- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05057572
Efficacy and Safety of Carvedilol in Cirrhosis Patients With Uncomplicated Ascites Without High Risk Esophageal Varices
Efficacy and Safety of Carvedilol in Cirrhosis Patients With Uncomplicated Ascites Without High Risk Esophageal Varices- A Randomised Controlled Trial"
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
AIM-To compare the safety and efficacy of addition of carvedilol to SMT (diuretics +/- albumin) compared to SMT alone in the prevention of complicated ascites (refractory ascites, AKI-HRS, SBP or severe hyponatremia) at 1year.
Methodology:
Study population: Patient of liver cirrhosis presenting with uncomplicated ascites and without high risk esophageal varices.
Study design:
- A prospective, randomized, single center open label study.
- The study will be conducted on the consecutive patients presenting with uncomplicated ascites and low risk esophageal varices seen at the outpatient clinics/wards of Department of Hepatology, ILBS, New Delhi from July 2021 to June 2023.
Study period: 2years from the date of ethics approval
Sample size with justification:
- Assuming that the complication rate in carvedilol group is 8% and placebo 30% so the complication free rate of 92% and 70 % further assuming alpha -5%, power 80%.
- Investigator need to enrol 108 cases in two groups further with 10% drop out rate it was decided to enroll 120 cases
- Randomisation into two groups by block randomisation method,taking block size 8
Intervention:
- Patients will be randomized into two Arms A & B.
- Arm A will receive carvedilol plus standard medical therpy,Carvedilol: will be started with initial dose of 3.125 mg BD then After 3 days, increase the dose to 6.25 mg BD, Maximum dose would be 12.5 mg BD, the same shall be switch to Maximum tollrated dose if SBP >90, HR >55.
- Arm B will receive standard medical therapy.SMT (as described) that is
- Grade II ascites - Lasilactone (20/50) OD then Change after 1 week as per response, monitor diuretic intolerance.
- Grade III ascites will undergo large volume paracentesis, lasilactone (20/50) OD Both groups will receive albumin as indicated (LT references as per protocol will be send for eligible patients)
- For Diuretic intolerance -Na, K, urea, creatnine will be monitred first weekly then once monthly then SOS as per need
- For Carvedilol heart rate will be monitored first weekly then monthly then SOS as per need
- Dose of carvedilol will be adjusted as per protocol.
- Other treatments given: Alumbin infusion to both group, lasilactone.
- Complications / Organ failures (3m, 6m, 1y or detected during tele/online consult or on opd basis
Data to be collected
- Baseline -
- Blood : KFT, LFT, CBC, INR, IL-6, CRP,TNF Alpha
- Imaging : USG upper abdomen and doppler for renal blood flow,
- 2D ECHO
- Urine : Urine R/E, Urine Na,AFP
- A/F analysis - for SBP
- HVPG, UGIE
- At 3 months, 6 months.
- Blood : LFT, KFT, INR,AFP
- At 1 year
- Blood : KFT, LFT, CBC, INR, TNF alpha,IL-6, CRP,AFP
- Imaging : USG upper abdomen
- Urine : Urine Na
- HVPG, UGIE
Statistical Analysis:
Data will be reported as mean + SD. Categorical variables will be compared using the chi-square test or Fisher exact test. Normal continuous variables will be compared using the Student's t testNon normal continuous variables will be compared using the Mann Whitney rank-sum test (unpaired data) or the Wilcoxon test (paired data). The actuarial probability of survival will be calculated by the Kaplan-Meier method and compared using the log-rank test.A Cox regression analysis will be performed to identify independent prognostic factors for survival.Univariate and multivariate analysis will be used whenever applicable.
Adverse effects:
Hypotension (2.6-17.6%) with minor side effets as fainting, shortness of breath, weight gain, swelling of the arms, hands, feet, ankles, or lower legs, chest pain, slow or irregular heartbeat, rash, itching, difficulty breathing and swallowing tiredness, weakness, lightheadedness, dizziness, headache, diarrhea, nausea, vomiting, vision change, joint pain difficulty falling asleep or staying asleep, cough dry eyes, numbness, burning, or tingling in the arms or legs.
Stopping rule of study:
- Severe complications requiring discontinuation of therapy severe Respiratory distress, severe bradycardia heart block not responding to dose reduction.
- Patient refusal to further participate in study.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Dr Rahul khauria, MD
- Phone Number: 01146300000
- Email: dr.rahulkhajuria@gmail.com
Study Locations
-
-
Delhi
-
New Delhi, Delhi, India, 110070
- Recruiting
- Institute of Liver & Biliary Sciences
-
Contact:
- Dr Rahul khauria, MD
- Phone Number: 01146300000
- Email: dr.rahulkhajuria@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 18-65 years
- Liver cirrhosis
- Grade II-III high SAAG ascites
- Small low risk or no esophageal varices
- CTP 7-12
Exclusion Criteria:
- Age <18 years
- AKI at enrollement (Prior transient volume responsive AKI stage I included)
- Post renal or liver transplantation
- History of CAD, PVD, ventricular arrythmia, Bronchial asthma
- SBP at diagnosis
- Severe Hyponatremia (Na <125 MEq/L)
- Grade II/III/IV HE
- Advanced HCC (BCLC C,D), PVTT, Pregnancy or Lactating mother
- High risk varices (Large varices or small high risk varices)
- CTP >12
- ACLF
- Mixed / TB ascites
- Bilirubin >5 mg/dl
- Known CKD, obstructive uropathy
- Patient on MV, NIV, systemic sepsis and shock
- Lack of informed consent
- Prior intolerance or S/E to carvedilol or diuretics
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 |
---|---|
Experimental: Carvedilol with Standard Medical Treatment
Arm A will receive carvedilol plus standard medical therpy,Carvedilol: will be started with initial dose of 3.125 mg BD then After 3 days, increase the dose to 6.25 mg BD, Maximum dose would be 12.5 mg BD, the same shall be switch to Maximum tollrated dose if SBP >90, HR >55.
