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Rifaximin Soluble Solid Dispersion (SSD) Tablets Plus Lactulose for the Treatment of Overt Hepatic Encephalopathy (OHE) (OHE)

Primary Purpose

Overt Hepatic Encephalopathy

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
40 mg Rifaximin SSD once daily
40 mg Rifaximin SSD twice daily
80 mg Rifaximin SSD once daily
80 mg Rifaximin SSD twice daily
Placebo
Sponsored by
Bausch Health Americas, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Overt Hepatic Encephalopathy

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Male or female age 18 to 75 years of age (inclusive) at the time of screening.
  • Females of childbearing potential, defined as a female who is fertile following menarche, must have a negative serum pregnancy test at screening and agree to use an acceptable method of contraception throughout their participation in the study.

Note: Female subjects who have been surgically sterilized (e.g., hysterectomy or bilateral tubal ligation) or who are postmenopausal (defined as total cessation of menses for > 1 year) will not be considered "female subjects of childbearing potential".

  • Subject is hospitalized with liver cirrhosis and/or OHE and has a confirmed diagnosis of OHE at Baseline.
  • Subject has a Grade 2 or Grade 3 HE episode according to the HE Grading Instrument (HEGI) following 8 to 12 hours of intravenous (IV) hydration and lactulose treatment.

Exclusion Criteria:

  • Subject has an uncontrolled major psychiatric disorder including major depression or psychoses as determined by the investigator.
  • Subject has been diagnosed with an infection for which they are currently taking oral or parenteral antibiotics, which cannot be discontinued at time of enrollment. Note: Subjects currently taking Rifaximin are not excluded
  • Subject shows presence of intestinal obstruction or has inflammatory bowel disease.
  • Subject has uncontrolled Type 1 or Type 2 diabetes. Note: Subjects with controlled diabetes may be enrolled if they are on stable doses of oral hypoglycemic drugs for at least 3 months prior to screening, and demonstrate clinically acceptable blood glucose control at Baseline, as determined by the investigator.
  • Subject has an active malignancy (exceptions: non-melanoma skin cancers).

Sites / Locations

  • Bausch Health Site 18
  • Bausch Health Site 15
  • Bausch Health Site 19
  • Bausch Health Site 04
  • Bausch Health Site 13
  • Bausch Health Site 08
  • Bausch Health Site 05
  • Bausch Health Site 33
  • Bausch Health Site 03
  • Bausch Health Site 07
  • Bausch Health 01
  • Bausch Health Site 25
  • Bausch Health Site 24
  • Bausch Health Site 27
  • Bausch Health Site 36
  • Bausch Health Site 09
  • Bausch Health Site 28
  • Bausch Health Site 17
  • Bausch Health Site 23
  • Bausch Health Site 11
  • Bausch Health Site 26
  • Bausch Health Site 10
  • Bausch Health Site 12
  • Bausch Health Site 16
  • Bausch Health Site 22
  • Bausch Health Site 35
  • Bausch Health Site 31
  • Bausch Health Site 02
  • Bausch Health Site 37
  • Bausch Health Site 30
  • Bausch Health Site 06
  • Bausch Health Site 21
  • Bausch Health Site 14
  • Bausch Health Site 20

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Cohort 1 40 mg Rifaximin SSD once daily

Cohort 2 40 mg Rifaximin SSD twice daily

Cohort 3 80 mg Rifaximin SSD once daily

Cohort 4 80 mg Rifaximin SSD twice daiy

Cohort 5 Placebo twice daily

Arm Description

40 mg Rifaximin immediate release (IR) rifaximin SSD once daily (QD) and lactulose

40 mg Rifaximin immediate release (IR) rifaximin SSD twice daily (BID) and lactulose

80 mg Rifaximin sustained extended release (SER) rifaximin SSD once daily (QD) and lactulose

80 mg Rifaximin sustained extended release (SER) rifaximin SSD twice daily (BID) and lactulose

SSD placebo twice daily (BID) and lactulose

Outcomes

Primary Outcome Measures

Time to Overt Hepatic Encephalopathy (OHE) Resolution Determined Using the Hepatic Encephalopathy Grading Instrument (HEGI), Defined as HEGI Score < 2
A participant was considered to have an overt HE episode if at least one of the following applied: (1) Disorientated to time or place or person, (2) Lethargic and has asterixis, (3) Inability to assess the patient due to disorientation to time and place and person; and/or somnolence, and/or coma. Severity of OHE episodes was graded using the HEGI scale, where Grade 1 is no clinical findings of OHE, and Grade 4 is comatose. Higher scores on the scale have higher severity (worse outcome).

