week 192
Number of Participants With HBV DNA<1000 IU/mL at Week 240week 240Number of participants with HBV DNA \<1000 IU/mL at week 240
Number of Participants With HBV DNA<20 IU/mL at Week 192week 192Number of participants with HBV DNA\<20 IU/mL at week 192
Number of Participants With HBV DNA<20 IU/mL at Week 240week 240Number of participants with HBV DNA\<20 IU/mL at week 240
Absence of Detectable Antiviral Drug-Resistant HBV Mutations at Week 192week 192Absence of detectable antiviral drug-resistant HBV mutations at Week 192
Cumulative Percent of Participants With HBsAg Loss at Week 240Week 240Cumulative percent of participants with HBsAg loss at week 240 estimated using Kaplan-Meier method
Number of Participants With Alanine Transaminase(ALT) Levels <= 38 U/L for Males and <=25 for Females at Week 192week 192Number of participants with alanine transaminase(ALT) levels \<= 38 U/L for males and \<=25 for females at week 192. The cut-offs 38 and 25 are approximately 1.25 times the upper limit of normal (30 U/L for males and 20 U/L for females) respectively.
Number of Participants With Normal Alanine Transaminase (ALT) Levels at Week 192week 192Number of participants with normal alanine transaminase (ALT) levels at week 192 (Normal ALT for males ≤30 U/L, for females ≤20 U/L)

Countries

Canada, United States

Participant flow

Participants by arm

ArmCount
Tenofovir
Tenofovir 192 weeks Tenofovir: 300 mg daily for 192 weeks (4 years)
102
Peginterferon-alfa 2a and Tenofovir
A combination of peginterferon-alfa 2a plus tenofovir for 24 weeks and then tenofovir only for 168 weeks Peginterferon-alfa 2a and tenofovir: A combination of peginterferon-alfa 2a 180 µg weekly plus tenofovir 300 mg daily for 24 weeks and then only tenofovir 300 mg daily for 168 weeks (3.5 years).
99
Total201

Baseline characteristics

CharacteristicTenofovirPeginterferon-alfa 2a and TenofovirTotal
Age, Continuous41 years41 years41 years
Albumin4.2 g/dL4.3 g/dL4.3 g/dL
ALT81 U/L71 U/L75 U/L
Body Mass Index25 kg/m^224 kg/m^224 kg/m^2
Bridiging Fibrosis or Cirrhosis (Ishak score 5-6)7 Participants7 Participants14 Participants
Creatinine clearance106 mL/min/1.73m296 mL/min/1.73m2101 mL/min/1.73m2
HBeAg Positive54 Participants50 Participants104 Participants
HBV DNA6.7 log10 IU/mL6.3 log10 IU/mL6.5 log10 IU/mL
Hemoglobin14.8 g/dL14.5 g/dL14.6 g/dL
Hepatitis B Virus (HBV) Genotype
A1
8 Participants4 Participants12 Participants
Hepatitis B Virus (HBV) Genotype
A2
7 Participants5 Participants12 Participants
Hepatitis B Virus (HBV) Genotype
B
37 Participants50 Participants87 Participants
Hepatitis B Virus (HBV) Genotype
C
32 Participants36 Participants68 Participants
Hepatitis B Virus (HBV) Genotype
D
12 Participants1 Participants13 Participants
Hepatitis B Virus (HBV) Genotype
E
5 Participants3 Participants8 Participants
Hepatitis B Virus (HBV) Genotype
F
1 Participants0 Participants1 Participants
Necroinflammatory Activity (HAI>= 3)97 Participants96 Participants193 Participants
Platelet Count192 cells X 10^3/mm^3196 cells X 10^3/mm^3193 cells X 10^3/mm^3
Quantitative HBeAg (qHBeAg) level3.0 log10 IU/mL2.6 log10 IU/mL2.9 log10 IU/mL
Quantitative HBsAg level3.9 log10 IU/mL3.6 log10 IU/mL3.8 log10 IU/mL
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
80 Participants85 Participants165 Participants
Race (NIH/OMB)
Black or African American
9 Participants7 Participants16 Participants
Race (NIH/OMB)
More than one race
2 Participants0 Participants2 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
2 Participants0 Participants2 Participants
Race (NIH/OMB)
White
9 Participants7 Participants16 Participants
Region of Enrollment
Canada
21 Participants22 Participants43 Participants
Region of Enrollment
United States
81 Participants77 Participants158 Participants
Sex: Female, Male
Female
31 Participants40 Participants71 Participants
Sex: Female, Male
Male
71 Participants59 Participants130 Participants
Total Bilirubin0.6 mg/dL0.7 mg/dL0.6 mg/dL
White Cell Count5.6 cells X 10^3/mm^35.2 cells X 10^3/mm^35.3 cells X 10^3/mm^3

