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Chronic Liver DiseasePhase 1NCT01851252

MBT Versus HVPG in Identifying Responders to Portal Hypertension Therapy

A Phase 1 study testing Methacetin (with Breath testing device) in people with Chronic Liver Disease and Cirrhosis, run by Meridian Bioscience, Inc. at 1 site in Israel.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to determine the effect on the (carbon 13 labelled(13C)-Methacetin Breath Test (MBT) of i.v. propranolol, a non-selective beta blocker (NSBB) following initial administration and after chronic use of each of these agents. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Methacetin (with Breath testing device)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
19 participants
Where
1 siteIsrael
Study dates
Oct 2013to Aug 2017
Phase
Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • -> 18 years old (M/F)
  • -Diagnosis of cirrhosis: i. By liver biopsy ii. Or strong suspicion of cirrhosis by accepted criteria for the clinical diagnosis of cirrhosis (e.g. peripheral edema or varices, palpable hard left lobe of the liver, small right lobe span or palpable splenomegaly), and/or radiological evidence of cirrhosis (by abdominal US, CT, or MRI, showing a nodular liver and/or portosystemic collaterals with portal vein patency and/or ascites and/or splenomegaly, and/or colloid shift on a colloid-isotope liver-spleen scan), and/or laboratory variables (platelets <100,000/mm3, albumin< 3.5g/dL, or international normalized ratio (INR)>1.3) iii. Presence of esophageal varices (without previous variceal bleeding episode) or HVPG≥10mmHg 12mmHg from previous testing.
  • -Has been scheduled for hemodynamic study testing, including response to acute therapy.-

Who cannot join

  • Patients already receiving beta blockers
  • Hepatocellular carcinoma
  • Portal vein thrombosis
  • Contraindications to non-selective beta blocker Propanolol
  • Cholestatic liver disease
  • Severe heart, pulmonary or renal disease.
Show all 15Show fewer
  • Patient has previous surgical bypass surgery for morbid obesity
  • Patient has extensive small bowel resection
  • Any major surgery in the past 3 months.
  • Patient is a recipient of any organ transplant
  • Patient allergic to acetaminophen.
  • Patients who are taking hepatotoxic drugs
  • Patient, based on the opinion of the investigator, should not be enrolled into this study.
  • Patients unable or unwilling to sign informed consent
  • Patients that are participating in other clinical trials evaluating experimental treatments or procedures or have participated in a clinical trial in the past 3 months.

Trial locations and contacts

1 site in 1 country.

Israel1 site
  • Carmel Medical Center

    Haifa, 34362

Other trials in Israel

About this study

Official title: Pilot Study to Evaluate the Correlation Between ¹³C Methacetin Breath Test (MBT) and HVPG Measurement as a Tool for Identifying Responders to Portal Hypertension Therapy

The purpose of this study is to determine the effect on the (carbon 13 labelled(13C)-Methacetin Breath Test (MBT) of i.v. propranolol, a non-selective beta blocker (NSBB) following initial administration and after chronic use of each of these agents. The correlation of the MBT with Hepatic Venous Pressure Gradient (HVPG) measurement before and after treatment will be assessed. Additionally, the MBT measurements following 60 days of therapy will be compared to the first MBT measurement and to the second MBT measurement, post HVPG. Each patient's subsequent MBT measurement will be compared to his previous MBT results in order to determine his/her response to therapy.

Read the detailed description

Variceal bleeding is a life threatening complication of cirrhosis, which still carries a high mortality. Non selective beta-adrenergic blockers are effective at preventing first time variceal bleeding and re-bleeding. The efficacy of these drugs depends on the magnitude of reduction in portal pressure after administration, which varies widely between patients. Studies have shown that a reduction in portal pressure (as measured by HVPG) to 20% from baseline or to values ≤ 12 millimeters of mercury (mmHg) is associated with a low residual risk of bleeding . Patients with such a reduction are considered to be "responders" to beta blocker (BB) therapy. Unfortunately, a significant percentage of patients do not respond to therapy and need to be prescribed to an alternative therapy. The clinical application of this observation is limited since it requires a repeated HVPG measurement,which is not feasible in most cases. A non-invasive breath test that can assess portal pressure in correlation to HVPG and allow efficient management of patients at risk, could be very useful.

Being tested
Methacetin (with Breath testing device)
Keywords
Cirrhotics, Esophageal varices, Portal Hypertension
Medical subject headings
Fibrosis, Esophageal and Gastric Varices, Hypertension, Portal, Hemorrhage

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Methacetin (with Breath testing device)Device

    The methacetin is enriched with carbon 13, a stable non- radioactive isotope, and has been found to be safe in hundreds of studies. The material is very similar to acetominophen. 75 milligrams (mm) of this material pre- dissolved in water are used. This material undergoes rapid metabolism by the liver.

Study groups in NCT01851252
Study groupRoleWhat they receive
Methacetin (for BT) before / after Propanolol treatment.ExperimentalThe methacetin breath test (MBT) will be performed before and after (within 2 hours) injection of Propanolol (BB) dose and once again after 60 days of oral administration of Propanolol.
Receives: Device: Methacetin (with Breath testing device)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Correlation between HVPG and MBT and their changes following the i.v. administration of Propranolol

    MBT baseline measure will be measured within a week before the anticipated HVPG procedure, but not on the same day. The HVPG will be measured approximately 30 minutes after i.v. propanolol is given and the MBT will be performed approximately one hour later.

