A Phase 2 Study to Evaluate the Safety, Tolerability, and Efficacy of Regimens Containing VIR-2218, VIR-3434, and/or PEG-IFNα in Subjects with Chronic Hepatitis B Virus Infection

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Vir Biotechnology Inc.

Participant type

Patients

Age range

18-64 years

Gender

Male and Female

Therapeutic area

Diseases [C] - Virus Diseases [C02]

Trial duration

16 Jun 2022 → ongoing

Decision date (initial)

2024-09-18

Transition trial

Yes

Low-intervention

No

Rare-disease indication

No

Vulnerable population

Yes

Funding sources

Vir Biotechnology, Inc.

External identifiers

EU CT number

2024-513177-48-00

EudraCT number

2021-001033-39

ClinicalTrials.gov

NCT04856085

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Safety, Efficacy, Dose response, Pharmacogenomic, Pharmacokinetic, Pharmacodynamic, Pharmacoeconomic, Therapy

• To evaluate the safety and tolerability of regimens containing VIR-2218, VIR-3434, and/or PEG-IFNα
• To evaluate the efficacy of regimens containing VIR-2218, VIR-3434, and/or PEG-IFNα

Secondary objectives 1

1. • To assess the effect of regimens containing VIR-2218, VIR-3434, and/or PEG-IFNα on serum hepatitis B surface antigen (HBsAg) • To assess the effect of regimens containing VIR-2218, VIR-3434, and/or PEG-IFNα on serum HBV DNA • For hepatitis B e antigen (HBeAg) positive subjects: to assess the effect of regimens containing VIR-2218, VIR-3434, and/or PEG-IFNα on HBeAg and anti-HBe • To assess the effect of regimens containing VIR-2218, VIR-3434, and/or PEG-IFNα on anti-HBs • To characterize the pharmacokinetics (PK) of VIR-3434 (Parts A, B, C, and D) • To assess the immunogenicity of VIR-3434 (Parts A, B, C, and D) • To evaluate the proportion of subjects meeting criteria for nucleos(t)ide reverse transcriptase inhibitor (NRTI) discontinuation or retreatment

Conditions and MedDRA coding

Chronic Hepatitis B Virus Infection

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 2

1. 1. Age ≥ 18 (or age of legal consent, whichever is older) to < 66 years 2. Body Mass Index (BMI) ≥ 18 kg/m2 to ≤ 35 kg/m2 3. Chronic HBV infection defined as a positive serum HBsAg, HBV DNA, or HBeAg on 2 occasions at least 6 months apart based on previous or current laboratory documentation (any combination of these tests performed 6 months apart is acceptable) 4. On continuous NRTI therapy for at least 2 months prior to screening 5. HBV DNA < 100 IU/mL at screening 6. HBsAg > the lower limit of detection 7. Negative anti-HBs at screening 8. Besides chronic infection with HBV, must be in good health, determined from medical history, and no clinically significant findings from physical examination, vital signs, and laboratory values 9. Female subjects must have a negative pregnancy test or confirmation of postmenopausal status. Post-menopausal status is defined as 12 months with no menses without an alternative medical cause (see Section 6.4 for additional details). Women of childbearing potential (WOCBP) must have a negative blood pregnancy test at screening and a negative urine pregnancy test on Day 1, cannot be breast feeding, and must be willing to use highly effective methods of contraception (Section 6.4) 14 days before study drug administration through 48 weeks after the last dose of study drug. Female subjects must also agree to refrain from egg donation and in vitro fertilization from the time of study drug administration through 48 weeks after the last dose of study drug.
2. 10. Male subjects with female partners of childbearing potential must agree to meet 1 of the following contraception requirements from the time of study drug administration through 48 weeks after the last dose of study drug: documentation of vasectomy or azoospermia, or male condom use plus partner use of 1 of the contraceptive options listed for contraception for WOCBP (Section 6.4). Male subjects must also agree to not donate sperm from the time of first study drug administration through 48 weeks after the last dose of study drug. 11. Willing to comply with the study requirements and able to provide written informed consent 12. Cohort 2b only: Previously enrolled in Cohort 1d of the VIR-2218-1001 study and completed the Treatment Period

