- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02557360
Effectiveness of S-adenosyl-L-methionine in Patients With Primary Biliary Cirrhosis
Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disorder which may lead to several symptoms such as intractable pruritus or chronic fatigue, significantly impairing patients quality of life. Recent studies show, that chronic liver diseases are associated with an acquired deficiency of S-adenosyl-L-methionine (SAMe) synthetase, responsible for the synthesis of SAMe from methionine. SAMe deficiency is associated with impaired detoxification and hepatoprotection and exacerbate liver injury. Supplementation with SAMe has proven useful in several liver diseases.
The study group will include 20 patients with PBC diagnosed with European Association for the Study of the Liver (EASL) criteria, who have been already treated with ursodeoxycholic acid (UDCA). They will receive SAMe in the dose of 1600 mg bd over the period of 6 months. Both clinical and laboratory aspects will be analyzed: liver serum biochemistry, serum and urine bile acids metabolites, transient elastography and health related quality of life.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background: Primary biliary cirrhosis is a chronic cholestatic liver disorder which may lead to end stage liver disease causing death or requiring liver transplantation. Additionally, a significant proportion of patients suffers from complications related to impaired bile secretion such as intractable pruritus, chronic fatigue, osteoporosis or lipid disturbance. They all have a significant consequence for patients well being, quality of life and economical aspects of health care systems. Pathogenesis of PBC remains to be fully elucidated. Recent studies show,that chronic liver diseases are associated with an acquired deficiency of S-adenosyl-L-methionine synthetase, an enzyme responsible for the synthesis of SAMe from methionine. SAMe initiates two very important protective metabolic pathways: transmethylation and transsulphuration. As a result of the later, glutathione, taurine and sulphate group are synthesized. Thus SAMe deficiency is associated with impaired detoxification and hepatoprotection and exacerbate liver injury. Supplementation with SAMe has proven useful in alcoholic liver disease, obstetric cholestasis and elimination of hepatitis C virus (HCV). The investigators' studies on experimental models where cholestasis was induced in vitro with lithocholic acid and 17-beta estradiol glucuronide showed that supplementation with SAMe exerts a significant anticholestatic effect. Interestingly, simultaneous administration of SAMe and ursodeoxycholic acid (UDCA) exerts an additive effect.
Methods: The study group will include 20 patients PBC diagnosed with EASL criteria, who have been already treated with UDCA. They will receive UDCA in the dose of 13 - 15mg/kg bw plus SAMe in the dose of 1600 mg bd over the period of 6 months.
The key aim of the project is to analyze the effect of SAMe on the health related quality of life and liver biochemistry. Blood and urine samples (from 24hr urine collection) will be collected for liver biochemistry and metabolites of bile acids. Additionally transient elastography will be performed before and after 6 months SAMe treatment.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
-
Szczecin, Poland
- Wunsch
-
Warsaw, Poland
- Milkiewicz
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- primary biliary cirrhosis diagnosed with EASL criteria;
- treatment with UDCA at least 3 months.
Exclusion Criteria:
- overlap syndromes (i.e. autoimmune hepatitis), viral hepatitis;
- decompensated liver cirrhosis (Child-Pugh class B-C);
- other diseases that can affect quality of life and mood: decompensated diabetes mellitus, renal insufficiency requiring dialyses, malignancy, heart failure ≥ New York Heart Association (NYHA) II, rheumatoid arthritis, asthma, mood disorders, depression;
- treatment with: steroids, statins, rifampicin, antidepressants.
Study Plan
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: S-adenosyl-L-methionine
Patients with primary biliary cirrhosis will be treated with S-adenosyl-L-methionine, tablets 800 mg twice a day (daily dosage 1600 mg) for six months
|
Patients will be treated with S-adenosyl-L-methionine, tablets 800 mg twice a day (daily dosage 1600 mg) for six months
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
PBC-40 questionnaire
Time Frame: 6 months
|
Questionnaire consists 40 questions in 5 domains: Cognition, Itch, Fatigue, Social-Emotional and Other Symptoms, marked with a five-point scale (1=never to 5=always), with higher scores denoting greater symptoms impact and poorer quality of life.
The possible range of each domain were: Other Symptoms domain 7-35, Itch 3-15, Fatigue 11-55, Cognitive 6-30, Social and Emotional 13-65 points.
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Liver fibrosis measured by transient elastography
Time Frame: 6 months
|
To analyse the influence of SAMe treatment on liver stiffness
|
6 months
|
Number of participants with abnormal laboratory values (liver biochemistry)
Time Frame: 6 months
|
To analyse the influence of SAMe treatment on liver function parameters
|
6 months
|
Number of participants with changes in bile acids pool
Time Frame: 6 months
|
To analyse the influence of SAMe treatment on 17 bile acids metabolites in serum and urine
|
6 months
|
Collaborators and Investigators
Collaborators
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
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
Other Study ID Numbers
- 2011/02/A/NZ5/00321
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.
Clinical Trials on Primary Biliary Cirrhosis
-
University Health Network, TorontoUnknown
-
CymaBay Therapeutics, Inc.TerminatedPrimary Biliary Cirrhosis (PBC)Germany, United States, Canada, United Kingdom, Poland
-
Xijing Hospital of Digestive DiseasesUnknownPrimary Biliary CirrhosisChina
-
University of AarhusAarhus University Hospital; Hvidovre University HospitalRecruiting
-
CymaBay Therapeutics, Inc.RecruitingPrimary Biliary CirrhosisUnited States, Korea, Republic of, Belgium, Spain, France, Switzerland, Romania, United Kingdom, Austria, Israel, Australia, Argentina, Canada, Chile, Germany, Greece, Hungary, Italy, Mexico, Netherlands, Poland, Czechia, New Zealand, Turke... and more
-
Target PharmaSolutions, Inc.Active, not recruitingBiliary Cirrhosis, PrimaryUnited States
-
IpsenActive, not recruitingPrimary Biliary CirrhosisUnited States, France, Spain, Belgium, Germany, Switzerland, Brazil, United Kingdom, Argentina, Canada, Chile, Italy, South Africa, Turkey
-
Instituto Mexicano del Seguro SocialActive, not recruitingPrimary Biliary CirrhosisMexico
-
Chia Tai Tianqing Pharmaceutical Group Co., Ltd.RecruitingPrimary Biliary CirrhosisChina
-
Zydus Therapeutics Inc.CompletedPrimary Biliary CirrhosisUnited States
Clinical Trials on S-adenosyl-L-methionine
-
Mclean HospitalStanley Medical Research InstituteCompletedDepression | Bipolar Disorder | Bipolar DepressionUnited States
-
Deakin UniversityCompleted
-
Mayo ClinicCompleted
-
Medical University of WarsawNational Science Centre, PolandRecruitingPrimary Sclerosing Cholangitis (PSC)Poland
-
Mayo ClinicPharmavite LLCCompleted
-
Dartmouth-Hitchcock Medical CenterActive, not recruitingOsteoarthritis HandUnited States
-
Beijing Insight Science & Technology Co. Ltd.Unknown
-
Eastern Hepatobiliary Surgery HospitalUnknownHepatocellular CarcinomaChina
-
National Institute of Diabetes and Digestive and...Terminated
-
Huang, Jeannie, M.D.CompletedAbdominal PainUnited States