Safety profile, antiviral capacity, and liver protection of a nasal therapeutic vaccine in patients with chronic hepatitis B: Five-year-follow-up outcomes after the end of treatment

Introduction There is a pressing need to develop novel drugs for treating patients with chronic hepatitis B (CHB), as commercially available antiviral drugs are endowed with safety and efficacy concerns. Methods A phase III clinical trial was conducted with a therapeutic vaccine containing two antigens of the hepatitis B virus (HBV; named NASVAC) in 78 patients with CHB expressing both HBV DNA and elevated levels of alanine aminotransferase (ALT) in the blood. Five years after the end of treatment (EOT), 60 NASVAC-recipient patients were enrolled in this long-term follow-up study to evaluate the safety, antiviral potential, and liver-protective capacity of NASVAC. Results NASVAC exhibited an excellent safety profile 5 years after EOT. The levels of HBV DNA in the sera were reduced in 55 of the 60 patients, and 45 of them were negative for HBV DNA in the sera. ALT levels were also normalized in 40 of the 60 patients 5 years after EOT. None of the patients receiving NASVAC developed liver cirrhosis or cancer. Discussion The present study is the first to exhibit long-term follow-up data of a finite immune therapy for CHB that is safe and endowed with potent antiviral and liver-protecting capacities.

[1]  Y. Hiasa,et al.  Intranasal therapeutic vaccine containing HBsAg and HBcAg for patients with chronic hepatitis B; 18 months follow‐up results of phase IIa clinical study , 2022, Hepatology research : the official journal of the Japan Society of Hepatology.

[2]  Y. Hiasa,et al.  Immune therapies against chronic hepatitis B , 2022, Journal of Gastroenterology.

[3]  I. Serio,et al.  Viral hepatitis: Innovations and expectations , 2022, World journal of gastroenterology.

[4]  Y. Hiasa,et al.  The Safety and Efficacy of a Therapeutic Vaccine for Chronic Hepatitis B: A Follow-Up Study of Phase III Clinical Trial , 2021, Vaccines.

[5]  Y. Hiasa,et al.  Sustained Antiviral and Liver Protection by a Nasal Therapeutic Vaccine (NASVAC, Containing Both HBsAg and HBcAg) in Patients with Chronic Hepatitis B: 2-Year Follow-Up of Phase III Clinical Trial , 2021, Pathogens.

[6]  G. Missale,et al.  Unraveling the Multifaceted Nature of CD8 T Cell Exhaustion Provides the Molecular Basis for Therapeutic T Cell Reconstitution in Chronic Hepatitis B and C , 2021, Cells.

[7]  Dongliang Yang,et al.  Immunopathogenesis of HBV Infection. , 2020, Advances in experimental medicine and biology.

[8]  H. Janssen,et al.  Limited sustained response after stopping nucleos(t)ide analogues in patients with chronic hepatitis B: results from a randomised controlled trial (Toronto STOP study) , 2019, Gut.

[9]  U. Gill,et al.  The impact of currently licensed therapies on viral and immune responses in chronic hepatitis B: Considerations for future novel therapeutics , 2018, Journal of viral hepatitis.

[10]  Y. Hiasa,et al.  Treatment of chronic hepatitis B naïve patients with a therapeutic vaccine containing HBs and HBc antigens (a randomized, open and treatment controlled phase III clinical trial) , 2018, PloS one.

[11]  Xin-min Zhou,et al.  Efficacy of nucleoside analogues for hepatitis B virus-related liver failure: A network meta-analysis , 2018, Acta pharmaceutica.

[12]  P. Lampertico,et al.  Treatment of hepatitis B: Is there still a role for interferon? , 2018, Liver international (Print).

[13]  A. de Laat,et al.  Network meta-analysis. , 2017, Journal of oral rehabilitation.

[14]  N. Terrault,et al.  AASLD guidelines for treatment of chronic hepatitis B , 2016, Hepatology.

[15]  R. Ozaras,et al.  Monotherapy for hepatitis B infection: a review of treatment options , 2015, Expert review of anti-infective therapy.

[16]  Y. Liaw,et al.  Hepatitis B flares in chronic hepatitis B: pathogenesis, natural course, and management. , 2014, Journal of hepatology.

[17]  Yong-Yuan Zhang,et al.  New perspective on the natural course of chronic HBV infection , 2014, Frontiers of Medicine.

[18]  S. Rahman,et al.  Therapeutic potential of a combined hepatitis B virus surface and core antigen vaccine in patients with chronic hepatitis B , 2013, Hepatology International.

[19]  P. Lampertico,et al.  Results of treatment of chronic hepatitis B with pegylated interferon. , 2013, Clinics in liver disease.

[20]  Y. Hiasa,et al.  Immune modulator and antiviral potential of dendritic cells pulsed with both hepatitis B surface antigen and core antigen for treating chronic HBV infection , 2010, Antiviral therapy.

[21]  J. Dienstag Benefits and risks of nucleoside analog therapy for hepatitis B , 2009, Hepatology.

[22]  J. Dienstag Benefits and Risks of Nucleoside Analog Therapy for Hepatitis , 2009 .

[23]  E. Rando,et al.  Phase I clinical trial in healthy adults of a nasal vaccine candidate containing recombinant hepatitis B surface and core antigens. , 2007, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[24]  Y. Lobaina,et al.  Comparative study of the immunogenicity and immunoenhancing effects of two hepatitis B core antigen variants in mice by nasal administration. , 2006, Vaccine.

[25]  N. Maffulli,et al.  A Review of Treatment Options , 2001 .

[26]  Antonio Bertoletti,et al.  The role of virus-specific CD8(+) cells in liver damage and viral control during persistent hepatitis B virus infection. , 2000 .

[27]  C. Bréchot,et al.  Specific vaccine therapy in chronic hepatitis B infection , 1994, The Lancet.