Exclusion criteria 4

1. 1. Significant fibrosis or cirrhosis as defined by having either a FibroScan result of > 8.5 kPa at screening or a liver biopsy within 1 year with Metavir F3 fibrosis or F4 cirrhosis. 2. History of clinically significant liver disease from non-HBV etiology 3. History of hepatic decompensation, including ascites, hepatic encephalopathy, and/or esophageal or gastric varices 4. History of immune complex disease 5. History of an autoimmune disorder 6. History of HBV-related extrahepatic disease, including but not limited to HBV-related rash, arthritis, or glomerulonephritis 7. History of allergic reactions, hypersensitivity, or intolerance to monoclonal antibodies, antibody fragments, or any excipients of VIR-3434 8. History of anaphylaxis 9. History of malignancy diagnosed or treated within 5 years (localized treatment of squamous or non-invasive basal cell skin cancers is permitted; cervical carcinoma in situ is allowed if appropriately treated prior to screening); subjects under evaluation for malignancy are not eligible. 10. History of bone marrow or solid organ transplant 11. Known active infection other than chronic HBV infection or any clinically significant acute condition such as fever (> 38° C) or acute respiratory illness within 7 days prior to Day 1 12. Co-infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV) or hepatitis D virus (HDV). Subjects who are HCV antibody or HDV antibody positive, but have a documented negative HCV RNA or HDV RNA, respectively, are eligible.
2. 13. Creatinine clearance (CLcr) < 30 mL/min as calculated by the Cockcroft-Gault formula at screening 14. Subject has the following laboratory parameters at screening by laboratory testing: a. ALT or aspartate aminotransferase (AST) > 3x ULN b. Direct bilirubin or INR > ULN 15. Regular consumption of more than 10 units of alcohol per week (1 unit = 1 glass of wine [125 mL] = 1 measure of spirits [30 mL] = one-half pint of beer [284 mL]), or more than 2 units of alcohol per day 16. History or clinical evidence of alcohol or drug abuse within the 12 months before screening or a positive drug screen at screening unless it can be explained by a prescribed medication (the diagnosis and prescription must be approved by the investigator). Note: cannabis use is permitted 17. Use of any of the following systemic medications within 14 days before study drug administration and throughout the study: a. Paracetamol (acetaminophen) ≥ 3 g/day b. Isoniazid c. Systemic steroids (prednisone equivalent of > 10 mg/day) or other immunosuppressive agents (Note: corticosteroid administration for the treatment of immune-mediated AEs is allowed.) d. Parts A, C, and D only: theophylline e. Parts A, C, and D only: methadone
3. 18. Received an investigational agent within 90 days or 5 half-lives (if known), whichever is longer, before study drug administration or are active in the follow-up phase of another clinical study involving interventional treatment. Subjects must also agree not to take part in any other interventional study at any time during their participation in this study, inclusive of the Follow-Up Period and NRTI Discontinuation Monitoring Period. Note: Participants who previously enrolled in Cohort 1d of the VIR-2218-1001 study are eligible for Cohort 2b only. 19. Receipt of an oligonucleotide (eg, siRNA, antisense oligonucleotide) with activity against HBV within 48 weeks before study drug administration Note: Participants who previously enrolled in Cohort 1d of the VIR-2218-1001 study and received VIR-2218 are eligible for Cohort 2b only. 20. Receipt of VIR-3434 within 24 weeks prior to Day 1 21. Any clinically significant medical or psychiatric condition that may interfere with study treatment, assessment, or compliance with the protocol or otherwise makes the subject unsuitable for participation in the study, as determined by the investigator. 22. Parts A, C, and D only: Known hypersensitivity or contraindication to an interferon product 23. Parts A, C, and D only: Current or prior history of psychosis, bipolar disorder, schizophrenia, moderate-severe depression, suicide ideation, attempt, or gesture, or high risk for suicide 24. Parts A, C, and D only: Current or prior history of clinically significant retinal disease
4. 25. Parts A, C, and D only: Current or prior history of chronic uncontrolled hypoglycemia, or uncontrolled hyperglycemia/diabetes (defined as HbA1c ≥ 8%) at screening 26. Parts A, C, and D only: Current or prior history of colitis 27. Parts A, C, and D only: Serum lipase ≥ 2 times the ULN 28. Parts A, C, and D only: Thyroid stimulating hormone (TSH) and free T4 above the ULN or below the lower limit of normal (LLN) 29. Parts A, C, and D only: Platelets < 90,000 cells/mm3 30. Parts A, C, and D only: Absolute neutrophil count (ANC) < 1,500 cells/mm3 31. Clinically significant abnormalities on 12-lead electrocardiogram (ECG) at screening (as determined by the investigator)

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. • Proportion of subjects with treatment-emergent adverse events (TEAEs) • Proportion of subjects with serious adverse events (SAEs) • Proportion of subjects with HBsAg loss (defined as undetectable HBsAg) at end of treatment • Proportion of subjects with HBsAg loss (defined as undetectable HBsAg) at 24 weeks post-end of treatment

Secondary endpoints 3

1. • Proportion of subjects achieving functional cure (defined as undetectable HBsAg and sustained suppression of HBV DNA [below the lower limit of quantification (< LLOQ), target not detected (TND)] for ≥ 24 weeks after discontinuation of all treatment, including NRTIs) • Proportion of subjects with serum HBsAg < 10 IU/mL at end of treatment • Proportion of subjects with serum HBsAg < 10 IU/mL at 24 weeks post-end of treatment
2. • Absolute serum HBsAg and change from baseline across timepoints in the study • Nadir and maximum reduction of serum of HBsAg from baseline • Time to achieve nadir of serum HBsAg • Time to achieve serum HBsAg loss • Proportion of subjects achieving sustained suppression of HBV DNA (< LLOQ for ≥ 24 weeks after discontinuation of all treatment, including NRTIs) • For HBeAg-positive subjects: proportion of subjects with HBeAg loss (undetectable HBeAg) and/or anti-HBe seroconversion
3. • For HBeAg-positive subjects: time to HBeAg loss (undetectable HBeAg) and/or anti-HBe seroconversion • Proportion of subjects with anti-HBs seroconversion • VIR-3434 PK parameters • Incidence and titers of anti-drug antibodies (ADA; if applicable) to VIR-3434 • Proportion of subjects meeting criteria for NRTI discontinuation • Proportion of subjects meeting criteria for NRTI retreatment

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 3

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Vir Biotechnology Inc.

Sponsor organisation

Vir Biotechnology Inc.

Address

1800 Owens Street Suite 900

City

San Francisco

Postcode

94158-2388

Country

United States

Scientific contact point

Organisation

Vir Biotechnology Inc.

Contact name

Carey Hwang

Public contact point

Organisation

Vir Biotechnology Inc.

Contact name

Study Inquiry

Third parties 20

Locations

2 EU/EEA countries · 4 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 19 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

3 submissions — initial application plus substantial / non-substantial modifications