Efficacy and Safety of Terlipressin With Albumin Versus Midodrine With Albumin Versus Albumin Alone in Prevention of Paracentesis Induced Circulatory Dysfunction in Cirrhosis
Randomized Trial Comparing the Efficacy and Safety of Terlipressin With Albumin Versus Midodrine With Albumin Versus Albumin Alone in Prevention of Paracentesis Induced Circulatory Dysfunction in Cirrhosis
- Study Population: Patients admitted or seen in Out Patient Department, Department of Hepatology, Institute of Liver and Biliary Sciences.
- Study Design: Prospective Open Labeled Randomized Controlled Trial.
- Study Period: January 2017 to December 2017
- Intervention- Subjects will be randomized to 3 groups
- All patients will receive Standard medical therapy - Albumin-8g/L of tap- one half of dose at beginning of tap and rest half after 6 hours of tapping.
Group A - Subjects will receive Terlipressin 1mg intravenous bolus at the onset of paracentesis and the remaining as 1 mg doses intravenous at 8 and 16 h after the first dose. ( total -3mg) Group B - Midodrine 7.5 mg TDS x 3 days Group C - Standard medical therapy only
- Monitoring and Assessment: Clinical evaluation will be done at regular intervals.
- Adverse Effects: Rise in blood pressure, arrthymias, hyponatremia and rarely cardiovascular side effects have been noted.
- Stopping Rule: Development of PICD, hypertension ( BP>160/90mmhg-JNC class II)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Delhi
-
New Delhi, Delhi, India, 110070
- Institute of Liver and Biliary Sciences
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients with cirrhosis who undergo Large volume paracentesis (> 5L)
- Patients with age from 18-75 years
Exclusion Criteria:
- Renal failure ( Creatinine>1.5mg/dl)
- Recent Gastrointestinal bleeding within 7 days
- Spontaneous bacterial Peritonitis
- Patients with Cardiovascular disease (Electrocardiogram, 2D Echo)
- Systemic arterial hypertension ( >160/90mmhg) Presence of hepatocellular carcinoma or portal vein thrombosis, Budd chiari syndrome
- Patients with active untreated sepsis
- Pregnancy
- Patients with hepatic encephalopathy
- No use of drugs affecting systemic hemodynamic 3 days prior to enrollment
- Refusal to participate
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Terlipressin
Terlipressin 1mg intravenous bolus at the onset of paracentesis and the remaining as 1 mg doses intravenous at 8 and 16 h after the first dose.
( total -3mg)
|
Terlipressin 1mg intravenous bolus at the onset of paracentesis and the remaining as 1 mg doses intravenous at 8 and 16 h after the first dose.
( total -3mg)
|
|
Active Comparator: Midodrine
Midodrine 7.5 mg thrice daily for 3 days.
|
Terlipressin 1mg intravenous bolus at the onset of paracentesis and the remaining as 1 mg doses intravenous at 8 and 16 h after the first dose.
( total -3mg)
|
|
Active Comparator: Standard Medical Therapy
Albumin-8g/L of tap- one half of dose at beginning of tap and rest half after 6 hours of tapping.
|
Albumin-8g/L of tap- one half of dose at beginning of tap and rest half after 6 hours of tapping.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Incidence of Paracentesis Induced Circulatory Dysfunction (PICD).
Time Frame: Day 6
|
Day 6
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Number of hospital admission withing 28 days in all the 3 groups
Time Frame: 28 days
|
28 days
|
|
|
Development of Hyponatremia in all the 3 groups
Time Frame: Day 28
|
Hyponatremia is defined as S.Na < 130 meq/dL.
|
Day 28
|
|
Development of Hepatic Encephalopathy in all the 3 groups
Time Frame: Day 28
|
Hepatic Encephalopathy defined as West Haven Grade > 1
|
Day 28
|
|
Recurrence of ascites in all the 3 groups
Time Frame: Day 28
|
Day 28
|
|
|
Development of Acute Kidney Injury in all the 3 groups
Time Frame: Day 28
|
Acute Kidney Injury is defined as increase S.Creatinine by more than 0.3 mg/dL
|
Day 28
|
|
Survival in all the 3 groups
Time Frame: Day 28
|
Day 28
|
Collaborators and Investigators
Sponsor
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Pathologic Processes
- Liver Diseases
- Fibrosis
- Liver Cirrhosis
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Autonomic Agents
- Peripheral Nervous System Agents
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Sympathomimetics
- Vasoconstrictor Agents
- Adrenergic alpha-1 Receptor Agonists
- Terlipressin
- Midodrine
Other Study ID Numbers
Other Study ID Numbers
- ILBS-Cirrhosis-10
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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