Eficácia e segurança da rosuvastatina para cirrose hepática nos Estados Unidos (LCN RESCU)
Liver Cirrhosis Network (LCN) Eficácia e segurança da rosuvastatina para cirrose nos Estados Unidos (RESCU): um estudo de fase 2 duplo-cego, randomizado e controlado por placebo
This is a double-blind, phase 2 study to evaluate safety and efficacy of rosuvastatin in comparison to placebo after 2 years in patients with compensated cirrhosis.
Visão geral do estudo
Status
Status
Condições
Condições
Intervenção / Tratamento
Intervenção / Tratamento
Descrição detalhada
This study is a randomized, double-blind, placebo-controlled Phase 2 clinical trial, of 20mg of rosuvastatin by mouth, once daily. Participants will be randomized (1:1) to either once daily placebo or once daily rosuvastatin.
Patients meeting all eligibility criteria will be assigned to a randomization arm prior to initiation of a 4-week lead-in phase of the study. All participants will undergo a 4-week, open-label active run-in phase to evaluate initial safety and adherence to rosuvastatin. During this active run-phase, all participants will receive target dose rosuvastatin-- 20 mg daily. After the active run-in phase, all participants will continue with their pre-assigned randomization (1:1) treatment of rosuvastatin 20 mg daily or matching placebo.
The total duration of the study will be 96 weeks in the assigned treatment arm plus the 4-week lead-in period. The primary outcome will be the mean change in liver stiffness from the baseline measurement to the end of study liver stiffness, as measured by ultrasound-based vibration-controlled transient elastography (VCTE).
There are 10 participating clinical centers, and we anticipate a total of 260 patients will be recruited for the initial lead-in as we estimate 20% of participants may dropout after the lead-in (260 x 0.8 = 208 for randomization into the study drug treatment phase).
Tipo de estudo
Tipo de estudo
Inscrição (Estimado)
Inscrição
Estágio
Estágio
- Fase 2
Contactos e Locais
Contato de estudo
Contato de estudo
- Nome: Crystal Santillanes, MS
- Número de telefone: 312-503-5536
- E-mail: lcn@northwestern.edu
Estude backup de contato
- Nome: Mary Beth Tull, MBA, CCRP
- Número de telefone: 312-503-4746
- E-mail: mary.tull@northwestern.edu
Locais de estudo
-
-
California
-
La Jolla, California, Estados Unidos, 92035
- Recrutamento
- University of California San Diego NAFLD Research Center
-
Contato:
- Rohit Loomba
- E-mail: roloomba@health.ucsd.edu
-
Los Angeles, California, Estados Unidos, 90033
- Recrutamento
- Keck Medical Center of USC
-
Contato:
- Norah Terrault
- E-mail: norah.terrault@med.usc.edu
-
Los Angeles, California, Estados Unidos, 90033
- Recrutamento
- LAC + USC Medical Center
-
Contato:
- Norah Terrault
- E-mail: norah.terrault@med.usc.edu
-
San Francisco, California, Estados Unidos, 94143
- Recrutamento
- UCSF Medical Center
-
Contato:
- Bilal Hameed
- E-mail: bilal.hameed@ucsf.edu
-
San Francisco, California, Estados Unidos, 94110
- Recrutamento
- UCSF/Zuckerberg San Francisco General Hospital and Trauma Center
-
Contato:
- Mandana Khalili
- E-mail: Mandana.Khalili@ucsf.edu
-
-
Florida
-
Miami, Florida, Estados Unidos, 33122
- Recrutamento
- University of Miami Health System
-
Contato:
- David Goldberg
- E-mail: dsgoldberg@med.miami.edu
-
-
Michigan
-
Ann Arbor, Michigan, Estados Unidos, 48109
- Recrutamento
- University of Michigan
-
Contato:
- Elliot Tapper
- E-mail: etapper@med.umich.edu
-
-
Minnesota
-
Rochester, Minnesota, Estados Unidos, 55901
