Acute on Chronic Liver Failure Clinical Trial
— DIALIVE _ACLFOfficial title:
A Multi-centre, Randomised Controlled Study, to Evaluate the Safety and Performance of The DIALIVE Liver Dialysis Device (LDD) in Patients With Acute on Chronic Liver Failure (ACLF) Versus Standard of Care (SOC)
Verified date | May 2021 |
Source | Yaqrit Ltd |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The First-In-Man study is a multi-centre, randomised, controlled, study to generate data for the evaluation of safety and performance of DIALIVE Liver Dialysis Device in 24 evaluable patients with Acute on Chronic Liver Failure (ACLF) versus standard of care (SOC).
Status | Completed |
Enrollment | 30 |
Est. completion date | January 15, 2020 |
Est. primary completion date | December 31, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 81 Years |
Eligibility | Inclusion Criteria: - Male or female subjects aged =18 years =81yr who have given informed consent to participate in the study and are able to understand and comply with the requirements of the study (otherwise written informed consent must be obtained on behalf of the subject in accordance with local ethical and legal requirements). - History indicative of alcohol-related cirrhosis based on clinical, radiological and/or histological evidence. - History of an acute decompensating event (including but not limited to ascites, gastrointestinal bleeding, hepatic encephalopathy and/or acute bacterial infections), occurring within =6 weeks of screening. - • Subject with : - ACLF Grade 1, 2 or 3a defined per the CLIF-C OF scoring system OR - single hepatic organ failure for serum bilirubin > 20 mg/dL (342 µmol/L) at screening and randomization, OR - AKI-stage 1b (sCr > 1.5 mg/dL or 134 µmol/L). - Where a subject has received corticosteroids for alcohol-induced ACLF, is unresponsive to at least 7 days of treatment (where lack of response defined as Lille score > 0.45 or steroids stopped before 7 days due to any complication such as infection). This refers to the first course of corticosteroid therapy only. Exclusion Criteria: - Co-infection with HIV and AIDS defining illness. - Subjects with acute or sub-acute liver failure without underlying cirrhosis. - Subjects with severe thrombocytopaenia, defined by the platelet count of < 40,000 / mm3 or rapid reduction in platelet count (> 50% reduction) 24 hrs prior to inclusion. - Subjects with International Normalised Ratio (INR) > 3 - ACLF 3b patients, i.e. ACLF with more than 3 organ failures. - Subjects with cirrhosis who develop decompensation at any time in the post-operative period following partial partial liver resection or major non-liver surgery. - Subjects with uncontrolled infection. Patients may be entered into the study provided antimicrobials have been administered for at least 48 hours with an appropriate response observed prior to randomization. - Subjects with respiratory organ failure (as per CLIF-C OF scoring: PaO2/FiO2< 200 mmHg or 27 kPa or SaO2/FiO2 < 214). - Subjects with haemodynamic instability: i) persistent hypotension (mean arterial pressure < 65 mmHg) with evidence of tissue hypoperfusion, not responsive to volume resuscitation and/or low dose vasopressor support; ii) a norepinephrine dose of > 0.2 µg/kg/min, or a second pressor (terlipressin for variceal haemorrhage and/or hepato-renal syndrome does not count as pressor, unless it is specifically used to treat systemic hypotension) at screening or randomization. Patients can be reconsidered for study inclusion after at least a 24 hour period of norepinephrine requirement < 0.2 µg/kg/min. - Subjects not considered appropriate for full active treatment including organ support or those with a Do Not Attempt Cardio-Pulmonary Resuscitation order (DNACPR). - Subjects with active, or with a history of non hepatic malignancy unless adequately treated or in complete remission for five or more years. - Patients with HCC outside Milan criteria. - Significant systemic or major illness other than liver disease, including coronary artery disease, cerebrovascular disease, pulmonary disease, renal failure, serious psychiatric disease, that, in the opinion of the Investigator would preclude the subject from participating in and completing the study. - Subject who has received any investigational drug or device within 30 days of dosing or who is scheduled to receive another investigational drug or device in the course of the study; concomitant observational studies are allowed. - Evidence of uncontrolled seizures. - Subjects diagnosed with Creutzfeldt-Jakob disease. - In females: known pregnancy or lactating. - Subjects weighing less than 30 kg (as per contra-indications of oXiris and septeX) - Where subjectspresent with a known allergy to heparine of have type II thrombocytopaenia caused by heparin (HIT syndrome type II) - In the opinion of the investigator, it is unsafe for the patient to be considered for the study. |
