Safety and efficacy of vebicorvir in virologically suppressed patients with chronic hepatitis B virus infection

Man Fung Yuen, Kosh Agarwal, Xiaoli Ma, Tuan T. Nguyen, Eugene R. Schiff, Hie Won L. Hann, Douglas T. Dieterich, Ronald G. Nahass, James S. Park, Sing Chan, Steven Huy B. Han, Edward J. Gane, Michael Bennett, Katia Alves, Marc Evanchik, Ran Yan, Qi Huang, Uri Lopatin, Richard Colonno, Julie MaSteven J. Knox, Luisa M. Stamm, Maurizio Bonacini, Ira M. Jacobson, Walid S. Ayoub, Frank Weilert, Natarajan Ravendhran, Alnoor Ramji, Paul Yien Kwo, Magdy Elkhashab, Tarek Hassanein, Ho S. Bae, Jacob P. Lalezari, Scott K. Fung, Mark S. Sulkowski

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background & Aims: HBV nucleos(t)ide reverse transcriptase inhibitors (NrtIs) do not completely suppress HBV replication. Previous reports indicate persistent viremia during NrtI treatment despite HBV DNA being undetectable. HBV core inhibitors may enhance viral suppression when combined with NrtIs. This phase II trial (NCT03576066) evaluated the efficacy and safety of the investigational core inhibitor, vebicorvir (VBR), in virologically- suppressed patients on NrtIs. Methods: Non-cirrhotic, NrtI-suppressed patients with chronic HBV were randomised to VBR 300 mg once daily or matching placebo (PBO) for 24 weeks. Treatment was stratified by hepatitis B e antigen (HBeAg) status. The primary endpoint was change from Baseline in serum HBeAg or hepatitis B surface antigen (HBsAg) after 24 weeks. Results: Of 73 patients enrolled, 47 were HBeAg positive and 26 were HBeAg negative. In HBeAg-positive and -negative patients, there were no differences in the change from Baseline at Week 24 for HBsAg or HBeAg. Using a novel, high-sensitivity assay to detect HBV DNA, a greater proportion of patients with detectable HBV DNA at Baseline achieved undetectable HBV DNA at Week 24 in the VBR+NrtI vs. PBO+NrtI group. In HBeAg-positive patients, a greater change from Baseline in HBV pregenomic (pg)RNA was observed at Week 24 with VBR+NrtI vs. PBO+NrtI. Treatment-emergent adverse events (TEAEs) in VBR+NrtI patients included upper respiratory tract infection, nausea, and pruritus. No serious adverse events, Grade 4 TEAEs, or deaths were reported. Conclusions: In this 24-week study, VBR+NrtI demonstrated a favourable safety and tolerability profile. While there were no significant changes in viral antigen levels, enhanced viral suppression was demonstrated by greater changes in DNA and pgRNA with the addition of VBR compared to NrtI alone. Clinical trials number: NCT03576066. Lay summary: Core inhibitors represent a novel approach for the treatment of chronic hepatitis B virus (HBV) infection, with mechanisms of action distinct from existing treatments. In this study, vebicorvir added to existing therapy reduced HBV replication to a greater extent than existing treatment and was generally safe and well tolerated.

Original languageEnglish
Pages (from-to)642-652
Number of pages11
JournalJournal of Hepatology
Volume77
Issue number3
DOIs
StatePublished - Sep 2022

Keywords

  • HBV
  • NrtI
  • antiviral
  • cccDNA
  • core inhibitor
  • hepatitis
  • pgRNA

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