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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04330508
Other study ID # IEC-D3/2018-866
Secondary ID
Status Completed
Phase
First received
Last updated
Start date March 1, 2018
Est. completion date December 31, 2021

Study information

Verified date February 2024
Source Postgraduate Institute of Medical Education and Research
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Minimal hepatic encephalopathy (MHE) is an important clinical variant of hepatic encephalopathy (HE), which occurs in up to 60-70% of patients with cirrhosis. The condition comprises a cognitive impairment, observed in patients with cirrhosis who have no clinical evidence of overt hepatic encephalopathy (OHE). It is associated with an increased incidence of road traffic accidents, reduced quality of life and it affects the ability to perform tasks of daily living. Successful treatment of hepatitis C has been reported to be associated with 62-84% reduction in all-cause mortality (deaths), 68-79% reduction in risk of HCC and 90% reduction in risk of liver transplantation. In addition, studies have shown that viral eradication may improve cognition when given interferon based regimens for HCV. With the available of safe, efficacious, all oral regimens for HCV, we plan to prospectively analyse the change in mood, depression and cognitive function in response to DAA therapy, in relation to outcomes of treatment.


Description:

Investigations will be performed according to the Declaration of Helsinki and approval of the enrolment as well as the usage of patient blood samples for research purpose will be obtained from the institutional ethics committee, and written informed consent will be obtained from all patients.The primary analysis upon which the sample size consideration was based involved the comparison of the SVR subgroup and the subgroup of patients without SVR. For the sample size calculation, we a two-factorial design (time course × SVR) with the use of a two-way analysis of variance (ANOVA) analysis, a significance level of 5% and a statistical power of at least 80% to detect a medium effect size (d = 0.5) and thus to show a significant group difference. Based on this background, the optimal sample size is calculated to be a total of 102 subjects. To consider asymmetric subgroups and to allow for a moderate dropout rate and additional calculations (secondary study objectives), we aim to include a total of at least 150 study participants in each group with 25 healthy volunteers as controls.


Recruitment information / eligibility

Status Completed
Enrollment 385
Est. completion date December 31, 2021
Est. primary completion date October 31, 2021
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 18 Years to 65 Years
Eligibility Inclusion Criteria: - Age 18-65 years and chronic HCV infection. - Group A: Patients with hepatitis C (Non-cirrhotic) [n= 150] - Group B: Patients with hepatitis C related compensated-cirrhosis [n= 150] - Group C: Healthy volunteers [n= 25] Exclusion Criteria: - Current overt hepatic encephalopathy or during the last 1 month - TIPS (transjugular intra- hepatic porto-systemic shunt) - elective surgery planned within the next 8 weeks - unable to give informed consent - HIV infection - chronic respiratory insufficiency - current infection and receiving antibiotics - renal failure (serum creatinine = 1.5 mg/l) - hepatocellular carcinoma, - patient with other neurological disease - intake of sedatives, antidepressants, benzodiazepines, or benzodiazepines-antagonists (flumazenil, neuromuscular blocking agents)

Study Design


Related Conditions & MeSH terms


Intervention

Other:
Depression and Cognitive Tests
Health Related Quality of Life, neurocognitive tests, PHES

Locations

Country Name City State
India Postgraduate Institute of Medical Education and Research Chandigarh

Sponsors (1)

Lead Sponsor Collaborator
Postgraduate Institute of Medical Education and Research

Country where clinical trial is conducted

India, 

References & Publications (8)

Amodio P, Montagnese S, Gatta A, Morgan MY. Characteristics of minimal hepatic encephalopathy. Metab Brain Dis. 2004 Dec;19(3-4):253-67. doi: 10.1023/b:mebr.0000043975.01841.de. — View Citation

Bajaj JS, Saeian K, Schubert CM, Hafeezullah M, Franco J, Varma RR, Gibson DP, Hoffmann RG, Stravitz RT, Heuman DM, Sterling RK, Shiffman M, Topaz A, Boyett S, Bell D, Sanyal AJ. Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test. Hepatology. 2009 Oct;50(4):1175-83. doi: 10.1002/hep.23128. — View Citation

Bajaj JS, Schubert CM, Heuman DM, Wade JB, Gibson DP, Topaz A, Saeian K, Hafeezullah M, Bell DE, Sterling RK, Stravitz RT, Luketic V, White MB, Sanyal AJ. Persistence of cognitive impairment after resolution of overt hepatic encephalopathy. Gastroenterology. 2010 Jun;138(7):2332-40. doi: 10.1053/j.gastro.2010.02.015. Epub 2010 Feb 20. — View Citation

Butterworth RF. Editorial: rifaximin and minimal hepatic encephalopathy. Am J Gastroenterol. 2011 Feb;106(2):317-8. doi: 10.1038/ajg.2010.460. — View Citation

Conn HO. Trailmaking and number-connection tests in the assessment of mental state in portal systemic encephalopathy. Am J Dig Dis. 1977 Jun;22(6):541-50. doi: 10.1007/BF01072510. No abstract available. — View Citation

Kircheis G, Knoche A, Hilger N, Manhart F, Schnitzler A, Schulze H, Haussinger D. Hepatic encephalopathy and fitness to drive. Gastroenterology. 2009 Nov;137(5):1706-15.e1-9. doi: 10.1053/j.gastro.2009.08.003. Epub 2009 Aug 15. — View Citation

Ortiz M, Cordoba J, Jacas C, Flavia M, Esteban R, Guardia J. Neuropsychological abnormalities in cirrhosis include learning impairment. J Hepatol. 2006 Jan;44(1):104-10. doi: 10.1016/j.jhep.2005.06.013. Epub 2005 Jul 11. — View Citation

Poordad FF. Review article: the burden of hepatic encephalopathy. Aliment Pharmacol Ther. 2007 Feb;25 Suppl 1:3-9. doi: 10.1111/j.1746-6342.2006.03215.x. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary Cognitive performance Computerized battery (Reaction times, simple and choice, visual memory, Number connection test, and Inhibitory Control Test) Day 0
Primary Cognitive performance Computerized battery (Reaction times, simple and choice, visual memory, Number connection test, and Inhibitory Control Test) 90 days after treatment completion
Primary Cognitive performance using conventional tests Psychometric hepatic encephalopathy score (PHES), Indian Version. Day 0
Primary Cognitive performance using conventional tests Psychometric hepatic encephalopathy score (PHES), Indian Version. 90 days after treatment completion
Primary HRQOL by SF-36 Day 0
Primary HRQOL by SF-36 90 days after treatment completion
Secondary Depression Scale Beck's Depression Inventory (BDI) Generalized anxiety disorder (GAD 7 score) Psychometric hepatic encephalopathy Score (PHES) Montreal Cognitive assessment Score (MoCA Score) Day 0
Secondary Depression Scale Beck's Depression Inventory (BDI) Generalized anxiety disorder (GAD 7 score) Psychometric hepatic encephalopathy Score (PHES) Montreal Cognitive assessment Score (MoCA Score) 90 days after treatment completion