Maternal Antiviral Prophylaxis to Prevent Perinatal Transmission of Hepatitis B Virus in Thailand (iTAP)

This study is currently recruiting participants.
Verified July 2013 by Institut de Recherche pour le Developpement
Sponsor:
Collaborators:
Gilead Sciences
Information provided by (Responsible Party):
Gonzague Jourdain, Institut de Recherche pour le Developpement
ClinicalTrials.gov Identifier:
NCT01745822
First received: December 6, 2012
Last updated: February 25, 2014
Last verified: July 2013

December 6, 2012
February 25, 2014
January 2013
September 2015   (final data collection date for primary outcome measure)
Infant's Hepatitis B infection status at 6 months of age [ Time Frame: 6 months of age ] [ Designated as safety issue: No ]
defined as HBsAg positive confirmed by HBV DNA
Infant's Hepatitis B infection status, defined as HBsAg positive confirmed by HBV DNA [ Time Frame: 6 months of age ] [ Designated as safety issue: No ]
Complete list of historical versions of study NCT01745822 on ClinicalTrials.gov Archive Site
  • Adverse events [ Time Frame: from enrollment (28 weeks' gestation) to 12 months postpartum ] [ Designated as safety issue: Yes ]
    Occurrence of maternal and infant adverse events, including maternal and infants Serious Adverse Events (as defined by the International Conference on Harmonization Good Clinical Practice) and NIH Division of AIDS grade 3/4 signs and symptoms, regardless of their relatedness to the study treatment.
  • Flares after study treatment interruption [ Time Frame: Following planned discontinuation of study treatment up to 12 months postpartum ] [ Designated as safety issue: Yes ]
    Flare, or acute exacerbation of hepatitis B, after study treatment interruption is defined as an Alanine Aminotransferase plasma level above 300 IU/mL
  • Infant's HBV infection status [ Time Frame: at or after 6 months through 12 months of age ] [ Designated as safety issue: No ]
    Infants will be considered HBV infected if at any time point at or after 6 months through 12 months of age, a sample tests positive for HBsAg and HBV DNA
  • Infant growth related outcomes, including weight, height and HC Z-scores [ Time Frame: at 6 months and 12 months of age ] [ Designated as safety issue: Yes ]
  • Occurrence of maternal and infant adverse events (AE), including ICH Maternal and Infants Serious Adverse Events and DAIDS grade 3/4 signs and symptoms, regardless of their relatedness to the study treatment. [ Time Frame: from enrollment to 12 months postpartum ] [ Designated as safety issue: Yes ]
  • Occurrence of acute exacerbation of hepatitis B after study treatment interruption [ Time Frame: Following planned discontinuation of study treatment up to 12 months postpartum ] [ Designated as safety issue: Yes ]
    The acute exacerbation or flare of hepatitis B is defined as ALT more than 10 times Upper Limit of Normal (ULN) and more than twice the baseline value
  • Infant's HBV infection status, defined as HBsAg positive confirmed by HBV DNA, [ Time Frame: at or after 6 months through 12 months of age ] [ Designated as safety issue: No ]
  • Infant growth related outcomes, including weight, height and HC Z-scores [ Time Frame: at 6 months and 12 months of age ] [ Designated as safety issue: Yes ]
Not Provided
Not Provided
 
Maternal Antiviral Prophylaxis to Prevent Perinatal Transmission of Hepatitis B Virus in Thailand
Phase 3, Randomized Clinical Trial to Assess the Efficacy and Safety of Tenofovir in Hepatitis B Virus Infected, s and e Antigen Positive, Pregnant Women to Prevent Perinatal Transmission Despite Infant Passive-active HBV Immunization.

Chronic hepatitis B (CHB) infection is complicated by cirrhosis and liver cancer. In Thailand, 7% of adults are chronically infected by Hepatitis B virus (HBV). The risk of perinatal transmission of HBV is about 12% when a mother has a high HBV load in her plasma, even if her infant receive specific immunoglobulin and vaccine.

The hypothesis of this study is that a potent antiviral, tenofovir, can decrease HBV load in HBV infected pregnant women and therefore reduce the risk of perinatal transmission/ Pregnant women participating in this study will receive tenofovir or placebo during the last trimester of pregnancy and two months postpartum. The risk of perinatal transmission will be compared between the two groups.

The results of the study will help define policy to manage HBV infected pregnant women to prevent perinatal transmission.

This is a phase III, placebo controlled, double blind, randomized clinical trial to assess the efficacy and safety of tenofovir disoproxil fumarate (TDF) given from 28 weeks' gestation until 2 months postpartum to pregnant women with Hepatitis B (HB) virus (HBV) chronic infection and positive for HB s and e antigen to prevent perinatal transmission of HBV to their infants. All infants will receive HBV passive (HB specific immunoglobulin) and active (vaccine) immunization.