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 1020 / 99
other
Total, other adverse events
50 / 10260 / 99
serious
Total, serious adverse events
11 / 1027 / 99

Outcome results

Primary

Percent of Participants With Hepatitis B Surface Antigen (HBsAg) Loss by Week 240

Estimated percent of participants who became HBsAg negative by week 240 from randomization

Time frame: Week 240

Population: This outcome is analyzed as a survival outcome with proportion estimated at week 240 using Kaplan-Meier Method

ArmMeasureValue (NUMBER)
TenofovirPercent of Participants With Hepatitis B Surface Antigen (HBsAg) Loss by Week 2404.1 Percentage of participants
Peginterferon-alfa 2a and TenofovirPercent of Participants With Hepatitis B Surface Antigen (HBsAg) Loss by Week 2405.2 Percentage of participants
p-value: 0.72Wald test
Secondary

Absence of Detectable Antiviral Drug-Resistant HBV Mutations at Week 192

Absence of detectable antiviral drug-resistant HBV mutations at Week 192

Time frame: week 192

Population: The anti-viral drug resistance test was not done

Secondary

Cumulative Percent of Participants With HBsAg Loss at Week 192

Cumulative percentage of participants with HBsAg loss at week 192 estimated using Kaplan-Meier method

Time frame: Week 192

ArmMeasureValue (NUMBER)
TenofovirCumulative Percent of Participants With HBsAg Loss at Week 1921.0 Cumulative percentage of participants
Peginterferon-alfa 2a and TenofovirCumulative Percent of Participants With HBsAg Loss at Week 1925.2 Cumulative percentage of participants
p-value: 0.09Wald Test
Secondary

Cumulative Percent of Participants With HBsAg Loss at Week 240

Cumulative percent of participants with HBsAg loss at week 240 estimated using Kaplan-Meier method

Time frame: Week 240

ArmMeasureValue (NUMBER)
TenofovirCumulative Percent of Participants With HBsAg Loss at Week 2404.1 percentage of participants
Peginterferon-alfa 2a and TenofovirCumulative Percent of Participants With HBsAg Loss at Week 2405.2 percentage of participants
p-value: 0.66Log Rank
Secondary

Number of Participants With Adverse Events

Number of participants with at least one adverse event between randomization and week 240

Time frame: up to 240 weeks

Population: All randomized participants

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With Adverse Events50 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With Adverse Events60 Participants
p-value: 0.12Fisher Exact
Secondary

Number of Participants With Alanine Transaminase(ALT) Levels <= 38 U/L for Males and <=25 for Females at Week 192

Number of participants with alanine transaminase(ALT) levels \<= 38 U/L for males and \<=25 for females at week 192. The cut-offs 38 and 25 are approximately 1.25 times the upper limit of normal (30 U/L for males and 20 U/L for females) respectively.

Time frame: week 192

Population: Participants with ALT data at week 192

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With Alanine Transaminase(ALT) Levels <= 38 U/L for Males and <=25 for Females at Week 19258 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With Alanine Transaminase(ALT) Levels <= 38 U/L for Males and <=25 for Females at Week 19272 Participants
p-value: 0.01Fisher Exact
Secondary

Number of Participants With HBeAg Loss at Week 240

Number of participants who became HBeAg negative at week 240 among HBeAg positive participants at baseline

Time frame: week 240

Population: Participants who were HBeAg positive at baseline and who had data for HBeAg at week 240 visit

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With HBeAg Loss at Week 24019 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With HBeAg Loss at Week 24028 Participants
p-value: 0.039Fisher Exact
Secondary

Number of Participants With HBeAg Seroconversion at Week 192

Number of participants who became HBeAg negative and developed anti-HBe at week 192 among HBeAg positive participants at baseline

Time frame: week 192

Population: HBeAg positives at baseline with HBeAg and anti-HBe data available at week 192

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With HBeAg Seroconversion at Week 1928 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With HBeAg Seroconversion at Week 19216 Participants
p-value: 0.06Fisher Exact
Secondary

Number of Participants With HBeAg Seroconversion at Week 240

Number of participants who became HBeAg negative and developed anti-HBe at week 240 among HBeAg positive participants at baseline