- Recrutamento
- Mayo Clinic
-
Contato:
- Doug A. Simonetto, MD
- Número de telefone: (507) 284-2511
- E-mail: simonetto.douglas@mayo.edu
-
-
New York
-
New York, New York, Estados Unidos, 10021
- Recrutamento
- New York Presbyterian/Weill Cornell
-
Contato:
- Robert Brown
- E-mail: rsb2005@med.cornell.edu
-
New York, New York, Estados Unidos, 10031
- Recrutamento
- Columbia University Iriving School of Medicine
-
Contato:
- Elizabeth Verna
- E-mail: ev77@cumc.columbia.edu
-
-
North Carolina
-
Durham, North Carolina, Estados Unidos, 27710
- Recrutamento
- Duke Liver Center
-
Contato:
- Cynthia Ann Moylan, MD, MHS, MS
- Número de telefone: 919-681-4044
- E-mail: cynthia.moylan@duke.edu
-
Contato:
- Mariko Kopping
- E-mail: mariko.kopping@duke.edu
-
-
Ohio
-
Cleveland, Ohio, Estados Unidos, 44192
- Recrutamento
- Cleveland Clinic
-
Contato:
- Srinivasan Dasarathy
- E-mail: DASARAS@ccf.org
-
-
Virginia
-
Richmond, Virginia, Estados Unidos, 23298
- Recrutamento
- Virginia Commonwealth University
-
Contato:
- Arun Sanyal
- E-mail: arun.sanyal@vcuhealth.org
-
-
Critérios de participação
Critérios de elegibilidade
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria
-
Age 18-75 years
-
Cirrhosis due to NAFLD, ALD, or chronic viral hepatitis (treated HBV or HCV)
-
Clinical diagnosis of cirrhosis as defined by investigator confirmation and the following:
a. At least one liver biopsy within 5 years prior to consent showing either: Metavir stage 4 fibrosis; Ishak Stage 5-6 fibrosis, OR b. At least 2 of the following: i. Evidence on imaging: Nodular liver with either splenomegaly or recanalized umbilical vein within the past 48 weeks ii. Liver stiffness: VCTE within 48 weeks prior to consent or during Screening ≥15.0 kPa or MRE within 48 weeks prior to consent or during Screening ≥5 kPa iii. Evidence of varices demonstrated on imaging or endoscopy within 3 years prior to consent or during Screening iv. Either: FIB-4>2.67 or platelets <150/mL within 6 months prior to consent or during Screening
-
Two measures of VCTE: one at screening and one at the open-label dispense study visit, meeting the following criteria:
- The first measure must be ≥ 15.0 kPa.
- The two measures must be at least 2 hours apart and no more than 60 days apart from one another.
- The mean of two measurements must be ≥ 15.0 kPa.
- Additionally, both screening and open-label dispense liver stiffness measures must be ≤50 kPa
-
Compensated defined by:
- Absence of ascites/hydrothorax, hepatic encephalopathy or variceal bleeding currently or in the last 48 weeks, as determined clinically by investigator.
- If prior history of decompensation, must be without current symptoms of decompensation and no longer requiring treatment of complications for the last 48 weeks, including the use of diuretics for the treatment of ascites, and/or rifaximin or lactulose for the treatment of hepatic encephalopathy. Use of non-selective beta blockers will be allowed.
- Child-Pugh score <8
-
Provision of written informed consent. Exclusion Criteria
-
Currently on a statin or any statin exposure within 24 weeks prior to consent.
-
Known indication for statin therapy, defined as:
- Prior peripheral vascular, cardiovascular or cerebrovascular event for which statins are indicated for secondary prevention, OR
- Documented familial hypercholesterolemia, heterozygous familial hypercholesterolemia, OR
- Fasting LDL-C ≥ 190 mg/dL
-
Myocardial infarction, Unstable angina, transient ischemic events, or stroke within 24 weeks of screening.
