- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03415698
G-CSF in Decompensated Cirrhosis: an Open Label Trial
Granulocyte Colony Stimulating Factor in Decompensated Cirrhosis: an Open Label Study
Globally, cirrhosis is the fifth commonest cause of mortality. Its natural history is typified by an initial, largely asymptomatic, "compensated" phase followed by "decompensation" due to complications of raised portal pressures and hepatocellular dysfunction.
Currently the only definitive treatment option for cirrhosis is liver transplantation which is limited in its applicability due to donor shortage, exorbitant costs and lack of widespread availability. The need for long term immunosuppression and its attendant complications are a further drawback. The ability of stem cells to differentiate into multiple cellular lineages makes one speculate that they can be used for tissue repair and regeneration when tissue-resident stem cells become overwhelmed. Bone marrow derived stem cells have amazing plasticity. They can "home" to the liver in response to injury and help in liver regeneration by trans-differentiation, cell fusion and augmentation of tissue- resident stem cell mediated repair. Two methods are available for the mobilisation of stem cells from the bone marrow to the liver. One involves the administration of cytokines like granulocyte-colony stimulating factor (G-CSF) and the other is the isolation of stem cells from the marrow followed by their injection into the hepatic artery or portal vein after purification. The latter is probably more cumbersome and may be potentially risky due to the underlying coagulation abnormalities in cirrhotic patients .
G-CSF has been shown to mobilise bone marrow stem cells and even increase survival in patients of severe alcoholic steatohepatitis and ACLF. There is conflicting evidence on the role of G-CSF in decompensated cirrhosis with some studies showing improved survival while others have shown a lack of clinical or biochemical benefit. Many of these studies have used a single course of G-CSF. Verma et al, in a recent study published in 2018, elegantly demonstrated the beneficial effect of multiple courses of G-CSF in improving mortality and transplant free survival in decompensated cirrhotics.
The investigators too speculate that multiple cycles of G-CSF could result in better outcomes in decompensated cirrhosis by causing more prolonged and sustained stem cell homing to the liver. Thus, this study is being undertaken to further evaluate the safety and efficacy of multiple cycles of G-CSF in decompensated cirrhotics.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Contact
- Name: Arka De, MD
- Phone Number: 9999816539
- Email: arkascore@gmail.com
Study Locations
-
-
-
Chandigarh, India, 160012
- Recruiting
- Post Graduate Institute of Medical Education and Research
-
Contact:
- Arka De, MD
- Phone Number: 9999816539
- Email: arkascore@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Decompensated Cirrhosis of liver irrespective of etiology
Exclusion Criteria:
- Acute on chronic liver failure (fulfilling either APASL or CANONIC criteria of ACLF)
- Splenic diameter of more than 18 cm
- Concomitant HCC or other active malignancy
- Upper gastrointestinal bleeding in the previous 7 days
- Portal vein thrombosis
- Severe renal dysfunction as defined by creatnine > 1.5mg/dl
- Severe cardiac dysfunction
- Uncontrolled diabetes (Hb A 1c ≥ 9) or diabetic retinopathy
- Acute infection or disseminate intravascular coagulation
- Active alcohol abuse in last 3 months
- Known hypersensitivity to G-CSF
- HIV co-infection
- Pregnancy
- Refusal to give informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Standard Medical Therapy
Standard medical therapy will include nutritional support, rifaximin, lactulose, bowel wash, albumin, diuretics, multivitamins, antibiotics.
fresh frozen plasma and packed red-cell transfusions (as required)
|
Nutritional support, rifaximin, lactulose, bowel wash, albumin, diuretics, multivitamins and antibiotics.
|
ACTIVE_COMPARATOR: G-CSF + Standard Medical Therapy
G-CSF at the dosage of 5 µg/Kg subcutaneously every 12 hr will be administered for five consecutive days.
Four such cycles at 3 monthly intervals will be administered.
|
Nutritional support, rifaximin, lactulose, bowel wash, albumin, diuretics, multivitamins and antibiotics.
G-CSF will be administered at the dosage of 5 µg/Kg subcutaneously every 12 hr for five consecutive days.
four such cycles will be administered at three monthly intervals.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Survival
Time Frame: One year
|
Survival at 1 year after start of therapy
|
One year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical improvement in liver functions
Time Frame: One Year
|
Occurrence of decompensations namely ascites, hepatic encephalopathy and variceal bleed
|
One Year
|
Improvement in quality of life
Time Frame: One year
|
Quality of life will be assessed using SF-36V2 Health Survey questionnaire
|
One year
|
Hemopoieticstem cell mobilisation
Time Frame: One Year
|
Mobilisation of CD 34+ cells in peripheral blood
|
One Year
|
Biochemical improvement in liver functions
Time Frame: One year
|
Improvment in MELD score
|
One year
|
Improvement in nutritional status
Time Frame: One Year
|
Nutritional status will be assesses by skeletal muscle index measurement using CT scan measurements at L3 level
|
One Year
|
Safety of G-CSF as assessed by its adverse effects
Time Frame: One Year
|
One Year
|
Collaborators and Investigators
Investigators
- Principal Investigator: Virendra Singh, DM, Professor, Department of Hepatology, PGIMER, Chandigarh
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- GCSF in cirrhosis
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
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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