A Phase 2, Open-label Study to Evaluate the Safety and Efficacy of Switching to Tenofovir Alafenamide (TAF) From Tenofovir Disoproxil Fumarate (TDF) and/or Other Oral Antiviral Treatment (OAV) in Virologically Suppressed Chronic Hepatitis B Subjects With Renal and/or Hepatic Impairment
| Registry | NCT03180619 |
|---|---|
| Status | Completed |
| Phase | Phase 2 |
| Study type | Interventional; non randomized, parallel, masking: none, treatment |
| Enrollment | 124 (Actual) |
| Sponsor | Gilead Sciences (Industry) |
| Conditions | Chronic Hepatitis B |
| Interventions | TAF (Drug) |
| Dates | start 2017-06-29, primary completion 2019-03-27, completion 2020-09-04, first posted 2017-06-08, last updated 2021-09-27 |
| Locations | 30 sites in United States, Canada, Hong Kong, Italy, New Zealand, South Korea, Taiwan, United Kingdom |
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The primary objective of this study is to evaluate the safety and tolerability and virologic response of tenofovir alafenamide (TAF) in virologically suppressed chronic hepatitis B participants with renal and/or hepatic impairment.
| Arm | Type | Interventions | Description |
|---|---|---|---|
| Part A (Renal Impairment): Moderate or Severe Renal Impairment | Experimental | Drug: TAF | Participants with chronic hepatitis B (CHB) and moderate or severe renal impairment who were virologically suppressed and taking tenofovir disoproxil fumarate (TDF), a TDF-containing anti-hepatitis B virus (HBV) regimen, or other oral antivirals (OAVs), will switch to tenofovir alafenamide (TAF) and receive TAF 25 milligram (mg) tablet once daily orally for 96 weeks. |
| Part A (Renal Impairment): End Stage Renal Disease | Experimental | Drug: TAF | Participants with CHB and end stage renal disease who were virologically suppressed and taking TDF, a TDF-containing anti-HBV regimen, or OAVs, will switch to TAF and receive TAF 25 mg tablet once daily orally for 96 weeks. |
| Part B: Hepatic Impairment | Experimental | Drug: TAF | Participants with CHB and moderate or severe hepatic impairment who were virologically suppressed and taking TDF, a TDF-containing anti-HBV regimen, or OAVs, will switch to TAF and receive TAF 25 mg tablet once daily orally for 96 weeks. |
Sex: All, ages: 18 Years to any
Key Inclusion Criteria: All Participants (Parts A and B): * Adult male or non-pregnant female individuals * Documented evidence of chronic HBV infection * Alanine aminotransferase (ALT) ≤ 10 × upper limit of normal (ULN) Part A Only (renal impairment): * Maintained on TDF and/or other OAV treatment(s) for CHB for at least 48 weeks and with viral suppression (HBV deoxyribonucleic acid \[DNA\] < lower limit of quantitation \[LLOQ\]) for ≥ 6 months prior to screening * All individuals must have HBV DNA < 20 International units per milliliter (IU/mL) at screening by central laboratory * Both Hepatitis B e-Antigen (HBeAg) positive and negative individuals are eligible to participate * Moderate renal impairment (30 milliliters per minute \[mL/min\] ≤ estimated glomerular filtration rate by the cockcroft-gault formula \[eGFRcg\] ≤ 59 mL/min), severe renal impairment (15 mL/min ≤ eGFRcg < 30 mL/min) or end stage renal disease (ESRD) (eGFR < 15 mL/min) maintained on hemodialysis (HD) * Stable renal function (for participants with moderate or severe impairment): serum creatinine measured at least once within three months prior to screening. The measurement difference between the value measured within three months prior to screening versus the screening value must be ≤ 25% of the screening value Part B Only (hepatic impairment): * Maintained on TDF and/or other OAV(s) for CHB for at least 48 weeks and with viral suppression (HBV DNA < LLOQ) for ≥ 6 months prior to screening * All individuals must have HBV