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

Liver Cirrhosis Clinical Trial

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).

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05542615
• Other study ID #: MINERVA
• Status: Recruiting
• Phase: Phase 2
• Start date: August 1, 2019
• Est. completion date: January 1, 2024

Study information

• Verified date: July 2023
• Source: University of Guadalajara
• Contact: Juan Armendariz-Borunda, PhD, FAASLD
• Phone: +52 1058 5200
• Email: armdbo[@]gmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 60
• Est. completion date: January 1, 2024
• Est. primary completion date: December 1, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

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, a-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.

Related Conditions & MeSH terms

• Epigenetic Disorder
• Hepatitis
• Hepatitis C
• Hepatitis C, Chronic
• Liver Cirrhosis

Intervention

Drug:
• Prolonged-Release Pirfenidone
1200 mg / day of Pirfenidone (KitosCell® LP)

Locations

Country	Name	City	State
Mexico	Institute for Molecular Biology in Medicine and Gene Therapy, CUCS, UdeG	Guadalajara	Jalisco
Mexico	Hospital Central Militar	Mexico City

Sponsors (2)

Lead Sponsor	Collaborator
University of Guadalajara	Hospital Central Militar

Country where clinical trial is conducted

Mexico, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Liver biopsy	Reduction of one unit in the METAVIR histological scale (F0-F4)	12 months
Primary	Elastography	=30% reduction in the final Pascal score, compared to baseline.	12 months
Secondary	Changes in the degree of methylation	of the following genes PPAR?, PPAR?, PPARa, TGFß1, Col1A1 and PDGFa in ccfDNA in DNA obtained by liver biopsy.	12 months
Secondary	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.	12 months
Secondary	Transcriptome measurement in ccfRNA	Changes in transcriptome measurement in ccfRNA	12 months
Secondary	Albumin and liver enzyme values	Albumin and liver enzyme values	12 months