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Study of ARC-520 With or Without Other Drugs Used in the Treatment of Chronic Chronic Hepatitis B Virus (HBV) (MONARCH)

Arrowhead Pharmaceuticals logo

Arrowhead Pharmaceuticals

Status and phase

Terminated
Phase 2

Conditions

Hepatitis D
Hepatitis B

Treatments

Drug: antihistamine
Drug: tenofovir disoproxil
Drug: ARC-520
Drug: entecavir
Biological: pegylated interferon alpha 2a

Study type

Interventional

Funder types

Industry

Identifiers

NCT02577029
Heparc-2008
2015-005499-46 (EudraCT Number)

Details and patient eligibility

About

Patients with chronic HBV infection will receive either ARC-520 alone or ARC-520 in combination with other treatments such as entecavir (ENT) or tenofovir (TDF) and/or pegylated interferon (PEG IFN) alpha 2a therapy, and be evaluated for safety and efficacy.

Full description

This is a multicenter, open-label study of ARC-520 based treatment regimens administered to patients with HBeAg positive or HBeAg negative immune active chronic Hepatitis B Virus (HBV) infection of various genotypes, or patients with Hepatitis D Virus (HDV). Eligible patients naive to previous treatment, and who have signed an Ethics Committee - approved informed consent, will be enrolled and will receive ARC-520 alone or ARC-520 plus additional treatments such as entecavir (ETV) or tenofovir (TDF) and/or pegylated interferon alpha 2a (PEG IFN) therapy. The study may initially involve up to a total of 96 eligible chronic HBV and HDV infected patients. Patients in all cohorts will receive a total of 13 doses of ARC-520 at 2mg/kg or 4 mg/kg. Patients will undergo the following evaluations at regular intervals during the study: medical history, physical examinations, vital sign measurements (blood pressure, heart rate, respiratory rate, and temperature), weight, adverse events assessment (AEs), 12-lead ECGs, liver fibrosis testing, concomitant medication assessment, blood sample collection for hematology, coagulation, chemistry, exploratory Pharmacodynamic (PD) measures, urinalysis, HBV serology, cytokines, Follicle Stimulating Hormone (FSH) testing (post-menopausal females) and pregnancy testing for females of childbearing potential. Clinically significant changes including AEs will be followed until resolution, until the condition stabilizes, until the event is otherwise explained, or until the patient is lost to follow-up. For each patient, the duration of the study is approximately 96 weeks, from enrolment to last visit. Prior to enrolment there is a 60 day screening period. Addition of new cohorts and additional treatment regimens are anticipated for this study.

Enrollment

79 patients

Sex

All

Ages

18 to 75 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Male or female, 18 to 75 years of age
  • Written informed consent
  • No clinically significant abnormalities at screening/pre-dose 12-lead ECG assessment
  • Diagnosis of HBeAg negative or positive chronic HBV infection.
  • Must be HBsAg (+) during screening.
  • Must be treatment naïve: never on PEG IFN alpha 2a and/or ETV or TDF; and
  • Have not used nucleoside/nucleotide analogs (NUCs) within the last 2 years prior to dosing on Day 1
  • Must use 2 effective methods of contraception (double barrier contraception or hormonal contraceptive along with a barrier contraceptive) (both male and female partners)

Exclusion criteria

  • Pregnant or lactating
  • Acute signs of hepatitis/other severe infections within 4 weeks of screening
  • Use within the last 14 days or anticipated requirement for anticoagulants, systemic corticosteroids, immunomodulators, or immunosuppressants
  • Use of prescription medication within 14 days prior to treatment administration except: topical products without systemic absorption, statins (except rosuvastatin), hypertension medications, over-the-counter (OTC) and prescription pain medication or hormonal contraceptives
  • History of poorly controlled autoimmune disease or any history of autoimmune hepatitis
  • History of heterozygous or homozygous familial hypercholesterolemia.
  • Human immunodeficiency virus (HIV) infection
  • Is sero-positive for Hepatitis C Virus (HCV), or has a history of delta virus hepatitis (except for cohort in which delta virus infection is acceptable)
  • Has hypertension: blood pressure > 170/100 mmHg; well-controlled blood pressure on hypertensive medication allowed
  • History of cardiac rhythm disturbances
  • Family history of congenital long QT syndrome, Brugada syndrome or unexplained sudden cardiac death
  • Symptomatic heart failure, unstable angina, myocardial infarction, severe cardiovascular disease within 6 months prior to study entry
  • History of malignancy, except for adequately treated basal cell carcinoma, squamous cell skin cancer, superficial bladder tumors, or in situ cervical cancer
  • Has had major surgery within 1 month of screening
  • Regular use of alcohol within 6 months prior to screening (ie, more than 14 units of alcohol per week)
  • Use of recreational drugs such as cocaine, phencyclidine (PCP), and methamphetamines, within 1 year prior to the screening
  • History of allergy to bee sting
  • Clinically significant history of any alcoholic liver disease, cirrhosis, Wilson's disease, hemochromatosis, or alpha-1 antitrypsin deficiency
  • Presence of cholangitis, cholecystitis, cholestasis, or duct obstruction
  • Clinically significant history or presence of poorly controlled/uncontrolled systemic disease
  • Presence of any medical or psychiatric condition or social situation that impacts compliance or results in additional safety risk
  • History of coagulopathy/stroke within past 6 months, and/or concurrent anticoagulant medication(s)

