Effect of Tolvaptan on Cognitive Function in Cirrhosis

February 6, 2014 updated by: Jasmohan Bajaj, Hunter Holmes Mcguire Veteran Affairs Medical Center

Effects of Tolvaptan on Cognitive Function, Brain Metabolism and Quality of Life in Hyponatremic Cirrhotics With Hepatic Encephalopathy: A Prospective Clinical Trial

Hypothesis: Tolvaptan will improve cognitive function, brain edema and health-related quality of life in cirrhotic patients with hyponatremia

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Baseline assessment will include a

  1. battery of eight cognitive tests
  2. Health related quality of life
  3. MRI head evaluating MR spectroscopy and diffusion tensor imaging

Patients will then be given tolvaptan 15-30mg qd for 14 days after which the tests will be repeated. During the first 3 days of tolvaptan administration, patients will be admitted and serum sodium will be drawn every 8 hours. 24 hr urine collection will also be performed.

Between the initiation and end of tolvaptan, patients will be seen at least every 3-5 days in between.

Participation will be terminated in case patients get transplanted or develop overt HE in between.

Study Type

Interventional

Enrollment (Actual)

25

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Virginia
      • Richmond, Virginia, United States, 23249
        • Hunter Holmes McGuire VA Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 75 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Cirrhosis diagnosed by liver biopsy or radiological evidence of nodular cirrhotic liver or varices on endoscopy or laboratory features (platelet count <150,000 with an AST/ALT ratio >1).
  • History of HE controlled on lactulose and/or rifaximin
  • Last HE episode >2 months prior to enrollment and <2 episodes within 6 months
  • Mini-mental status exam score ≥25
  • Serum sodium <130mg/dl within the last 14 days and the day of enrollment
  • Availability of a caregiver
  • Able to undergo MR of the head

Exclusion Criteria:

  • Uncontrolled HE manifested by MMSE <25
  • Alcohol abuse within 3 months
  • Illicit drug use within 3 months
  • Psychoactive drug use other than regularly scheduled anti-depressants or methadone.
  • Contraindication to MR examination (see attached MRI Safety Form)
  • Placement of a transjugular intra-hepatic portosystemic shunt (TIPS)
  • Creatinine Clearance less than 10 ml/min or undergoing hemodialysis
  • HIV infection
  • Use of azole medications
  • Pregnancy
  • Current use of tolvaptan, hypertonic saline or other medical therapies for hyponatremia

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Tolvaptan
Open label study of tolvaptan. First 3 days as an inpatient then outpatient for the remainder of the study
Drug: Tolvaptan
15 to 30mg qd titrated to sodium concentration
Other Names:
  • Samsca

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Cognitive performance
Time Frame: 14 days
14 days

Secondary Outcome Measures

Outcome Measure
Time Frame
Brain MR Spectroscopy
Time Frame: 14 days
14 days
Brain Diffusion Tensor Imaging
Time Frame: 14 days
14 days
Health-related Quality of Life
Time Frame: 14 days
14 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Hunter Holmes Mcguire Veteran Affairs Medical Center

Collaborators

Otsuka America Pharmaceutical

Investigators

  • Principal Investigator: Jasmohan S Bajaj, MD, Hunter Holmes McGuire VA Medical Center

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

April 1, 2011

Primary Completion (Actual)

June 1, 2013

Study Completion (Actual)

June 1, 2013

Study Registration Dates

First Submitted

March 15, 2012

First Submitted That Met QC Criteria

March 15, 2012

First Posted (Estimate)

March 16, 2012

Study Record Updates

Last Update Posted (Estimate)

February 7, 2014

Last Update Submitted That Met QC Criteria

February 6, 2014

Last Verified

February 1, 2014

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Bajaj 01720

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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