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Fenofibrate Combined With Ursodeoxycholic Acid in Subjects With Primary Biliary Cholangitis

Primary Purpose

Primary Biliary Cholangitis

Status
Recruiting
Phase
Phase 3
Locations
China
Study Type
Interventional
Intervention
Placebo Combined With Ursodeoxycholic Acid
Fenofibrate Combined With Ursodeoxycholic Acid
Sponsored by
Xijing Hospital of Digestive Diseases
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Primary Biliary Cholangitis

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Must have provided written informed consent; Age 18-75 years; BMI 17-28 kg/m2 Male or female with a diagnosis of PBC, by at least two of the following criteria: History of AP above ULN for at least six months; Positive AMA titers (>1/40 on immunofluorescence or M2 positive by enzyme linked immunosorbent assay (ELISA) or positive PBC-specific antinuclear antibodies; Documented liver biopsy result consistent with PBC. Incomplete response to UDCA defined by Xi'an criteria (ALP >2.5× ULN, AST>2×ULN or TBIL>1×ULN) after UDCA treatment for 4-6 weeks with at least one abnormal test in ALP or TBIL. Exclusion Criteria: History or presence of other concomitant liver diseases. ALT/AST > 5×ULN, TBIL > 3×ULN. If female: known pregnancy, or has a positive urine pregnancy test (confirmed by a positive serum pregnancy test), or lactating. Allergic to fenofibrate or ursodeoxycholic acid. Taking hepatotoxic drugs (e.g., dapsone, erythromycin, fluconazole, ketoconazole, rifampicin) for more than 2 weeks within 6 months, and long-term hormonal users. Recurrent variceal bleeding, poorly controlled hepatic encephalopathy or refractory ascites. Patients with a history of severe cardiac, cerebrovascular, renal, respiratory disease or functional failure, and psychiatric disorders (including those due to alcohol and drug abuse). Creatinine >1.5×ULN and creatinine clearance <60 ml/min. Currently using statins (such as pravastatin, fluvastatin, and simvastatin), other fibrates (such as gemfibrozil and bezafibrate), and drugs structurally similar to fenofibrate (like ketoprofen). Planned to receive an organ transplant or an organ transplant recipient. Needing Liver transplantation within 1 year according to the Mayo Rick score. Any other condition(s) that would compromise the safety of the subject or compromise the quality of the clinical study, as judged by the Investigator.

Sites / Locations

  • Ying hanRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Experimental

Arm Label

Placebo

Fenofibrate

Arm Description

1 tablet/ day

200 mg/day

Outcomes

Primary Outcome Measures

Percentage of patients with complete biochemical response
The normalisation of Alkaline Phosphatase (ALP) and total bilirubin (TBIL).

Secondary Outcome Measures

Percentage of patients having complete biochemical response
The normalisation of Alkaline Phosphatase (ALP) and total bilirubin (TBIL) at 4, 12, 24, and 36 weeks.
Assessment of the fatigue and the quality of life
Change from baseline in primary biliary cholangitis -40 (PBC-40) quality of life (QoL) questionnaire scores.
Assessment of the fatigue and the quality of life
Change from baseline in pruritus as assessed by Visual Analogue Scale (VAS) total score for fatigue and pruritus.
Evolution of the biological markers of the hepatic function or being in the usual prognostic scores
Mayo score at 4, 12, 24, 36, and 48 weeks
Evolution of the biological markers of the hepatic function or being in the usual prognostic scores
Child-Puch score at 4, 12, 24, 36, and 48 weeks
Evolution of the biological markers of the hepatic function or being in the usual prognostic scores
MELD score at 4, 12, 24, 36, and 48 weeks
Evolution of the biological markers of the hepatic function or being in the usual prognostic scores
GLOBE-PBC score at 48 weeks
Evolution of the biological markers of the hepatic function or being in the usual prognostic scores
UK-PBC score at 48 weeks
Percentage of patients having biological or clinical adverse events
Increase of creatinine
Percentage of patients having biological or clinical adverse events
Increase of Blood urea nitrogen
Percentage of patients having biological or clinical adverse events
Increase of creatine kinase
Percentage of patients having biological or clinical adverse events
Increase of ALT and AST.
Survival without transplantation and hepatic impairment
Occurrence of ascites, variceal bleeding, hepatic encephalopathy, liver-transplantation, or death.