Trial design

Primary purpose

Treatment

Allocation

Non-Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

79 participants in 8 patient groups

Cohort 1
Experimental group
Description:
Treatment-naïve, hepatitis B "e" antigen (HBeAg)-positive participants with chronic hepatitis B (CHB) of any genotype administered ARC-520 (2 mg/kg intravenous \[IV\]) every 4 weeks for 48 weeks (13 doses).
Treatment:
Drug: ARC-520
Drug: antihistamine
Cohort 2
Experimental group
Description:
Treatment-naïve, HBeAg-positive, Genotype B participants with CHB administered ARC-520 (2 mg/kg increasing to 4 mg/kg or 4 mg/kg IV) every 4 weeks for 48 weeks (13 doses) concomitantly with daily orally administered ETV or TDF for approximately 60 weeks starting Day 1 and weekly subcutaneously administered peginterferon (PEG IFN) alpha 2a for 48 weeks starting Day 87.
Treatment:
Biological: pegylated interferon alpha 2a
Drug: ARC-520
Drug: antihistamine
Drug: entecavir
Drug: tenofovir disoproxil
Cohort 3
Experimental group
Description:
Treatment-naïve, HBeAg-negative, Genotype B participants with CHB administered ARC-520 (2 mg/kg increasing to 4 mg/kg or 4 mg/kg IV) every 4 weeks for 48 weeks (13 doses) concomitantly with daily orally administered ETV or TDF for approximately 60 weeks starting Day 1 and weekly subcutaneously administered PEG IFN alpha 2a for 48 weeks starting Day 87.
Treatment:
Biological: pegylated interferon alpha 2a
Drug: ARC-520
Drug: antihistamine
Drug: entecavir
Drug: tenofovir disoproxil
Cohort 4
Experimental group
Description:
Treatment-naïve, HBeAg-positive, Genotype C participants with CHB administered ARC-520 (2 mg/kg increasing to 4 mg/kg or 4 mg/kg IV) every 4 weeks for 48 weeks (13 doses) concomitantly with daily orally administered ETV or TDF for approximately 60 weeks starting Day 1 and weekly subcutaneously administered PEG IFN alpha 2a for 48 weeks starting Day 87.
Treatment:
Biological: pegylated interferon alpha 2a
Drug: ARC-520
Drug: antihistamine
Drug: entecavir
Drug: tenofovir disoproxil
Cohort 5
Experimental group
Description:
Treatment-naïve, HBeAg-negative, Genotype C participants with CHB administered ARC-520 (2 mg/kg increasing to 4 mg/kg or 4 mg/kg IV) every 4 weeks for 48 weeks (13 doses) concomitantly with daily orally administered ETV or TDF for approximately 60 weeks starting Day 1 and weekly subcutaneously administered PEG IFN alpha 2a for 48 weeks starting Day 87.
Treatment:
Biological: pegylated interferon alpha 2a
Drug: ARC-520
Drug: antihistamine
Drug: entecavir
Drug: tenofovir disoproxil
Cohort 6
Experimental group
Description:
Treatment-naïve, HBeAg-negative, Genotype D participants with CHB administered ARC-520 (2 mg/kg increasing to 4 mg/kg or 4 mg/kg IV) every 4 weeks for 48 weeks (13 doses) concomitantly with daily orally administered ETV or TDF for approximately 60 weeks starting Day 1 and weekly subcutaneously administered PEG IFN alpha 2a for 48 weeks starting Day 87.
Treatment:
Biological: pegylated interferon alpha 2a
Drug: ARC-520
Drug: antihistamine
Drug: entecavir
Drug: tenofovir disoproxil
Cohort 7
Experimental group
Description:
Treatment-naïve, HBeAg-negative or HBeAg-positive participants with hepatitis delta virus (HDV) administered ARC-520 (2 mg/kg increasing to 4 mg/kg or 4 mg/kg IV) every 4 weeks for 48 weeks (13 doses) and weekly subcutaneously administered PEG IFN alpha 2a for 48 weeks starting Day 15.
Treatment:
Biological: pegylated interferon alpha 2a
Drug: ARC-520
Drug: antihistamine
Cohort 8
Experimental group
Description:
Treatment-naïve, HBeAg-positive participants with CHB of any genotype administered ARC-520 (4 mg/kg IV) every 4 weeks for 48 weeks (13 doses).
Treatment:
Drug: ARC-520
Drug: antihistamine

Trial contacts and locations

33

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Data sourced from clinicaltrials.gov

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