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    Clinical Trial Results:
    A Phase IIb, Open Label, Single Arm, Multicenter Study to Evaluate the Effect of 48-weeks Peginterferon alfa-2a (PEG-IFN) Administration on Serum HBsAg in Chronic Hepatitis B, HBeAg-Negative, Genotype D Patients on Treatment with Nucleos(t)ide Analogues (NAs), Showing Stable HBV DNA Suppression.

    Summary
    EudraCT number
    2012-000080-25
    Trial protocol
    IT  
    Global end of trial date
    25 Nov 2014

    Results information
    Results version number
    v1
    This version publication date
    10 Jul 2016
    First version publication date
    10 Jul 2016
    Other versions
    v2

    Trial information

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    Trial identification
    Sponsor protocol code
    ML28262
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01706575
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    F. Hoffmann-La Roche AG
    Sponsor organisation address
    Grenzacherstrasse 124, Basel, Switzerland, CH-4070
    Public contact
    F. Hoffmann-La Roche AG, F. Hoffmann-La Roche AG, +41 616878333, global.trial_information@roche.com
    Scientific contact
    F. Hoffmann-La Roche AG, F. Hoffmann-La Roche AG, +41 616878333, global.trial_information@roche.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Interim
    Date of interim/final analysis
    18 Dec 2014
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    30 Sep 2013
    Global end of trial reached?
    Yes
    Global end of trial date
    25 Nov 2014
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the decline in serum Hepatitis B surface Antigen (HBsAg) at the end of combination treatment with Pegylated Interferon (Peginterferon) Alfa-2a (PEG-IFN) and nucleos(t)ide analogues (NA) (Study Week 48).
    Protection of trial subjects
    All study subjects were required to read and sign an informed consent form.
    Background therapy
    Subjects continued to nucleos(t)ide analogues (NA) therapy along with the study medication.
    Evidence for comparator
    -
    Actual start date of recruitment
    24 Jan 2013
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy
    Long term follow-up duration
    11 Months
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Italy: 76
    Worldwide total number of subjects
    76
    EEA total number of subjects
    76
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    76
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A total of 76 subjects started the study and were included in lead-in period. Out of 76 subjects, 70 received study drug. Data is reported here for the interim analysis (up to 48 weeks).

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Pegylated Interferon (Peginterferon) Alfa-2a
    Arm description
    Subjects receiving nucleos(t)ide analogues (NA) therapy with Hepatitis B surface Antigen (HBsAg) decline less than (<) 0.5 log 10 international unit/milliliter (IU/ml) at baseline received peginterferon alfa-2a 180 microgram (mcg), subcutaneously (SC) once weekly for 48 weeks along with their NA therapy.
    Arm type
    Experimental

    Investigational medicinal product name
    Pegylated Interferon (Peginterferon) Alfa-2a
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Peginterferon alfa-2a 180 mcg, subcutaneously (SC) once weekly for 48 weeks.

    Number of subjects in period 1
    Pegylated Interferon (Peginterferon) Alfa-2a
    Started
    76
    Completed
    46
    Not completed
    30
         Lack of Compliance
    1
         Started but not Treated
    6
         Subject Withdrew Consent
    2
         Adverse Event
    8
         No HBsAg Decrease at Week 24
    11
         Reason not Specified
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Pegylated Interferon (Peginterferon) Alfa-2a
    Reporting group description
    Subjects receiving nucleos(t)ide analogues (NA) therapy with Hepatitis B surface Antigen (HBsAg) decline less than (<) 0.5 log 10 international unit/milliliter (IU/ml) at baseline received peginterferon alfa-2a 180 microgram (mcg), subcutaneously (SC) once weekly for 48 weeks along with their NA therapy.

    Reporting group values
    Pegylated Interferon (Peginterferon) Alfa-2a Total
    Number of subjects
    76 76
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    30.98 ± 12.33 -
    Gender categorical
    Units: Subjects
        Female
    13 13
        Male
    63 63

    End points

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    End points reporting groups
    Reporting group title
    Pegylated Interferon (Peginterferon) Alfa-2a
    Reporting group description
    Subjects receiving nucleos(t)ide analogues (NA) therapy with Hepatitis B surface Antigen (HBsAg) decline less than (<) 0.5 log 10 international unit/milliliter (IU/ml) at baseline received peginterferon alfa-2a 180 microgram (mcg), subcutaneously (SC) once weekly for 48 weeks along with their NA therapy.