Country | Name | City | State |
---|---|---|---|
Austria | university Hospital Graz | Graz | |
Belgium | University Hospital Erasmus | Brussels | |
Denmark | University Hospital | Aarhus | |
France | Hôpital Beaujon | Clichy | |
France | Paul Brousse Hospital | Villejuif | |
Germany | University Hospital of Rostock | Rostock | |
Romania | Fundeni Clinical Institute | Bucharest | |
Spain | Hospital Clinic Barcelona | Barcelona | |
Spain | University Hospital Gregorio Maragnon | Madrid | |
United Kingdom | university hospital BASILDON | Basildon | |
United Kingdom | Royal Free Hospital London NHS | London | Hampstead |
United Kingdom | Queens Medical Centre | Nottingham |
Lead Sponsor | Collaborator |
---|---|
Yaqrit Ltd | European Foundation for Chronic Liver Failure, Fakkel bvba, University College, London |
Austria, Belgium, Denmark, France, Germany, Romania, Spain, United Kingdom,
Lee KC, Baker LA, Stanzani G, Alibhai H, Chang YM, Jimenez Palacios C, Leckie PJ, Giordano P, Priestnall SL, Antoine DJ, Jenkins RE, Goldring CE, Park BK, Andreola F, Agarwal B, Mookerjee RP, Davies NA, Jalan R. Extracorporeal liver assist device to exchange albumin and remove endotoxin in acute liver failure: Results of a pivotal pre-clinical study. J Hepatol. 2015 Sep;63(3):634-42. doi: 10.1016/j.jhep.2015.04.020. Epub 2015 May 1. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Efficacy of the DIALIVE for liver function: changes in MELD score | Outcome measure as compared between SoC and DIALIVE arm is:
Liver: Changes in MELD score, plasma/serum cCK18/M30 and flCK18/M65 (markers of liver cell death). Liver: serum bilirubine Model for End-Stage Liver Disease (MELD) Scoring Systems. |
Treatment period is from 1 to 10 days post-randomization | |
Other | Efficacy of the DIALIVE for kidney function: changes in creatine and NGAL | Outcome measure as compared between SoC and DIALIVE arm is:
- Kidney: Changes in serum creatinine and urinary NGAL (Neutrophil gelatinase-associated lipocalin - marker of kidney injury). |
Treatment period is from 1 to 10 days post-randomization | |
Other | Efficacy of the DIALIVE for brain function: changes in West Haven Criteria | Outcome measure as compared between SoC and DIALIVE arm is:
- Brain: West Haven Criteria to assess changes in severity of hepatic encephalopathy. |
Treatment period is from 1 to 10 days post-randomization | |
Other | Efficacy of the DIALIVE for immune function. | Outcome measure as compared between SoC and DIALIVE arm is:
- Immune function: Incidence of Infection. Changes in white cell count and plasma-induced neutrophil function (Phagoburst and Phagotest), serum CRP and cytokines (TNF-a, IL-6, IL-8, IL-10, IL1RA). |
Treatment period is from 1 to 10 days post-randomization | |
Other | Assessment of coagulation and haemostasis. | Outcome measure as compared between SoC and DIALIVE arm is:
- Coagulation: Changes in INR and platelet levels. |
Treatment period is from 1 to 10 days post-randomization | |
Other | Efficacy of the DIALIVE for pulmonary function. | Outcome measure as compared between SoC and DIALIVE arm is:
- Lung: P/F or S/F ratio. |
Treatment period is from 1 to 10 days post-randomization | |
Other | Efficacy of the DIALIVE for the cardiovascular function. | Outcome measure as compared between SoC and DIALIVE arm is:
- Cardiovascular system: measurement off the Mean Arterial Pressure. |
Treatment period is from 1 to 10 days post-randomization | |
Primary | Safety of DIALIVE in terms of percentage of ACLF patients experiencing serious adverse events during DIALIVE treatment period. | To evaluate the safety of the DIALIVE device in patients with Acute on Chronic Liver Failure Grades 1 and 2 (ACLF). Outcome measure is: The percentage of subjects who experience at least one (1) serious adverse event (SAE) between Day 1 and Day 10.(DIALIVE arm only).
