- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05699824
To Study the Hemodynamic Response of Early Addition of Carvedilol to Terlipressin in Acute Variceal Bleed in Child's B and C Cirrhosis
To Study the Hemodynamic Response of Early Addition of Carvedilol to Terlipressin in Acute Variceal Bleed in Child's B and C Cirrhosis- A Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Aim and Objective To compare the hemodynamic response of early addition of carvedilol with terlipressin in patients with cirrhosis presenting with acute esophageal variceal bleeding.
Primary objective • To study the hemodynamic response (HVPG reduction of ≥20% from baseline or absolute reduction of HVPG </= 12 mmHg) in the groups at 5-days.
Secondary objective
- Rebleeding rate in the two groups at 5-days
- Rebleeding rate at 6-weeks
- Reduction of HVPG <16mm Hg in both groups at 5-days
- Salvage treatment, TIPS in both groups at 5-days and at 6-weeks
- Salvage treatment, SEMS, SB tube placement in-between groups at 5-days and at 6- weeks
- Survival at 6-weeks
- Liver related decompensation in-between groups at 6-weeks
- Adverse events between the groups at 6-weeks
Methodology:
Study population: Patients with Child's B and C cirrhosis who present with acute esophageal variceal bleed, between 18-75 years will be enrolled and randomized based on inclusion and exclusion criteria.
Study design- Prospective open label RCT
Study period - 1.5 years
Sample Size:Sample size will be calculated assuming that baseline characteristics (22.2±5.0 mmHg) are same and HVPG reduction on 5th day with terlipressin is 19.1±5 mmHg [7] and estimating a further reduction of 15% with addition of carvedilol [14] (16.3±4.3 mmHg), with an alpha value equal to 5 % and power of 80%, we need to enrol 45 cases in both arms. Assuming an attrition rate of 10%, it was decided to enrol 100 cases, 50 in each group, randomly allocated by block randomization method with block size of 10.
Intervention: All patients to receive Inj. Terlipressin, 1 mg at 4 hours along with standard management for acute variceal bleed as per institutional protocol
Arm A- Carvedilol will be initiated on day 2, at a dose of 3.125mg twice a day (6.25mg/day), along with standard management as per institutional protocol for AVB.
Arm B- Carvedilol will be initiated on day 6, at a dose of 3.125mg twice a day (6.25mg/day), along with standard management as per institutional protocol for AVB.
- Monitoring and assessment: Patients will be admitted in GI-bleed ICU and will be randomized into the study groups after successful endoscopic control of the bleed. Each patient will be monitored as per the institutional protocol for management of upper GI bleed. A detailed clinical history will be taken, and blood investigations and other relevant investigations required will be done as mentioned in the table 2. Patient will undergo HCC surveillance as per the guideline. Once discharged, patient will be called for OPD visits and routine investigations as planned will be done. Patient will be assessed for the tolerance of carvedilol and dose escalation to a maximum dose of 6.25mg twice a day (12.5mg/day) will be achieved. Each patient will maintain a "patient diary" for ease in recording details.
Table 2: Investigations
Day 0-5 Complete physical evaluation Hemogram, Kidney function test, Liver function test, INR Ultrasound abdomen with spleno-portal axis doppler Fibroscan-liver and spleen Coagulation parameter, vWF, ADAMTS-13 2D-ECHO, ECG Rest investigation, monitoring, antibiotics as per hospital protocol HVPG on Day 1 and at Day 5 Planned OPD visits on day 7, 14, 28, 42 Hemogram, Kidney function test, Liver function test, INR Follow-up visits Repeat upper GI endoscopy every 3 weeks till variceal eradication
Expected outcome of the project:
HVPG guided treatment and achieving hemodynamic response post bleed will reduce rebleeding rates and will prevent further decompensation and reduce mortality in patients with Child B and C cirrhosis.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Dr Ibrar Ahmed, MD
- Phone Number: 01146300000
- Email: ibrarkhangmc29@gmail.com
Study Locations
-
-
Delhi
-
New Delhi, Delhi, India, 110070
- Recruiting
- Institute of Liver & Biliary Sciences
-
Contact:
- Dr Ibrar Ahmed, MD
- Phone Number: 01146300000
- Email: ibrarkhangmc29@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Cirrhosis with Acute Variceal Bleed
- Child's B and C cirrhosis (CTP ≤ 12)
- Patients age between 18 to 75 years
Exclusion Criteria:
- Gastric variceal bleed
- Bleeding related to coagulopathy
- Other causes of portal hypertensive bleeding
- Acute on chronic liver failure
- Sepsis
- Shock(persistence of hypotension)
- Acute kidney injury (>1.5 mg%)
- Grade 3 Ascites
- Hyponatremia (Na < 125 mEq/L)
- Complete portal vein thrombosis
- Hepatocellular carcinoma (>3cm lesion)
- Tumoral portal vein thrombosis
- Chronic kidney disease
- Coronary artery disease
- Valvular heart disease
- Sick sinus syndrome/ Pacemaker
- Arrythmia
- Uncontrolled hypothyroidism and hyperthyroidism
- Pregnancy
- Failure to give consent
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 at Day2 + Standard Medical Treatment
Arm A- Carvedilol will be initiated on day 2, at a dose of 3.125mg twice a day (6.25mg/day), along with standard management as per institutional protocol for AVB. All patients to receive Inj. Terlipressin, 1 mg at 4 hours along with standard management for acute variceal bleed as per institutional protocol |
All patients to receive Inj. Terlipressin, 1 mg at 4 hours along with standard management for acute variceal bleed as per institutional protocol.
Standard Medical Treatment
Carvedilol will be initiated on day 2, at a dose of 3.125mg twice a day (6.25mg/day),
along with standard management as per institutional protocol for AVB.
|
Active Comparator: Carvedilol at Day6 + Standard Medical Treatment
Arm B- Carvedilol will be initiated on day 6, at a dose of 3.125mg twice a day (6.25mg/day), along with standard management as per institutional protocol for AVB. All patients to receive Inj. Terlipressin, 1 mg at 4 hours along with standard management for acute variceal bleed as per institutional protocol |
All patients to receive Inj. Terlipressin, 1 mg at 4 hours along with standard management for acute variceal bleed as per institutional protocol.
Standard Medical Treatment
Carvedilol will be initiated on day 6, at a dose of 3.125mg twice a day (6.25mg/day),
along with standard management as per institutional protocol for AVB.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hemodynamic response in both groups
Time Frame: Day 5
|
Hemodynamic response (HVPG reduction of ≥20% from baseline or absolute reduction of HVPG </= 12 mmHg) in the groups at 5-days.
|
Day 5
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rebleeding within 6-week in both groups
Time Frame: 6-weeks
|
6-weeks
|
|
Death in both groups
Time Frame: 6-weeks
|
6-weeks
|
|
Adverse Effects in both groups
Time Frame: 6 weeks
|
6 weeks
|
|
Decompensation events (ascites) at 6-weeks in both groups
Time Frame: 6 weeks
|
Ascites defined as either development of ascites during the follow-up or worsening of pre-existing ascites either in the form of increasing the dose requirement of diuretic or requirement of therapeutic paracentesis.
|
6 weeks
|
Decompensation events (Hepatic Encephalopathy) at 6-weeks in both groups
Time Frame: 6 weeks
|
New onset of Hepatic Encephalopathy.
Hepatic encephalopathy is defined based on clinical parameters as per the West-Haven criteria.
|
6 weeks
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- Liver Diseases
- Fibrosis
- Liver Cirrhosis
- 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-53
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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