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Liver Diseases, AlcoholicSIPHONNCT03308916

Screening At-risk Populations for Hepatic Fibrosis With Non-invasive Markers

A study testing transient elastography, Enhanced liver fibrosis test and Indirect serum markers of liver fibrosis in people with Liver Diseases, Alcoholic and Fibrosis, run by Maja Thiele at 1 site in Denmark.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Prospective screening study at Odense University Hospital to assess the effect of transient elastography and other serum and imaging markers of liver fibrosis to detect advanced fibrosis (Kleiner Fibrosis score F3-F4) in patients at risk of non-alcoholic fatty liver disease, alcoholic fatty liver disease, with a… Read more about this study

Who is it for?
Ages 30 to 75 years
Conditions the study is for
Liver Diseases, Alcoholic, Fibrosis
What is being tested?
transient elastography, Enhanced liver fibrosis test and Indirect serum markers of liver fibrosis
Could I receive a placebo?
No, everyone receives an active treatment
How many people
6,500 participants
Where
1 siteDenmark
Study dates
6 Oct 2017to 30 Oct 2035
Phase
Interventional
Are there results?
Not yet: the study is under way

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 30 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients are eligible for screening if the following inclusion criteria are fulfilled:
  • Age 30-75 years (except the general population, which should be aged 40-75)
  • Informed consent to study investigations
  • Ability to read and write Danish AND (only at-risk patients)
  • Prior or current alcohol overuse, defined as an average intake of ≥24 grams/day (14 units/week) for women and ≥36 grams/day (21 units/week) for men, for at least 5 years; OR
  • Presence of the metabolic syndrome defined by central obesity plus any two of the following four metabolic risk factors: (a) raised triglycerides, (b) reduced HDL cholesterol, (c) raised blood pressure and (d) raised fasting plasma glucose;[38] OR
  • Type 2 diabetes mellitus defined by either fasting plasma glucose ≥7 mmol/L, HbA1c ≥48 mmol/mol, a random plasma glucose ≥11.1 mmol/L in the presence of classic diabetes or an oral glucose tolerance test with fasting plasma glucose ≥7.0 mmol/L and/or 2 hour plasma glucose ≥11.1 mmol/L.

Who cannot join

  • We will exclude patients from screening in case of:
  • Evidence of decompensated liver disease, defined by clinically obvious ascites, overt hepatic encephalopathy, jaundice or large esophageal varices with/without variceal bleeding.
  • Known concurrent liver disease other than ALD and NAFLD.
  • Cancer or other debilitating disease with an expected survival of less than 12 months.
  • Inability to comply with the study protocol.
  • In screened patients with liver stiffness ≥8 kPa we will abstain from a liver biopsy in case of:
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  • Contraindications for a percutaneous liver biopsy
  • Severe alcoholic hepatitis or other hepatic inflammation evidenced by transaminase elevation of more than three times the upper limit of normal.
  • Hepatic congestion or bile duct dilation evidenced by ultrasound.
  • Decrease of TE below 6.0 kPa from screening to time of planned liver biopsy.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Maja Thiele, MD, PhD, Professor contact

+4524998068

maja.thiele@rsyd.dk

Denmark1 site, 1 recruiting
  • Department of Gastroenterology and Hepatology, Odense University Hospital

    Odense, 5000

    Maja Thiele, MD, PhD, 65412752 ext. 45, maja.thiele@rsyd.dk

    Maja Thiele, MD PhD

    Recruiting

Other trials in Denmark

About this study

Prospective screening study at Odense University Hospital to assess the effect of transient elastography and other serum and imaging markers of liver fibrosis to detect advanced fibrosis (Kleiner Fibrosis score F3-F4) in patients at risk of non-alcoholic fatty liver disease, alcoholic fatty liver disease, with a control group of participants recruited from the general population.

Read the detailed description

This protocol describes a prospective screening study at Odense University Hospital, Department of Gastroenterology and Hepatology. The investigators will use liver stiffness measurements with transient elastography to screen 3000 participants from at-risk populations and 3500 participants from the general population for advanced liver fibrosis. At-risk is defined as either (A) a prior or current alcohol overuse (≥21 units/week for men and ≥14 units/week for women) for more than 5 years, or (B) presence of the metabolic syndrome with or without concomitant type 2 diabetes mellitus.