Secondary Outcome Measures

Time to Improvement in Hepatic Encephalopathy Grading Instrument (HEGI) Score, Defined as at Least One Grade Decrease (Improvement)
A participant was considered to have an overt HE episode if at least one of the following applied: (1) Disorientated to time or place or person, (2) Lethargic and has asterixis, (3) Inability to assess the patient due to disorientation to time and place and person; and/or somnolence, and/or coma. Severity of OHE episodes was graded using the HEGI scale, where Grade 1 is no clinical findings of OHE, and Grade 4 is comatose. Higher scores on the scale have higher severity (worse outcome).
Time to Hospital Discharge
Time in days until discharge from the hospital

Full Information

First Posted
April 12, 2018
Last Updated
March 17, 2023
Sponsor
Bausch Health Americas, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03515044
Brief Title
Rifaximin Soluble Solid Dispersion (SSD) Tablets Plus Lactulose for the Treatment of Overt Hepatic Encephalopathy (OHE)
Acronym
OHE
Official Title
A Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging, Multicenter Study to Assess the Efficacy and Safety of Rifaximin Soluble Solid Dispersion (SSD) Tablets Plus Lactulose for the Treatment of Overt Hepatic Encephalopathy (OHE)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
September 13, 2018 (Actual)
Primary Completion Date
March 12, 2020 (Actual)
Study Completion Date
March 12, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Bausch Health Americas, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Study to Assess the Efficacy and Safety of Rifaximin Soluble Solid Dispersion (SSD) Tablets Plus Lactulose for the Treatment of Overt Hepatic Encephalopathy (OHE).
Detailed Description
The primary objective of this study is to assess the efficacy of rifaximin SSD plus lactulose versus placebo plus lactulose for the treatment of overt hepatic encephalopathy (OHE). The secondary objectives of this study are to assess the safety of rifaximin SSD in subjects with OHE and to assess the effects of treatment with rifaximin SSD on key secondary endpoints.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Overt Hepatic Encephalopathy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging, Multicenter Study
Masking
ParticipantCare ProviderInvestigator
Masking Description
Blinding will be maintained in the QD SSD cohorts by administering placebo as the second daily dose.
Allocation
Randomized
Enrollment
71 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1 40 mg Rifaximin SSD once daily
Arm Type
Experimental
Arm Description
40 mg Rifaximin immediate release (IR) rifaximin SSD once daily (QD) and lactulose
Arm Title
Cohort 2 40 mg Rifaximin SSD twice daily
Arm Type
Experimental
Arm Description
40 mg Rifaximin immediate release (IR) rifaximin SSD twice daily (BID) and lactulose
Arm Title
Cohort 3 80 mg Rifaximin SSD once daily
Arm Type
Experimental
Arm Description
80 mg Rifaximin sustained extended release (SER) rifaximin SSD once daily (QD) and lactulose
Arm Title
Cohort 4 80 mg Rifaximin SSD twice daiy
Arm Type
Experimental
Arm Description
80 mg Rifaximin sustained extended release (SER) rifaximin SSD twice daily (BID) and lactulose
Arm Title
Cohort 5 Placebo twice daily
Arm Type
Experimental
Arm Description
SSD placebo twice daily (BID) and lactulose
Intervention Type
Drug
Intervention Name(s)
40 mg Rifaximin SSD once daily
Intervention Description
SSD once daily (QD)
Intervention Type
Drug
Intervention Name(s)
40 mg Rifaximin SSD twice daily
Intervention Description
SSD twice daily (BID)
Intervention Type
Drug
Intervention Name(s)
80 mg Rifaximin SSD once daily
Intervention Description
SSD once daily (QD)
Intervention Type
Drug
Intervention Name(s)
80 mg Rifaximin SSD twice daily
Intervention Description
SSD twice daily (BID)
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Administered twice daily (BID)
Primary Outcome Measure Information:
Title
Time to Overt Hepatic Encephalopathy (OHE) Resolution Determined Using the Hepatic Encephalopathy Grading Instrument (HEGI), Defined as HEGI Score < 2
Description
A participant was considered to have an overt HE episode if at least one of the following applied: (1) Disorientated to time or place or person, (2) Lethargic and has asterixis, (3) Inability to assess the patient due to disorientation to time and place and person; and/or somnolence, and/or coma. Severity of OHE episodes was graded using the HEGI scale, where Grade 1 is no clinical findings of OHE, and Grade 4 is comatose. Higher scores on the scale have higher severity (worse outcome).
Time Frame
14 days
Secondary Outcome Measure Information:
Title
Time to Improvement in Hepatic Encephalopathy Grading Instrument (HEGI) Score, Defined as at Least One Grade Decrease (Improvement)
Description
A participant was considered to have an overt HE episode if at least one of the following applied: (1) Disorientated to time or place or person, (2) Lethargic and has asterixis, (3) Inability to assess the patient due to disorientation to time and place and person; and/or somnolence, and/or coma. Severity of OHE episodes was graded using the HEGI scale, where Grade 1 is no clinical findings of OHE, and Grade 4 is comatose. Higher scores on the scale have higher severity (worse outcome).
Time Frame
14 days
Title
Time to Hospital Discharge
Description
Time in days until discharge from the hospital
Time Frame