-
Alcohol Use Disorder Identification Test (AUDIT) total score of ≥8 at screening.
-
Patients with limitations in attending study visits.
-
Prisoners.
-
Known prior or current hepatocellular carcinoma (HCC) or cholangiocarcinoma.
-
Known transjugular intrahepatic portosystemic shunt (TIPS), balloon retrograde transvenous obliteration (BRTO) or porto-systemic shunt surgery regardless of time of occurrence.
-
Current (in past 24 weeks prior to consenting) use of medications known to cause hepatic fibrogenesis or confound endpoint assessment, defined as:
- amiodarone
- methotrexate
- warfarin
-
Current (in past 24 weeks prior to consenting) use of medications which may increase risk for rosuvastatin-related myositis or DILI, defined as:
-
fenofibrate
-
erythromycin
-
gemfibrozil
-
niacin (500 mg or more)
-
HIV protease inhibitors (darunivar, indinavir, nelfinavir, amprenavir)
-
colchicine
-
cyclosporin
-
Additional medications that will be excluded:
atazanavir/ritonavir capmatinib darolutamide dasabuvir/ombitasvir/paritaprevir/ritonavir ledipasvir/sofosbuvir elbasvir/grazoprevir erythromycin lopinavir/ritonavir regorafenib ritonavir, in any combination simeprevir sofbuvir/velpatasvir/voxilaprevir sofosbuvir/velpatasvir tafamidis tamoxifen teriflunomide
*If exposure was for 7 or less days for one of these medications can consider enrollment after 28 days from final dose.
-
-
Presence of portal or hepatic vein thrombosis
-
Diagnosis of untreated hypothyroidism or on unstable treatment regimen for hypothyroidism
-
Receiving an elemental diet or parenteral nutrition
-
Chronic pancreatitis or pancreatic insufficiency
-
Etiology of cirrhosis other than ALD, NAFLD, or viral hepatitis (excluded diagnoses include cryptogenic immune-mediated such as AIH, PSC and PBC, cardiac cirrhosis or Fontan-associated liver disease, A1AT, Wilson's disease, etc.)
-
Conditions which may confound study outcome:
a. Unstable or active inflammatory bowel disease b. Active infection c. Any malignant disease (other than squamous or basal cell carcinoma of the skin) within previous 3 years d. Prior solid organ or hematopoietic cell transplant e. Bariatric surgery in the last 24 weeks prior to consent or planned bariatric surgery within the next 96 weeks f. Current liver-unrelated end-stage organ failures such as end-stage renal disease on dialysis, stage 3-4 congestive heart failure (CHF), current chronic obstructive pulmonary disease (COPD) on home oxygen.
-
Known current medical or psychiatric conditions which, in the opinion of the investigator, would make the participant unsuitable for the study for safety reasons or interfere with or prevent adherence to the protocol.
-
The following laboratory abnormalities within 90 days of screening:
a. Hemoglobin <10 g/dL b. Albumin <3.0 g/dL c. Prolonged international normalized ratio (INR) >1.5 d. Total bilirubin ≥ 2.0 mg/dl (unless due to Gilbert's syndrome or hemolysis as denoted by normal direct bilirubin fraction) e. Direct bilirubin ≥ 0.9 f. Uncontrolled diabetes (HbA1c ≥ 9.5%) within past 90 days.
-
Kidney function abnormalities including:
- Dialysis
- Baseline eGFR < 30 cc/min with CKD-Epi equation
- Known nephrotic proteinuria, defined as 3g or greater of protein in 24-hour urine collection
-
Recent (within 48 weeks) or present hepatic decompensation with ascites/hydrothorax, hepatic encephalopathy or variceal bleeding
-
Untreated chronic hepatitis B or C infection
- HCV eligible for enrollment if HCV RNA negative at baseline or documentation of prior SVR12
- HBV eligible if an HBV DNA <100 IU/mL within the last 48 weeks and on treatment
-
Serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥ 200 U/L within the past 24 weeks or alkaline phosphatase (ALP) ≥ 300.