    Measured: 7 days

  2. The changes between MBT at baseline level and after chronic treatment in Propranolol

    MBT baseline measure will be measured within a week before the anticipated HVPG procedure, but not on the same day. The HVPG will be measured approximately 30 minutes after i.v. propanolol is given and the MBT will be performed approximately one hour later.

    Measured: 7 days

  3. MBT correlation to clinical events after 2 month of treatment

    The MBT will be performed on subjects again after 60 days of oral beta blocker treatment and its results will be compared to previous MBT values.

    Measured: 67 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 May 2013 (estimated)
  2. Study startOct 2013
  3. Primary completionAug 2017
  4. Study completionAug 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Supportive care
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
19 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01851252
Sponsor's protocol ID
HVPG-BB-EX-513
Status last verified
Dec 2022
First submitted
8 May 2013
Last updated
20 Dec 2022
Results posted
No
Data monitoring committee
No

Publications

  • Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, Pandya P, Sitaraman S, Shen J. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol. 2003 Mar;98(3):653-9. doi: 10.1111/j.1572-0241.2003.07294.x.

    PubMed 12650802
  • Carbonell N, Pauwels A, Serfaty L, Fourdan O, Levy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004 Sep;40(3):652-9. doi: 10.1002/hep.20339.

    PubMed 15349904
  • Stokkeland K, Brandt L, Ekbom A, Hultcrantz R. Improved prognosis for patients hospitalized with esophageal varices in Sweden 1969-2002. Hepatology. 2006 Mar;43(3):500-5. doi: 10.1002/hep.21089.

    PubMed 16496319
  • de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2005 Jul;43(1):167-76. doi: 10.1016/j.jhep.2005.05.009. No abstract available.

    PubMed 15925423
  • Ripoll C, Groszmann R, Garcia-Tsao G, Grace N, Burroughs A, Planas R, Escorsell A, Garcia-Pagan JC, Makuch R, Patch D, Matloff DS, Bosch J; Portal Hypertension Collaborative Group. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007 Aug;133(2):481-8. doi: 10.1053/j.gastro.2007.05.024. Epub 2007 May 21.

    PubMed 17681169
  • Abraldes JG, Tarantino I, Turnes J, Garcia-Pagan JC, Rodes J, Bosch J. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology. 2003 Apr;37(4):902-8. doi: 10.1053/jhep.2003.50133.

    PubMed 12668985
  • Turnes J, Garcia-Pagan JC, Abraldes JG, Hernandez-Guerra M, Dell'Era A, Bosch J. Pharmacological reduction of portal pressure and long-term risk of first variceal bleeding in patients with cirrhosis. Am J Gastroenterol. 2006 Mar;101(3):506-12. doi: 10.1111/j.1572-0241.2006.00453.x.

    PubMed 16542287
  • Groszmann RJ, Bosch J, Grace ND, Conn HO, Garcia-Tsao G, Navasa M, Alberts J, Rodes J, Fischer R, Bermann M, et al. Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology. 1990 Nov;99(5):1401-7. doi: 10.1016/0016-5085(90)91168-6.

    PubMed 2210246
  • Feu F, Garcia-Pagan JC, Bosch J, Luca A, Teres J, Escorsell A, Rodes J. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet. 1995 Oct 21;346(8982):1056-9. doi: 10.1016/s0140-6736(95)91740-3.

    PubMed 7564785
  • Merkel C, Bolognesi M, Sacerdoti D, Bombonato G, Bellini B, Bighin R, Gatta A. The hemodynamic response to medical treatment of portal hypertension as a predictor of clinical effectiveness in the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology. 2000 Nov;32(5):930-4. doi: 10.1053/jhep.2000.19322.

    PubMed 11050041
  • Bureau C, Peron JM, Alric L, Morales J, Sanchez J, Barange K, Payen JL, Vinel JP. "A La Carte" treatment of portal hypertension: Adapting medical therapy to hemodynamic response for the prevention of bleeding. Hepatology. 2002 Dec;36(6):1361-6. doi: 10.1053/jhep.2002.36945.

    PubMed 12447860
  • Bosch J, Groszmann RJ. Measurement of azygos venous blood flow by a continuous thermal dilution technique: an index of blood flow through gastroesophageal collaterals in cirrhosis. Hepatology. 1984 May-Jun;4(3):424-9. doi: 10.1002/hep.1840040312.

    PubMed 6609870
  • Escorsell A, Bordas JM, Castaneda B, Llach J, Garcia-Pagan JC, Rodes J, Bosch J. Predictive value of the variceal pressure response to continued pharmacological therapy in patients with cirrhosis and portal hypertension. Hepatology. 2000 May;31(5):1061-7. doi: 10.1053/he.2000.6779.

    PubMed 10796880
  • Garcia-Tsao G, Grace ND, Groszmann RJ, Conn HO, Bermann MM, Patrick MJ, Morse SS, Alberts JL. Short-term effects of propranolol on portal venous pressure. Hepatology. 1986 Jan-Feb;6(1):101-6. doi: 10.1002/hep.1840060119.

    PubMed 3943775
  • La Mura V, Abraldes JG, Raffa S, Retto O, Berzigotti A, Garcia-Pagan JC, Bosch J. Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension. J Hepatol. 2009 Aug;51(2):279-87. doi: 10.1016/j.jhep.2009.04.015. Epub 2009 May 24.

    PubMed 19501930

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Methacetin (with Breath testing device) in people with Chronic Liver Disease and Cirrhosis, run by Meridian Bioscience, Inc. at 1 site in Israel.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 20 Dec 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Israel. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Correlation between HVPG and MBT and their changes following the i.v. administration of Propranolol (time frame: 7 days). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01851252, which also lists 25 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Dec 2022.

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