- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05187715
To Study the Safety and Efficacy of Simvastatin in Patients With Hepatopulmonary Syndrome in Cirrhosis.
To Study the Safety and Efficacy of Simvastatin in Patients With Hepatopulmonary Syndrome in Cirrhosis- A Double Blind Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Methodology:
- Study population:All the consecutive patients of cirrhosis admitted to Hepatology department of ILBS will be evaluated for inclusion.
- Study design: Double Blind randomized control trial: Superiority trial. The study will be conductedin Department of Hepatology ILBS.
- Study period: 2 years
Sample size:
- Assuming 40% as the response rate to simvastatin and 1% to standard medical treatment with α 5% , power 80% and superiority marging as 10% ,we need to enroll 36 cases 18 in each arm.Further considering 10% drop rate, decided to enroll 40 cases with 20 randomised to 2 groups using block randomisation method taking block score of 4.It is decided to allocate the cases in 2:1 ratio (Simvastatin 2: 1 Placebo) decided to enroll 45 cases so that 30 in simvastatin arm and 15 in standard medical therapy
(Not on pentoxiphylline) arm with block size 15
Intervention:
- Patients to be divided into 2 groups
- Group A-Simvastatin 40mg OD plus standard treatment
- Group B-Matched placebo plus standard treatment (excluding Pentoxiphylline)
- Stopping-rule-Development of drug related side effects
- Disease progression (Increase in baseline MELD by 4 or >25)
Monitoring and assessment
- Patients with known cirrhotics will be enrolled as per inclusion criteria and baseline routine testing with complete blood count, liver and kidney function test, ultrasonography of the abdomen, lipid profile, total CPK, measurement of liver and splenic stiffness.Pulmonary blood at the time of HVPG for endothelin-1 and TNF alpha,Nitric oxide levels,S1P expression,KLF-2 levels.
- Matched placebo not on pentoxiphylline are included.
- MELD score and Child score, Arterial blood gas analysis, Pulmonary function test,6 minute walk test,Saline contrast 2D ECHO at baseline and at 6months.
- Clinical evaluation done monthly. Response at the end of 6months.
- Hepatic venous pressure gradient (HVPG):
- Prior to the HVPG measurement, a venous access was performed under ultrasonography after local anesthesia. The Seldinger technique was used to insert a catheter into the right brachial vein or the right internal jugular vein. An occlusion balloon catheter of 6 F was guided in a branch of the hepatic veins, usually the median or right vein, under fluoroscopic control and continuous electrocardiographic and pressure monitoring.
- After inflating the balloon at the catheter's tip (maximum diameter ranges from 8.5-11.5 mm), a venous check was performed to demonstrate complete vessel occlusion. The wedged hepatic vein pressure (WHVP) was measured in this condition. Following that, the free hepatic vein pressure (FHVP) was measured after deflating the balloon at the catheter's tip. On a multi-channel recorder, a permanent trace was obtained. Pressures were also achieved in the inferior vena cava and the right atrium. According to the Baveno VI consensus, the HVPG-response was defined as a 20% or 12 mmHg reduction in HVPG after NSBB treatment.
- HVPG= WHVP - FHVP (Normal is <5mm of Hg)
- Ultrasonography of the abdomen:
- dilated portal vein (>13 mm): non-specific
- biphasic or reverse flow in portal vein (late stage): pathognomonic
- recanalization of paraumbilical vein: pathognomonic
- portal-systemic collateral pathways (collateral vessels/varices)
- splenomegaly
- ascites
- The damping index (showing changes in the doppler hepatic vein waveform) corresponds with hemodynamically significant portal hypertension and HVPG values (together with HVPG changes after treatment)
- splenic arterial resistive index
Liver and splenic stiffness:
- A 3.5-MHz ultrasound transducer probe is mounted on the axis of a vibrator in the FibroScan device. Mild amplitude, low-frequency (50 Hz) vibrations are transmitted to the liver tissue, causing an elastic shear wave to propagate through the underlying tissue. If the success rate was greater than 60% and the interquartile range (IQR) was greater than 30% of the median value, LS values were accepted.
