- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02066649
Carvedilol vs Band Ligation vs Combination Therapy for Primary Prophylaxis of Variceal Bleeding
A Phase 3 Study of Carvedilol vs Variceal Band Ligation vs Combination Therapy for Primary Prophylaxis of Variceal Bleeding
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Inclusion criteria for the study will be an individual > 18 years old with a diagnosis of cirrhosis (either by history, serology or imaging), with medium or large esophageal varices on variceal screening esophagogastroduodenoscopy (EGD), and no prior history of gastrointestinal (GI) bleeding, as related to portal hypertension. Exclusion criteria will be the following: pregnant females; patients on beta blockers or nitrates for any underlying condition; allergies to carvedilol; mean arterial pressure < 55 mm Hg or pulse < 55 beats per minute at baseline; presence of hepatocellular carcinoma; presence of portal vein thrombosis; patients with severe, uncontrolled respiratory disease (asthma, COPD); patients with complete heart block or other significant arrhythmias; those with significant renal disease (CKD stage III or higher); patients who are unable to provide consent; and patients who in the opinion of the principal investigator are not suitable for participation in the trial.
Patients will be randomized to one of the following three treatment groups: (1) carvedilol group, (2) variceal band ligation and (3) combination therapy (carvedilol plus variceal band ligation). Since the standard of care at University Hospital is use of beta blocker medications, the carvedilol group will serve as the control group.
After consent has been obtained for the EGD and research study and patients have met the non-endoscopic inclusion and exclusion criteria mentioned above, they will undergo a screening EGD to look for varices. Varices will be graded by the 2-group classification system of "small" and "large". Varices are graded as large if > 5mm and small if < 5mm in size. A biopsy forceps will be inserted through the biopsy channel of the gastroscope and opened. An open biopsy forceps measures approximately 5mm in diameter. This will be used to measure the size of the varices and will be confirmed by two physicians. If a patient is found to have small esophageal varices, they will be excluded from the study and managed as per the standard of care. Once a patient has been identified in having large esophageal varices, he or she will undergo randomization during that initial endoscopy. A random number generator will be used to randomize the patient into one of the three treatment groups described above. If a patient is randomized to the carvedilol group, the endoscopic procedure will be terminated and the patient will be given a prescription for carvedilol at the time of discharge. He or she will then be followed up in our Gastroenterology clinics in a regular fashion where medication can be titrated and symptoms can be assessed. If a patient is randomized to the variceal band ligation group, the patient will undergo banding of the esophageal varices with a Wilson-Cook multi-banding device. He/she will be started on a proton-pump inhibitor post-procedure to minimize the risk of post-banding ulcers, a known complication of variceal banding. Once the patient has been treated with VBL, this procedure will be scheduled and repeated every two weeks until the obliteration of varices (ie once varices cannot be detected on endoscopy). The first surveillance EGD after obliteration will then be performed 1-3 months after obliteration and then every 6 months to check for variceal recurrence. If a patient is randomized to the combination group, the patient will undergo the banding protocol described above. The patient will then be given a prescription for carvedilol and a proton-pump inhibitor on discharge and followed in our clinics as scheduled.
Study Type
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
New Jersey
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Newark, New Jersey, United States, 07103
- Rutgers NJ Medical School
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Inclusion criteria for the study will be an individual > 18 years old with a diagnosis of cirrhosis (either by history, serology or imaging), with medium or large esophageal varices on variceal screening esophagogastroduodenoscopy (EGD), and no prior history of gastrointestinal (GI) bleeding, as related to portal hypertension
Exclusion Criteria:
- Exclusion criteria will be the following: pregnant females; patients on beta blockers or nitrates for any underlying condition; allergies to carvedilol; mean arterial pressure < 55 mm Hg or pulse < 55 beats per minute at baseline; presence of hepatocellular carcinoma; presence of portal vein thrombosis; patients with severe, uncontrolled respiratory disease (asthma, COPD); patients with complete heart block or other significant arrhythmias; those with significant renal disease (CKD stage III or higher); patients who are unable to provide consent; and patients who in the opinion of the principal investigator are not suitable for participation in the trial.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Carvedilol
Initiating patient on carvedilol after diagnosis of varices made on endoscopy
|
Administering carvedilol to patients diagnosed with large varices on endoscopy
Other Names:
|
Active Comparator: Variceal Band Ligation
performing variceal band ligation during endoscopy on patient after diagnosis of esophageal varices made on endoscopy
|
Performing variceal band ligation during endoscopy after diagnosis of large varices on endoscopy
|
Active Comparator: Combination Group (Carvedilol + Variceal band ligation)
once patient has confirmed large esophageal varices on endoscopy, he/she will be started on carvedilol (post-procedure) in addition to having variceal band ligation performed during endoscopy
|
Administering carvedilol to patients diagnosed with large varices on endoscopy
Other Names:
Performing variceal band ligation during endoscopy after diagnosis of large varices on endoscopy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Incidence of first variceal bleed
Time Frame: within 2 year follow-up period
|
within 2 year follow-up period
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Bleed-related mortality
Time Frame: within 2-year follow-up period
|
within 2-year follow-up period
|
Overall mortality
Time Frame: Within 2 year follow-up period
|
Within 2 year follow-up period
|
Recurrence of varices
Time Frame: within 2 year follow-up period
|
within 2 year follow-up period
|
Collaborators and Investigators
Investigators
- Principal Investigator: NIKOLAOS T PYRSOPOULOS, MD, RUTGERS - NJMS- DEPARTMENT OF MEDICINE
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Cardiovascular Diseases
- Vascular Diseases
- Liver Diseases
- Hypertension
- Hypertension, Portal
- Physiological Effects of Drugs
- Adrenergic beta-Antagonists
- Adrenergic Antagonists
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Vasodilator Agents
- Protective Agents
- Membrane Transport Modulators
- Calcium-Regulating Hormones and Agents
- Calcium Channel Blockers
- Antioxidants
- Adrenergic alpha-1 Receptor Antagonists
- Adrenergic alpha-Antagonists
- Carvedilol
Other Study ID Numbers
- Pro2013003729
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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