14 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Male or female age 18 to 75 years of age (inclusive) at the time of screening. Females of childbearing potential, defined as a female who is fertile following menarche, must have a negative serum pregnancy test at screening and agree to use an acceptable method of contraception throughout their participation in the study. Note: Female subjects who have been surgically sterilized (e.g., hysterectomy or bilateral tubal ligation) or who are postmenopausal (defined as total cessation of menses for > 1 year) will not be considered "female subjects of childbearing potential". Subject is hospitalized with liver cirrhosis and/or OHE and has a confirmed diagnosis of OHE at Baseline. Subject has a Grade 2 or Grade 3 HE episode according to the HE Grading Instrument (HEGI) following 8 to 12 hours of intravenous (IV) hydration and lactulose treatment. Exclusion Criteria: Subject has an uncontrolled major psychiatric disorder including major depression or psychoses as determined by the investigator. Subject has been diagnosed with an infection for which they are currently taking oral or parenteral antibiotics, which cannot be discontinued at time of enrollment. Note: Subjects currently taking Rifaximin are not excluded Subject shows presence of intestinal obstruction or has inflammatory bowel disease. Subject has uncontrolled Type 1 or Type 2 diabetes. Note: Subjects with controlled diabetes may be enrolled if they are on stable doses of oral hypoglycemic drugs for at least 3 months prior to screening, and demonstrate clinically acceptable blood glucose control at Baseline, as determined by the investigator. Subject has an active malignancy (exceptions: non-melanoma skin cancers).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Angela Bulawski
Organizational Affiliation
Bausch Health
Official's Role
Study Director
Facility Information:
Facility Name
Bausch Health Site 18
City
Corona Del Mar
State/Province
California
ZIP/Postal Code
92118
Country
United States
Facility Name
Bausch Health Site 15
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
Bausch Health Site 19
City
Los Angeles
State/Province
California
ZIP/Postal Code
90048
Country
United States
Facility Name
Bausch Health Site 04
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Name
Bausch Health Site 13
City
Bristol
State/Province
Connecticut
ZIP/Postal Code
06010
Country
United States
Facility Name
Bausch Health Site 08
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Bausch Health Site 05
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Bausch Health Site 33
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
Bausch Health Site 03
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
Bausch Health Site 07
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48109
Country
United States
Facility Name
Bausch Health 01
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48127
Country
United States
Facility Name
Bausch Health Site 25
City
Tupelo
State/Province
Mississippi
ZIP/Postal Code
38801
Country
United States
Facility Name
Bausch Health Site 24
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63104
Country
United States
Facility Name
Bausch Health Site 27
City
Newark
State/Province
New Jersey
ZIP/Postal Code
07102
Country
United States
Facility Name
Bausch Health Site 36
City
Brooklyn
State/Province
New York
ZIP/Postal Code
11215
Country
United States
Facility Name
Bausch Health Site 09
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Facility Name
Bausch Health Site 28
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Name
Bausch Health Site 17
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45219
Country
United States
Facility Name
Bausch Health Site 23
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
Bausch Health Site 11
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
Bausch Health Site 26
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Facility Name
Bausch Health Site 10
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19141
Country
United States
Facility Name
Bausch Health Site 12
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States
Facility Name
Bausch Health Site 16
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425
Country
United States
Facility Name
Bausch Health Site 22
City
Dallas
State/Province
Texas
ZIP/Postal Code
75203
Country
United States
Facility Name
Bausch Health Site 35
City
Dallas
State/Province
Texas
ZIP/Postal Code
75246
Country
United States
Facility Name
Bausch Health Site 31
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States
Facility Name
Bausch Health Site 02
City
Houston
State/Province
Texas
ZIP/Postal Code
77001
Country
United States
Facility Name
Bausch Health Site 37
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Bausch Health Site 30
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23226
Country
United States
Facility Name
Bausch Health Site 06
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23249
Country
United States
Facility Name
Bausch Health Site 21
City
Seattle
State/Province
Washington
ZIP/Postal Code
98104
Country
United States
Facility Name
Bausch Health Site 14
City
Seattle
State/Province
Washington
ZIP/Postal Code
98195
Country
United States
Facility Name
Bausch Health Site 20
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53226
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
35750249
Citation
Bajaj JS, Hassanein TI, Pyrsopoulos NT, Sanyal AJ, Rahimi RS, Heimanson Z, Israel RJ, Rockey DC. Dosing of Rifaximin Soluble Solid Dispersion Tablets in Adults With Cirrhosis: 2 Randomized, Placebo-controlled Trials. Clin Gastroenterol Hepatol. 2023 Mar;21(3):723-731.e9. doi: 10.1016/j.cgh.2022.05.042. Epub 2022 Jun 22.
Results Reference
derived

Learn more about this trial

Rifaximin Soluble Solid Dispersion (SSD) Tablets Plus Lactulose for the Treatment of Overt Hepatic Encephalopathy (OHE)

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