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TRimetazidine for acUte on Chronic Liver Failure STudy (TRUST)

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ClinicalTrials.gov Identifier: NCT03737448
Recruitment Status : Suspended (Lack of enrollment)
First Posted : November 9, 2018
Last Update Posted : March 4, 2021
Sponsor:
Information provided by (Responsible Party):
Martin Pharmaceuticals

Tracking Information
First Submitted Date  ICMJE November 7, 2018
First Posted Date  ICMJE November 9, 2018
Last Update Posted Date March 4, 2021
Actual Study Start Date  ICMJE November 28, 2018
Estimated Primary Completion Date June 30, 2021   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: November 7, 2018)
  • plasma pharmacokinetics [ Time Frame: 28 days ]
    Cmax
  • plasma pharmacokinetics [ Time Frame: 28 days ]
    AUC
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: November 8, 2018)
Incidence of treatment-emergent adverse events [Safety and Tolerability] [ Time Frame: 90 days ]
Adverse events
Original Secondary Outcome Measures  ICMJE
 (submitted: November 7, 2018)
Safety and tolerability [ Time Frame: 90 days ]
Adverse events
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE TRimetazidine for acUte on Chronic Liver Failure STudy
Official Title  ICMJE A Phase 1b Open-Label Study Assessing the Pharmacokinetics, Tolerability, and Safety of Oral Trimetazidine in Subjects With Acute-on-Chronic Liver Failure
Brief Summary The study will assess the pharmacokinetics (PK), tolerability, and safety of oral trimetazidine administered to subjects with AD (ACLF Grade 0) or with ACLF Grade 1 or 2.
Detailed Description

The study will assess the PK, tolerability, and safety of oral trimetazidine administered to subjects with acute-on-chronic (ACLF) Grades 1 and 2 with liver failure and a range of renal function. Subjects will receive up to 60 mg/day for 28 days.

Two groups of subjects will be enrolled:

Group 1

  • AD with serum creatinine ≥ 1 and < 2 mg/dL, OR
  • ACLF 1 with

    • liver failure and serum creatinine ≥ 1.5 and < 2 mg/dl, or
    • liver failure and West Haven grade 1-2 hepatic encephalopathy, or
    • coagulation failure and serum creatinine ≥ 1.5 and < 2 mg/dl, or
    • coagulation failure and West Haven grade 1-2 hepatic encephalopathy, OR
  • ACLF 2 with

    • liver failure and coagulation failure, or
    • liver failure and West Haven grade 3-4 hepatic encephalopathy.

Group 2

  • ACLF 1 with renal failure (serum creatinine ≥ 2.0 and < 3.5 mg/dL), OR
  • ACLF 2 with

    • liver failure and renal failure (serum creatinine ≥ 2.0 and < 3.5 mg/dL), or
    • coagulation failure and renal failure (serum creatinine ≥ 2.0 and < 3.5 mg/dL).
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 1
Study Design  ICMJE Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)
Primary Purpose: Other
Condition  ICMJE Acute-On-Chronic Liver Failure
Intervention  ICMJE Drug: Trimetazidine
Subjects with receive up to 60 mg daily
Study Arms  ICMJE
  • Experimental: Group 1
    • AD with serum creatinine ≥ 1 and < 2 mg/dL, OR
    • ACLF 1 with

      • liver failure and serum creatinine ≥ 1.5 and < 2 mg/dl, or
      • liver failure and West Haven grade 1-2 hepatic encephalopathy, or
      • coagulation failure and serum creatinine ≥ 1.5 and < 2 mg/dl, or
      • coagulation failure and West Haven grade 1-2 hepatic encephalopathy, OR
    • ACLF 2 with

      • liver failure and coagulation failure, or
      • liver failure and West Haven grade 3-4 hepatic encephalopathy.
    Intervention: Drug: Trimetazidine
  • Experimental: Group 2
    • ACLF 1 with renal failure (serum creatinine ≥ 2.0 and < 3.5 mg/dL), OR
    • ACLF 2 with

      • liver failure and renal failure (serum creatinine ≥ 2.0 and < 3.5 mg/dL), or
      • coagulation failure and renal failure (serum creatinine ≥ 2.0 and < 3.5 mg/dL).
    Intervention: Drug: Trimetazidine
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Suspended
Estimated Enrollment  ICMJE
 (submitted: November 7, 2018)
30
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE June 30, 2021
Estimated Primary Completion Date June 30, 2021   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  1. Age 18 to 75 years, inclusive, at screening.
  2. Stable diagnosis of AD, ACLF Grade 1 or ACLF Grade 2 for no less than 2 days (as determined at the discretion of the investigator)*.
  3. Anticipated duration of hospital stay of at least 7 days.
  4. For Group 1:

    • AD with SCr ≥ 1 and < 2 mg/dL, OR
    • ACLF 1 with

      • Tbil ≥ 12 mg/dL, SCr ≥ 1.5 and < 2 mg/dl, and HE 0-2, or
      • Tbil ≥ 12 mg/dL, and SCr < 1.5 mg/dL, and HE 1-2, or
      • INR ≥ 2.5, SCr ≥ 1.5 and < 2 mg/dl, and HE 0-2, or
      • INR ≥ 2.5, SCr < 1.5 mg/dL, and HE 1-2, OR
    • ACLF 2 with

      • Tbil ≥ 12 mg/dL, INR ≥ 2.5, and SCr < 2 mg/dL, or
      • Tbil ≥ 12 mg/dL, HE 3-4, and SCr < 2 mg/dL
  5. For Group 2:

    • ACLF 1 with SCr ≥ 2.0 and < 3.5 mg/dL, OR
    • ACLF 2 with

      • Tbil ≥ 12 mg/dL, and SCr ≥ 2 and < 3.5 mg/dL, or
      • INR ≥ 2.5, and SCr ≥ 2 and < 3.5 mg/dL.
  6. Female patients must be of non-childbearing potential, or, if non-sterile, must agree to sexual abstinence or use a highly effective method of contraception from Screening to 3 days after the final dose.
  7. Non sterile male patients must agree to sexual abstinence or use a highly effective method of contraception from Screening to 3 days after the final dose if sexually active.
  8. Able to comprehend and willing to sign an informed consent form, or, if unable to consent, consent is conducted per local requirements.

Exclusion Criteria:

  1. Diagnosis of AD or ACLF (of any grade) >14 days before enrollment*.
  2. Circulatory failure.
  3. Respiratory failure i.e. PaO2/FiO2 ≤ 200 and/or baseline SpO2/FiO2 ≤ 214.
  4. Brain failure (West Haven grade 3 or 4 hepatic encephalopathy) with coagulation failure (INR > 2.5).
  5. Gastrointestinal bleeding within 72 hours prior to enrollment. (Subjects who fail this criterion may qualify after 72 hours).
  6. Uncontrolled bacterial infection (urinary tract infection, spontaneous bacterial peritonitis, pneumonia, bacteremia, soft tissue infections, etc.) (as determined at the discretion of the investigator).
  7. Invasive fungal infection.
  8. Platelet count <30,000 cells/mL.
  9. White blood cell count <1000 cells/uL.
  10. Patients on hemodialysis or continuous venovenous hemofiltration.
  11. Patients who have undergone or are scheduled for imminent organ transplantation. (Patients may be on a transplant list as long as no date has been set for transplantation)
  12. Hospitalization for ACLF within the 3 months prior to screening.
  13. History of hepatocellular carcinoma, unless within Milan Criteria (up to 3 lesions each < 3 cm or 1 lesion < 5 cm; no extrahepatic involvement; no evidence of gross vascular invasion).
  14. Active non-hepatic malignancy.
  15. Parkinson's disease, Parkinsonian-type symptoms (gait disorder, tremor, etc.), restless leg syndrome or other movement disorders other than asterixis.
  16. Fulminant Wilson's, fulminant autoimmune hepatitis, or Budd-Chiari syndrome.
  17. Septic shock (hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mm Hg or greater and having a serum lactate level greater than 2 mmol/L (> 18 mg/dL) after adequate fluid resuscitation.
  18. Patients who have undergone placement of a transjugular intrahepatic portosystemic shunt (TIPS) or surgical shunt in the past 6 months.
  19. Any invasive procedure within 48 hours prior to enrollment with high risk of uncontrolled bleeding (as determined at the discretion of the investigator).
  20. Female with a positive pregnancy test or lactating.
  21. Positive results for human immunodeficiency virus HIV-1 or HIV-2.
  22. Current treatment with trimetazidine.
  23. Known allergy to trimetazidine or excipients.
  24. Currently receiving an investigational treatment.
  25. Any condition that, in the opinion of the Investigator (or designee), would limit the subject's ability to complete or participate in this clinical study.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 75 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE Austria,   Belgium,   France,   Germany,   Spain
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03737448
Other Study ID Numbers  ICMJE MP-0614-001
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Martin Pharmaceuticals
Study Sponsor  ICMJE Martin Pharmaceuticals
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Study Director: Chief Medical Officer Martin Pharmaceuticals
PRS Account Martin Pharmaceuticals
Verification Date March 2021

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP