Evaluation of Pirfenidone as a Novel Therapeutic Strategy Against Recurrent Acute Pancreatitis.

Recurrent Acute Pancreatitis Clinical Trial

— PirfenidoneRAP  

Official title:

Evaluation of Pirfenidone as a Novel Therapeutic Strategy Against Recurrent Acute Pancreatitis.

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06253117
• Other study ID #: IRB-300012263
• Secondary ID: HT9425-23-1-0900
• Status: Not yet recruiting
• Phase: Phase 2
• Start date: June 1, 2024
• Est. completion date: February 1, 2028

Study information

• Verified date: April 2024
• Source: University of Alabama at Birmingham
• Contact: Vikas Dudeja, M.B.B.S.
• Phone: 2059343028
• Email: vdudeja[@]uabmc.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This clinical will evaluate the safety, tolerability and early efficacy of pirenidone in patients with recurrent acute pancreatitis.

Description:

Background: Recurrent Acute Pancreatitis (RAP) is occurrence of 2 or more distinct episodes of Acute Pancreatitis (AP) (separated by at least 3 months). RAP not only leads to significant morbidity and reduced quality of life; patients with RAP have a substantial (up to 40%) risk of progressing to chronic pancreatitis (CP). Unfortunately, there is no therapy, which can help prevent future attacks of pancreatitis in RAP patients. In this regard, our published work suggest that pirfenidone, a therapy approved by FDA for the treatment of Idiopathic Pulmonary Fibrosis (IPF), has the potential to emerge as a novel treatment for patients with RAP. Briefly, our results suggest that: 1) Pirfenidone, when administered prophylactically, reduces the risk of AP development; 2) Pirfenidone, when given to experimental animals with severe AP, leads to amelioration of local and systemic injury; and 3) Pirfenidone, when administered to experimental animals with ongoing RAP, reduces risk of progression to CP. Thus, our results suggest that pirfenidone has potential to emerge as novel therapeutic strategy for RAP patients. These studies have high translational value as pirfenidone is already in clinical use for IPF and has over 8 years of record of safety.

Hypothesis: "Pirfenidone treatment in patients with RAP will be safe, tolerable, and efficacious." Objectives: The study has following primary and secondary objectives. Primary Objective: 1) To evaluate the safety and tolerability of pirfenidone compared to placebo, in patients with RAP. 2) To evaluate the efficacy of pirfenidone in reducing the laboratory markers of inflammation.

Secondary Objective: 1) To evaluate the efficacy of pirfenidone in reducing- a) recurrence of AP; b) pancreatitis related emergency room visits and readmissions; c) severity of pancreatitis, if acute pancreatitis was to develop; d) Improving quality of life measures; e) Improvement in patient reported outcomes. 2) To develop a predictive biomarker of efficacy of pirfenidone, which can be incorporated in a future clinical trial.

Specific aims and study design. Pilot Clinical Trial of the Safety, Tolerability and Efficacy of Pirfenidone in RAP. We will conduct a randomized, double-blind, placebo controlled pilot trial of pirfenidone in patients with RAP. RAP patients, 18-85 years of age who meet the eligibility criteria, will be recruited at one of the three participating sites (UAB, Mayo clinic Rochester and Brigham and Women's Hospital, Boston), and randomly assigned to pirfenidone or placebo treatment for 6 months. The primary endpoints of this clinical trial are a) feasibility; and b) safety. We have multiple efficacy secondary endpoints endpoint like cumulative incidence and rate of recurrent attacks of AP, severity of recurrent attacks of AP (mild/moderate/severe), readmissions and/or ER visits for pain, changes in quality of life as measured by PANQOLI and SF-12 health survey questionnaires, and changes in changes in patient reported outcome as measured by PAN-PROMISE score. We plan to recruit 60 patients at the three study sites over the duration of this clinical trial.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 60
• Est. completion date: February 1, 2028
• Est. primary completion date: February 1, 2028
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 85 Years

Eligibility

Inclusion Criteria:

1. Patients 18 - 85 years of age

2. Two or more documented attacks of acute pancreatitis, separated by 3 months from one another, defined by at least 2 of the following 3:

1. amylase or lipase values, or both, that are greater than 3 times the upper limit of normal values

2. characteristic cross-sectional imaging

3. typical upper abdominal pain according to the revised Atlanta classification28

3. Drug/placebo treatment to start

1. Mild AP

• Patient is discharged out of the hospital

• 30 days after diagnosis of mild AP

2. Moderate Severe or Severe AP

• Patient is discharged out of hospital

• Intra-abdominal collections are either resolved on imaging, or are improving and asymptomatic and do not warrant any intervention (per treating physician)

4. Ability to understand and the willingness to sign a written informed consent document and medical release

5. Willing and able to comply with trial protocol and follow up

6. 2nd AP episode despite correction of the AP etiology (if identified) after the 1st episode as follows i. Patients with biliary pancreatitis who have undergone cholecystectomy, with or without ERCP (if indicated) ii. Patients with hypertriglyceridemia induced pancreatitis who have serum triglyceride levels below 250 with medication management iii. Patients with medication induced AP developing a 2nd AP episode despite stopping the culprit medication

