A Novel Combination Therapeutic Strategy Aiming to Functional Cure for Chronic Hepatitis B Virus Infection (Sustained HBsAg Loss) (B)

NCT05771402 | Recruiting Phase 2 DMC

• 1 other identifier: 2023-0221
• Study Type: interventional
• Target: 120
• Locations: 1 country
• Sites: 1

Brief Summary

Hepatitis B virus (HBV) infection is a major public health threat in China. At present, a functional cure, also known as clinical cure or sustained Hepatitis B surface antigen (HBsAg) loss, is recommended as the ideal endpoint of HBV treatment. However, HBsAg loss can be achieved in less than 10% of chronic hepatitis B (CHB) patients treated with current available antiviral drug interferon (IFNα) or nucleos(t)ide analogues (NAs) monotherapy. With the support of the national major special funding for infectious diseases from "11th Five-Year Plan" to "13th Five-Year Plan", we have implemented a pioneer clinical study of sequential combination of IFNα therapy on NAs to treat NAs-treated CHB patients (ie. New Switch Study). This is the world's first clinical trial aiming to functional cure, which increased the rate of HBsAg loss to 15% in the overall population in our study, and to 30-50% among those with lower baseline HBsAg levels. How to further improve the HBsAg loss rate is an urgent issue for us. The key point of achieving functional cure is to reverse the HBV-specific T cell exhaustion and establish the long-term immune control against HBV infection. (Programmed death-1) PD-1/programmed death-ligand 1 (PD-L1) axis blockade has been demonstrated to reinvigorate exhausted CD8+ T cells, and would be a potential strategy to treat chronic HBV infection. In this study, a large multicenter prospective study will be performed to explore the safety and efficacy of a novel combination strategy involving immune checkpoint inhibitor (anti-PD-1 antibody) and IFNα in CHB patients, observe the HBsAg loss rate in NA-treated CHB patients receiving this combination strategy, evaluate the potential of breaking immune tolerance by this strategy, and further assess its efficacy to further improve the clinical cure rate on the basis of New Switch Study. Based on New Switch Study, this study further attempts to reverse T cell exhaustion in CHB patients, explore a novel platform of combination therapy development for clinical cure, and ultimately increase the HBsAg loss rate to higher than 50% in overall patients. The implementation of the project is expected to reduce the burden of HBV infection in China and contribute to the goal of global elimination of hepatitis B and C by 2030 (WHO 2030).

Conditions

Chronic Hepatitis b; Anti-PD-1 Antibody; Peg-IFNα

Outcome Measures

Primary Outcomes (12)

• Serum HBsAg

  Serum HBsAg level

  Baseline

• Serum HBsAg

  Serum HBsAg level

  24 weeks after the treatment

• Serum HBsAg

  Serum HBsAg level

  48 weeks after the treatment

• Serum HBsAg

  Serum HBsAg level

  24 weeks after the end of treatment

• Serum HBV DNA

  Serum HBV DNA level

  Baseline

• Serum HBV DNA

  Serum HBV DNA level

  24 weeks after the treatment

• Serum HBV DNA

  Serum HBV DNA level

  48 weeks after the treatment

• Serum HBV DNA

  Serum HBV DNA level

  24 weeks after the end of treatment

• Serum alanine aminotransferase (ALT)

  Serum ALT level

  Baseline

• Serum ALT

  Serum ALT level

  24 weeks after the treatment

• Serum ALT

  Serum ALT level

  48 weeks after the treatment

• Serum ALT

  Serum ALT level

  24 weeks after the end of treatment

Other Outcomes (9)

• Other HBV markers (HBsAb, HBeAg, HBeAb, and HBcAb)

  Baseline

• Other HBV markers (HBsAb, HBeAg, HBeAb, and HBcAb)

  24 weeks after the treatment

• Other HBV markers (HBsAb, HBeAg, HBeAb, and HBcAb)

  48 weeks after the treatment

Study Arms (2)

Group 1

EXPERIMENTAL

NAs combined with anti-PD-1 antibody and Peg-IFNα

Drug: Anti-PD-1 antibody; Drug: NAs; Drug: Peg-IFNα

Group 2

ACTIVE COMPARATOR

NAs combined with Peg-IFNα

Drug: NAs; Drug: Peg-IFNα

Interventions

Anti-PD-1 antibody DRUG

Once/two or three weeks, dose lower than the dose used in cancer patients, subcutaneous/intravenous injection

Group 1

NAs DRUG

Once/day, 1 capsule/time, oral

Also known as: ETV/TDF/TAF

Group 1; Group 2

Peg-IFNα DRUG

Once/week, 180μg/time, subcutaneous injection

Group 1; Group 2

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• \) 18-70 years old. The weight of male subjects is not less than 45 kg, and the weight of female subjects is not less than 40 kg. Body mass index (BMI) is within the range of 18-32 kg/m\^2;
• \) NAs-naive/NAs-experienced CHB patients.