Outcome is measured on day 10 and compared between treatment arms. |
Treatment period is from 1 to 10 days post-randomization. | |
Primary | Safety of DIALIVE in terms of percentage of ACLF patients who discontinued treatment due to severe adverse event. | The outcome measure is the percentage of subjects who discontinued DIALIVE treatment due to a serious adverse device event (SADE) between Day 1 (first day of treatment) and Day 10.(DIALIVE arm only) | Treatment period is from 1 to 10 days post-randomization. | |
Secondary | Performance of DIALIVE by assessing removal of endotoxins. | To evaluate the performance of the DIALIVE device in patients with ACLF (DIALIVE arm only). Outcome measure is :
- Change in Plasma endotoxin concentrations between end of treatment with DIALIVE and the beginning of treatment with DIALIVE (Day 1). TV: 40% reduction; AV: 20% reduction |
End of DIALIVE treatment (max 10 days after randomization) | |
Secondary | Performance of DIALIVE by assessing removal of albumin. | To evaluate the performance of the DIALIVE device in patients with ACLF (DIALIVE arm only). Outcome measure is :
- Change in Albumin function (Human non-mercapt albumin -2 (HNA-2) / Human mercapt albumin (HMA ratio) between end of treatment with DIALIVE and the beginning of treatment with DIALIVE (Day 1) |
End of DIALIVE treatment (max 10 days after randomization) | |
Secondary | Change in Clinical Parameters by DIALIVE treatment (ACLF grade and score) between treatment arms. | Evaluate the improvement in clinical parameters between Acute on Chronic Liver Failure (ACLF) patients receiving DIALIVE treatment vs Standard of Care. Outcome measure is:
- Change in CLIF-C score (Chronic LIver Failure Consortium) |
Treatment period is from 1 to 10 days post-randomization | |
Secondary | Change in Clinical Parameters by DIALIVE treatment (ACLF grade) between treatment arms. | Evaluate the improvement in clinical parameters between Acute on Chronic Liver Failure (ACLF) patients receiving DIALIVE treatment vs Standard of Care. Outcome measure is:
- Change in ACLF Grade |
Treatment period is from 1 to 10 days post-randomization | |
Secondary | Change in mortality between treatment arms. | The outcome measure is the difference in mortality between the DIALIVE treatment arm and the Standard of Care arm at day 28 post-randomization.
During the study, the follow up period was prolonged to 90 days (3 months). |
At day 28 post-randomization (for all patients). At day 90 for those patients enrolled under protocol version 6.0. | |
Secondary | Change in Clinical Parameters by DIALIVE treatment (CLIF-C score) between treatment arms. | Evaluate the improvement in clinical parameters between Acute on Chronic Liver Failure (ACLF) patients receiving DIALIVE treatment vs Standard of Care. Outcome measure is:
- Change in CLIF-C score (Chronic LIver Failure Consortium) |
Treatment period is from 1 to 10 days post-randomization | |
Secondary | Status of ICU and hospital discharge. | Location of patient at day 28 and 90 post randomization, and timing of discharge from hospital. | Treatment period is from 1 to 90 days post-randomization. | |
Secondary | Length of stay in ICU and in hospital | Evaluation of length of stay of patient in the hospital and on the ICU. | Assessment is done on day 28 and day 90. | |
Secondary | ICU and hospital re-adminssions with another episode of ACLF | Assessment of re-admissions of patients for another episode of ACLF after hospital discharge post-randomization. | Assessment is done on day 28 and day 90. |
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