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The Efficacy and Safety of Pioglitazone in Patients With Nonalcoholic Steatohepatitis

Primary Purpose

Hepatitis

Status
Completed
Phase
Phase 2
Locations
Taiwan
Study Type
Interventional
Intervention
Pioglitazone
placebo
Sponsored by
Kaohsiung Medical University Chung-Ho Memorial Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatitis focused on measuring NASH, Pioglitazone, Treatment

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Main inclusion criteria:

  1. Male and female patients with 18-70 years of age
  2. Liver biopsy findings consistent with the diagnosis of NASH with or without compensated cirrhosis within one year before baseline
  3. Compensated liver disease
  4. Negative urine or blood pregnancy test (for women of childbearing potential) documented within the 24-hour period prior to the first dose of study drug
  5. All fertile males and females must be using two forms of effective contraception during treatment during the 3 months after treatment.
  6. ALT level between 1.3-5 x ULN for 2 occasions during 6 months before screening.
  7. HbA1C ≦ 8.0 during screening

Main exclusion criteria:

  1. Therapy with any systemic anti-neoplastic or immunomodulatory treatment (including supraphysiologic doses of steroids and radiation) *6 months before baseline.
  2. History or other evidence of a medical condition associated with chronic liver disease other than NASH (e.g., hemochromatosis, autoimmune hepatitis, alcoholic liver disease, > 20 g/day for female or > 40 g/day for male, toxin exposures)
  3. hepatocellular carcinoma
  4. History or other evidence of bleeding from esophageal varices or other conditions consistent with decompensated liver disease
  5. Serum creatinine level >1.5 times the upper limit of normal at screening and calculated creatinine clearance as calculated by Cockcroft and Gault < 60mL/min during screening
  6. History of ischemic heart disease during screening
  7. New York Heart Association (NYHA) Functional Class 1-4 cardiac status during screening
  8. Albumin <3.2g/dL during screening
  9. Total bilirubin >1.2 x ULN during screening. Patients with history of asymptomatic indirect hyperbilirubinemia whose total bilirubin < 2 x ULN and direct bilirubin < 20% of total bilirubin could be included.
  10. History of prothrombin time > 15 seconds or International normalized ratio (INR) > 1.3
  11. Organ, stem cell, or bone marrow transplant
  12. History of serious concurrent medical illness that in the investigator's opinion might interfere with therapy this includes significant systemic illnesses (other than liver disease) such as chronic pancreatitis
  13. Active systemic autoimmune disorder
  14. Pregnancy (or lactation) or, in subjects capable of bearing children, inability / unwillingness to practice adequate contraception
  15. Females of child-bearing potential (post-puberty) unwilling or unable to have pregnancy testing at any study visit
  16. Therapy with a systemic antiviral agent (with the exception of prophylaxis or treatment of influenza or chronic HSV) within the past 30 days prior to screening.
  17. Concurrent participation in another clinical trial in which the subject is or will be exposed to another investigational or a non-investigational drug or device within 6 weeks of the screening visit
  18. Current therapy with insulin within 1 week prior to screening.
  19. Experienced use with PPARg agonist (e.g., rosiglitazone, pioglitazone) within 6 months prior to screening.
  20. Known hypersensitivity to any component of PPARg agonists
  21. A history of hepatotoxicity to TZDs and/or a history of severe edema or a medically serious fluid-related event associated with the use of TZDs
  22. History of metformin use within 3 months prior to screening.
  23. Type Ⅰ diabetes
  24. Seropositive of HBsAg, anti-HCV or anti-HIV during screening or 3 month prior to screening.

Sites / Locations

  • Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University
  • Kaohsiung Medical University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Pioglitazone

Placebo

Arm Description

Pioglitazone 30 mg/day for 6 months and 3 months of follow-up period after treatment

Placebo 30 mg/day for 6 months and 3 months of follow-up period after treatment

Outcomes

Primary Outcome Measures

Comparison between Pioglitazone and placebo groups in terms of steatosis and liver function tests
Evaluation of clinical safety of Pioglitazone

Secondary Outcome Measures

Comparison between Pioglitazone and placebo groups in terms of liver necroinflammation and fibrosis.