The study goal is to evaluate the aptitude of transient elastography as a screening tool for advanced liver fibrosis, based on analyses of benefit, harm, detection rate, technical applicability and prognostic potential. Secondary aims are to compare novel serum markers of liver fibrosis as potential screening tools against transient elastography: The Enhanced Liver Fibrosis test, neoepitope markers of extracellular matrix turnover, cytokeratin-18 based markers and indirect indices of fibrosis from algorithms combining routine liver blood test. Screened participants with elevated liver stiffness (≥8.0 kiloPascal; estimated 400 participants with alcoholic liver disease, 400 participants with non-alcoholic fatty liver disease and 280 participants from the general population) will be investigated with 2-dimensional shear-wave elastography and abdominal ultrasonography and a liver biopsy to confirm or reject presence of advanced fibrosis.

All participants with a positive screening elastography will be invited for repeated liver stiffness measurements and serum fibrosis markers after a minimum of one year from inclusion.

Participants at risk of alcoholic and non-alcoholic liver disease, independent of liver stiffness measurement at inclusion, will be invited for repeated liver stiffness measurements and serum fibrosis markers after a minimum of one year from inclusion. At-risk participants with elevated liver stiffness measurements at a follow-up visit (>6.0 kiloPascal) will be offered a liver biopsy, however no earlier than two years after the index biopsy.

All participants will be followed for 10 years to assess liver-related outcomes and all-course mortality.

Being tested
transient elastography, Enhanced liver fibrosis test, Indirect serum markers of liver fibrosis, Direct serum markers of liver fibrosis, LiverTRAIL
Keywords
elastography, screening, non-invasive markers, microbiome, gut-liver-axis, cost-benefit, fibroscan, aixplorer, ultrasound elastography, liver fibrosis, alcoholic liver disease, advanced fibrosis, enhanced liver fibrosis test, direct liver fibrosis markers, ELF, cytokeratin-18, neoepitopes, collagen, NAFLD, ALD
Medical subject headings
Liver Diseases, Alcoholic, Fibrosis, Liver Cirrhosis, Non-alcoholic Fatty Liver Disease

What participants receive

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

  • transient elastographyDiagnostic test

    Also called FibroScan, TE

    Ultrasound elastography using shear-wave elastography to measure liver stiffness as a marker of liver fibrosis. Patients with transient elastography above 8.0 kPa selected for liver biopsy to detect advanced liver fibrosis

  • Enhanced liver fibrosis testDiagnostic test

    Also called ELF

    Patented, commercially available algorithm of hyaluronic acid (HA), N-terminal propeptide of collagen type 3 (P3NP) and tissue inhibitor of metalloproteinase 1 (TIMP-1)

  • Indirect serum markers of liver fibrosisDiagnostic test

    Also called Forns index, FIB-4, APRI, AST-ALT ratio

    Diagnostic markers using combination of routine liver biochemistry: age, AST, ALT, platelet count, cholesterol, GGT

  • Direct serum markers of liver fibrosisDiagnostic test

    Also called Neoepitopes, Collagen products, Extracellular matrix

    Serum markers that reflect liver extracellular matrix turnover and -accumulation

  • LiverTRAILDiagnostic test

    Software that contain 199 diagnostic algorithms, containing combinations of routine tests: age, AST, albumin, alkaline phosphatase, bilirubin, GGT, INR, platelet count, cholesterol and sodium, and specialist tests: transient elastography and direct serum markers of fibrosis.

  • Cytokeratin 18Diagnostic test

    Also called CK18, M30, M65

    Cytokeratin 18 from liver cell cytoskeleton; when cells undergo apoptosis, caspase-cleaved CK18 is released (M30), whereas full-length CK18 is realised during necrosis (M65)

  • Omics markersDiagnostic test

    Also called Multi-omics markers, Lipidomics, Microbiomics, Genomics

    Markers combining signatures of liver fibrosis and hepatic inflammation from many 'omics technologies

Study groups in NCT03308916
Study groupRoleWhat they receive
Liver stiffness measurementExperimentalTransient elastography in fasting state
Receives: Diagnostic Test: transient elastography; Diagnostic Test: Enhanced liver fibrosis test; Diagnostic Test: Indirect serum markers of liver fibrosis; Diagnostic Test: Direct serum markers of liver fibrosis; Diagnostic Test: LiverTRAIL; Diagnostic Test: Cytokeratin 18; Diagnostic Test: Omics markers

