- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT05014594
Sodium-glucose Linked Transporter 2 (SGLT-2) Inhibitors in Recurrent Ascites: a Pilot RCT
The development of ascites is a landmark event in the natural history of cirrhosis and signifies a grim prognosis. Portal hypertension and splanchnic arterial vasodilatation are the major contributors in the development of ascites. Vasodilatation with the consequential decrease in effective circulating volume leads to the activation of sympathetic nervous system and renin angiotensin aldosterone system (RAAS), leading to antinatriuretic effects and retention of sodium and water. This results in the formation of ascites. Management of ascites primarily consists of salt restrictrion and diuretics. Liver transplant is the ultimate panacea.
Dapaglifozin, a Sodium glucose linked transporter-2(SGLT-2) inhibitor, is a part of the routine armamentarium for treatment of patients with Diabetes Mellitus type-2. Its safety is well established in non-diabetic patients too where it has been shown to improve cardiovascular outcomes. The risk of hypoglycemia is negligible as its action is independent of insulin. By virtue of its natriuretic effect, it has been shown to reduce hospitalisations in patients with heart failure irrespective of the presence of diabetes. We hypothesise that a similar natriuretic effect may help in suppressing the renin-angiotensin axis with improved mobilization of ascites in patients with cirrhosis. Pharmacokinetic data on the use of Dapaglifozin suggest that there is no need for dose modification in cirrhosis. The AUC and Cmax for Dapaglifozin in Child Pugh C cirrhosis is 67% and 40%, respectively. In a recent small case series, SGLT-2 inhibitors including dapaglifozin led to improvement in fluid retention and serum sodium, without acute kidney injury or encephalopathy, in patients with cirrhosis. However, SGLT-2 inhibitors have not been evaluated in randomized controlled trials. In this pilot study, we plan to evaluate the efficacy and safety of dapaglifozin in cirrhotics patients with recurrent ascites.
Studieöversikt
Status
Betingelser
Studietyp
Inskrivning (Förväntat)
Fas
- Fas 2
Kontakter och platser
Studiekontakt
- Namn: Virendra Singh, MD,DM,FASGE
- Telefonnummer: 0172-275-6338
- E-post: virendrasingh100@hotmail.com
Studera Kontakt Backup
- Namn: Rishav Aggarwal, MBBS
- Telefonnummer: 9914032190
- E-post: rishavaggarwal90@gmail.com
Studieorter
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Chandigarh, Indien, 160012
- Rekrytering
- Dept of Hepatology, PGIMER
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Kontakt:
- Virendra Singh, MD, DM
- Telefonnummer: +911722756338
- E-post: virendrasingh100@hotmail.com
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Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
- Age 18-70 years
- Cirrhosis as determined by clinical findings, hemogram and liver function tests, endoscopic findings and imaging
- Recurrent ascites: Recurrent ascites will be defined as tense ascites recurring at least thrice within the last 1-year despite optimal standard medical treatment including large volume paracentesis and diuretics
Exclusion Criteria:
- Presence of chronic kidney disease as defined by an estimated glomerular filtration rate of <60 ml/min for more than 3 months. The MDRD-6 equation will be used for estimating GFR.
- Portal vein thrombosis
- Hepatocellular carcinoma.
- Gastrointestinal bleed in the preceding 2-weeks
- Overt hepatic encephalopathy in the preceding 1-month
- Documented hypoglycemia in the preceding 1-month
- Serum sodium < 125 meq/l
- History of skeletal fracture in the preceding year or any past history of fragility fracture
- History of peripheral vascular disease
- Acute kidney injury as defined by the International Club of Ascites criteria
- Infection within 1-month preceding the study
- Anatomic urologic defects that predispose to urinary tract infection
- Mixed ascites (additional etiology of ascites apart from portal hypertension)
- Any severe extra hepatic condition including respiratory and cardiac failure
- Acute-on-chronic liver failure as per the APASL or CANONIC criteria
- Treatment with drug with known effects on systemic and renal hemodynamics within 7 days of inclusion excepting beta-blockers
- Patients opting for liver transplant or TIPS
- Refusal to give consent
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Behandling
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Fyrdubbla
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
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Aktiv komparator: Group A (Dapaglifozin)
Group A will receive oral Dapaglifozin (10 mg/day) along with standard medical therapy for 6 months
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Oral Dapaglifozin (10 mg/day) along with standard medical therapy will be given to Group A while a placebo of dapaglifozin along with standard medical therapy will be used in Group B
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Placebo-jämförare: Group B (Placebo)
Group B will receive placebo of Dapaglifozin along with standard medical therapy for 6 months
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Standard medical therapy will include dietary restriction of sodium, treatment with diuretics, repeated LVP as needed and other supportive care.