-
Documented history of intolerance to statins
-
Serious comorbid medical disease which in the investigator's opinion renders a life-expectancy less than 96 weeks
-
Active illicit substance use (other than THC), including inhaled or injected drugs, in the 24 weeks prior to screening
-
Pregnancy, planned pregnancy or breastfeeding
-
Current participation in active medication treatment trials (within 24 weeks prior to randomization) or planned participation in active medication treatment trials simultaneous to participation in present trial.
-
Significant existing muscle pain or tenderness or prior history of myasthenia gravis as determined by a site physician.
-
Failure or inability to provide informed consent.
-
East Asian Descent within one degree of relatedness (e.g., if the participant's parents are of East Asian descent)
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Quadruplicar
Número de braços
Armas e Intervenções
Grupo de Participantes / BraçoGrupo de Participantes / Braço |
Intervenção / TratamentoIntervenção / Tratamento |
|---|---|
|
Experimental: Active
Open-label lead-in period of 4 weeks on 20 mg rosuvastatin by mouth once daily, followed by a period of 96 weeks rosuvastatin 20 mg daily. |
Patients meeting all eligibility criteria will be assigned to a randomization arm prior to initiation of a 4-week lead-in phase of the study. All participants will undergo a 4-week, open-label active run-in phase to evaluate initial safety and adherence to rosuvastatin. During this active run-phase, all participants will receive target dose rosuvastatin-- 20 mg daily . After the active run-in phase, all participants will continue with their pre-assigned randomization (1:1) treatment of rosuvastatin 20 mg daily or matching placebo.
Outros nomes:
|
|
Comparador de Placebo: Placebo
Open-label lead-in period of 4 weeks on 20 mg rosuvastatin by mouth once daily, followed by a period of 96 weeks placebo. |
Patients meeting all eligibility criteria will be assigned to a randomization arm prior to initiation of a 4-week lead-in phase of the study. All participants will undergo a 4-week, open-label active run-in phase to evaluate initial safety and adherence to rosuvastatin. During this active run-phase, all participants will receive target dose rosuvastatin-- 20 mg daily . After the active run-in phase, all participants will continue with their pre-assigned randomization (1:1) treatment of rosuvastatin 20 mg daily or matching placebo.
Outros nomes:
|
O que o estudo está medindo?
Medidas de resultados primários
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Mean change in liver stiffness
Prazo: 96 weeks
|
Mean change in liver stiffness as measured in kilopascal with Vibration-Controlled Transient Elastography between study entry and week 96. Range: 2 to 75 kilopascal. Higher stiffness indicates increased disease progression |
96 weeks
|
Medidas de resultados secundários
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Time to disease progression
Prazo: 96 weeks
|
Time to disease progression defined as time to development of decompensation event (ascites, hepatic encephalopathy, variceal bleed) or hepatocellular carcinoma. Analyzed as time-to-event; binary if low counts. |
96 weeks
|
|
All-cause mortality
Prazo: 96 weeks
|
All-cause mortality: time-to-event, binary if low counts |
96 weeks
|
|
Time to development of ascites
Prazo: 96 weeks
|
Ascites: time-to-event, binary if low counts |
96 weeks
|
|
Time to development of overt hepatic encephalopathy
Prazo: 96 weeks
|
Time to development of overt hepatic encephalopathy: time-to-event, binary if low counts |
96 weeks
|
|
Time to development of variceal bleed
Prazo: 96 weeks
|
Variceal bleed: time-to-event, binary if low counts |
96 weeks
|
|
Time to development of hepatocellular carcinoma
Prazo: 96 weeks
|
Hepatocellular carcinoma: time-to-event, binary if low counts |
