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Liver Failure, AcutePRO-SURFASANCT05473403

Validation of a Prognostic Score for Steroid Therapy Response in Acute Severe Autoimmune Hepatitis

A study testing Corticosteroid therapy in people with Liver Failure, Acute and Hepatitis, Autoimmune, run by Assistance Publique - Hôpitaux de Paris at 26 sites in France.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
Search all trials

Trial summary

Autoimmune hepatitis (AIH) is a chronic liver disease, which is characterized by the increase of immunoglobulin G (IgG) level, the presence of auto-antibodies and a typical histology, in the absence of other liver disease. Read more about this study

Who is it for?
Ages 18 to 99 years
What is being tested?
Corticosteroid therapy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
150 participants
Where
26 sitesFrance
Study dates
1 Jun 2024to 30 Jun 2028
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 18 to 99 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 18 years
  • Strong clinical suspicion of severe acute autoimmune hepatitis defined by the presence of increased IgG and/or autoantibodies and/or histology characteristic of the disease in the absence of other causes of severe acute hepatitis.
  • International Normalized Ratio (INR) ≥ 1.5
  • Informed, written consent
  • Patient having the rights to French social insurance

Who cannot join

  • Previous medical history of chronic liver disease including autoimmune liver disease (AIH, Primary Biliary Cholangitis (PBC), Primary Sclerosing Cholangitis (PSC) , alcoholic hepatitis etc.)
  • Other causes of acute severe hepatitis:
  • Hepatitis A Virus (HAV) hepatitis, defined by HAV Immunoglobulin M (IgM) antibodies
  • Hepatitis B Virus (HBV) hepatitis, defined by HBs antigen and HBV IgM antibodies
  • Hepatitis E Virus (HEV) hepatitis, defined by HEV IgM antibodies or positive HEV-RNA in immunosuppressed patients
  • Drug induced hepatitis, histologically proved or induced by well-known hepatotoxic substances
Show all 13Show fewer
  • Acute hypoxemic hepatitis, context of shock, hypoxemia or heat shock
  • Budd-Chiari syndrome, diagnosed by imagery (Doppler ultrasound, CT scan)
  • Acute hepatitis in the context of a HELLP (Hemolysis, Elevated Liver enzymes and a Low Platelet count) syndrome or acute fatty liver of pregnancy
  • Use of corticosteroids 1 month before inclusion
  • Pregnant or lactating woman
  • Curator or guardianship or patient placed under judicial protection
  • Participation in other interventional research during the study

Trial locations and contacts

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

Eleonora DE MARTIN, MD, PhD contact

33 (0)1.45.59.64.33

eleonora.demartin@aphp.fr

Jean-Charles DUCLOS-VALLEE, MD, PhD contact

33 (0)1.45.59.64.28

jean-charles.duclos-vallee@aphp.fr

26 sites in 1 country

France26 sites
  • CHU Angers, Service Hepato-gastro-enterologie

    Angers, 49933

    Adrien LANNES, MD, 33 (0)2.41.35.31.42, adrien.lannes@chu-angers.fr

    Adrien LANNES, MD

  • CHU Jean Minjoz Besançon, Service d'hepatologie et de soins intensifs digestifs

    Besançon, 25030

    Vincent DI MARTINO, MD, Vdimartino@chu-besancon.fr

    Vincent DI MARTINO, MD

  • APHP, Hopital Avicenne, Service Hepatologie et Oncologie Hépatique

    Bobigny, 93000

    Nathalie GANNE, MD, 33 (0)1.48.02.66.66, nathalie.ganne@aphp.fr

    Nathalie GANNE, MD

  • CHU Brest, Hopital de la Cavale Blanche Service Gastro-enterologie

    Brest, 29609

    Noemi REBOUX, MD, noemi.reboux@chu-brest.fr

    Noemi REBOUX, MD

  • CHU de Caen, Hopital de la Cote de Nacre, Service Hepato-Gastro-Enterologie et Nutrition

    Caen, 14033

    Isabelle OLLIVIER-HOURMAND, MD, 33 (0)2.31.06.45.44, ollivierhourmand-i@chu-caen.fr