DNA < 20 IU/mL at screening by central laboratory * Both HBeAg positive and negative individuals are eligible to participate * Child-pugh-turcotte (CPT) score of 7-12 (inclusive) OR a past history of CPT score ≥ 7 and any CPT score ≤ 12 at screening * eGFRCG ≥ 30 mL/min using the Cockcroft-Gault equation Key Exclusion Criteria: All Individuals (Parts A \& B): * Women who are breastfeeding or who believe they may wish to become pregnant during the course of the study * Males and females of reproductive potential who are unwilling to use an "effective", protocol-specified method(s) of contraception during the study * Co-infection with hepatitis C virus (HCV), human immunodeficiency virus (HIV), or hepatitis D virus (HDV) * Prior Interferon (IFN) use within 6 months of screening * Evidence of hepatocellular carcinoma * Received solid organ or bone marrow transplant * Significant cardiovascular, pulmonary, or neurological disease * Malignancy within 5 years prior to screening, with the exception of specific cancers that are cured by surgical resection (basal cell skin cancer, etc.). Individuals under evaluation for possible malignancy are not eligible * Currently receiving therapy with immunomodulators (e.g. corticosteroids), nephrotoxic agents, or agents capable of modifying renal excretion * Known hypersensitivity to study drugs, metabolites, or formulation excipients * Current alcohol or substance abuse judged by the investigator to potentially interfere with individual's compliance * Any other clinical condition or prior therapy that, in the opinion of the Investigator, would make the individual unsuitable for the study or unable to comply with dosing requirements. Part A Only (Renal Impairment): * Current or historical evidence of clinical hepatic decompensation (e.g., ascites, encephalopathy or variceal hemorrhage) * Abnormal hematological and biochemical parameters, including: * Hemoglobin < 9 grams per deciliter (g/dL) * Absolute neutrophil count < 750/cubic millimeter (mm\^3) * Platelets ≤ 50,000/mm\^3 * Aspartate aminotransferase (AST) > 10 × ULN * Albumin < 3.0 g/dL * Total bilirubin > 2.5 × ULN * International normalized ratio of prothrombin time (INR) > 1.5 × ULN (unless stable on anticoagulant regimen) * Individuals with ESRD (i.e. eGFRcg < 15 mL/min) not on HD, or those on other forms of renal replacement therapy (i.e. peritoneal dialysis) Part B Only (Hepatic Impairment): * Active variceal bleeding within 6 months or prior placement of a portosystemic shunt (such as transjugular intrahepatic portosystemic shunt \[TIPS\]) * History of hepatorenal syndrome, hepatopulmonary syndrome, Grade 3 or Grade 4 hepatic encephalopathy, or spontaneous bacterial peritonitis within 6 months of screening * Grade 2 hepatic encephalopathy at screening * Model for end-stage liver disease (MELD) score ≥ 30 * Abnormal hematological and biochemical parameters, including * Absolute neutrophil count < 750/mm\^3 * Platelets < 30,000/mm\^3 * Hemoglobin < 8.0 g/dL Note: Other protocol defined Inclusion/Exclusion criteria may apply.
| Milestone | Part A (Renal Impairment): Moderate or Severe Renal Impairment | Part A (Renal Impairment): End Stage Renal Disease | Part B: Hepatic Impairment |
|---|---|---|---|
| Started | 78 | 15 | 31 |
| Completed | 67 | 14 | 25 |
| Not completed | 11 | 1 | 6 |
Time frame: Adverse Events: From the first dose date up to last dose date (maximum: 108.1 weeks) plus 3 days; All-Cause Mortality: Enrollment up to last dose date (maximum: 166.2 weeks) plus 3 days
| Arm | Deaths | Serious adverse events | Other adverse events |
|---|---|---|---|
| Part A (Renal Impairment): Moderate or Severe Renal Impairment | 2/78 (2.6%) | 12/78 (15.4%) | 34/78 (43.6%) |
| Part A (Renal Impairment): End Stage Renal Disease (Cohort 2) | 1/15 (6.7%) | 8/15 (53.3%) | 15/15 (100.0%) |