Full Information

First Posted
February 11, 2010
Last Updated
July 22, 2020
Sponsor
Kaohsiung Medical University Chung-Ho Memorial Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT01068444
Brief Title
The Efficacy and Safety of Pioglitazone in Patients With Nonalcoholic Steatohepatitis
Official Title
A Double-Blind, Randomized, Placebo-Controlled, Phase II Study to Assess the Efficacy and Safety of Pioglitazone in Patients With Nonalcoholic Steatohepatitis
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
April 2009 (undefined)
Primary Completion Date
July 2020 (Actual)
Study Completion Date
July 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Kaohsiung Medical University Chung-Ho Memorial Hospital

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Recent studies have demonstrated that PPARγ as well as diet control could improve glycemic control, decrease serum ALT level, decrease hepatic fat distribution, and increase intrahepatic insulin sensitivity. The purposes of this study are: 1. Primary aims: Comparison between Pioglitazone and placebo groups in terms of steatosis and liver function tests. Evaluation of clinical safety of Pioglitazone 2. Secondary aims: Comparison between Pioglitazone and placebo groups in terms of liver necroinflammation and fibrosis. The impact of Pioglitazone on the related metabolic index, including insulin resistance(HOMA-IR), newly-onset diabetes, metabolic syndrome, lipid profiles (T-Chol, HDL-C, LDL-C, TG). Comparison between Pioglitazone and placebo groups in terms of high-sensitive C-reactive protein changes. 3. Interventional aim: Assessment the association between magnetic resonance imaging study and intrahepatic fat distribution before and after Pioglitazone treatment.
Detailed Description
Pioglitazone belongs to thiazolidinediones and anti-diabetes drug which decreases the insulin resistance. It increases the use of glucose of peripheral tissues and decrease the production of glucose from liver and dose not influence the production of insulin. It is agonist of peroxisome proliferator-activated receptor-gamma (PPARγ) and by binding to the receptors of PPARγ in various tissues it has effects on transcription of the insulin-dependent gene. In animal model, pioglitazone has shown to influence the metabolism by the insulin-dependent mechanism. Recent studies have demonstrated that PPARγ as well as diet control could improve glycemic control, decrease serum ALT level, decrease hepatic fat distribution, and increase intrahepatic insulin sensitivity. Meanwhile, PPARγ could also prevent the development of alcohol-induced steatohepatitis, improve hepatic necroinflammatory activity, and decrease lipid deposition. It is not yet clearly known how the effect of P-PARγ agonist among Asian peoples.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatitis
Keywords
NASH, Pioglitazone, Treatment