    Isabelle OLLIVIER-HOURMAND, MD

  • CHU Trousseau Chambray, Service Gastro-enterologie et hepatologie

    Chambray-lès-Tours, 37170

    Helene BARRAUD, MD, 33 (0)2.47.47.59.16, h.barraud@chu-tours.fr

    Helene BARRAUD, MD

  • CHU Dijon, Service Hepato-gastroenterologie et cancerologie digestive

    Dijon, 21079

    Anne MINELLO, MD, 33 (0)3.80.29.37.50, anne.minello@chu-dijon.fr

    Anne MINELLO, MD

  • CHRU de Lille, Hopital Claude Huriez, Service des maladies de l'appareil digestif et de la nutrition

    Lille, 59037

    Alexandre LOUVET, MD, alexandre.louvet@chru-lille.fr

    Alexandre LOUVET, MD

  • CHU Limoges, Hopital Dupuytren, Service Hepato-gastroenterologie et nutrition

    Limoges, 87042

    Marilyne DEBETTE-GRATIEN, MD, 33 (0)5.55.05.66.21, marilyne.gratien@chu-limoges.fr

    Marilyne DEBETTE-GRATIEN, MD

  • CHU Hopital Edouard Herriot, Service Hepato-gastro-enterologie

    Lyon, 69003

    Jerome DUMORTIER, MD, 33 (0)4.72.11.01.09, jerome.dumortier@chu-lyon.fr

    Jerome DUMORTIER, MD

  • CHU Lyon, Hopital Croix Rousse, Service Hepato-gastro-enterologie

    Lyon, 69317

    Teresa Maria ANTONINI-MICHELLE, MD, teresa.antonini@chu-lyon.fr

    Teresa Maria ANTONINI-MICHELLE, MD

  • Hopital Saint Joseph, Service Hepato-gastro-enterologie

    Marseille, 13285

    Olivia PIETRI, MD, 33 (0)4 91 80 70 61, opietri@hopital-saint-joseph.fr

    Olivia PIETRI, MD

  • CHU Montpellier, Hopital Saint Eloi, Service Hepato-gastro-enterologie

    Montpellier, 34295

    Lucy MEUNIER, MD, 33 (0)4.67.33.66.33, lucy.meunier@chu-montpellier.fr

    Lucy MEUNIER, MD

  • CHU Nice, Hopital de l'Archet 2, Service Hepatologie

    Nice, 06200

    Rodolphe ANTY, MD, 33 (0)4.92.03.63.85, anty.r@chu-nice.fr

    Rodolphe ANTY, MD

  • CHU Orleans, Hopital de la Source, Service Gastro-enterologie et hepatologie

    Orléans, 45100

    Pascal POTIER, MD, 33 (0)2.38.22.96.43, pascal.potier@chr-orleans.fr

    Pascal POTIER, MD

  • AP-HP, Hopital St Antoine, Service Hepato-gastro-enterologie

    Paris, 75012

    Olivier CHAZOULLIERES, MD, 33 (0)1.49.28.29.23, olivier.chazouilleres@aphp.fr

    Olivier CHAZOULLIERES, MD

  • APHP, Hopital Pitie-Salpetriere, Service d'hepatologie et de gastroenterologie

    Paris, 75013

    Marika RUDLER, MD, 33 (0)1.42.17.56.91, Marika.rudler@aphp.fr

    Marika RUDLER, MD

  • AP-HP, Hopital Cochin Service Hepatologie

    Paris, 75014

    Charlotte MOULIADE, MD, charlotte.mouliade@aphp.fr

    Charlotte MOULIADE, MD

  • CHU Bordeaux, GH Sud Haut-Leveque, Service Hepato-gastro-enterologie

    Pessac, 33604

    Victor DE LEDINGHEN, MD, 33 (0)5.57.65.64.39, victor.deledinghen@chu-bordeaux.fr

    Victor DE LEDINGHEN, MD

  • CHU La Miletrie, Service Hepato-gastro-enterologie

    Poitiers, 86000

    Christine SILVAIN, MD, 33 (0)5.49.44.44.38, c.silvain@chu-poitiers.fr

    Christine SILVAIN, MD

  • CHU Reims, Hopital Robert Debré, Service Hepato-Gastroenterologie et de Cancerologie digestive

