- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06050837
Spleen Stiffness as a Measure to Assess the REsponse to β Blocker Therapy (SPARE-B)
Spleen Stiffness as a Measure to Assess the REsponse to β Blocker Therapy (SPARE-B).
HVPG is the gold standard for measurement of the presence and severity of portal hypertension. Clinically Significant Portal Hypertension (CSPH) is defined as HVPG ≥ 10 mmHg. Reducing the HVPG by use of non-selective beta blockers has been associated with reduced risk of variceal hemorrhage, ascites, SBP and thus has a positive effect on survival. Response to Beta blocker therapy is defined as a reduction of HVPG by 10% or to ≤ 12 mmHg.
HVPG is an invasive method of assessment of portal pressures, with lack of availability at many centres. While non-invasive tests to predict CSPH have been defined, predicting response to beta-blockers non-invasively is an unmet clinical need.
The aim of this study is to use splenic stiffness measurement, a non-invasive test, as a surrogate to assess the response of HVPG to beta blocker therapy.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Aim and Objective: To evaluate change in splenic stiffness measurement as a surrogate for response to non-selective beta blockers in patients with high-risk esophageal varices.
Primary objectives: To evaluate the diagnostic accuracy of change in splenic stiffness to predict HVPG responders to beta-blockers at 4 weeks
- Study population: All patients aged ≥ 18 years and ≤ 70 years presenting to Institute of Liver and Biliary Sciences, New Delhi with high-risk esophageal varices upon presentation and are giving written consent for participation in the study.
- Study design - Single center, Prospective, observational study.
- Study period - 1 year
- Sample size - We are enrolling 130 patients in the study
- Intervention - Carvedilol will be initiated to all patients with high-risk esophageal varices (in the absence of any contraindications) at a dose of 3.125mg BD and titrated to the maximum tolerable dose within 7 days.
- Monitoring and assessment -
Investigations - performed at Baseline
- CBC, RFT, LFT, PT/INR, vWF-Ag, HbA1c
- Collagen markers: Procollagen 3 peptide, tissue inhibitor of matrix metalloproteinase 1, Hyaluronic acid
- ECG
- 2D Echocardiography
- CECT Whole Abdomen
- Splenic stiffness measurement
- Liver stiffness measurement
- Upper GI endoscopy
- HVPG
Investigations - performed at 1 month of maximum tolerable dose of Carvedilol
- CBC, RFT, LFT, PT/INR, vWF-Ag
- Collagen markers: Procollagen 3 peptide, tissue inhibitor of matrix metalloproteinase 1, Hyaluronic acid
- ECG
- Splenic stiffness measurement
- Liver stiffness measurement
- HVPG
Adverse effects (of carvedilol)
- Allergy
- Light headedness
- Exercise intolerance
- Fatigue
- Chest tightness
Stopping rule - Development of variceal bleed
Expected outcome of the project:
Change in splenic stiffness will correlates with change in HVPG and can reliably predict response to non-selective beta blockers in patient with high-risk esophageal varices.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Dr Omkar Rudra, MD
- Phone Number: 01146300000
- Email: omkar.rudra@gmail.com
Study Locations
-
-
Delhi
-
New Delhi, Delhi, India, 110070
- Institute of Liver & Biliary Sciences
-
Contact:
- Dr Omkar Rudra, MD
- Phone Number: 01146300000
- Email: omkar.rudra@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Age ≥ 18 years
- Cirrhosis of liver of different etiologies, with evidence of high-risk esophageal varices
- Alcohol abstinence for 3 months
- Written informed consent
Exclusion Criteria:
- Age ≥ 70 years
- Previous or imminent variceal ligation
- Non Cirrhotic Portal Hypertension
- Portal vein, splenic vein thrombosis
- Porto-systemic shunts > 10 mm
- Patients already on beta blockers
Contraindications to beta blocker therapy :
- Heart rate < 50 bpm
- Systolic BP < 100 mm Hg
- Severe COPD
- Atrioventricular block
- Known PVD
- Poor control of T2DM (HbA1c>9)
- Technical difficulties for splenic stiffness measurement
- Cardio-pulmonary disorders
- Budd Chiari Syndrome
- Grade 3 ascites
- Acute Kidney Injury or Chronic Kidney Disease
- Severely Obese patients (BMI > 40)
- Pregnant women
- Advanced HCC
- Psychiatric Illness
- Lack of informed consent
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
To evaluate the diagnostic accuracy of change in splenic stiffness to predict HVPG responders to beta-blockers at 4 weeks
Time Frame: 4 weeks
|
4 weeks
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Change in Liver stiffness measurement
Time Frame: 4 weeks
|
4 weeks
|
Change in Fib-4, Fib-5
Time Frame: 4 weeks
|
4 weeks
|
Change in vWF-antigen, VITRO
Time Frame: 4 weeks
|
4 weeks
|
Change in collagen markers - Procollagen 3 peptide, tissue inhibitor of matrix metalloproteinase 1, Hyaluronic acid
Time Frame: 4 weeks
|
4 weeks
|
To develop an AI based model to predict HVPG responders to beta blockers
Time Frame: 4 weeks
|
4 weeks
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Estimated)
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
Other Study ID Numbers
- ILBS-SPARE-B-01
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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