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
90 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Pioglitazone
Arm Type
Experimental
Arm Description
Pioglitazone 30 mg/day for 6 months and 3 months of follow-up period after treatment
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo 30 mg/day for 6 months and 3 months of follow-up period after treatment
Intervention Type
Drug
Intervention Name(s)
Pioglitazone
Other Intervention Name(s)
GLITOS
Intervention Description
Name: GLITOS(Pioglitazone) Dosage form: Tablets Dose(s): 30mg Dosing schedule: QD Duration: 6 months
Intervention Type
Drug
Intervention Name(s)
placebo
Intervention Description
placebo 30 mg/d for 6 months
Primary Outcome Measure Information:
Title
Comparison between Pioglitazone and placebo groups in terms of steatosis and liver function tests
Time Frame
9 months
Title
Evaluation of clinical safety of Pioglitazone
Time Frame
9 months
Secondary Outcome Measure Information:
Title
Comparison between Pioglitazone and placebo groups in terms of liver necroinflammation and fibrosis.
Time Frame
9 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Main inclusion criteria: Male and female patients with 18-70 years of age Liver biopsy findings consistent with the diagnosis of NASH with or without compensated cirrhosis within one year before baseline Compensated liver disease Negative urine or blood pregnancy test (for women of childbearing potential) documented within the 24-hour period prior to the first dose of study drug All fertile males and females must be using two forms of effective contraception during treatment during the 3 months after treatment. ALT level between 1.3-5 x ULN for 2 occasions during 6 months before screening. HbA1C ≦ 8.0 during screening Main exclusion criteria: Therapy with any systemic anti-neoplastic or immunomodulatory treatment (including supraphysiologic doses of steroids and radiation) *6 months before baseline. History or other evidence of a medical condition associated with chronic liver disease other than NASH (e.g., hemochromatosis, autoimmune hepatitis, alcoholic liver disease, > 20 g/day for female or > 40 g/day for male, toxin exposures) hepatocellular carcinoma History or other evidence of bleeding from esophageal varices or other conditions consistent with decompensated liver disease Serum creatinine level >1.5 times the upper limit of normal at screening and calculated creatinine clearance as calculated by Cockcroft and Gault < 60mL/min during screening History of ischemic heart disease during screening New York Heart Association (NYHA) Functional Class 1-4 cardiac status during screening Albumin <3.2g/dL during screening Total bilirubin >1.2 x ULN during screening. Patients with history of asymptomatic indirect hyperbilirubinemia whose total bilirubin < 2 x ULN and direct bilirubin < 20% of total bilirubin could be included. History of prothrombin time > 15 seconds or International normalized ratio (INR) > 1.3 Organ, stem cell, or bone marrow transplant History of serious concurrent medical illness that in the investigator's opinion might interfere with therapy this includes significant systemic illnesses (other than liver disease) such as chronic pancreatitis Active systemic autoimmune disorder Pregnancy (or lactation) or, in subjects capable of bearing children, inability / unwillingness to practice adequate contraception Females of child-bearing potential (post-puberty) unwilling or unable to have pregnancy testing at any study visit Therapy with a systemic antiviral agent (with the exception of prophylaxis or treatment of influenza or chronic HSV) within the past 30 days prior to screening. Concurrent participation in another clinical trial in which the subject is or will be exposed to another investigational or a non-investigational drug or device within 6 weeks of the screening visit Current therapy with insulin within 1 week prior to screening. Experienced use with PPARg agonist (e.g., rosiglitazone, pioglitazone) within 6 months prior to screening. Known hypersensitivity to any component of PPARg agonists A history of hepatotoxicity to TZDs and/or a history of severe edema or a medically serious fluid-related event associated with the use of TZDs History of metformin use within 3 months prior to screening. Type Ⅰ diabetes Seropositive of HBsAg, anti-HCV or anti-HIV during screening or 3 month prior to screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wan-Long Chuang, MD, PhD
Organizational Affiliation
Kaohsiung Medical University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University
City
Kaohsiung City
ZIP/Postal Code
812
Country
Taiwan
Facility Name
Kaohsiung Medical University Hospital
City
Kaohsiung
ZIP/Postal Code
803
Country
Taiwan

12. IPD Sharing Statement

Citations:
PubMed Identifier
34386935
Citation
Huang JF, Dai CY, Huang CF, Tsai PC, Yeh ML, Hsu PY, Huang SF, Bair MJ, Hou NJ, Huang CI, Liang PC, Lin YH, Wang CW, Hsieh MY, Chen SC, Lin ZY, Yu ML, Chuang WL. First-in-Asian double-blind randomized trial to assess the efficacy and safety of insulin sensitizer in nonalcoholic steatohepatitis patients. Hepatol Int. 2021 Oct;15(5):1136-1147. doi: 10.1007/s12072-021-10242-2. Epub 2021 Aug 12.
Results Reference
derived
PubMed Identifier
28472039
Citation
Huang JF, Yeh ML, Huang CF, Huang CI, Tsai PC, Tai CM, Yang HL, Dai CY, Hsieh MH, Chen SC, Yu ML, Chuang WL. Cytokeratin-18 and uric acid predicts disease severity in Taiwanese nonalcoholic steatohepatitis patients. PLoS One. 2017 May 4;12(5):e0174394. doi: 10.1371/journal.pone.0174394. eCollection 2017.
Results Reference
derived

Learn more about this trial

The Efficacy and Safety of Pioglitazone in Patients With Nonalcoholic Steatohepatitis

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