What is being measured

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

  1. Biopsy-verified advanced fibrosis

    Number of patients with biopsy-verified, advanced fibrosis (Kleiner fibrosis score ≥F3) detected by screening

    Measured: 5 years

  2. Liver-related outcomes

    Number of liver-related clinical outcomes during 10 years of follow up after the first screened patient, compared to a matched, historical control group (The Inter99 study and the Copenhagen and Odense alcohol rehabilitation cohorts). Liver-related outcomes are defined as liver-related death, liver transplant, progression to liver-related complications (ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, jaundice, bleeding from esophagastric varices, hepatocellular carcinoma) or MELD-Na score >15

    Measured: 10 years

Secondary outcomes (2)
  1. Liver related outcomes

    Number of liver-related clinical outcomes during 10 years of follow up after the first screened patient, compared to a matched, historical control group (The Inter99 study and the Copenhagen and Odense alcohol rehabilitation cohorts). Liver-related outcomes are defined as liver-related death, liver transplant, progression to liver-related complications (ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, jaundice, bleeding from esophagastric varices, hepatocellular carcinoma) or MELD-Na score >15

    Measured: 10 years

  2. Mortality

    Overall number of deaths during 10 years of follow up after the first screened patient, compared to a matched, historical control group (The Inter99 study and the Copenhagen and Odense alcohol rehabilitation cohorts).

    Measured: 10 years

Timeline

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

  1. First posted13 Oct 2017
  2. Study start6 Oct 2017
  3. Primary completion30 Dec 2025 (estimated)
  4. Study completion30 Oct 2035 (estimated)

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 N/A
Primary purpose
Diagnosis
Allocation
Not applicable
Intervention model
Single group
Model description
Single intervention group selected for screening with a historical control group
Masking
None (open label)
Enrolment
6,500 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03308916
Sponsor's protocol ID
S-20170087
Acronym
SIPHON
Status last verified
Aug 2022
First submitted
4 Feb 2016
Last updated
1 Sep 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: OPEN - Odense Patient Exploratory data Network, managed by Odense University Hospital

Publications

  • Hansen CD, Hansen JK, Israelsen M, Andersen P, Pikkupeura LM, Lindvig KP, Stinson SE, Schnefeld HL, Tellerup J, Fogt M, Torp N, Kjaergaard M, Bech KT, Thorhauge KH, Johansen S, Spedtsberg I, Deluran E, Villesen IF, Detlefsen S, Hansen T, Krag A, Thiele M. Prevalence, severity and determinants of steatotic liver disease among individuals with metabolic and alcohol risk from the community. J Hepatol. 2025 Dec;83(6):1278-1291. doi: 10.1016/j.jhep.2025.06.020. Epub 2025 Jul 5.

    PubMed 40618958
  • Kjaergaard M, Lindvig KP, Thorhauge KH, Andersen P, Hansen JK, Kastrup N, Jensen JM, Hansen CD, Johansen S, Israelsen M, Torp N, Trelle MB, Shan S, Detlefsen S, Antonsen S, Andersen JE, Graupera I, Gines P, Thiele M, Krag A. Using the ELF test, FIB-4 and NAFLD fibrosis score to screen the population for liver disease. J Hepatol. 2023 Aug;79(2):277-286. doi: 10.1016/j.jhep.2023.04.002. Epub 2023 Apr 21.

    PubMed 37088311

Questions about this trial

What is this clinical trial studying?

A study testing transient elastography, Enhanced liver fibrosis test and Indirect serum markers of liver fibrosis in people with Liver Diseases, Alcoholic and Fibrosis, run by Maja Thiele at 1 site in Denmark.

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 7 inclusion and 10 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: looking for participants now, as of the sponsor's last update on 1 Sep 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 Denmark. 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.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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

Contact Maja Thiele, MD, PhD, Professor (+4524998068, maja.thiele@rsyd.dk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Biopsy-verified advanced fibrosis (time frame: 5 years). The study lists 2 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 NCT03308916, which also lists 2 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 1 Sep 2022.

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