Pentoxifylline for Primary Biliary Cirrhosis - Full Text View

Purpose

Primary biliary cirrhosis (PBC) is cholestatic liver disease characterized by progressive destruction of small bile ducts within the liver that can lead to end stage liver disease and all its complications.

Although ursodeoxycholic acid (UDCA) is associated with increased survival in many patients with PBC, there is absence of an adequate response to UDCA in a significant proportion of PBC patients.

Tumor necrosis factor alpha (TNF-alpha) is a cytokine that plays an important role in the pathogenesis of PBC. Other fibrosis biomarkers such as tissue metallo proteinase 1 (TIMP-1) are associated with progression of liver fibrosis in PBC. Pentoxifylline (PTX) is a methylxanthine derivative that inhibits pro-inflammatory cytokines and also has shown anti-fibrotic effects in serum of patients with PBC. Furthermore, PTX has well known clinical and safety profiles. The main hypothesis of this study is that therapy with pentoxifylline (PTX) will result in improvement of liver disease in PBC patients who are incomplete responders to UDCA.

The focus of this proposal is on the effectiveness of PTX in improving laboratory parameters of liver disease and levels of cytokines involved in the pathogenesis of the disease in patients with PBC.

Condition	Intervention	Phase
Primary Biliary Cirrhosis	Drug: Pentoxifylline	Phase 2


Study Type:	Interventional
Study Design:	Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	A Pilot Study of Pentoxifylline for the Treatment of Primary Biliary Cirrhosis

Resource links provided by NLM:

Genetics Home Reference related topics: North American Indian childhood cirrhosis progressive familial intrahepatic cholestasis

MedlinePlus related topics: Cirrhosis

Drug Information available for: Pentoxifylline

Genetic and Rare Diseases Information Center resources: Primary Biliary Cholangitis

U.S. FDA Resources

Further study details as provided by The Cleveland Clinic:

Primary Outcome Measures:

Change in Serum Alkaline Phosphatase Levels. [ Time Frame: 6 months ] [ Designated as safety issue: No ]
Serum alkaline phosphatase levels at entry and at 6 months of therapy with PTX will be measured and compared.

Secondary Outcome Measures:

Change in Serum Concentration of Tissue Inhibitor Metalloproteinase 1 (TIMP-1) After PTX Therapy. [ Time Frame: 6 months ] [ Designated as safety issue: No ]
Serum concentration of tissue inhibitor metalloproteinase 1 (TIMP-1), a fibrosis biomarker of interest, will be measured and the change in serum levels between entry and end of study will be calculated.
Safety of Therapy in the Pilot Study of PTX Therapy in Patients With PBC Will be Assessed [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]
The number of participants that experienced any severe adverse events will be monitored and recorded.


Enrollment:	20
Study Start Date:	November 2010
Study Completion Date:	March 2013
Primary Completion Date:	June 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Pentoxifylline 400 mg TID This study is an open label pilot with only one arm.	Drug: Pentoxifylline Patients will take 400mg of pentoxifylline three times daily for a total duration of 6 months.

Eligibility


Ages Eligible for Study:	18 Years to 76 Years (Adult, Senior)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Male and female patients ages 18 to 76 years.
Established diagnosis of PBC based on at least three of the following criteria:
- Detectable anti-mitochondrial antibodies (AMA)
- Cholestatic biochemical pattern
- Liver biopsy compatible with PBC
- Appropriate exclusion of other liver diseases.
Therapy with UDCA at adequate dose (13-15mg/kg/d) for at least six months and evidence of suboptimal response defined by alkaline phosphatase levels that did not normalize and remain elevated by at least 1.5 times the upper limit of normal.
No history or present hepatic decompensation (e.g. variceal hemorrhage, encephalopathy, or poorly controlled ascites).

Exclusion Criteria:

Findings highly suggestive of liver disease of other etiology.
A score >=10 points on the Revised Scoring System for autoimmune hepatitis (AIH), supporting a diagnosis of PBC/AIH overlap.
Patients on steroids (systemic), immunosuppressants, or immunomodulatory agents within the previous 6 months.
Patients with clinical or laboratory evidence suggestive of decompensated cirrhosis.
Hypersensitivity to PTX or the methylxanthines (caffeine, theophylline, theobromine).
History of cerebral or retinal hemorrhage.
Other medical comorbidities (such as cardiac, renal, cancer) that would interfere with completion of the study.
Patients taking Theophylline or Coumadin because of potential drug-drug interactions with PTX. In addition, patients taking low molecular weight heparin preparations.
Pregnant or nursing women.

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01249092

Locations


United States, Ohio
Cleveland Clinic
Cleveland, Ohio, United States, 44195

Sponsors and Collaborators

The Cleveland Clinic

Investigators


Principal Investigator:	Claudia O. Zein, MD, MSc	The Cleveland Clinic

More Information


Responsible Party:	Claudia Zein, MD, Staff Physician, Digestive Disease Institute, The Cleveland Clinic
ClinicalTrials.gov Identifier:	NCT01249092 History of Changes
Other Study ID Numbers:	07-1003
Study First Received:	November 24, 2010
Results First Received:	July 31, 2013
Last Updated:	October 16, 2013
Health Authority:	United States: Food and Drug Administration

Keywords provided by The Cleveland Clinic:


biliary cirrhosis

Additional relevant MeSH terms:


Fibrosis Liver Cirrhosis Liver Cirrhosis, Biliary Pathologic Processes Liver Diseases Digestive System Diseases Cholestasis, Intrahepatic Cholestasis Bile Duct Diseases Biliary Tract Diseases Pentoxifylline	Phosphodiesterase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Platelet Aggregation Inhibitors Radiation-Protective Agents Protective Agents Physiological Effects of Drugs Vasodilator Agents Free Radical Scavengers Antioxidants

ClinicalTrials.gov processed this record on September 28, 2016