This is a multicenter, open-label, randomized clinical trial to Assess Efficacy and Safety of 3 Doses of Myrcludex B for 24 Weeks in Combination with Tenofovir Compared to Tenofovir Alone to Suppress HBV Replication in Patients with Chronic Hepatitis D
This is a multicenter, open-label, randomised, phase II study. The study will be conducted in Russia and Germany. The study is designed to evaluate the benefit of 3 MXB doses versus observation in patients on background therapy with tenofovir, suffering from hepatitis delta with very limited therapeutic options; the patients will be randomized 1:1:1:1 into 3 treatment arms and an observation arm. Patients with compensated cirrhosis at screening will be stratified to allow similar distribution into each treatment arm. If patients were not receiving treatment with nucleoside/nucelotide analogue, the comparator/background drug will be initiated after the eligibility confirmation, for 12 weeks prior to randomization visit; patients who previously received tenofovir will continue the dosing; patients on different nucleoside/nucleotide analogue will be switched to tenofovir. Observation is considered an adequate control group, as daily placebo injections for 24 weeks are regarded not feasible and ethically questionable. It is planned to screen 200 patients, and 120 patients will be randomised into four treatment arms in the 1:1:1:1 ratio. * Arm A (30 patients): Myrcludex B, 2 mg/day subcutaneously (s.c.) for 24 weeks + tenofovir with a further follow-up period of 24 weeks of continued tenofovir therapy. * Arm B (30 patients): Myrcludex B, 5 mg/day subcutaneously (s.c.) for 24 weeks + tenofovir with a further follow-up period of 24 weeks of continued tenofovir therapy. * Arm C (30 patients): Myrcludex B, 10 mg/day subcutaneously (s.c.) for 24 weeks + tenofovir with a further follow-up period of 24 weeks of continued tenofovir therapy. * Arm D (30 patients): tenofovir treatment for 48 weeks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
2 mg, once daily, subcutaneously
5 mg, once daily, subcutaneously
10 mg, once daily, subcutaneously
Ifi-Institut für interdisziplinäre Medizin an der Asklepios Klinik St. Georg
Hamburg, Germany
HDV RNA Response at Week 24
HDV RNA negativation or decrease by ≥2 log10 from baseline to Week 24
Time frame: 24 weeks
Durability of HDV RNA Response
Durability of HDV RNA response to 24 weeks post treatment
Time frame: 48 weeks
Combined Response: HDV RNA Response and Normal ALT at Treatment Week 24
Combined response: HDV RNA negativation or ≥2 log decline and normal ALT at treatment week 24
Time frame: 24 weeks
Changes in ALT Values
Changes in ALT values at Week 24 and Week 48 compared to baseline.
Time frame: 24 and 48 weeks
Change (Absence of Increase) in Fibrosis Marker
Change (absence of increase) in fibrosis marker: serum alpha-2-macroglobulin at Week 24 and Week 48 compared to baseline
Time frame: 24 and 48 weeks
Change in Hepatitis B Surface Antigen
Changes in hepatitis B surface antigen (HBsAg) (defined as decline in HBsAg levels, disappearance of HBsAg and HBsAg seroconversion to anti-HBsAg) at week 24 and week 48 compared to baseline
Time frame: 24 and 48 weeks
Change in HBV DNA Levels at Week 24 and Week 48 Compared to Baseline
Change in hepatitis B virus (HBV) DNA levels at Week 24 and Week 48 compared to baseline.
Time frame: 24 and 48 weeks
Absence of a Fibrosis Progression According to the Findings of Transient Elastometry
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Enrollment
120
tenofovir disoproxil 245 mg, equivalent to tenofovir disoproxil fumarate 300 mg
Universitätsklinikum Hamburg-Eppendorf Medizinische Klinik Studienambulanz Hepatologie
Hamburg, Germany
Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover
Hanover, Germany
UniversitätsKlinikum Heidelberg - Medizinische Klinik, Abteilung Klinische Pharmakologie & Pharmakoepidemiologie
Heidelberg, Germany
State Budgetary educational institution of higher professional education "South Ural State Medical University" Ministry of healthcare
Chelyabinsk, Russia
State Autonomous Healthcare Institution "Republican Clinical Infectious Diseases Hospital named after Prof. A.F. Agafonov "(SAHI RCID)
Kazan', Russia
Federal Budget Institution of Science "Central Research Institute of Epidemiology" of The Federal Service on Customers' Rights Protection and Human Well-being Surveillance
Moscow, Russia
LLC "Clinic of Modern Medicine"
Moscow, Russia
Moscow Regional Research Clinical Institute n.a. M.F. Vladimirskiy
Moscow, Russia
State Budget Health Institution of Moscow "Infectious Clinical Hospital No. 1 of the Moscow Healthcare Department"
Moscow, Russia
...and 5 more locations
Decrease in liver stiffness and absence of a fibrosis progression according to the findings of transient elastometry (fibroscan) at week 24 compared to baseline
Time frame: 24 weeks
Number of Participants With Improvement of Histological Findings According to the Liver Biopsy Results
Change (improvement/ worsening) in fibrosis and histological activity stage according to the liver biopsy study results at week 24 compared to baseline. Liver fibrosis was evaluated by histological staging systems with stage 0 corresponding to absence of fibrosis and with the highest score (the last stage in all systems) corresponding to cirrhosis. Improvement is defined as a decrease of at least 1 point in histological staging systems; worsening is defined as an increase of at least 1 point. Data should be interpreted with caution due to low number of paired biopsies available.
Time frame: 24 weeks