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

Last updated: July 3, 2023
Sponsor: University of Guadalajara
Overall Status: Active - Recruiting

Phase

2

Condition

Liver Disorders

Hepatitis

Hyponatremia

Treatment

Prolonged-Release Pirfenidone

Clinical Study ID

NCT05542615
MINERVA
  • Ages > 18
  • All Genders

Study 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.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. Patients with a history of Chronic Viral Hepatitis C, of all genotypes, demonstratedwith 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 withAAD, 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) withconsumption 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

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 ofthis 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, α-1-antitrypsin deficiency, amyloidosis, autoimmune hepatitis, and Primary BiliaryCholangitis).
  7. Concomitant systemic infection including viral hepatitis B, HIV, as well asrespiratory infections, urinary, digestive, cellulite, etc.
  8. Serious concomitant conditions such as Heart Failure, Respiratory Failure and ChronicKidney Failure.
  9. Malignant neoplasms including hepatocellular carcinoma. Patients with basal cellcarcinoma or those with malignancies with more than 5 years of inactivity may beconsidered for the study.
  10. Decompensated diabetes mellitus (defined as that with fasting blood glucose valuesgreater than 175 mg / dL and / or glycated hemoglobin greater than 8%).
  11. Uncontrolled hypertension despite medications (defined as systolic values ≥ 150 anddiastolic 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 theopinion of the main investigator, may interfere with the study.
  15. Any other clinical condition that in the opinion of the main investigator couldcompromise the safety and well-being of the patient or jeopardize the conduct of thestudy.

Study Design

Total Participants: 60
Treatment Group(s): 1
Primary Treatment: Prolonged-Release Pirfenidone
Phase: 2
Study Start date:
August 01, 2019
Estimated Completion Date:
January 01, 2024

Study 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.

Connect with a study center

  • Institute for Molecular Biology in Medicine and Gene Therapy, CUCS, UdeG

    Guadalajara, Jalisco 44340
    Mexico

    Site Not Available

  • Hospital Central Militar

    Mexico City, 11200
    Mexico

    Active - Recruiting

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