    Primary: Efficacy: Percent Change From Baseline in Serum Hepatitis B Surface Antigen (HBsAg) Titer at End of the Combination Treatment (Week 48)

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    End point title
    Efficacy: Percent Change From Baseline in Serum Hepatitis B Surface Antigen (HBsAg) Titer at End of the Combination Treatment (Week 48) [1]
    End point description
    Intent to Treat (ITT) population included all subjects who received at least one dose of study drug. Here number of subjects analyzed is total number of subjects who were evaluable for this outcome measure.
    End point type
    Primary
    End point timeframe
    Baseline up to Week 48
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Statistical analysis was not performed as planned.
    End point values
    Pegylated Interferon (Peginterferon) Alfa-2a
    Number of subjects analysed
    69
    Units: percent change
        arithmetic mean (standard deviation)
    54.97 ± 31.29
    No statistical analyses for this end point

    Primary: Efficacy: Percentage of Subjects With Serum Hepatitis B Surface Antigen (HBsAg) Decrease >/= 50% From Baseline at End of the Combination Treatment (Week 48)

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    End point title
    Efficacy: Percentage of Subjects With Serum Hepatitis B Surface Antigen (HBsAg) Decrease >/= 50% From Baseline at End of the Combination Treatment (Week 48) [2]
    End point description
    Subject who stopped pegylated interferon (PEG-IFN) treatment during the add-on phase due to serum HBsAg loss and HBsAg seroconversion were considered as responders. ITT population included all subjects who received at least one dose of study drug. Here number of subjects analyzed is total number of subjects who were evaluable for this outcome measure. The Last Observation Carried Forward (LOCF) approach was applied to lost-to-follow-up subjects without efficacy measurement at week 48.
    End point type
    Primary
    End point timeframe
    Baseline and Week 48
    Notes
    [2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Statistical analysis was not performed as planned.
    End point values
    Pegylated Interferon (Peginterferon) Alfa-2a
    Number of subjects analysed
    69
    Units: percentage of subjects
        number (not applicable)
    43.48
    No statistical analyses for this end point

    Secondary: Number of Subjects With Adverse Events (AE)

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    End point title
    Number of Subjects With Adverse Events (AE)
    End point description
    An AE is defined as any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. Safety population included all subjects who received least one dose of the study drug and had at least one post-dose safety assessment.
    End point type
    Secondary
    End point timeframe
    Baseline up to Week 48
    End point values
    Pegylated Interferon (Peginterferon) Alfa-2a
    Number of subjects analysed
    70
    Units: subjects
        number (not applicable)
    62
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Baseline up to Week 48
    Adverse event reporting additional description
    Safety population included all subjects who received least one dose of the study drug and had at least one post-dose safety assessment.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    15.1
    Reporting groups
    Reporting group title
    Pegylated Interferon (Peginterferon) Alfa-2a
    Reporting group description
    Subjects receiving nucleos(t)ide analogues (NA) therapy with Hepatitis B surface Antigen (HBsAg)decline less than <0.5 log 10 international unit/milliliter (IU/ml) at baseline received peginterferon alfa-2a 180 microgram (mcg), subcutaneously (SC) once weekly for 48 weeks along with their NA therapy.

    Serious adverse events
    Pegylated Interferon (Peginterferon) Alfa-2a
    Total subjects affected by serious adverse events
         subjects affected / exposed
    5 / 70 (7.14%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Squamous cell carcinoma of skin
         subjects affected / exposed
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Thyroid cancer
         subjects affected / exposed
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Rib fracture
         subjects affected / exposed
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Lymphadenopathy
         subjects affected / exposed
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Haemoptysis
         subjects affected / exposed
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Intervertebral disc protrusion
         subjects affected / exposed
    1 / 70 (1.43%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Pegylated Interferon (Peginterferon) Alfa-2a
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    56 / 70 (80.00%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    17 / 70 (24.29%)
         occurrences all number
    38
    Blood and lymphatic system disorders
    Thrombocytopenia
         subjects affected / exposed
    7 / 70 (10.00%)
         occurrences all number
    8
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    26 / 70 (37.14%)
         occurrences all number
    38
    Irritability
         subjects affected / exposed
    6 / 70 (8.57%)
         occurrences all number
    6
    Pyrexia
         subjects affected / exposed
    18 / 70 (25.71%)
         occurrences all number
    27
    Not coded yet
         subjects affected / exposed
    13 / 70 (18.57%)
         occurrences all number
    18
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    5 / 70 (7.14%)
         occurrences all number
    6
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    4 / 70 (5.71%)
         occurrences all number
    4
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    4 / 70 (5.71%)
         occurrences all number
    4
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    6 / 70 (8.57%)
         occurrences all number
    7
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    6 / 70 (8.57%)
         occurrences all number
    6
    Back pain
         subjects affected / exposed
    6 / 70 (8.57%)
         occurrences all number
    6
    Musculoskeletal pain
         subjects affected / exposed
    10 / 70 (14.29%)
         occurrences all number
    14
    Myalgia
         subjects affected / exposed
    14 / 70 (20.00%)
         occurrences all number
    19
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    4 / 70 (5.71%)
         occurrences all number
    4

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    29 May 2014
    1. Amendment was released to recalculate the sample size. 2. This descriptive analysis of the reduction of HBsAg at week 48 was also introduced with the amendment. 3. The amendment also states that subjects with HBsAg loss and seroconversion according to 2012 European Association for the Study of the Liver (EASL) Hepatitis B Virus (HBV) Guidelines during the add-on period would stop both PEG-INF and NA treatments, enter the follow-up period and be considered as responders.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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