    Reims, 51092

    Alexandra HEURGUE-BERLOT, MD, 33 (0)3.26.78.78.78, aheurgue@chu-reims.fr

    Alexandra HEURGUE-BERLOT, MD

  • CHU de Rennes, Hopital de Pontchaillou, Service Maladie du foie

    Rennes, 35000

    Pauline HOUSSEL-DEBRY, MD, 33 (0).99.28.42.98, pauline.houssel-debry@chu-rennes.fr

    Pauline HOUSSEL-DEBRY, MD

  • CHU Rouen, Service d'hepatogastro-enterologie

    Rouen, 76031

    Odile GORIA, MD, Odile.Goria@chu-rouen.fr

    Odile GORIA, MD

  • CHU Strasbourg, Hopital de Hautepierre, Service Hepato-gastro-enterologie

    Strasbourg, 67200

    Camille BESCH, MD, 33 (0)3.88.12.74.48, camille.besch@chru-strasbourg.fr

    Camille BESCH, MD

  • CHU Toulouse, Hopital Rangueil, Service Hepatologie

    Toulouse, 31059

    Christophe BUREAU, MD, 33 (0)5.61.77.25.27, bureau.c@chu-toulouse.fr

    Christophe BUREAU, MD

  • AP-HP, Paul Brousse Hospital, Centre Hepato-Biliaire

    Villejuif, 94800

    Eleonora DE MARTIN, MD, PhD, 33 (0)1.45.59.64.33, eleonora.demartin@aphp.fr

    Eleonora DE MARTIN, MD, PhD

Other trials in France

About this study

Official title: Validation of a Prognostic Score for Steroid Therapy Response in Acute Severe Autoimmune Hepatitis, a National Prospective Multicentre Study

Autoimmune hepatitis (AIH) is a chronic liver disease, which is characterized by the increase of immunoglobulin G (IgG) level, the presence of auto-antibodies and a typical histology, in the absence of other liver disease.

Due to the heterogeneity of AIH manifestations, different scoring systems have been validated in order to make a reliable diagnosis. The two most recent scoring systems are: the revised International Autoimmune Hepatitis Group (IAIHG) criteria and the IAIHG simplified criteria. The second one is recommended by the European Association for the Study of the Liver (EASL) clinical practice guidelines (CPGs).

Read more

The EASL clinical practice guidelines suggests that the treatment of ASAIH (Acute Severe AIH) is high doses of corticosteroids (superior to 1mg/kg/day) as early as possible and a lack of improvement within seven days should lead to listing for emergency liver transplantation (LT). However, the "lack of improvement" is not objectively defined and the grading of recommendation is III (Opinions of respected authorities).

The hypothesis of the study is that the previously developed decisional score on a retrospective series will prospectively allow the differentiation between patients with ASAIH (Acute Severe AIH) who respond to corticosteroid therapy and should be maintained on treatment and patients who do not respond and should be rapidly evaluated for LT. The score will be computed at day 3 since corticosteroid introduction.

Read the detailed description

All the interventions (blood samples, imagery examinations, visits, liver biopsy, corticosteroid therapy, liver transplantation) will be performed following the standard of care for ASAIH. The investigators of the participating centers will not change their standard management for the study protocol. The management will follow the recommendation of EASL CPGs.

The prognostic score will allow to distinguish between patient's responders and non-responders to corticosteroid therapy in ASAIH. This knowledge will avoid the prolonged duration of the corticosteroid therapy in patients for whom this therapy is futile or harmful and rapidly select the patients for LT. Of course considering that the created score is decisional whether a patient is a candidate for LT, a prospective validation is mandatory to use it as a clinical tool for the day-to-day practice. This is the first prospective study on ASAIH.

