- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06245590
Evaluation of Low-dose Albumin and Midodrine Versus Midodrine Alone in Outcome of Recurrent Ascites in Patients With Decompensated Cirrhosis.
Evaluation of Low-dose Albumin and Midodrine Versus Midodrine Alone in Outcome of Recurrent Ascites in Patients With Decompensated Cirrhosis - An Open Label Multicentric Randomized Controlled Trial.
The project is about evaluation of albumin and midodrine versus midodrine alone in outcome of recurrent ascites in patients with decompensated cirrhosis.
Cirrhosis occcurs in 50% of patients over 10 years. The mortality is approximately 40% at 1 year and 50% at 2 years (12.7 per 100,000 population). A lot of times the prognosis is poor and the main factors leading to it are - acute kidney injury, hepatorenal syndrome, hyponatremia, grade of ascites-recurrent ascites, sarcopenia, low mean arterial pressure.
Post review of the literature, it is realized that there are some gap areas -
- It is unknown whether combination of vasoconstrictor with albumin versus vasoconstrictor alone is superior for ascites resolution in patients with recurrent ascites.
- There are no studies till date on using combination of vasoconstrictor with albumin versus vasoconstrictor alone in patients with recurrent ascites.
- There are no studies on impact of combining vasoconstrictor and albumin in preventing the development of AKI and chronic kidney disease in these patients.
In an effort to bridge these gap areas, this project works on the following hypothesis - "Midodrine would have a synergistic effect with albumin in improving the systemic hemodynamics and circulatory dysfunction and will cause rapid control of ascites, reduce the incidence of large volume paracentesis (LVP), complications, reduce the incidence of chronic kidney disease (HRS-CKD) and improve outcome of patients with recurrent ascites in patients with decompensated cirrhosis as compared to midodrine alone"
Primary objective: To assess the effect of midodrine alone vs. a combination of midodrine and albumin on the survival free of TIPS and liver transplant at 6 months
Secondary objective:
The effect of midodrine alone vs. combination of midodrine and albumin on the cumulative frequency of therapeutic paracentesis at 6 and 12 months Proportion of patients achieving control of ascites at 6 and 12 months
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
- Study population: Consecutive patients with decompensated cirrhosis with recurrent ascites seen as inpatients or outpatients in the Department of Hepatology at Institute of Liver and Biliary Sciences, who meet the inclusion criteria and provide informed consent
- Study design: Multicentre Open-label Randomised Controlled Trial
- Sample Size: Assuming that survival rate with albumin and midodrine is 80%, whereas with midodrine alone is 50% (i.e. 30% absolute difference is observed with alpha of 5% power, beta of 80%) we need to enroll 43 cases in each arm and taking 15% drop out rate we need to enrol 50 cases in each group.
- Intervention: Group A will be treated with 20 grams/ week Albumin + Midodrine (5mg thrice daily and will be increased every 3 days upto 15 mg thrice daily with target MAP (>75 mm and <90) and Group B midodrine alone titrated based on MAP. Albumin infusions will be provided with large volume paracentesis and if the patient develops AKI, SBP in the recommended dosage in accordance to the International Club of ascites. The protocol will be followed for 6 months
Adverse effects: Allergic reactions to albumin, worsening of dyspnea, volume-overload
Stopping Rule: adverse reaction to Albumin
- Cardiopulmonary compromise
- Allergic reaction
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Dr Rakhi Maiwall, DM
- Phone Number: 01146300000
- Email: rakhi_2011@yahoo.co.in
Study Locations
-
-
Delhi
-
New Delhi, Delhi, India, 110070
- Institute of Liver & Biliary Sciences
-
Contact:
- Dr Rakhi Maiwall, DM
- Phone Number: 01146300000
- Email: rakhi_2011@yahoo.co.in
-
Principal Investigator:
- Dr Rakhi Maiwall, DM
-
-
Hyderabad
-
Somajiguda, Hyderabad, India, 500082
- Asian institute of Gastroenterology
-
Contact:
- Dr Mithun Sharma, DM
- Phone Number: 04023378888
- Email: iecaig2044@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 18 -70yr and Cirrhosis with recurrent ascites.
Exclusion Criteria:
- Recent Gastrointestinal bleeding within 7 days
- Systemic arterial hypertension (>160/90mmhg)
- Presence of hepatocellular carcinoma or portal vein thrombosis, Budd-chiari syndrome.
- Pregnancy
- No use of drugs affecting systemic hemodynamics (excepting beta blockers) 7 days prior to enrolment.