You may not qualify if:

• \) A history of allergy, or who are suspected by the researcher to be allergic to the active ingredient of the drug under study or its excipients;
• \) Use of inhibitors, inducers or substrates of CYP3A4 within 28 days before enrollment;
• \) Systematical use of immunosuppressants, immunomodulators (thymosin) and cytotoxic drugs within 6 months before enrollment, or vaccination of live attenuated vaccine within 1 month before enrollment;
• \) Acute infection within 2 weeks before enrollment which requires intravenous antibiotic treatment, or existing infection which requires anti-infection treatment when enrollment;
• \) Clinically significant acute and chronic liver disease not caused by HBV infection (judged by reseachers);
• \) Confirmed or suspected decompensated cirrhosis, including but not limited to: hepatic encephalopathy, hepatorenal syndrome, bleeding from esophageal varices, splenomegaly, ascites, etc, or evidence of progressive liver fibrosis;
• \) Primary liver cancer, or alpha-fetoprotein (AFP) is greater than 50 ug/L or imaging suggests the possibility of malignant liver lesions, or other malignant tumors or a history of other malignant tumors within 5 years before enrollment (except that the malignant tumors have been completely relieved after treatment and patients have not received additional medical or surgical intervention within 3 years before screening);
• \) A history of pathological fracture or osteoporosis;
• \) Gastrointestinal dysfunction or gastrointestinal diseases that might affect the absorption of oral drugs, such as severe gastric ulcer, erosive gastritis, partial gastrectomy, and persistent gastrointestinal symptoms (such as nausea, vomiting, or diarrhea) \>2 grades;
• \) Serious diseases of circulatory, respiratory, urinary, blood, metabolic, immune, mental, neurological, renal and other systems;
• \) Major trauma or major surgery within 3 months before enrollment, or planned surgery during the study period;
• \) Blood donation/loss ≥ 400 mL within 3 months before enrollment, or given a blood transfusion within 3 months before enrollment, or blood donation/loss ≥ 200 mL within 1 month before enrollment;
• \) Platelet count\<90 × 10\^9/L, white blood cell count\<3.0 × 10\^9/L, neutrophil count\<1.3 × 10\^9/L, total serum bilirubin\>2 × upper limit of normal (ULN), albumin\<30 g/L, creatinine clearance ≤ 60 mL/min (calculated by CKD-EPI formula), or international normalized ratio of prothrombin time (INR)\>1.5 (unless receiving stable anticoagulant therapy);
• \) Hepatitis C virus (HCV) antibody (+), HIV antigen/antibody (+), or treponema pallidum antibody (+) and rapid plasma regain (RPR) test (+);
• \) A history of continuous alcohol abuse within 3 years before enrollment (average daily alcohol consumption exceeds 20 gram);

Sponsors & Collaborators

• The Second Affiliated Hospital of Chongqing Medical University: lead
• The Affiliated Hospital Of Southwest Medical University: collaborator
• Guizhou Provincial People's Hospital: collaborator
• Chongqing Three Gorges Central Hospital: collaborator
• First Affiliated Hospital of Chongqing Medical University: collaborator

Study Sites (1)

The 2nd affiliated Hospital of Chongqing Medical University

Chongqing, Chongqing Municipality, 400010, China

RECRUITING

MeSH Terms

Conditions

Hepatitis B, Chronic

Interventions

spartalizumab; nas

Condition Hierarchy (Ancestors)

Hepatitis B; Blood-Borne Infections; Communicable Diseases; Infections; Hepadnaviridae Infections; DNA Virus Infections; Virus Diseases; Hepatitis, Viral, Human; Hepatitis, Chronic; Hepatitis; Liver Diseases; Digestive System Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Hong Ren, MM

  The Second Affiliated Hospital of Chongqing Medical University

  STUDY DIRECTOR

Central Study Contacts

Dachuan Cai, MD

CONTACT

+86 18323409779; cqmucdc@cqmu.edu.cn

Min Chen, PhD

CONTACT

+86 17338600343; mchen@hospital.cqmu.edu.cn

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 23, 2023
• First Posted: March 16, 2023
• Study Start: October 10, 2023
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026
• Last Updated: September 11, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)