Angiotensin Receptor Blockade as an Anti-Fibrotic Intervention in Patients With Chronic Hepatitis C

Hepatitis C Clinical Trial

Official title:

Angiotensin Receptor Blockade an Anti-Fibrotic Intervention in Patients With Chronic Hepatitis C

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT00930995
• Other study ID #: CN-05SBala-01-B
• Status: Withdrawn
• Phase: Phase 2
• First received: July 1, 2009
• Last updated: April 23, 2012

Study information

• Verified date: April 2012
• Source: Kaiser Permanente
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

Hepatitis C is the most common reason for liver transplantation in the United States and affects nearly 4 million Americans. Treatments for hepatitis C are available but are poorly tolerated and are not always effective. Morbidity and mortality from hepatitis C are related to the development and progression of hepatic fibrosis to cirrhosis and end stage liver disease. Efforts to block progression of liver disease would thus result in prevention of morbidity and mortality as well as costs incurred by the health system in the care of these conditions.

Scar tissue in the liver is secreted by a type of cell, called the stellate cell, in an activated state. This cell carries a receptor for angiotensin, a hormone, when activated. If this receptor is blocked, the cell becomes inactive and does not participate in scar tissue formation. Thus, we hypothesize that using a drug such as candesartan, which blocks angiotensin receptors, should result in less scar tissue formation in the livers of patients with hepatitis C.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 21 Years to 65 Years

Eligibility

Inclusion Criteria:

• Adults, age 21 and older

• Patients with viral hepatitis C that are not on interferon based therapy.

• Detectable viral load

• Baseline biopsy within six months or willing to undergo biopsy prior to drug initiation

• At least grade 2 inflammation on biopsy, fibrosis of stage 1 or higher

• Willing to undergo biopsy at the end of treatment

• No interferon for at least 6 months prior to or after initial biopsy for study

Exclusion Criteria:

• Renal impairment defined by a serum creatinine of >1.8

• Congestive heart failure

• Hepatocellular cancer

• Concurrent treatment with pentoxyfylline, steroids, interferon alpha or interferon gamma.

• Active psychosis (affective disorders without loss of reality testing acceptable)

• Active IV drug use

• Prior liver transplant

• Pregnancy

• Decompensated cirrhosis as defined by the presence of ascites, hepatic encephalopathy or coagulopathy with an INR>1.4

• HIV seropositivity

• Hypotension defined by a baseline systolic blood pressure of less than 90mm of mercury

• Contraindication to ARB use or allergy to medication

• Treatment with potassium sparing diuretics

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Hepatitis
• Hepatitis A
• Hepatitis C
• Hepatitis C, Chronic
• Hepatitis, Chronic

Intervention

Drug:
• Candesartan
16mg po daily
• Placebo
once daily

Locations

Country	Name	City	State
United States	Kaiser Permanente	Roseville	California
United States	Kaiser Permanente	Sacramento	California

Sponsors (2)

Lead Sponsor	Collaborator
Kaiser Permanente	University of California, Davis

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Primary: • Stellate cell activity by alpha SMA stain quantitated by morphometry		48 weeks	No
Primary	• Hepatic fibrosis by morphometry		48 weeks	Yes
Secondary	Surrogate markers for fibrosis (liver TGF-beta levels, serum procollagen-III peptide levels)		48 weeks	No
Secondary	Functional status- Albumin, INR, T. Bilirubin, MELD score		48 weeks	Yes