|
- Arm A will receive carvedilol plus standard medical therpy,Carvedilol: will be started with initial dose of 3.125 mg BD then After 3 days, increase the dose to 6.25 mg BD, Maximum dose would be 12.5 mg BD, the same shall be switch to Maximum tollrated dose if SBP>90, HR >55.
|
Active Comparator: Standard Medical Treatment
- Arm B will receive standard medical therapy.SMT (as described) that is Grade II ascites - Lasilactone (20/50) OD then Change after 1 week as per response, monitor diuretic intolerance.
|
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Complicated ascites (any of refractory ascites, SBP, AKI-HRS)
Time Frame: 1 year
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mortality
Time Frame: 1 year
|
1 year
|
|
Ascites resolution in both groups
Time Frame: 3 Months
|
Ascites well controlled with appropriate medical treatment, i.e, the minimum diuretic dose necessary to control weight gain and ascites formation that did not lead to diuretic-induced complications, such as renal impairment, hyponatremia, hypokalemia or hyperkalemia, or HE
|
3 Months
|
Ascites resolution in both groups
Time Frame: 6 Months
|
Ascites well controlled with appropriate medical treatment, i.e, the minimum diuretic dose necessary to control weight gain and ascites formation that did not lead to diuretic-induced complications, such as renal impairment, hyponatremia, hypokalemia or hyperkalemia, or HE
|
6 Months
|
Ascites resolution in both groups
Time Frame: 1 year
|
Ascites well controlled with appropriate medical treatment, i.e, the minimum diuretic dose necessary to control weight gain and ascites formation that did not lead to diuretic-induced complications, such as renal impairment, hyponatremia, hypokalemia or hyperkalemia, or HE
|
1 year
|
Need and frequency of Large Volume Paracentesis
Time Frame: 1 year
|
1 year
|
|
Incidence of PICD in 1 year
Time Frame: 1 year
|
1 year
|
|
Change in grade of varices in both groups
Time Frame: 1 year
|
Change is defined as from garde I to garde II/ grade III
|
1 year
|
Reduction in HVPG in both groups
Time Frame: 1 year
|
1 year
|
|
Change in MELD score in both groups
Time Frame: 3 months
|
Minimum MELD=6 Maximum MELD=40
|
3 months
|
Change in MELD score in both groups
Time Frame: 6 months
|
Minimum MELD=6 Maximum MELD=40
|
6 months
|
Change in MELD score in both groups
Time Frame: 1 year
|
Minimum MELD=6 Maximum MELD=40
|
1 year
|
Change in CTP score in both groups
Time Frame: 3 months
|
CTP Change is CTP- C to CTP- B & CTP- B to CTP- A
|
3 months
|
Change in CTP score in both groups
Time Frame: 6 months
|
CTP Change is CTP- C to CTP- B & CTP- B to CTP- A
|
6 months
|
Change in CTP score in both groups
Time Frame: 1 year
|
CTP Change is CTP- C to CTP- B & CTP- B to CTP- A
|
1 year
|
Incidence of HE in both groups
Time Frame: 6 months
|
6 months
|
|
Incidence of HE in both groups.
Time Frame: 1 year
|
1 year
|
|
Incidence of variceal bleed in both groups
Time Frame: 6 months
|
6 months
|
|
Incidence of variceal bleed in both groups
Time Frame: 1 year
|
1 year
|
|
Incidence of AKI in both groups
Time Frame: 6 months
|
6 months
|
|
Incidence of AKI in both groups
Time Frame: 1 year
|
1 year
|
|
Incidence of SBP in both groups
Time Frame: 6 months
|
6 months
|
|
Incidence of SBP in both groups
Time Frame: 1 year
|
1 year
|
|
Incidence of severe hyponatremia in both groups
Time Frame: 6 months
|
6 months
|
|
Incidence of severe hyponatremia in both groups
Time Frame: 1 year
|
1 year
|
|
Incidence of refractory ascites in both groups
Time Frame: 6 months
|
6 months
|
|
Incidence of refractory ascites in both groups
Time Frame: 1 year
|
1 year
|
|
Maximum tolerated dose of carvedilol
Time Frame: 1 year
|
1 year
|
|
Tretament (carvedilol) related adverse events and their grades
Time Frame: 1 year
|
Adverse Events are defined as incidence of Bradycardia,Hypotension,Breathlessness
|
1 year
|
Collaborators and Investigators
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
Additional Relevant MeSH Terms
- Digestive System Diseases
- Pathologic Processes
- Gastrointestinal Diseases
- Liver Diseases
- Esophageal Diseases
- Hypertension, Portal
- Fibrosis
- Liver Cirrhosis
- Ascites
- Esophageal and Gastric Varices
- 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
- ILBS-Cirrhosis-44
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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