Patients on non-selective beta blockers will continue to do so with dose modifications/withdrawal as per Baveno VI guidelines.
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Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
control of ascites at 6-months
Tidsram: 6 months
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Control of ascites will be defined as follows-
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6 months
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Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Change in eGFR measured by MDRD-6 at 3 months and 6 months
Tidsram: 6 months
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eGFR will be measured by MDRD-6 formula
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6 months
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Change in urine output at 2-weeks, 3-months and 6-months
Tidsram: 6-months
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Change in 24-hour urine output (ml) at 6-months
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6-months
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Change in serum sodium (mEq/l) at 2-weeks, 3-months and 6 months
Tidsram: 6 months
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Change in serum sodium (mEq/l)
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6 months
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Change in 24-hours urinary sodium (mEq) at 2 weeks, 3 months and 6 months
Tidsram: 6 months
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Change in 24-hours urinary sodium (mEq)
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6 months
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Change in HbA1c at 3 and 6 months
Tidsram: 6 months
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Change in HbA1c
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6 months
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Change in Child-Turcotte-Pugh (CTP) score at 3 months and 6 months
Tidsram: 6 months
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Change in CTP score.
The CTP score incorporates the variables of serum bilirubin, albumin, prothrombin time-INR, grade of ascites and hepatic encephalopathy.
The score ranges from 5-15 and a higher score portends a worse prognosis
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6 months
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Change in model for end stage liver disease (MELD) score at 3 months and 6 months
Tidsram: 6 months
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Change in MELD score.
The MELD score incorporates the variables of serum bilirubin, creatinine and Internation Normalised Ratio (INR).
Higher MELD score indicates worse prognosis
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6 months
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Incidence of spontaneous bacterial peritonitis (SBP), urinary tract infection (UTI) and other infections
Tidsram: 6 months
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The diagnosis of SBP will be based on neutrophil count in ascitic fluid of >250/mm3 as determined by microscopy and positive ascitic fluid culture or >250 /mm3 with negative culture called as culture negative neutrocytic ascites.Other infections will be diagnosed as per CDC criteria.
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6 months
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Incidence of overt hepatic encephalopathy over 6-months
Tidsram: 6 months
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Over hepatic encephalopathy (HE) will be defined as grade II or higher HE as per the West haven classification
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6 months
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Incidence of acute kidney injury over 6-months
Tidsram: 6 months
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Acute kidney injury will be defined as per the International Club of Ascites criteria
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6 months
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Incidence of Hyponatremia (serum sodium <130 meq/L), hypokalemia (Serum potassium < 3.5 meq/L), hyperkalemia (Serum potassium >6meq/L) over 6-months.
Tidsram: 6 months
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Hyponatremia: serum sodium <130 meq/L hypokalemia: serum potassium < 3.5 meq/L hyperkalemia: serum potassium >6meq/L)
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6 months
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Incidence of skeletal fractures over 6-months
Tidsram: 6 months
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Incidence of skeletal fractures over 6-months
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6 months
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Change in bone densitometry as assessed by DEXA at 6-months
Tidsram: 6 months
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Bone densitometry will be assessed by DEXA
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6 months
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Incidence of diabetic ketoacidosis or hyperglycemic hyperosmolar nonketotic coma over 6-months
Tidsram: 6 months
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Incidence of diabetic ketoacidosis or hyperglycemic hyperosmolar nonketotic coma over 6-months
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6 months
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Incidence of hepatocellular carcinoma over 6-months
Tidsram: 6 months
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Hepatocellular carcinoma will be diagnosed based on imaging findings and AFP
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6 months
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Changes in plasma renin activity and aldosterone levels at 6- months
Tidsram: 6 months
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Changes in plasma renin activity (ng/ml/hr) and aldosterone (ng/dL) levels at 6- months
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6 months
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Frequency and volume of LVP over 6-months.
Tidsram: 6 months
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Frequency and volume of ascitic fluid removed (in litres) over 6-months.
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6 months
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Survival at 6-months
Tidsram: Survival at 6-months
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Survival at 6-months after start of therapy
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Survival at 6-months
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Safety of dapaglifozin as assessed by adverse effects
Tidsram: 6 months
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Safety of dapaglifozin as assessed by adverse effects
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6 months
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Renal resistive index at 6 months
Tidsram: 6 months
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Renal resistive index will be measured using ultrasound doppler interrogation of intrarenal arteries using formula (peak systolic velocity - end-diastolic velocity) / peak systolic velocity
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6 months
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Samarbetspartners och utredare
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Förväntat)
Avslutad studie (Förväntat)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Faktisk)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- Dapa recurrent ascites
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