Clinical Trial Details
— Status: Active, not recruiting
Administrative data
| NCT number |
NCT05663944 |
| Other study ID # |
20GA057 |
| Secondary ID |
|
| Status |
Active, not recruiting |
| Phase |
Phase 2
|
| First received |
|
| Last updated |
|
| Start date |
July 25, 2022 |
| Est. completion date |
July 31, 2024 |
Study information
| Verified date |
February 2024 |
| Source |
Nottingham University Hospitals NHS Trust |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial Summary
Background: Advanced liver scarring leads to liver failure, liver cancer and premature death.
It mainly affects people in the working age group (18-65 years) and is the only major cause
of death that is still increasing every year in the UK. It costs the NHS £2.1 billion a year.
This will continue to rise due to increasing alcohol misuse and the obesity crisis.
Advanced liver scarring remains incurable as there is no treatment to slow progression of
scarring. Sirolimus is a medication that has been used to prevent rejection after organ
transplantation for over 20 years. It reduces liver scarring, improves liver functioning and
prolongs life in animals. It has also been shown to reduce liver scarring in patients after
liver transplantation. Sirolimus, therefore offers a potential treatment option for liver
scarring.
Question and Objectives: If used in patients with advanced liver scarring, can sirolimus slow
the progression of scarring? The main objective is to undertake a small-scale study (proof of
concept) to investigate if sirolimus could slow the progression of scarring in patients with
advanced liver scarring using clinically relevant biomarkers, which will see if the liver
responds to treatment. How it will be done: The study will be conducted in Nottingham
University Hospitals NHS Trust. 45 patients with advanced liver scarring will be randomly
given either sirolimus or placebo tablets daily for 6 months. Participants will have a liver
biopsy and a MRI scan at the start and end of the study to measure the change in the
biomarkers of liver scarring. A reduction in these markers will indicate successful
treatment. Participants will be monitored for safety of the drug. Potential Impact: If found
efficacious, sirolimus would provide an acceptable treatment for patients with advanced liver
scarring and would also save a substantial sum of money for the NHS.
Description:
TRIAL DESIGN This is a phase II, randomised, patient-blinded, placebo-controlled, proof of
concept, parallel group single centre trial. Phase I information is not required since
sirolimus has been in use for other therapeutic indications.
STUDY SETTING This is a single centre study and will be undertaken at Nottingham University
Hospitals NHS Trust.
TRIAL PROCEDURES Recruitment Recruitment will be over 15 months from hepatology clinics.
Based on previous experience, recruiting 3 patients per month will achieve the recruitment of
45 participants over 15 months. Progression criteria around recruitment, retention and
treatment compliance will be defined as assessed at three monthly intervals.
Patient identification The chief investigator who is part of the clinical team will identify
potential participants by reviewing patient records (e.g., previous clinic letters) of
patients attending hepatology clinics. Information packs (patient information sheet and trial
team contact details) will be sent to all patients who appear to meet the eligibility
criteria. A delegated research professional (e.g., research nurse) will then gauge the
interest of the patient through a telephone call 1 - 2 weeks after sending the information
pack via post.
Screening Screening will include a baseline clinic which will involve eligibility check,
medical history and general physical examination, informed consent, routine bloods and liver
biopsy, followed by an MRI scan 2 weeks after the baseline clinic visit.
Medical history will include clinically significant diseases, surgeries, reproductive status,
smoking history, use of alcohol and illicit/recreational drugs and all medication
(prescription and over the counter drugs, herbal and homeopathic remedies, nutritional
supplements) used by the patient within 90 days prior to the baseline clinic visit. A full
physical examination will include general, cardiorespiratory, abdominal and neurological
examination. Routine bloods and a liver biopsy (either percutaneous or endoscopic ultrasound
guided) will be performed, unless the participant has had a liver biopsy within the past 3
months of the baseline clinic visit. Participants will then undergo an optional MRI scan at
Sir Peter Mansfield Imaging Centre, University of Nottingham 2 weeks after the baseline
clinic. If participants are found to be ineligible using all criteria, clinical care will
continue as usual. Anonymised information on participants who are not randomised will be kept
for CONSORT reporting the generalisability of the results.
Consent Written informed consent for participation in the study will be obtained before
performing any study-specific screening tests or evaluations. Written informed consent maybe
obtained up to 28 Days before the start of the study. Informed consent forms for enrolled
patients and for patients who are not subsequently enrolled will be maintained at the study
site. A copy of signed consent form will be provided to the patient or their authorised
representative. All signed and dated consent forms will remain in each patient's study file
and will be available for verification at any time. The consent form will be revised if there
are any changes to the study procedures or if new information becomes available that may
affect the willingness of the patient to participate.
The randomisation scheme All screening evaluations will be completed and reviewed to confirm
that patients meet all eligibility criteria before randomisation. A screening log will be
maintained to record details of all patients screened and to confirm eligibility or record
the reasons for the screening failure, as appropriate. Randomisation will be 2:1
(sirolimus:placebo) to allow interpretation of safety and provide an indication of placebo
response for future trial development.
Baseline data After informed consent, participants will undertake up to a 4-week screening
period to provide baseline data to ensure eligibility. During this period, participants will
undergo blood tests, transjugular liver biopsy and MRI scan. At baseline clinic (visit 1),
routine bloods including full blood count, electrolytes and renal function, liver function
test, and clotting screen will be collected. Blood will also be collected for extraction of
serum and plasma. A liver biopsy will be undertaken on the same day as the baseline clinic
(visit 1), unless the participant has undergone a liver biopsy within the past 3 months, in
which case the previous liver biopsy sample will be utilised for this study with the consent
of the patient. A non-contrast MRI scan will be undertaken at Sir Peter Mansfield Imaging
Centre, University of Nottingham 2 weeks after the baseline clinic/liver biopsy. Trial
assessments Once randomised, participants will receive either sirolimus or placebo daily for
6 months. Participants will start on a dose of 1mg daily (2 x 0.5mg tablets) and will have
weekly blood sirolimus trough levels measured to determine the next dose. The aim will be to
achieve a steady state blood trough level of 3-7 ng/ml, which is usually achieved in 3-5
weeks. Placebo will also be started at 2 tablets daily. All participants will undergo weekly
blood tests for the first 3-5 weeks and placebo doses will be adjusted randomly to maintain
blinding. All participants will be reviewed by a research nurse at 2, 4 and 6 months (visits
3, 4 and 5) and the following will be recorded: assessment of toxicity of previous dose,
weight, routine bloods - full blood count, electrolytes and renal function, liver function
test and clotting screen, blood sirolimus trough levels and serum and plasma samples for
research. Sirolimus dose will be adjusted according to the blood sirolimus trough level to
maintain a blood trough level of 3- 7ng/ml, as needed. Measurement of sirolimus trough levels
will also be used, along with tablet counting, to assess compliance. Only the trial
pharmacist will be unblinded and involved in dose adjustment and tablet counting. They will
liaise with the chief investigator if needed.
All participants will undergo a repeat liver biopsy at 6 months and a non-contrast MRI scan
at the Sir Peter Mansfield Imaging Centre, University of Nottingham 2 weeks later.
