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The aim of the prospective study is to determine whether combination/ sequential therapy with Entecavir, Peginterferon alfa-2b and immunomodulators Granulocyte Macrophage Colony Stimulating Factor (GMCSF)+vaccine could induce HBsAg loss in chronic hepatitis B patients with maintained Hepatitis B Virus (HBV) DNA suppression on long-term nucleoside or nucleotide analogue (NA).
Patents who were treated with NA at least one year and achieved HBV DNA suppression are enrolled in this study, they will receive Entecavir (ETV) for 60 weeks, HBV vaccine (60ug/month, every four weeks) for 24 weeks, GMCSF (75 μg/day, first 5 days each month, subcutaneous) from baseline to week 16 and from week 60 to week 84, and Y peginterferon alfa-2b (180 μg/week, subcutaneous) from week 16 to week 108.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Sequential combination arm | Experimental | Drug: Entecavir for 60 weeks Drug: HBV vaccine (60ug/month, every four weeks) for 24 weeks Drug: Granulocyte Macrophage Colony Stimulating Factor (75 μg/day, first 5 days each month, subcutaneous) from baseline to week 16 and from week 60 to week 84 Drug: Y peginterferon alfa-2b (180 μg/week, subcutaneous) from week 16 to week 108 |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Entecavir | Drug | Entecavir is used for 96 weeks |
|
| Measure | Description | Time Frame |
|---|---|---|
| HBsAg loss rate | Percentages of patients who achieve HBsAg loss at the end of treatment | at week 108 |
| Measure | Description | Time Frame |
|---|---|---|
| HBsAg level | Dynamic change in HBsAg level from baseline to the end of treatment | at week 60 |
| HBsAg level | Dynamic change in HBsAg level from baseline to the end of treatment |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Qin Ning | Tongji Hospital | Principal Investigator |
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| ID | Term |
|---|---|
| D019694 | Hepatitis B, Chronic |
| ID | Term |
|---|---|
| D006509 | Hepatitis B |
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
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| ID | Term |
|---|---|
| C413685 | entecavir |
| D016178 | Granulocyte-Macrophage Colony-Stimulating Factor |
| D014612 | Vaccines |
| ID | Term |
|---|---|
| D003115 | Colony-Stimulating Factors |
| D006023 | Glycoproteins |
| D006001 | Glycoconjugates |
| D002241 | Carbohydrates |
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| Granulocyte Macrophage Colony Stimulating Factor | Drug | Granulocyte-macrophage colony stimulating factor is used intermittently from baseline to week 16 and from 60 to week 84 |
|
|
| Y peginterferon alfa-2b | Drug | Y peginterferon alfa-2b is used for 96 weeks |
|
|
| HBV vaccine | Drug | 60ug HBV vaccine is used every four week for 24 weeks |
|
|
| at week 108 |
| decline in HBsAg level | Decline in HBsAg level from baseline to the end of treatment | at week 60 |
| decline in HBsAg level | Decline in HBsAg level from baseline to the end of treatment | at week 108 |
| HBsAb appearance rate | Percentages of HBsAb appearance at the end of treatment | at week 108 |
| HBsAb seroconversion rate | Percentages of HBsAb seroconversion at the end of treatment | at week 108 |
| HBeAg loss rate | Percentages of HBeAg loss in the HBeAg-positive patients at the end of treatment | at week 108 |
| HBeAg seroconversion rate | Percentages of HBeAg seroconversion in the HBeAb-negative patients at the end of treatment | at week 108 |
| Rate of HBV DNA level <1000 copies/mL | Percentages of HBV DNA level <1000 copies/mL at the end of treatment | at week 108 |
| Rate of alanine aminotransferase (ALT) normalisation | Percentages of ALT normalisation at the end of treatment | at week 108 |
| Sustained HBsAg loss rate | Percentages of sustained HBsAg loss at the end of follow-up | at week 156 |
| The rate of progression to cirrhosis | The rate of progression to cirrhosis at the end of follow-up | at week 156 |
| The incidence rate of hepatocarcinoma | The incidence rate of hepatocarcinoma at the end of follow-up | at week 156 |
| D018347 |
| Hepadnaviridae Infections |
| D004266 | DNA Virus Infections |
| D014777 | Virus Diseases |
| D006525 | Hepatitis, Viral, Human |
| D006521 | Hepatitis, Chronic |
| D006505 | Hepatitis |
| D008107 | Liver Diseases |
| D004066 | Digestive System Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D016298 |
| Hematopoietic Cell Growth Factors |
| D016207 | Cytokines |
| D036341 | Intercellular Signaling Peptides and Proteins |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D011506 | Proteins |
| D001685 | Biological Factors |
| D001688 | Biological Products |
| D045424 | Complex Mixtures |