Guidelines for measuring SS is same as LS. SS was performed on a supine patient with maximal abduction of the left arm, with the probe positioned in an intercostal space where the spleen was correctly visualized by US. Furthermore, in accordance with the FibroScan's technical features, patients with a splenic parenchymal thickness of >4 cm under the probe were excluded.
- STATISTICAL ANALYSIS:
For comparison of parameters pretherapy and posttherapy, the Wilcoxon signed rank test was used. P.05 was considered significant. SPSS version 15.0 statistical software (SPSS Inc, Chicago, Illinois) was used for analysis.
- Adverse effects:
- 1. Major Sideeffects of Simvastatin
- Rhabdomyolysis(Raised Total CPK > 3ULN)
- Bradycardia
- Transaminitis (ALT >5ULN)
- Headache
- Constipation
Upper respiratory tract infection
2. HVPG related complications
- Transient arrhythmias
- Vagal reaction
- Local access pain and bleeding
- Stopping rule :
- Development of serious adverse effects leading to withdrawal of the drug or death from any cause.
- Disease progression (Increase in baseline MELD by 4 or >25)
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Dr Akhil Deshmukh, MD
- Phone Number: 01146300000
- Email: akhildeshmukh52@gmail.com
Study Locations
-
-
Delhi
-
New Delhi, Delhi, India, 110070
- Recruiting
- Institute of Liver & Biliary Sciences
-
Contact:
- Dr Akhil Deshmukh, MD
- Phone Number: 01146300000
- Email: akhildeshmukh52@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Diagnosed case of Hepato-pulmonary syndrome AaPO2 > 15 mm Hg on standing room air arterial blood gas (ABG). PaO2<80 mmHg for clinical HPS between 18-70 years of years
- Child A/B cirrhosis, Child C with CTP score of =/<10
- Patient with no liver transplant option
Exclusion Criteria:
- Child-C cirrhosis CTP >10
- Very Severe HPS
- Acute-on-chronic liver failure
- Thrombosis of splenoportal axis
- Hepatocellular carcinoma
- Renal dysfunction
- Patients intolerant to beta blockers (history of hypotension or bradycardia)
- Contraindication for beta-blockers (history of chronic obstructive pulmonary disease, atrioventricular block)
- Pregnant females
- Refusal to participate in the study
- Hepatic Hydrothorax
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Simvastatin with Standard Medical Treatment
Simvastatin 40mg OD plus standard treatment plus standard treatment (excluding Pentoxiphylline)
|
Simvastatin 40mg OD
Standard medical Treatment eccluding pentoxiphylline
|
Active Comparator: Placebo with Standard Medical Treatment
Matched placebo plus standard treatment (excluding Pentoxiphylline)
|
Placebo
Standard medical Treatment eccluding pentoxiphylline
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Achievement of complete response by the end of 6 months
Time Frame: 6 months
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Transplant free survival
Time Frame: 3 months
|
3 months
|
|
Transplant free survival
Time Frame: 6 months
|
6 months
|
|
Severity of Liver Disease
Time Frame: 6 months
|
Severity will be assess by MELD Na (Model for End Stage Liver Disease)
|
6 months
|
Development of serious adverse effects leading to withdrawal of the drug or death from any cause.
Time Frame: 2 years
|
2 years
|
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
- Respiratory Tract Diseases
- Lung Diseases
- Liver Diseases
- Fibrosis
- Liver Cirrhosis
- Hepatopulmonary Syndrome
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antimetabolites
- Anticholesteremic Agents
- Hypolipidemic Agents
- Lipid Regulating Agents
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
- Simvastatin
Other Study ID Numbers
- ILBS-Cirrhosis-46
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
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