| Part B (Hepatic Impairment): Moderate or Severe Hepatic Impair | 2/31 (6.5%) | 10/31 (32.3%) | 23/31 (74.2%) |
| Term | Organ system | Part A (Renal Impairment): Moderate or Severe Renal Impairment | Part A (Renal Impairment): End Stage Renal Disease (Cohort 2) | Part B (Hepatic Impairment): Moderate or Severe Hepatic Impair |
|---|---|---|---|---|
| Anaemia | Blood and lymphatic system disorders | 0/78 | 1/15 | 0/31 |
| Thrombocytopenia | Blood and lymphatic system disorders | 0/78 | 1/15 | 0/31 |
| Atrial flutter | Cardiac disorders | 0/78 | 0/15 | 1/31 |
| Atrioventricular block complete | Cardiac disorders | 1/78 | 0/15 | 0/31 |
| Deafness neurosensory | Ear and labyrinth disorders | 0/78 | 1/15 | 0/31 |
| Adrenal mass | Endocrine disorders | 0/78 | 0/15 | 1/31 |
| Cataract | Eye disorders | 2/78 | 0/15 | 0/31 |
| Abdominal pain | Gastrointestinal disorders | 0/78 | 1/15 | 0/31 |
| Ascites | Gastrointestinal disorders | 0/78 | 0/15 | 1/31 |
| Colitis | Gastrointestinal disorders | 0/78 | 1/15 | 0/31 |
| Duodenal ulcer haemorrhage | Gastrointestinal disorders | 0/78 | 0/15 | 1/31 |
| Gingival bleeding | Gastrointestinal disorders | 0/78 | 0/15 | 1/31 |
| Intestinal obstruction | Gastrointestinal disorders | 0/78 | 1/15 | 0/31 |
| Upper gastrointestinal haemorrhage | Gastrointestinal disorders | 0/78 | 0/15 | 1/31 |
| Catheter site discharge | General disorders | 0/78 | 1/15 | 0/31 |
| Bile duct stone | Hepatobiliary disorders | 0/78 | 0/15 | 1/31 |
| Hepatic failure | Hepatobiliary disorders | 0/78 | 0/15 | 1/31 |
| Hepatorenal syndrome | Hepatobiliary disorders | 0/78 | 0/15 | 1/31 |
| Bacteraemia | Infections and infestations | 0/78 | 1/15 | 0/31 |
| Fungal cystitis | Infections and infestations | 0/78 | 0/15 | 1/31 |
| Lower respiratory tract infection | Infections and infestations | 0/78 | 1/15 | 0/31 |
| Lower respiratory tract infection viral | Infections and infestations | 0/78 | 1/15 | 0/31 |
| Peritonitis bacterial | Infections and infestations | 0/78 | 0/15 | 1/31 |
| Pneumonia | Infections and infestations | 2/78 | 1/15 | 0/31 |
| Sepsis | Infections and infestations | 0/78 | 1/15 | 1/31 |
| Urinary tract infection | Infections and infestations | 0/78 | 0/15 | 1/31 |
| Arteriovenous fistula site complication | Injury, poisoning and procedural complications | 0/78 | 1/15 | 0/31 |
| Arteriovenous fistula thrombosis | Injury, poisoning and procedural complications | 0/78 | 1/15 | 0/31 |
| Drain site complication | Injury, poisoning and procedural complications | 0/78 | 0/15 | 1/31 |
| Head injury | Injury, poisoning and procedural complications | 1/78 | 0/15 | 0/31 |
| Shunt occlusion | Injury, poisoning and procedural complications | 0/78 | 1/15 | 0/31 |
| Subdural haematoma | Injury, poisoning and procedural complications | 0/78 | 0/15 | 1/31 |
| Carcinoembryonic antigen increased | Investigations | 1/78 | 0/15 | 0/31 |
| Model for end stage liver disease score increased | Investigations | 0/78 | 0/15 | 1/31 |
| Hyperkalaemia | Metabolism and nutrition disorders | 1/78 | 0/15 | 0/31 |
| Back pain | Musculoskeletal and connective tissue disorders | 1/78 | 0/15 | 0/31 |
| Focal myositis | Musculoskeletal and connective tissue disorders | 0/78 | 1/15 | 0/31 |
| Bladder cancer | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | 1/78 | 0/15 | 0/31 |
| Hepatocellular carcinoma | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | 0/78 | 1/15 | 1/31 |
| Lung neoplasm malignant | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | 1/78 | 0/15 | 0/31 |
| Ovarian cancer | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | 0/78 | 1/15 | 0/31 |
| Rectal cancer | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | 1/78 | 0/15 | 0/31 |
| Encephalopathy | Nervous system disorders | 0/78 | 0/15 | 1/31 |