Full Information

First Posted
December 13, 2022
Last Updated
March 3, 2023
Sponsor
Xijing Hospital of Digestive Diseases
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1. Study Identification

Unique Protocol Identification Number
NCT05751967
Brief Title
Fenofibrate Combined With Ursodeoxycholic Acid in Subjects With Primary Biliary Cholangitis
Official Title
A Prospective, Multi-center, Randomized, Double-blind, Placebo-controlled Study: Fenofibrate Combined With Ursodeoxycholic Acid in Subjects With Primary Biliary Cholangitis and an Inadequate Response to Ursodeoxycholic Acid
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 22, 2023 (Actual)
Primary Completion Date
December 1, 2024 (Anticipated)
Study Completion Date
December 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Xijing Hospital of Digestive Diseases

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
Current treatment guidelines recommend ursodeoxycholic acid (UDCA) as the first-line treatment for new-diagnosed primary biliary cholangitis (PBC) patients. However, up to 40% patients are insensitive to UDCA monotherapy, and evaluation of UDCA response at 12 months may result in long period of ineffective treatment. We aimed to develop a new criterion to reliably identify non-response patients much earlier. Recently, our team designed and validated a new early criterion for distinguishing high-risk PBC patients in a Chinese population for the first time. Our data indicated that PBC patients with ALP ≤ 2.5 × ULN, AST ≤ 2 × ULN, and TBIL ≤ 1 × ULN (Xi'an criterion) after 1 month UDCA treatment were likely to have better prognosis. It can be readily applied in the rapid identification of PBC patients who require additional therapeutic approaches. However, whether it is reasonable to apply it to the response definition of clinical research, and the guidance of PBC management and choice of second-line treatment, further research is needed.
Detailed Description
This is a multi-center, randomized, placebo-controlled, parallel-group study that will assess the efficacy and safety of fenofibrate in patients with PBC who had an inadequate biochemical response to UDCA, as defined by the Xi'an criteria. Fenofibrate or placebo 200 mg will be daily administered in combination with UDCA 13-15 mg/kg/d for 48 months. Patient safety will be monitored. Primary end-point will be the percentage of patients with a complete normalization of the ALP and TBIL. Secondary endpoints will include the percentage of drug-related adverse events, survival rates without liver transplantation or liver decompensation, time course of non-invasive liver fibrosis measurements (LSM), time course of endoscopic, ultrasound, and biochemical features of portal hypertension, time course of pruritus and of quality of life using validated scales.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Primary Biliary Cholangitis