Exclusion Criteria:

1. Age < 18 or > 85 years.

2. Body weight > 200 kg.

3. Ongoing AP or diagnosis of AP in previous 30 days.

4. Diagnosis of chronic pancreatitis, one of the following

1. Ductal stricture, calcification and/or atrophy, as seen on CT scan/MRI

2. 5 or more of the 9 EUS criteria used to diagnose CP

5. Known hypersensitivity to Pirfenidone.

6. AST/ALT = 2 times the upper normal limit.

7. Alkaline phosphatase = 1.5 times the upper normal limit.

8. Bilirubin higher than upper normal limit.

9. Moderate to severe heart failure and/or coronary heart disease (New York Heart Association (NYHA) Functional Class III/IV).

10. On home oxygen or home mechanical ventilation.

11. Advanced liver disease or cirrhosis.

12. Paralytic ileus or significant nausea and vomiting preventing administration of full liquid diet.

13. Chronic diarrhea.

14. Immunosuppressive disorder or on immunosuppressive medications.

15. Active or advanced malignancy.

16. Known cancer that is end-stage with ongoing palliative care or for which palliative care is appropriate.

17. Known history of infective hepatitis.

18. Ongoing photosensitivity and rash.

19. Known live vaccines or therapeutic infectious agents within one month of admission.

20. Known pregnancy or lactation at the time of admission.

21. Women of childbearing potential who are not on oral or injectable contraceptives or IUDs, and do not consent to practice abstinence/adequate contraception while on, and for 90 days after the administration of the drug/placebo.

22. Known to be currently participating in a trial testing any investigational medicinal product or participation in a clinical study involving a medicinal product in the last three months.

23. Problematic pattern of alcohol use or moderate to severe alcohol use disorder (Appendix 2)

24. Substance use disorder (except recreational or medicinal use of marijuana)

25. Family or personal history of long QT syndrome ( > 500 msec).

26. Strong CYP1A2 inhibitors (e.g., fluvoxamine, enoxacin) or moderate CYP1A2 Inhibitors (e.g., ciprofloxacin).

27. Medications like sildenafil.

28. Renal disease with GFR < 30.

29. Any condition other than above that, in the opinion of the investigator, is likely to result in the death of the patient within the next 2 years.

30. Any condition that, in the opinion of the investigator, might be significantly exacerbated by the known side effects associated with the administration of Pirfenidone.

Related Conditions & MeSH terms

• Pancreatitis
• Recurrence
• Recurrent Acute Pancreatitis

Intervention

Drug:
• Pirfenidone
Pirfenidone Days 1-7: 267 mg PO TID (801 mg/day) Days 8-14: 534 mg PO TID (1602 mg/day) Day 15 and thereafter: 801 mg PO TID; not to exceed 2403 mg/day Duration of treatment- total 6 months
• Placebo
Placebo

Locations

Country	Name	City	State
n/a

Sponsors (2)

Lead Sponsor	Collaborator
University of Alabama at Birmingham	Congressionally Directed Medical Research Programs

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Adverse Event	Development of anticipated or un-anticipated serious adverse events (class 3-4)	6 months
Secondary	Development of Recurrent AP	Cumulative incidence and rate of recurrent attacks of AP over 2 year period following randomization into drug/placebo	2 years
Secondary	Severity of Recurrent Attacks of AP	Classified as mild/moderate/severe	2 years
Secondary	ER Visits	Readmissions and/or ER visits for pain but not AP, over 2 years following randomization into drug/placebo	2 years
Secondary	QOL	SF-12 (0-100, higher score means better physical and mental health functioning)	2 years
Secondary	Patient reported outcomes	Changes in patient reported outcome as measured by PAN-PROMISE score (0-70, with higher score meaning worse symptoms)	2 years
Secondary	Laboratory Marker of Inflammation	Changes in the laboratory markers of inflammation CRP	2 years
Secondary	Laboratory Marker of Inflammation	Changes in the laboratory markers of inflammation IL-10	2 years
Secondary	Laboratory Marker of Inflammation	Changes in the laboratory markers of inflammation TNF-a	2 years
Secondary	Laboratory Marker of Inflammation	Changes in the laboratory markers of inflammation IL-1	2 years
Secondary	Laboratory Marker of Inflammation	Changes in the laboratory markers of inflammation IL-6	2 years
Secondary	Laboratory Marker of Inflammation	Changes in the laboratory markers of inflammation Angiopoietin-2	2 years
Secondary	Development of CP	Fecal Elastase	2 years
Secondary	Development of Chronic Pancreatitis	Development of CP, as evaluated by secretin MRCP at the end of the study	2 years
Secondary	Development of Diabetes	hemoglobin A1C	2 years
Secondary	Development of Diabetes	Fasting blood sugar	2 years