| Hepatic encephalopathy | Nervous system disorders | 0/78 | 0/15 | 2/31 |
| Ischaemic stroke | Nervous system disorders | 2/78 | 0/15 | 1/31 |
| Subarachnoid haemorrhage | Nervous system disorders | 1/78 | 0/15 | 1/31 |
| Bronchospasm | Respiratory, thoracic and mediastinal disorders | 0/78 | 1/15 | 0/31 |
| Dyspnoea | Respiratory, thoracic and mediastinal disorders | 0/78 | 1/15 | 0/31 |
| Haemothorax | Respiratory, thoracic and mediastinal disorders | 0/78 | 1/15 | 0/31 |
| Pleural effusion | Respiratory, thoracic and mediastinal disorders | 0/78 | 2/15 | 0/31 |
| Pneumonia aspiration | Respiratory, thoracic and mediastinal disorders | 1/78 | 0/15 | 1/31 |
| Respiratory failure | Respiratory, thoracic and mediastinal disorders | 1/78 | 0/15 | 0/31 |
| Term | Organ system | Part A (Renal Impairment): Moderate or Severe Renal Impairment | Part A (Renal Impairment): End Stage Renal Disease (Cohort 2) | Part B (Hepatic Impairment): Moderate or Severe Hepatic Impair |
|---|---|---|---|---|
| Anaemia | Blood and lymphatic system disorders | 2/78 | 3/15 | 1/31 |
| Blood loss anaemia | Blood and lymphatic system disorders | 0/78 | 1/15 | 0/31 |
| Coagulopathy | Blood and lymphatic system disorders | 0/78 | 1/15 | 0/31 |
| Thrombocytopenia | Blood and lymphatic system disorders | 0/78 | 1/15 | 1/31 |
| Thrombotic thrombocytopenic purpura | Blood and lymphatic system disorders | 0/78 | 1/15 | 0/31 |
| Deafness neurosensory | Ear and labyrinth disorders | 0/78 | 1/15 | 0/31 |
| Ear haemorrhage | Ear and labyrinth disorders | 0/78 | 1/15 | 0/31 |
| Ear pain | Ear and labyrinth disorders | 0/78 | 1/15 | 0/31 |
| Vertigo | Ear and labyrinth disorders | 1/78 | 1/15 | 0/31 |
| Cataract | Eye disorders | 1/78 | 1/15 | 1/31 |
| Cataract nuclear | Eye disorders | 0/78 | 1/15 | 0/31 |
| Conjunctival haemorrhage | Eye disorders | 0/78 | 1/15 | 1/31 |
| Iridocyclitis | Eye disorders | 0/78 | 1/15 | 0/31 |
| Abdominal pain | Gastrointestinal disorders | 2/78 | 1/15 | 2/31 |
| Abdominal pain lower | Gastrointestinal disorders | 1/78 | 1/15 | 0/31 |
| Ascites | Gastrointestinal disorders | 0/78 | 2/15 | 4/31 |
| Constipation | Gastrointestinal disorders | 2/78 | 4/15 | 3/31 |
| Dental caries | Gastrointestinal disorders | 0/78 | 1/15 | 2/31 |
| Diarrhoea | Gastrointestinal disorders | 3/78 | 3/15 | 6/31 |
| Flatulence | Gastrointestinal disorders | 0/78 | 0/15 | 2/31 |
| Haemorrhoids | Gastrointestinal disorders | 2/78 | 1/15 | 0/31 |
| Mouth ulceration | Gastrointestinal disorders | 0/78 | 1/15 | 0/31 |
| Nausea | Gastrointestinal disorders | 1/78 | 1/15 | 1/31 |
| Peptic ulcer | Gastrointestinal disorders | 0/78 | 1/15 | 0/31 |
| Portal hypertensive gastropathy | Gastrointestinal disorders | 0/78 | 0/15 | 2/31 |
| Stomatitis | Gastrointestinal disorders | 0/78 | 1/15 | 0/31 |
| Toothache | Gastrointestinal disorders | 3/78 | 1/15 | 0/31 |
| Vomiting | Gastrointestinal disorders | 0/78 | 1/15 | 2/31 |
| Chest discomfort | General disorders | 0/78 | 1/15 | 0/31 |
| Fatigue | General disorders | 0/78 | 0/15 | 2/31 |
| Oedema peripheral | General disorders | 1/78 | 1/15 | 2/31 |
| Pain | General disorders | 0/78 | 1/15 | 0/31 |
| Pyrexia | General disorders | 0/78 | 3/15 | 5/31 |
| Jaundice | Hepatobiliary disorders | 0/78 | 1/15 | 0/31 |
| Cellulitis | Infections and infestations | 0/78 | 1/15 | 0/31 |
| Conjunctivitis | Infections and infestations | 0/78 | 1/15 | 2/31 |
| Endophthalmitis | Infections and infestations | 0/78 | 1/15 | 0/31 |
| Hordeolum | Infections and infestations | 0/78 | 1/15 | 0/31 |
| Nasopharyngitis | Infections and infestations | 6/78 | 0/15 | 0/31 |
| Pneumonia | Infections and infestations | 2/78 | 1/15 | 1/31 |
| Skin infection | Infections and infestations | 0/78 | 1/15 | 0/31 |
| Upper respiratory tract infection | Infections and infestations | 11/78 | 3/15 | 6/31 |