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
150 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
1 tablet/ day
Arm Title
Fenofibrate
Arm Type
Experimental
Arm Description
200 mg/day
Intervention Type
Drug
Intervention Name(s)
Placebo Combined With Ursodeoxycholic Acid
Other Intervention Name(s)
UDCA 13-15mg/kg/d
Intervention Description
1 tablet/ day
Intervention Type
Drug
Intervention Name(s)
Fenofibrate Combined With Ursodeoxycholic Acid
Other Intervention Name(s)
UDCA 13-15mg/kg/d
Intervention Description
200 mg/day
Primary Outcome Measure Information:
Title
Percentage of patients with complete biochemical response
Description
The normalisation of Alkaline Phosphatase (ALP) and total bilirubin (TBIL).
Time Frame
48 weeks
Secondary Outcome Measure Information:
Title
Percentage of patients having complete biochemical response
Description
The normalisation of Alkaline Phosphatase (ALP) and total bilirubin (TBIL) at 4, 12, 24, and 36 weeks.
Time Frame
4, 12, 24, 36, and 48 weeks
Title
Assessment of the fatigue and the quality of life
Description
Change from baseline in primary biliary cholangitis -40 (PBC-40) quality of life (QoL) questionnaire scores.
Time Frame
4, 12, 24, 36, and 48 weeks
Title
Assessment of the fatigue and the quality of life
Description
Change from baseline in pruritus as assessed by Visual Analogue Scale (VAS) total score for fatigue and pruritus.
Time Frame
4, 12, 24, 36, and 48 weeks
Title
Evolution of the biological markers of the hepatic function or being in the usual prognostic scores
Description
Mayo score at 4, 12, 24, 36, and 48 weeks
Time Frame
4, 12, 24, 36, and 48 weeks
Title
Evolution of the biological markers of the hepatic function or being in the usual prognostic scores
Description
Child-Puch score at 4, 12, 24, 36, and 48 weeks
Time Frame
4, 12, 24, 36, and 48 weeks
Title
Evolution of the biological markers of the hepatic function or being in the usual prognostic scores
Description
MELD score at 4, 12, 24, 36, and 48 weeks
Time Frame
4, 12, 24, 36, and 48 weeks
Title
Evolution of the biological markers of the hepatic function or being in the usual prognostic scores
Description
GLOBE-PBC score at 48 weeks
Time Frame
48 weeks
Title
Evolution of the biological markers of the hepatic function or being in the usual prognostic scores
Description
UK-PBC score at 48 weeks
Time Frame
48 weeks
Title
Percentage of patients having biological or clinical adverse events
Description
Increase of creatinine
Time Frame
4, 12, 24, 36, and 48 weeks
Title
Percentage of patients having biological or clinical adverse events
Description
Increase of Blood urea nitrogen
Time Frame
4, 12, 24, 36, and 48 weeks
Title
Percentage of patients having biological or clinical adverse events
Description
Increase of creatine kinase
Time Frame
4, 12, 24, 36, and 48 weeks
Title
Percentage of patients having biological or clinical adverse events
Description
Increase of ALT and AST.
Time Frame
4, 12, 24, 36, and 48 weeks
Title
Survival without transplantation and hepatic impairment
Description
Occurrence of ascites, variceal bleeding, hepatic encephalopathy, liver-transplantation, or death.
Time Frame
48 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Must have provided written informed consent; Age 18-75 years; BMI 17-28 kg/m2 Male or female with a diagnosis of PBC, by at least two of the following criteria: History of AP above ULN for at least six months; Positive AMA titers (>1/40 on immunofluorescence or M2 positive by enzyme linked immunosorbent assay (ELISA) or positive PBC-specific antinuclear antibodies; Documented liver biopsy result consistent with PBC. Incomplete response to UDCA defined by Xi'an criteria (ALP >2.5× ULN, AST>2×ULN or TBIL>1×ULN) after UDCA treatment for 4-6 weeks with at least one abnormal test in ALP or TBIL. Exclusion Criteria: History or presence of other concomitant liver diseases. ALT/AST > 5×ULN, TBIL > 3×ULN. If female: known pregnancy, or has a positive urine pregnancy test (confirmed by a positive serum pregnancy test), or lactating. Allergic to fenofibrate or ursodeoxycholic acid. Taking hepatotoxic drugs (e.g., dapsone, erythromycin, fluconazole, ketoconazole, rifampicin) for more than 2 weeks within 6 months, and long-term hormonal users. Recurrent variceal bleeding, poorly controlled hepatic encephalopathy or refractory ascites. Patients with a history of severe cardiac, cerebrovascular, renal, respiratory disease or functional failure, and psychiatric disorders (including those due to alcohol and drug abuse). Creatinine >1.5×ULN and creatinine clearance <60 ml/min. Currently using statins (such as pravastatin, fluvastatin, and simvastatin), other fibrates (such as gemfibrozil and bezafibrate), and drugs structurally similar to fenofibrate (like ketoprofen). Planned to receive an organ transplant or an organ transplant recipient. Needing Liver transplantation within 1 year according to the Mayo Rick score. Any other condition(s) that would compromise the safety of the subject or compromise the quality of the clinical study, as judged by the Investigator.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yulong Shang
Phone
+86 18629661032
Email
shangyl870222@163.com
First Name & Middle Initial & Last Name or Official Title & Degree
Ying Han
Phone
+86-29-84771539
Email
hanying1@fmmu.edu.cn
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ying Han, Doctor
Organizational Affiliation
Xijing Hospital, Air Force Military Medical University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Ying han
City
Xi'an
State/Province
Shaanxi
ZIP/Postal Code
710032
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ying Han
Phone
+86-29-84771539
Email
hanying1@fmmu.edu.cn

12. IPD Sharing Statement

Plan to Share IPD
No

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Fenofibrate Combined With Ursodeoxycholic Acid in Subjects With Primary Biliary Cholangitis

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