- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04311489
Refractory Ascites in Patients With Liver Cirrhosis, and the Potential Treatment With 48 Hours Infusion of Ularitide. (ULA04)
Single-center, Randomized, Double-blind, Placebo-controlled Clinical Trial for the Safety, Tolerability and Efficacy of Ularitide in Cirrhosis Patients With Refractory Ascites.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The investigators hypothesize that ularitide infusion is more effective than placebo to induce and maintain clinically meaningful natriuresis and diuresis in patients with liver cirrhosis and refractory ascites.
Participants will be given ularitide or placebo intravenously while hospitalized at Department of Hepatology and Gastroenterology at Aarhus University Hospital. During the hospitalization blood and urine samples are frequently collected.
30 ng/kg/min is the starting dosage for all participants. Depending on effects and/or side effects, ULA04 is designed to individualize treatment doses by up- and/or downtitration of the infusion dose within a predefined dose range. Relevant safety precautions are incorporated in the study design and treatment will be prematurely discontinued if a pre-defined stopping criteria presents.
Patients will be followed up for the appearance of serious adverse events 30 days after the treatment.
If a separate written consent is given by the participants, additional blood and urine samples will be collected and stored in a biobank for future research.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Henning Grønbæk, Prof,MD,PhD
- Phone Number: +45 21 67 92 81
- Email: henngroe@rm.dk
Study Contact Backup
- Name: Rasmus H Gantzel, MD
- Phone Number: +45 40 87 92 22
- Email: ragant@rm.dk
Study Locations
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Central Denmark Region
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Aarhus, Central Denmark Region, Denmark, 8200
- Department of Hepatology and Gastroenterology, Aarhus University Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Men and women >18 years
- Liver cirrhosis confirmed by fibroscan (>20 kPa), or by imaging with signs of an irregular liver surface with collaterals, or clinically by cirrhosis stigmata
- Refractory ascites Definition: failure to respond to or intolerance to high dose diuretics (spironolactone up to 400mg/day and furosemide up to 160mg/day) and early ascites recurrence (reappearance of grade 2 or 3 ascites within 4 weeks of initial mobilization or ≥2 paracentesis within last 3 months)
- Urine sodium excretion <60 mmol/24 hour
- Serum creatinine <150 µmol/L
- Child-Turcotte-Pugh score of B or C (<13)
- Bilirubin <150 µmol/L
- Prothrombin time (PP) 0.20-0.60 (INR 1.3-2.5)
- Systolic blood pressure ≥95 mmHg
- Written informed consent to participate in the clinical trial
Exclusion Criteria:
- Gastrointestinal bleeding within 2 weeks prior to inclusion
- Proteinuria >500 mg/day
- Hemoglobin <5.5 mmol/L
- Spontaneous bacterial peritonitis within 2 weeks prior to inclusion
- Loculated ascites
- Hepatic encephalopathy grade 2-4 (West-Haven classification)
- Obstructive uropathy
- Primary kidney disease
- Known diagnosis of congestive heart failure
- Known diagnosis of acute-on-chronic liver failure
- Known diagnosis of systemic inflammatory response syndrome
- Acute infections by known diagnosis and/or antibiotic treatment
- Known HIV infection
- Known allergy to the investigational drug or other natriuretic peptides
- Treatment with dobutamine, levosimendan, milrinone, any phosphodiesterase inhibitor, octreotide, midodrine, vasopressin, dopamine or other vasopressors within 2 weeks prior to inclusion
- Nephrotoxic drugs within 1 month prior to inclusion
- Fertile women not using contraception, either an intrauterine device or hormonal contraception
- Positive pregnancy test in pre-menopausal women or in breast-feeding women
- Participation in an interventional clinical drug trial within 1 month prior to inclusion
- Legal incapacity or limited legal capacity
- Patients who are employees or relatives of the investigator
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Ularitide
Test product.
Continuous intravenous infusion with 30 ng/kg/min for 48 hours.
|
Continuous intravenous infusion for 48 hours at a dose of 30 ng/kg/min.
Depending on effect and/or side effects dose can be adjusted to 15 ng/kg/min or 45 ng/kg/min.
Other Names:
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Placebo Comparator: Placebo
Matching placebo.
Continuous IV infusion for 48 hours.
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Continuous intravenous infusion for 48 hours at a bodyweight-adjusted infusion rate.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Absolute and relative change in sodium excretion rate.
Time Frame: After 24 hours and at termination of treatment (up to 48 hours)
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After 24 hours and at termination of treatment (up to 48 hours)
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Absolute and relative change in urine volume.
Time Frame: After 24 hours and at termination of treatment (up to 48 hours)
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After 24 hours and at termination of treatment (up to 48 hours)
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Change of absolute body weight.
Time Frame: At termination of treatment (up to 48 hours)
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At termination of treatment (up to 48 hours)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of responders in the ularitide group versus the placebo group, defined by:
Time Frame: Throughout the treatment period. Latest measure at termination of treatment (up to 48 hours)
|
Urine volume increase of ≥100 % versus baseline, urine volume increase ≥50 % versus baseline, natriuresis increase by ≥100 % versus baseline and/or body weight reduction by ≥2 kg versus baseline.