Time frame: week 240

Population: HBeAg positive participants at baseline with HBeAg and anti-HBe data at week 240

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With HBeAg Seroconversion at Week 24014 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With HBeAg Seroconversion at Week 24015 Participants
p-value: 0.66Fisher Exact
Secondary

Number of Participants With HBsAg Seroconversion at Week 192

Number of participants who became with HBsAg negative and developed anti-HBs at week 192

Time frame: week 192

Population: Participants with data on HBsAg and anti-HBs at week 192

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With HBsAg Seroconversion at Week 1921 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With HBsAg Seroconversion at Week 1924 Participants
p-value: 0.2Fisher Exact
Secondary

Number of Participants With HBsAg Seroconversion at Week 240

Number of participants who became HBsAg negative and developed anti-HBs at week 240

Time frame: week 240

Population: HBsAg and antiHBs data at week 240

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With HBsAg Seroconversion at Week 2402 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With HBsAg Seroconversion at Week 2404 Participants
p-value: 0.44Fisher Exact
Secondary

Number of Participants With HBV DNA<1000 IU/mL at Week 192

Number of participants with HBV DNA \<1000 IU/mL at week 192

Time frame: week 192

Population: Participants with HBV DNA data at week 192

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With HBV DNA<1000 IU/mL at Week 19295 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With HBV DNA<1000 IU/mL at Week 19290 Participants
p-value: >0.99Fisher Exact
Secondary

Number of Participants With HBV DNA<1000 IU/mL at Week 240

Number of participants with HBV DNA \<1000 IU/mL at week 240

Time frame: week 240

Population: Participants with HBV DNA data available at week 240

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With HBV DNA<1000 IU/mL at Week 24066 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With HBV DNA<1000 IU/mL at Week 24065 Participants
p-value: 0.87Fisher Exact
Secondary

Number of Participants With HBV DNA<20 IU/mL at Week 192

Number of participants with HBV DNA\<20 IU/mL at week 192

Time frame: week 192

Population: Participants with HBV DNA data at week 192

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With HBV DNA<20 IU/mL at Week 19282 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With HBV DNA<20 IU/mL at Week 19287 Participants
p-value: 0.02Fisher Exact
Secondary

Number of Participants With HBV DNA<20 IU/mL at Week 240

Number of participants with HBV DNA\<20 IU/mL at week 240

Time frame: week 240

Population: Participants with HBV DNA data at week 240

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With HBV DNA<20 IU/mL at Week 24046 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With HBV DNA<20 IU/mL at Week 24048 Participants
p-value: 0.66Fisher Exact
Secondary

Number of Participants With Hepatitis B e Antigen (HBeAg) Loss at Week 192

Number of participants who became Hepatitis B e antigen (HBeAg) negative at week 192 among HBeAg positive participants at randomization (baseline)

Time frame: week 192

Population: Among HBeAg positive participants at baseline who had HBeAg data available at week 192

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With Hepatitis B e Antigen (HBeAg) Loss at Week 19214 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With Hepatitis B e Antigen (HBeAg) Loss at Week 19229 Participants
p-value: 0.002Fisher Exact
Secondary

Number of Participants With Normal Alanine Transaminase (ALT) Levels at Week 192

Number of participants with normal alanine transaminase (ALT) levels at week 192 (Normal ALT for males ≤30 U/L, for females ≤20 U/L)

Time frame: week 192

Population: Participants with ALT data at week 192

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With Normal Alanine Transaminase (ALT) Levels at Week 19237 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With Normal Alanine Transaminase (ALT) Levels at Week 19251 Participants
p-value: 0.02Fisher Exact
Secondary

Number of Participants With Normal Alanine Transaminase (ALT) Levels at Week 240

Number of participants with normal alanine transaminase (ALT) levels \[males ≤30 U/L, for females ≤20 U/L\] at week 240

Time frame: week 240

Population: Participants with ALT data at week 240

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With Normal Alanine Transaminase (ALT) Levels at Week 24038 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With Normal Alanine Transaminase (ALT) Levels at Week 24041 Participants
p-value: 0.55Fisher Exact
Secondary

Number of Participants With Serious Adverse Events

Number of participants with at least one serious adverse event between randomization and week 240

Time frame: Up to 240 weeks

Population: All randomized participants

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
TenofovirNumber of Participants With Serious Adverse Events11 Participants
Peginterferon-alfa 2a and TenofovirNumber of Participants With Serious Adverse Events7 Participants
p-value: 0.46Fisher Exact

Source: ClinicalTrials.gov · Data processed: Feb 10, 2026