96 weeks
|
|
Change in spleen stiffness as measured by Vibration-Controlled Transient Elastography (VCTE)
Prazo: 96 weeks
|
Units: kilopascal; Range: 5 to 100 kilopascal; higher stiffness indicates increased disease progression |
96 weeks
|
|
Change in Child-Turcotte-Pugh score
Prazo: 96 weeks
|
Ordinal score from 5 to 15; higher score indicates further disease progression |
96 weeks
|
|
Change in Model for End Stage Liver Disease - Sodium (MELD-Na)
Prazo: 96 weeks
|
Unitless; Range: 6-40; higher score indicates further disease progression |
96 weeks
|
|
Change in liver stiffness via Magnetic Resonance Elastography
Prazo: 96 weeks
|
Units: kilopascal; Range: 0 to 20; higher stiffness indicates increased disease progression |
96 weeks
|
|
Change in Enhanced Liver Fibrosis test
Prazo: 96 weeks
|
Unitless; Range: 5 to 11; Higher score is worse |
96 weeks
|
|
Change in Fibrosis-4
Prazo: 96 weeks
|
Unitless; Range: 0 to 10; higher score indicates more stiffness |
96 weeks
|
|
Change in patient-reported quality of life scores
Prazo: 96 weeks
|
Patient Reported Outcomes Measurement Information System (29-item version) Global Health T-Score: Population centered at 50 points, standard deviation of 10 (higher score signifies "better" health) |
96 weeks
|
|
Rate of adverse events
Prazo: 96 weeks
|
Count |
96 weeks
|
|
Rate of serious adverse events
Prazo: 96 weeks
|
Count |
96 weeks
|
|
Rate of adverse events of special interest
Prazo: 96 weeks
|
Rate of adverse events of special interest (myopathy, drug-induced liver injury, cardiovascular events, cancer other than hepatocellular carcinoma, new onset diabetes as separate outcomes): Count |
96 weeks
|
|
Time to cardiovascular events
Prazo: 96 weeks
|
Cardiovascular events: time-to-event, binary if low counts |
96 weeks
|
|
Time to new onset diabetes
Prazo: 96 weeks
|
New onset diabetes: time-to-event, binary if low counts |
96 weeks
|
Colaboradores e Investigadores
Patrocinador
Patrocinador
Colaboradores
Colaboradores
Investigadores
Investigadores
- Investigador principal: Abigail Smith, PhD, Northwestern University
Publicações e links úteis
Links úteis
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Início do estudo
Conclusão Primária (Estimado)
Conclusão Primária
Conclusão do estudo (Estimado)
Conclusão do estudo
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Primeira postagem
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última Atualização Postada
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Processos Patológicos
- Doenças do aparelho digestivo
- Doenças do Fígado
- Transtornos Relacionados a Substâncias
- Distúrbios induzidos quimicamente
- Distúrbios Relacionados ao Álcool
- Fígado gordo
- Doenças Hepáticas Alcoólicas
- Transtornos induzidos pelo álcool
- Condições Patológicas, Sinais e Sintomas
- Fibrose
- Doença hepática gordurosa não alcoólica
- Cirrose hepática
- Cirrose Hepática Alcoólica
- Compostos de enxofre
- Produtos químicos orgânicos
- Compostos heterocíclicos, 1 anel
- Compostos heterocíclicos
- Hidrocarbonetos
- Amidas
- Pirimidinas
- Hidrocarbonetos, halogenados
- Sulfonamidas
- Sulfonas
- Fluorobenzenos
- Hidrocarbonetos, fluorados
- Rosuvastatina Cálcio
Outros números de identificação do estudo
Outros números de identificação do estudo
- Pro00070580
- 5U24DK130164-04 (Concessão/Contrato do NIH dos EUA)
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Descrição do plano IPD
Dataset with National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Repository.
Tipo de informação de suporte de compartilhamento de IPD
- PROTOCOLO DE ESTUDO
- CIF
Informações sobre medicamentos e dispositivos, documentos de estudo
Estuda um medicamento regulamentado pela FDA dos EUA
Estuda um produto de dispositivo regulamentado pela FDA dos EUA
Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .