Efficacy of Switching or Adding Pegylated Interferon in Chronic Hepatitis B Patients on Long Term Oral Antiviral Therapy
Summary
Patients with Chronic Hepatitis B on long term oral antiviral therapy have to continue treatment indefinitely unless they achieve HBeAg seroconversion or HBsAg seroclearance, when therapy can be stopped. While HBeAg seroconversion is a more achievable endpoint, only 20-25% of patients develop this after one year of oral antiviral therapy. HBsAg seroclearance is universally infrequent. Strategies to improve these endpoints such as combination oral antiviral therapy have not been generally successful and recently studies have examined the possibility of switching or adding peginterferon therapy. However these have not been tested adequately in the group of patients that have been on long term oral antiviral therapy. Consequently this study was conceived to evaluate whether switching or adding peginterferon compared to continuing oral antiviral therapy are more efficacious strategies. HBeAg positive and HBeAg negative patients (n=310)will be randomised to continue oral antiviral therapy, switch or add pegylated interferon for 48 weeks in a ratio of 1:2:2 respectively. The study endpoints are HBsAg seroclearance, reduction of qHBsAg \>1 log, qHBsAg\<200 IU/ml, HBeAg loss and seroconversion, and HBV DNA suppression, all at week 72.
Timeline
- Start
- 2014-01
- Primary completion
- 2018-12
- Completion
- 2018-12
Publications
- Huang DQ, Shen L, Phyo WW, Cloherty G, Butler EK, Kuhns MC, McNamara AL, Holzmayer V, Gersch J, Anderson M, Yang WL, Ngu JH, Chang J, Tan J, Ahmed T, Dan YY, Lee YM, Lee GH, Tan PS, Muthiah M, Khine HTW, Lee C, Tay A, Lim SG. Quantitative HBeAg is a strong predictor of HBeAg loss among patients receiving pegylated interferon. Antiviral Res. 2024 Jul;227:105876. doi: 10.1016/j.antiviral.2024.105876. Epub 2024 Apr 17.
- Lim SG, Yang WL, Ngu JH, Chang J, Tan J, Ahmed T, Dan YY, Lim K, Lee YM, Lee GH, Tan PS, Wai KL, Phyo WW, Khine HHTW, Lee C, Tay A, Chan E. Switching to or Add-on Peginterferon in Patients on Nucleos(t)ide Analogues for Chronic Hepatitis B: The SWAP RCT. Clin Gastroenterol Hepatol. 2022 Feb;20(2):e228-e250. doi: 10.1016/j.cgh.2021.04.031. Epub 2021 Apr 22.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Adefovir | Unknown | 10 mg | Oral |
| Subject | Entecavir | Small molecule | 0.5 mg | Oral |
| Subject | Entecavir | Small molecule | 1 mg | Oral |
| Subject | Lamivudine | Other / unclassified | 100 mg | Oral |
| Subject | Peginterferon alfa-2b | Protein / enzyme biologic | 1.5 ug/kg | — |
| Subject | Tenofovir | Small molecule | 300 mg | Oral |