- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02508623
Effect of Administration of Rifaximin on the Portal Pressure of Patients With Liver Cirrhosis and Esophageal Varices (ERASE)
July 27, 2015 updated by: Piero Amodio, University of Padova
Effect of Administration "Add on" of Rifaximin on Portal Hypertension of Patients With Liver Cirrhosis and Esophageal Varices in Standard Therapy With Propranolol
The purpose of this study is to assess whether the add of Rifaximin in patients with liver cirrhosis and esophageal varices treated with a standard therapy with beta blockers, leads to a significant reduction of portal hypertension.
Study Overview
Status
Unknown
Conditions
Intervention / Treatment
Detailed Description
It is well recognized that the gut flora may play an important role in the development of complications of liver cirrhosis, such as hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP) and variceal bleeding, which are are directly caused or aggravated by the translocation of enteric bacteria or their products into the blood of cirrhotic patients.Preliminary studies have shown that selective intestinal decontamination appears to ameliorate the hyperdynamic circulatory state of cirrhosis.
The investigators hypothesize that a modulation of gut microbiota by administering a non-adsorbable antibiotic, in addition to beta-blockers, can be a safe strategy to reduce the portal pressure, influencing favorably hemodynamics of portal circulation.
Thus, the purpose of this study is to evaluate if in patients with liver cirrhosis and esophageal varices at high risk of bleeding, Rifaximin, administered in addition to standard therapy with beta - blockers (propranolol), for a time of 60 days: leads to a significant reduction of Hepatic Venous Pressure Gradient (it will be assessed by hepatic vein catheterization), 2) modify the intestinal flora in favor of specific families of bacteria (it will be assessed by fecal microbiota analysis), 3) change systemic inflammatory responses (it will be assessed by serum pro-inflammatory cytokines) 4) change in cognitive functions (it will be assessed by neuropsychological and electroencephalogram evaluations).
Study Type
Interventional
Enrollment (Anticipated)
60
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 Contact
- Name: Francesca Campagna, MD
- Phone Number: +39 0498218675
- Email: francescacampagna3@gmail.com
Study Locations
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-
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Padua, Italy, 35140
- Recruiting
- Azienda Ospedaliera di Padova
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Contact:
- Claudio Dario
- Phone Number: +39 0498212105
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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:
- Diagnosis of liver cirrhosis (based on clinical, biochemical and radiological criteria with or without liver biopsy)
- Presence of esophageal varices at high risk of bleeding
- Hepatic Venous Pressure Gradient > 12 mmHg.
- 19≤ age ≤75
- Informed Consent
Exclusion Criteria:
- Patients already treated with beta blockers
- Treatment with systemic antibiotics and/or non-absorbable intestinal antibiotics in the previous two weeks
- Bacterial infection, spontaneous bacterial peritonitis
- overt hepatic encephalopathy in the last week
- active gastrointestinal bleeding, or in the last week
- active alcoholism or drug abuse in last 3 weeks
- Acute Alcoholic Hepatitis
- Hepatocellular carcinoma or other neoplasm
- significant coronary artery disease (angina NYHA III/IV), congestive heart failure (NYHA III/IV), relevant cardiomyopathy, history of myocardial infarct within the last 12 months
- Contraindications to the administration of beta blockers; allergy to Rifaximin
- Pregnancy or breastfeeding
- Refusal to participate
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: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Rifaximin
Rifaximin 550 mg 1 tablet BID for 60 days
|
Rifaximin 550 mg tablet BID for 60 days
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Placebo Comparator: Placebo
Placebo 1 tablet BID for +60 days
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Placebo 1 tablet BID for 60 days
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change of Hepatic Venous Pressure Gradient
Time Frame: Time 0 and after 60 days
|
At Time 0 and after 60 days all patients will underwent hepatic vein catheterization to obtain the Hepatic Venous Pressure Gradient.
Treatment response is defined as a decrease from baseline in the hepatic venous pressure gradient of at least 20% or less than 12 mmHg
|
Time 0 and after 60 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Modification of fecal bacteria
Time Frame: Time 0 and after 60 days
|
Both at time 0 and after 60 days, samples of 3 mL of faeces produced within 6 hours will be collected and frozen at -80° for the analysis of the gut microbiota (the samples will be stored at -80°C).
Gut microbiota will be studied through sequencing of hyper-variable regions of the 16S Ribosomal Ribonucleic Acid gene.
|
Time 0 and after 60 days
|
Change of systemic inflammatory response
Time Frame: Time 0 and after 60 days
|
Both at time 0 and after 60 days, the storage of a serum sample at -80 ° for the assay of proinflammatory cytokines will be done.
|
Time 0 and after 60 days
|
Change of cognitive function
Time Frame: Time 0 and after 60 days
|
Cognitive function will be assessed at time 0 and after 60 days by neuropsychological and neurophysiological measures.
Neuropsychological investigation will be performed using the Italian version of the Psychometric Hepatic Encephalopathy Score that and with the Animal Naming Test (number of animals named in 60 sec).
Neurophysiological investigation will be done by Emotiv Electroencephalogram equipment.
Spontaneous closed-eyes rest activity will be recorded by a 14 channels plus 2 references offering optimal positioning for accurate spatial resolution.
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Time 0 and after 60 days
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Piero Amodio, University of Padova
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
July 1, 2015
Primary Completion (Anticipated)
January 1, 2017
Study Completion (Anticipated)
July 1, 2017
Study Registration Dates
First Submitted
July 21, 2015
First Submitted That Met QC Criteria
July 24, 2015
First Posted (Estimate)
July 27, 2015
Study Record Updates
Last Update Posted (Estimate)
July 28, 2015
Last Update Submitted That Met QC Criteria
July 27, 2015
Last Verified
July 1, 2015
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Digestive System Diseases
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Gastrointestinal Diseases
- Liver Diseases
- Esophageal Diseases
- Fibrosis
- Hypertension
- Liver Cirrhosis
- Esophageal and Gastric Varices
- Hypertension, Portal
- Anti-Infective Agents
- Gastrointestinal Agents
- Anti-Bacterial Agents
- Rifaximin
Other Study ID Numbers
- 3250/AO/14
- 2014-000102-35 (EudraCT Number)
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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