Chronic hepatitis B (CHB) infection is complicated by cirrhosis and hepatocellular carcinoma (HCC), the 10th leading cause of death worldwide.

In 2011, about 7% of adults in Thailand were HBsAg carriers. Infant hepatitis B (HB) immunization and HB immune globulin (HBIg) administered at birth effectively prevent most mother-to-child transmission (MTCT) of HBV. However, about 12% of mothers with high load of HBV transmit the virus to their infants, despite active and passive immunization.

Studies have suggested that antiviral treatment at the end of pregnancy and during early postpartum can reduce the risk of transmission to the child. A potential limitation to this approach is the risk of hepatic disease exacerbation following discontinuation of antiviral treatment postpartum, and this risk has not been properly evaluated. No randomized clinical trials have adequately demonstrated the efficacy and safety of maternal antiviral treatment the prevention of mother to child transmission of HBV. This is the reason why this approach is not currently recommended by the Associations for the Study of Liver Diseases.

We hypothesize that a potent antiviral, tenofovir, can decrease HBV viral load in HBV infected pregnant women and therefore reduce the risk of perinatal transmission, before infants are definitely protected by passive-active immunization. We also hypothesize that only moderate exacerbations of liver disease will be observed after discontinuation of a short antiviral course (5 months). While the primary objective of the study is to assess the efficacy of tenofovir versus placebo for the prevention of perinatal transmission, an important secondary objective is the assessment of the risk of postpartum hepatic disease exacerbation.

Within 2 years, 328 women and their infants will be enrolled from public hospitals in Thailand and randomized to receive either tenofovir disoproxil fumarate or matching placebo from 28 weeks of pregnancy until 2 months postpartum. Mothers and infants will be followed until one year postpartum.

The primary endpoint will be the detection of HBsAg and HBV DNA in infants at six months of life. An interim analysis will be conducted when half of the outcomes are available.

Interventional
Phase 3
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
  • Hepatitis B Chronic Infection
  • Pregnancy
  • Drug: tenofovir disoproxil fumarate
    administration: tablet 300 mg, once a day, from enrollment at 28 weeks' gestation until 2 months postpartum
    Other Names:
    • Viread
    • TDF
    • tenofovir
  • Drug: placebo
  • Experimental: Tenofovir disoproxil fumarate
    tenofovir disoproxil fumarate, 300 mg tablets
    Intervention: Drug: tenofovir disoproxil fumarate
  • Placebo Comparator: Placebo
    matching placebo (of tenofovir disoproxil fumarate)
    Intervention: Drug: placebo

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
328
December 2016
September 2015   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Pregnancy
  • At least 18 years of age
  • Negative Human Immunodeficiency Virus (HIV) serology
  • Positive HBsAg and hepatitis B e antigen (HBeAg) tests
  • Gestational age of 28 weeks (+ or - 10 days) as determined by obstetrician
  • Alanine Aminotransferase (ALT)≤30 U/L, confirmed ≤60 U/L on a subsequent blood draw
  • Agreeing to bring their infants at the planned study visits at one study site until one year after delivery and to inform the site investigators if they plan to move to another place and not be able to return to the clinic.
  • Understanding the need for adequate infant immunization and agreeing to the blood draws from their infants and the need for close follow up to manage possible exacerbation of hepatitis.

Exclusion Criteria:

  • History of tenofovir treatment at any time, or any other anti-HBV treatment during the current pregnancy
  • Creatinine clearance <50 ml/min, calculated using the Cockcroft-Gault formula
  • Dipstick proteinuria>1+ (>30 mg/dL) or normoglycemic glucosuria confirmed on two separate occasions
  • Positive serology for Hepatitis C infection less than 12 months prior to enrollment
  • Evidence of pre-existing fetal anomalies incompatible with life
  • Any concomitant condition or treatment that, in the view of the clinical site investigator, would contraindicate participation or satisfactory follow up in the study.
  • Concurrent participation in any other clinical trial without written agreement of the two study teams
Female
18 Years and older
No
Contact: Gonzague Jourdain, MD, PhD +66818830065 Gonzague.Jourdain@ird.fr
Contact: Nicole Ngo-Giang-Huong, PharmD, PhD +66898511178 Nicole.Ngo-Giang-Huong@ird.fr
Thailand
 
NCT01745822
U01HD071889, U01HD071889
Yes
Gonzague Jourdain, Institut de Recherche pour le Developpement
Institut de Recherche pour le Developpement
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
  • Centers for Disease Control and Prevention
  • Gilead Sciences
Principal Investigator: Gonzague Jourdain, MD, PhD Institut de Recherche pour le Developpement
Institut de Recherche pour le Developpement
July 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP