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Prolonged Release Pirfenidone for Advanced Residual Liver Fibrosis (MINERVA).

Primary Purpose

Liver Cirrhosis, Hepatitis C, Chronic, Epigenetic Disorder

Status
Recruiting
Phase
Phase 2
Locations
Mexico
Study Type
Interventional
Intervention
Prolonged-Release Pirfenidone
Sponsored by
University of Guadalajara
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Liver Cirrhosis

Eligibility Criteria

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

Inclusion Criteria:

  1. Patients with a history of Chronic Viral Hepatitis C, of all genotypes, demonstrated with previous studies (positive viral load).
  2. History of treatment with direct acting antivirals (AAD).
  3. Demonstration of negative viral load at least 6 months after completing treatment with AAD, considered as sustained viral response (SVR).
  4. Fibrotest and / or Liver Elastography test with advanced liver fibrosis scores (F3-F4).
  5. Verification of advanced liver fibrosis in a liver biopsy.
  6. Patients with Child Pugh functional class A or B and in stable clinical conditions (without active variceal hemorrhage, ascites or refractory encephalopathy) with consumption of drugs at stable doses in at least 30 days.
  7. Laboratory tests that confirm her condition and functional class, with results that, in the opinion of the main researcher, do not put the patient at risk:

    • Complete blood count, with hemoglobin values ≥ 10 g / dL, leukocytes ≥ 3,000 mL, platelets ≥ 50,000 mL
    • Creatinine <1.8 mg / dL

Exclusion Criteria:

  1. Child Pugh functional class C (≥ 10 points)
  2. Pregnancy and lactation.
  3. History of known allergy or hypersensitivity to PFD.
  4. Having participated in another clinical study in the 60 days prior to the start of this one.
  5. Hospitalization within 30 days prior to the start of administration of the medication.
  6. Co-existing liver pathology: alcohol cirrhosis, hemochromatosis, Wilson's disease, α-1-antitrypsin deficiency, amyloidosis, autoimmune hepatitis, and Primary Biliary Cholangitis).
  7. Concomitant systemic infection including viral hepatitis B, HIV, as well as respiratory infections, urinary, digestive, cellulite, etc.
  8. Serious concomitant conditions such as Heart Failure, Respiratory Failure and Chronic Kidney Failure.
  9. Malignant neoplasms including hepatocellular carcinoma. Patients with basal cell carcinoma or those with malignancies with more than 5 years of inactivity may be considered for the study.
  10. Decompensated diabetes mellitus (defined as that with fasting blood glucose values greater than 175 mg / dL and / or glycated hemoglobin greater than 8%).
  11. Uncontrolled hypertension despite medications (defined as systolic values ≥ 150 and diastolic values ≥ 100 mmHg).
  12. Patients with active alcohol intake in the last 6 months.
  13. Use of drugs known as concomitant hepatoprotectors (ursodexosicolic acid, s-adenosyl-methionine, silymarin, among others).
  14. Patients with treatment of CYP1A2 inhibitor drugs or other CYP isoenzymes such as: fluvoxamine, amiodarone, fluconazole, chloramphenicol, fluoxentine, paroxentine, ciprofloxacin, rifampin or propafenone, or other medicinal products that, in the opinion of the main investigator, may interfere with the study.
  15. Any other clinical condition that in the opinion of the main investigator could compromise the safety and well-being of the patient or jeopardize the conduct of the study.

Sites / Locations

  • Institute for Molecular Biology in Medicine and Gene Therapy, CUCS, UdeG
  • Hospital Central MilitarRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Patient

Arm Description

Sixty patients with chronic Viral C hepatitis, who have been treated with direct-acting antivirals, with a sustained viral response and who still have advanced fibrosis (F3-F4).

Outcomes

Primary Outcome Measures

Liver biopsy
Reduction of one unit in the METAVIR histological scale (F0-F4)
Elastography
≥30% reduction in the final Pascal score, compared to baseline.

Secondary Outcome Measures

Changes in the degree of methylation
of the following genes PPARγ, PPARζ, PPARα, TGFβ1, Col1A1 and PDGFα in ccfDNA in DNA obtained by liver biopsy.
Changes in expression levels of miRNA's
Changes in expression levels of miR-122, miR192, miR-200a / b, miR-221/222, miR-34a, miR-16, miR-21, and miR-181b.
Transcriptome measurement in ccfRNA
Changes in transcriptome measurement in ccfRNA
Albumin and liver enzyme values
Albumin and liver enzyme values

Full Information

First Posted
September 13, 2022
Last Updated
July 3, 2023
Sponsor
University of Guadalajara
Collaborators
Hospital Central Militar
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1. Study Identification

Unique Protocol Identification Number
NCT05542615
Brief Title
Prolonged Release Pirfenidone for Advanced Residual Liver Fibrosis (MINERVA).
Official Title
Evaluation of Prolonged-release Pirfenidone in Patients With Viral C Hepatitis, With Sustained Viral Response and Advanced Residual Liver Fibrosis. Potential Role of Epigenetics to Understand Therapeutic Changes (MINERVA).
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 1, 2019 (Actual)
Primary Completion Date
December 1, 2023 (Anticipated)
Study Completion Date
January 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Guadalajara
Collaborators
Hospital Central Militar

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
Data Monitoring Committee
No

5. Study Description

Brief Summary
Prolonged-Release Pirfenidone (PR-PFD) is an anti-fibrogenic and anti-inflammatory molecule used for the treatment of idiopathic pulmonary fibrosis (approved by FDA) and liver fibrosis (approved in Mexico by COFEPRIS). PFD effects are mediated in part through inhibition of TGFβ, TNFα, IL-1 and IL-6, along with NFκB activation down-regulation causing reduced TNFα and IFNγ levels. The aim of this protocol is to know if the epigenetic factors induced by PR-PFD have a regulatory role to understand the progression variants in liver fibrosis in a group of patients with viral hepatitis C, with a history of sustained viral response and advanced residual liver fibrosis. To assess the safety and efficacy of two daily doses of pirfenidone (KitosCell® LP), in patients with compensated liver cirrhosis.
Detailed Description
Design: Observational clinical study, in an open population, of 12 months duration. Sixty patients with chronic Viral C hepatitis, who have been treated with direct-acting antivirals, with a sustained viral response and who still have advanced fibrosis (F3-F4). Aim: to know if the epigenetic factors induced by PR-PFD have a regulatory role to understand the progression variants in liver fibrosis in a group of patients with viral hepatitis C, with a history of sustained viral response and advanced residual liver fibrosis. To assess the safety and efficacy of two daily doses of pirfenidone (KitosCell® LP), in patients with compensated liver cirrhosis. Dosage: 1200 mg / day of Pirfenidone (KitosCell® LP) Variables to Analyze: Reduction of fibrosis and evaluation of epigenetic changes in the expression of various genes: PPARγ, PPARδ, PPARα, TGFβ1, Col1A1 and PDGFα. Additionally, changes in the expression levels of miR-122, miR192, miR-200a / b, miR-34a, miR-16, miR-21 and miR-181b will be evaluated, as well as changes in the transcriptome in ccfRNA. Ethical considerations: The study will be conducted in accordance with the Declaration of Helsinki and the E6 Good Clinical Practice Standards International Conference on Harmonization (ICH). Statistical Data Analysis: Descriptive statistics will be used and according to analytical statistical requirements that include parametric or non-parametric tests. The value of p <0.05 will be considered as significant.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Liver Cirrhosis, Hepatitis C, Chronic, Epigenetic Disorder

