The goal of this clinical trial is to evaluate the efficacy and safety of L47 in the treatment of chronic hepatitis D. Patients with compensated CHD who satisfy the eligibility criteria are stratified by the presence or absence of liver cirrhosis and randomized into three groups at a 1:1:1 ratio. The subjects will receive continuous L47 (2.1 mg/d and 4.2 mg/d, s.c.) treatment for 48 weeks (groups A and B), or delayed treatment for 48 weeks (group C). Primary endpoint evaluation will be performed after the subjects complete the 48-week treatment.
This is a three-arm, parallel-group, randomized, open-label, delayed-controlled phase IIb clinical trial. The study flow chart is shown in Fig. 1.2.1. CHD patients with compensated liver function who satisfy the eligibility criteria are stratified by the presence or absence of liver cirrhosis and randomized into the 2.1 mg group, 4.2 mg group, and delayed treatment group at a 1:1:1 ratio (Table 1.1). The subjects will receive continuous L47 (2.1 mg/d and 4.2 mg/d, s.c.) treatment for 48 weeks (groups A and B), or delayed treatment for 48 weeks (group C). The 1st interim analysis will be performed when all subjects complete the Week12 visit to determine the optimal dose for the extended treatment period following the trial. The 2nd interim analysis will be performed when all subjects complete the Week24 visit. Upon completion of the 48th week of treatment, the primary endpoint was assessed, and the trial was officially concluded. After the conclusion of the trial, all subjects in each group entered the extension treatment period and were all treated continuously with the L47 optimal dose for 96 weeks. After the extension treatment ended, all groups discontinued the medication and were observed for 48 weeks follow-up.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
90
hepalatide of 2.1 mg/d or 4.2mg/d s.c. treatment for 48 weeks
National cancer canter of Monglia
Ulaanbaatar, Mongolia
National Center for Communicable Diseases
Ulaanbaatar, Mongolia
compound response
Decrease in HDV RNV by ≥ 2 log10 from baseline and ALT normalization
Time frame: Week 48
HDV RNA below LLOQ
The incidence of subjects with HDV RNA lower than LLOQ.
Time frame: Week 48
Decrease in HDV RNA by ≥ 2 log10 from baseline or undetectable HDV RNA
The incidence of subjects with Decrease in HDV RNA by ≥ 2 log10 from baseline or undetectable HDV RNA
Time frame: Week 48
Decrease in HDV RNA from baseline
HDV RNA reduction from baseline.
Time frame: Week 48
ALT normalization
The rate of ALT relapse in subjects.
Time frame: Week 48
Decrease in ALT from baseline
ALT reduction from baseline.
Time frame: Week 48
Changes in subjects' METAVIR system scores from baseline.
The METAVIR score is a test used to determine the degree of inflammation and necrosis in the liver biopsy, as well as the extent of fibrosis. The degree of liver fibrosis is divided into five grades from F 0 to F4. The degree of inflammatory activity in liver tissue is divided into four grades from A0 to A3. Higher score means worse outcome. When the liver tissue inflammation and necrosis score decreased by ≥2 points compared with baseline (the change of inflammatory activity A value compared with baseline was ≤ -2 points), and there was no increase in liver fibrosis score; Or the liver fibrosis score decreased by ≥1 point (fibrosis stage F value change from baseline ≤ 0 points),it means Liver tissue response.
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Time frame: Week 48
Change in fibrosis 4 (FIB-4) index from baseline
Fibrosis 4(FIB-4)Index is a non-invasive method for assessing liver fibrosis in patients with chronic liver disease. The FIB-4 index is \<1.45, indicating no significant liver fibrosis or only 2nd degree or lower liver fibrosis. And the FIB-4 index\>3.25 indicates that the degree of liver fibrosis is 3-4 or higher.
Time frame: Week 48
Change in Child-Pugh score from baseline
Child-Pugh scores is a test that determines the scope and severity of liver failure as well as the prognosis for the patient. Three categories "A, B and C " indicate the severity of liver breakdown on the Child-Pugh rating scale. The higher the scale, the more serious outcomes.
Time frame: Week 48
Change in Model for End-Stage Liver Disease (MELD) score from baseline
R = 9.6 \\\* ln(serum creatinine in mg/dl) + 3.8 \\\* ln(bilirubin in mg/dl) + 11.2 \\\* ln(INR) + 6.4 \\\* cause (cause: cholestasis and alcoholic cirrhosis = 0, viral and other causes of cirrhosis = 1). The higher the R value, the greater the risk, and the lower the survival rate.
Time frame: Week 48
The incidence rate of Liver-related endpoint events.
The incidence of Liver-related endpoint events such as cirrhosis, hepatic decompensation, HCC, liver transplantation, liver-related death.
Time frame: Week 240