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Throughout the treatment period. Latest measure at termination of treatment (up to 48 hours)
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Absolute and relative change in sodium excretion rate.
Time Frame: After 2 hours and 4 hours of treatment and at 6 hours post-treatment follow-up
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After 2 hours and 4 hours of treatment and at 6 hours post-treatment follow-up
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Absolute and relative change in urine volume.
Time Frame: After 2 hours and 4 hours of treatment and at 6 hours post-treatment follow-up
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After 2 hours and 4 hours of treatment and at 6 hours post-treatment follow-up
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Absolute and relative change in plasma cyclic guanosine monophosphate (cGMP) concentration.
Time Frame: Throughout the treatment period. Latest measure at 6 hours post-treatment follow-up
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Throughout the treatment period. Latest measure at 6 hours post-treatment follow-up
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Absolute and relative change in waist circumference.
Time Frame: After 24 hours and at termination of treatment (up to 48 hours)
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After 24 hours and at termination of treatment (up to 48 hours)
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Absolute and relative change in serum creatinine.
Time Frame: After 24 hours and at termination of treatment (up to 48 hours)
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After 24 hours and at termination of treatment (up to 48 hours)
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Absolute and relative change in estimated glomerular filtration rate (eGFR).
Time Frame: After 24 hours and at termination of treatment (up to 48 hours)
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After 24 hours and at termination of treatment (up to 48 hours)
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Absolute and relative change in plasma and urine osmolalities.
Time Frame: Throughout the treatment period. Latest measure at 6 hours post-treatment follow-up
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Throughout the treatment period. Latest measure at 6 hours post-treatment follow-up
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Absolute and relative change in GFR-24h-Crea (Glomerular filtration rate based on 24-hour creatinine clearance).
Time Frame: After 24 hours and 48 hours of treatment
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After 24 hours and 48 hours of treatment
|
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Absolute and relative change in hematocrit.
Time Frame: After 24 hours and 48 hours of treatment and at 6 hours post-treatment follow-up
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After 24 hours and 48 hours of treatment and at 6 hours post-treatment follow-up
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Absolute and relative change in plasma copeptin concentration.
Time Frame: After 24 hours and 48 hours of treatment and at 6 hours post-treatment follow-up
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After 24 hours and 48 hours of treatment and at 6 hours post-treatment follow-up
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Absolute and relative change in plasma renin concentration.
Time Frame: After 24 hours and 48 hours of treatment and at 6 hours post-treatment follow-up
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After 24 hours and 48 hours of treatment and at 6 hours post-treatment follow-up
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Absolute and relative change in plasma angiotensin concentration.
Time Frame: After 24 hours and 48 hours of treatment and at 6 hours post-treatment follow-up
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After 24 hours and 48 hours of treatment and at 6 hours post-treatment follow-up
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Absolute and relative change in plasma aldosterone concentration.
Time Frame: After 24 hours and 48 hours of treatment and at 6 hours post-treatment follow-up
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After 24 hours and 48 hours of treatment and at 6 hours post-treatment follow-up
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Other Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Incidence of adverse events/reactions.
Time Frame: Throughout the treatment period and until 6 hours post-treatment follow-up
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Throughout the treatment period and until 6 hours post-treatment follow-up
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Incidence of serious adverse events/reactions.
Time Frame: Throughout the treatment period and until 30 days post-treatment follow-up
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Throughout the treatment period and until 30 days post-treatment follow-up
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Incidence of stopping criteria leading to a dose reduction.
Time Frame: Throughout the treatment period (up to 48 hours)
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Throughout the treatment period (up to 48 hours)
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Incidence of stopping criteria leading to early termination of treatment.
Time Frame: Throughout the treatment period (up to 48 hours)
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Throughout the treatment period (up to 48 hours)
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Henning Grønbæk, Prof,MD,PhD, Department of Hepatology and Gastroenterology, Aarhus University Hospital,
Publications and helpful links
General Publications
- Carstens J, Greisen J, Jensen KT, Vilstrup H, Pedersen EB. Renal effects of a urodilatin infusion in patients with liver cirrhosis, with and without ascites. J Am Soc Nephrol. 1998 Aug;9(8):1489-98. doi: 10.1681/ASN.V981489.
- Carstens J, Gronbaek H, Larsen HK, Pedersen EB, Vilstrup H. Effects of urodilatin on natriuresis in cirrhosis patients with sodium retention. BMC Gastroenterol. 2007 Jan 26;7:1. doi: 10.1186/1471-230X-7-1.
- Gantzel RH, Meyer M, Mazgareanu S, Aagaard NK, Jepsen P, Holzmeister J, Watson H, Gronbaek H. Ularitide as treatment of refractory ascites in cirrhosis- a study protocol for a randomised trial. Dan Med J. 2021 Nov 12;68(12):A07210610.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
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
- ULA04
- 2019-002268-28 (EudraCT Number)
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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