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
This will be a real-life, open-label, proof of concept trial to assess the safety and efficacy of two daily doses of pirfenidone (KitosCell® LP), in patients with compensated liver cirrhosis.
Masking
None (Open Label)
Allocation
N/A
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Patient
Arm Type
Experimental
Arm Description
Sixty patients with chronic Viral C hepatitis, who have been treated with direct-acting antivirals, with a sustained viral response and who still have advanced fibrosis (F3-F4).
Intervention Type
Drug
Intervention Name(s)
Prolonged-Release Pirfenidone
Intervention Description
1200 mg / day of Pirfenidone (KitosCell® LP)
Primary Outcome Measure Information:
Title
Liver biopsy
Description
Reduction of one unit in the METAVIR histological scale (F0-F4)
Time Frame
12 months
Title
Elastography
Description
≥30% reduction in the final Pascal score, compared to baseline.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Changes in the degree of methylation
Description
of the following genes PPARγ, PPARζ, PPARα, TGFβ1, Col1A1 and PDGFα in ccfDNA in DNA obtained by liver biopsy.
Time Frame
12 months
Title
Changes in expression levels of miRNA's
Description
Changes in expression levels of miR-122, miR192, miR-200a / b, miR-221/222, miR-34a, miR-16, miR-21, and miR-181b.
Time Frame
12 months
Title
Transcriptome measurement in ccfRNA
Description
Changes in transcriptome measurement in ccfRNA
Time Frame
12 months
Title
Albumin and liver enzyme values
Description
Albumin and liver enzyme values
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with a history of Chronic Viral Hepatitis C, of all genotypes, demonstrated with previous studies (positive viral load). History of treatment with direct acting antivirals (AAD). Demonstration of negative viral load at least 6 months after completing treatment with AAD, considered as sustained viral response (SVR). Fibrotest and / or Liver Elastography test with advanced liver fibrosis scores (F3-F4). Verification of advanced liver fibrosis in a liver biopsy. Patients with Child Pugh functional class A or B and in stable clinical conditions (without active variceal hemorrhage, ascites or refractory encephalopathy) with consumption of drugs at stable doses in at least 30 days. Laboratory tests that confirm her condition and functional class, with results that, in the opinion of the main researcher, do not put the patient at risk: Complete blood count, with hemoglobin values ≥ 10 g / dL, leukocytes ≥ 3,000 mL, platelets ≥ 50,000 mL Creatinine <1.8 mg / dL Exclusion Criteria: Child Pugh functional class C (≥ 10 points) Pregnancy and lactation. History of known allergy or hypersensitivity to PFD. Having participated in another clinical study in the 60 days prior to the start of this one. Hospitalization within 30 days prior to the start of administration of the medication. Co-existing liver pathology: alcohol cirrhosis, hemochromatosis, Wilson's disease, α-1-antitrypsin deficiency, amyloidosis, autoimmune hepatitis, and Primary Biliary Cholangitis). Concomitant systemic infection including viral hepatitis B, HIV, as well as respiratory infections, urinary, digestive, cellulite, etc. Serious concomitant conditions such as Heart Failure, Respiratory Failure and Chronic Kidney Failure. Malignant neoplasms including hepatocellular carcinoma. Patients with basal cell carcinoma or those with malignancies with more than 5 years of inactivity may be considered for the study. Decompensated diabetes mellitus (defined as that with fasting blood glucose values greater than 175 mg / dL and / or glycated hemoglobin greater than 8%). Uncontrolled hypertension despite medications (defined as systolic values ≥ 150 and diastolic values ≥ 100 mmHg). Patients with active alcohol intake in the last 6 months. Use of drugs known as concomitant hepatoprotectors (ursodexosicolic acid, s-adenosyl-methionine, silymarin, among others). Patients with treatment of CYP1A2 inhibitor drugs or other CYP isoenzymes such as: fluvoxamine, amiodarone, fluconazole, chloramphenicol, fluoxentine, paroxentine, ciprofloxacin, rifampin or propafenone, or other medicinal products that, in the opinion of the main investigator, may interfere with the study. Any other clinical condition that in the opinion of the main investigator could compromise the safety and well-being of the patient or jeopardize the conduct of the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Juan Armendariz-Borunda, PhD, FAASLD
Phone
+52 1058 5200
Ext
34882
Email
armdbo@gmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Eira Cerda-Reyes, MD
Phone
+52 55 2122 1100
Ext
1510 - 1511
Email
arieirace@yahoo.com.mx
Facility Information:
Facility Name
Institute for Molecular Biology in Medicine and Gene Therapy, CUCS, UdeG
City
Guadalajara
State/Province
Jalisco
ZIP/Postal Code
44340
Country
Mexico
Individual Site Status
Active, not recruiting
Facility Name
Hospital Central Militar
City
Mexico City
ZIP/Postal Code
11200
Country
Mexico
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Eira Cerda-Reyes, MD
Phone
+52 55 2122 1100
Ext
1510 - 1511
Email
arieirace@yahoo.com.mx

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Prolonged Release Pirfenidone for Advanced Residual Liver Fibrosis (MINERVA).

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