- Patients with Cardiovascular disease (NYHA > II) or chronic obstructive pulmonary disease
- Refusal to participate
- Known or suspected hypersensitivity to albumin
- Prior TIPS
- Post liver or kidney transplantation
- Patients enrolled in other clinical trials
- Extrahepatic malignancy
- Patients on cardiac glycosides like digoxin, phenylephrine, ephedrine, thyroid hormones, ergot derivatives, salt retaining steroids like fludrocortisone, MAO inhibitors, alpha blockers metformin and ranitidine (known to have interactions with midodrine)
- Patients with intrinsic kidney disease, organ nephropathy and CKD stage 4 and
- MELD > 25 and extremely moribund patient
- Serum albumin less than 2 gm/dl or >3.5 gm/dl
- Significant ongoing alcohol with abstinence less than 3 months
- Significant findings on ECHO with cardiac dysfunction
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: Albumin + Midodrine
Albumin + Midodrine (5mg thrice daily and will be increased every 3 days upto 15 mg thrice daily with target MAP (>75 mm and <90).
|
20 grams/ week Albumin + Midodrine (5mg thrice daily and will be increased every 3 days upto 15 mg thrice daily with target MAP (>75 mm and <90).
Midodrine
|
Active Comparator: Midodrine +standard of care
Midodrine alone titrated based on MAP.
|
Standard of Care
Midodrine
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Survival free of transplant and TIPS at 6 months.
Time Frame: 6 months
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The cumulative mean of the number of therapeutic paracentesis at 6 and 12 months would be compared between the two groups.
Time Frame: 6 & 12 months
|
6 & 12 months
|
Proportion of patients achieving resolution of ascites (complete grade 1-0 without diuretics and partial as garde 0-1 ascites on diuretics)
Time Frame: 6 & 12 months
|
6 & 12 months
|
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 (Estimated)
Study Record Updates
Last Update Posted (Estimated)
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
- Ascites
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Autonomic Agents
- Peripheral Nervous System Agents
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Sympathomimetics
- Vasoconstrictor Agents
- Adrenergic alpha-1 Receptor Agonists
- Midodrine
Other Study ID Numbers
- ILBS-Cirrhosis-58
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.
Clinical Trials on Decompensated Cirrhosis
-
Region StockholmSahlgrenska University Hospital, SwedenRecruitingHemostasis in Decompensated Liver Cirrhosis | Inflammation in Decompensated Liver CirrhosisSweden
-
University College, LondonLondon School of Hygiene and Tropical Medicine; CyberLiver LtdRecruitingDecompensated CirrhosisUnited Kingdom
-
Institute of Liver and Biliary Sciences, IndiaNot yet recruitingDecompensated CirrhosisIndia
-
Beijing 302 HospitalVCANBIO Cell & Gene Engineering Corporation, LtdRecruitingDecompensated CirrhosisChina
-
Beijing 302 HospitalLanZhou University; Chinese PLA General Hospital; Renmin Hospital of Wuhan University and other collaboratorsNot yet recruitingDecompensated CirrhosisChina
-
Chinese Academy of SciencesThe Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical...UnknownDecompensated CirrhosisChina
-
Zagazig UniversityCompletedDecompensated Cirrhosis
-
Institute of Liver and Biliary Sciences, IndiaUnknown
-
Shandong Qilu Stem Cells Engineering Co., Ltd.First Affiliated Hospital of Fujian Medical University; Shanghai Public Health... and other collaboratorsUnknownDecompensated Liver Cirrhosis
-
Medical University of GrazActive, not recruitingDecompensated CirrhosisAustria
Clinical Trials on Standard of Care
-
Johns Hopkins UniversityRecruitingCompartment Syndrome of Leg | Extracorporeal Membrane Oxygenation Complication | Limb Ischemia, Critical | Limb IschemiaUnited States
-
brett rasmussenCompleted
-
Indonesia UniversityCompletedCovid19 | AcupunctureIndonesia
-
Aventusoft, LLC.National Heart, Lung, and Blood Institute (NHLBI); Cleveland Clinic FloridaRecruitingHeart Failure (HF)United States
-
Vascular Biogenics Ltd. operating as VBL TherapeuticsCompletedSevere COVID-19Israel
-
Ruijin HospitalRecruitingCOVID-19 PneumoniaChina
-
Institut Claudius RegaudCompletedMETASTATIC CANCERFrance
-
Ziv HospitalNot yet recruiting
-
Hofseth Biocare ASAKGK Science Inc.CompletedCovid-19 | COVIDCanada, Brazil, Hungary, Mexico, Serbia
-
City University of New York, School of Public HealthNew York State Psychiatric Institute; University of KwaZulu; International Initiative... and other collaboratorsCompleted