Being tested
Corticosteroid therapy
Keywords
Acute Severe AutoImmune Hepatitis (ASAIH), Decisional score, Prognostic score
Medical subject headings
Liver Failure, Acute, Hepatitis, Autoimmune

What participants receive

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

  • Corticosteroid therapyOther

    Administration of high doses of corticosteroids as early as possible. Patient non-responder to treatment should lead to listing for emergency liver transplantation (LT).

Study groups in NCT05473403
Study groupRoleWhat they receive
Corticosteroid therapyExperimentalPrednisone or Prednisolone or Methylprednisolone : Patient with ASAIH will be treated in oral or intravenous (IV) with high doses ( ≥ 1mg/kg/day) of corticosteroids (Prednisone or Prednisolone or Methylprednisolone) until relapse (confirmed by blood tests and clinical status) requiring an emergency Liver Transplantation (LT) or death.
Receives: Other: Corticosteroid therapy
Patient without corticosteroid therapyNo interventionPatient not treated will undergo to emergency Liver Transplantation (LT) or death.

What is being measured

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

  1. Prospectively validate the previously elaborated SURFASA-score, evaluating its ability to predict non-response outcome to corticosteroid therapy in a new population of patients with acute severe autoimmune hepatitis.

    Patient response within 90 days to corticosteroid therapy defined as: responders (alive without LT) or non-responders (dead or transplanted) within 90 days since corticosteroid therapy introduction.

    Measured: Day 90

Secondary outcomes (8)
  1. The association between infection occurrence and death during hospitalization

    Documented infections during hospitalization

    Measured: participation period (treatment+follow-up): 12 months

  2. the management of infected ASAIH patients in usual practice

    Antibiotic therapy : doses

    Measured: participation period (treatment+follow-up): 12 months

  3. The risk factors for early AIH flair after corticosteroid therapy response.

    The frequency of AIH flair

    Measured: D90

  4. The risk factors for AIH recurrence after liver transplantation

    AIH recurrence

    Measured: participation period (treatment+follow-up): 12 months

  5. The evolution of patients after LT

    Retransplantation, alive, death

    Measured: participation period (treatment+follow-up): 12 months

  6. The evolution of patients not treated with corticosteroids but meeting the inclusion and non-inclusion criteria

    Retransplantation, alive, death

    Measured: participation period (treatment+follow-up): 12 months

  7. The prognostic factors for survival in patients treated with corticosteroids who underwent or not LT

    quality of the graft, immunosuppression, rejection episode,

    Measured: participation period (treatment+follow-up): 12 months

  8. The association of histological features (liver biopsy) with response to corticosteroids and survival at 90 days since admission

    Presence of centrilobular necrosis and inflammatory infiltration

    Measured: 90 days

Timeline

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

  1. First posted25 Jul 2022
  2. Study start1 Jun 2024 (estimated)
  3. Primary completion31 May 2027 (estimated)
  4. Study completion30 Jun 2028 (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
Other
Allocation
Non-randomised
Intervention model
Parallel groups
Model description
This is a multicenter, prognostic, non-randomized, comparative, longitudinal, prospective, external validation cohort, which aims to evaluate a decisional score previously developed in a retrospective cohort.
Masking
None (open label)
Enrolment
150 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05473403
Sponsor's protocol ID
D20180121
Other IDs
2021-A01869-32
Acronym
PRO-SURFASA
Status last verified
Sep 2023
First submitted
7 Jun 2022
Last updated
13 Mar 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Corticosteroid therapy in people with Liver Failure, Acute and Hepatitis, Autoimmune, run by Assistance Publique - Hôpitaux de Paris at 26 sites in France.

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 5 inclusion and 13 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: opening soon, as of the sponsor's last update on 13 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 26 sites in France. 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 Eleonora DE MARTIN, MD, PhD (33 (0)1.45.59.64.33, eleonora.demartin@aphp.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Prospectively validate the previously elaborated SURFASA-score, evaluating its ability to predict non-response outcome to corticosteroid therapy in a new population of patients with acute severe autoimmune hepatitis. (time frame: Day 90). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 13 Mar 2024.

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