| Urinary tract infection | Infections and infestations | 3/78 | 1/15 | 0/31 |
| Arteriovenous fistula site complication | Injury, poisoning and procedural complications | 0/78 | 1/15 | 0/31 |
| Incision site pain | Injury, poisoning and procedural complications | 0/78 | 1/15 | 0/31 |
| Ligament sprain | Injury, poisoning and procedural complications | 1/78 | 1/15 | 0/31 |
| Limb injury | Injury, poisoning and procedural complications | 0/78 | 1/15 | 0/31 |
| Procedural pain | Injury, poisoning and procedural complications | 0/78 | 1/15 | 0/31 |
| Shunt occlusion | Injury, poisoning and procedural complications | 0/78 | 1/15 | 0/31 |
| Vascular pseudoaneurysm | Injury, poisoning and procedural complications | 0/78 | 1/15 | 0/31 |
| Blood bilirubin increased | Investigations | 0/78 | 0/15 | 2/31 |
| Blood creatinine increased | Investigations | 1/78 | 0/15 | 2/31 |
| Bone density decreased | Investigations | 1/78 | 0/15 | 5/31 |
| Hyperkalaemia | Metabolism and nutrition disorders | 1/78 | 2/15 | 0/31 |
| Hyperlipidaemia | Metabolism and nutrition disorders | 1/78 | 0/15 | 2/31 |
| Hypokalaemia | Metabolism and nutrition disorders | 0/78 | 1/15 | 1/31 |
| Metabolic acidosis | Metabolism and nutrition disorders | 0/78 | 1/15 | 0/31 |
| Vitamin B12 deficiency | Metabolism and nutrition disorders | 0/78 | 1/15 | 0/31 |
| Arthralgia | Musculoskeletal and connective tissue disorders | 0/78 | 2/15 | 3/31 |
| Back pain | Musculoskeletal and connective tissue disorders | 2/78 | 1/15 | 0/31 |
37 more terms not shown.
| Facility | City | Country | Status |
|---|---|---|---|
| Coalition of Inclusive Medicine | Los Angeles, California | United States | |
| Silicon Valley Research Institute, Inc | San Jose, California | United States | |
| Henry Ford Health System | Detroit, Michigan | United States | |
| Harborview Medical Center | Seattle, Washington | United States | |
| University of Calgary Liver Unit | Calgary | Canada | |
| Centre de Recherche du Centre Hospitalier de l'Universite de Montreal | Montreal | Canada | |
| University Health Network,Toronto general Hospital,Toronto centre for liver disease | Toronto | Canada | |
| Toronto Liver Centre | Toronto | Canada | |
| (G.I.R.I.) GI Research Institute | Vancouver | Canada | |
| Prince of Wales Hospital | Shatin, NT | Hong Kong | |
| Princess Margaret Hospital | Kowloon | Hong Kong | |
| Alice Ho Miu Ling Nethersole Hospital | Tai Po | Hong Kong | |
| U.O. Medicina Generale Epatologia IRCCS Humanitas Centro di Ricerca Traslazionale in Epatologia | Rozzano, Milan | Italy | |
| Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) AOU Policlinico S.Orsola-Malpighi di Bologna | Bologna | Italy | |
| UOC Gastroenterol-Epatol.-Fondazione IRCCS Ca Granda | Milan | Italy | |
| Auckland Clinical Studies | Grafton, Auckland | New Zealand | |
| Dong-A University Hospital | Busan | South Korea | |
| Pusan National University Hospital | Busan | South Korea | |
| Asan Medical Center | Seoul | South Korea | |
| Yonsei University Health System, Severance Hospital | Seoul | South Korea | |
| Changhua Christian Hospital | Changhua | Taiwan | |
| Ditmanson Medical Foundation Chia-Yi Christian Hospital | Chiayi City | Taiwan | |
| Kaohsiung Medical University Chung-Ho Memorial Hospital | Kaohsiung City | Taiwan | |
| Kaohsiung Chang Gung Memorial Hospital | Kaohsiung City | Taiwan | |
| Taichung Veterans Genl Hosp | Taichung | Taiwan | |
| National Taiwan University Hospital | Taipei | Taiwan | |
| Veterans General Hospital-Taipei | Taipei | Taiwan | |
| Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital | Taoyuan City | Taiwan | |
| Nottingham University Hospital | London | United Kingdom | |
| King's College Hospital NHS Foundation Trust | London | United Kingdom |
NIH grants: 2016