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Trial registered on ANZCTR
Registration number
ACTRN12612001026819
Ethics application status
Approved
Date submitted
19/09/2012
Date registered
24/09/2012
Date last updated
24/09/2012
Type of registration
Prospectively registered
Titles & IDs
Public title
Bacterial translocation and amelioration of liver cell damage in response to treatment with propranolol, with or without rifaximin, in patients with cirrhosis and portal hypertension
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Scientific title
Bacterial translocation and amelioration of liver cell damage in response to treatment with propranolol, with or without rifaximin, in patients with cirrhosis and portal hypertension
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Secondary ID [1]
281259
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Nil
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Universal Trial Number (UTN)
U1111-1134-8680
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Cirrhosis and portal hypertension
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Condition category
Condition code
Oral and Gastrointestinal
287793
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0
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Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
All patients will be treated with oral propranolol, 40 mg thrice daily for 28 days. In patients in whom a satisfactory reduction in portal venous hypertension is not achieved at this time point, propranolol will be continued at unchanged dose and oral rifaximin, 550 mg twice daily will be added for 28 days. Patients in whom propranolol is either contraindicated or not tolerated will be treated with oral rifaximin monotherapy, 550 mg twice daily for 28 days.
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Intervention code [1]
285730
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Treatment: Drugs
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Comparator / control treatment
Results in individual patients after intervention with propranolol, propranolol + rifaximin or rifaximin alone (as described above) will be compared to results in individual patients prior to intervention (standard care). Patients thus act as their own control. There is no placebo-treted group in this study.
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Control group
Active
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Outcomes
Primary outcome [1]
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Portal venous pressure, as assessed by direct measurement of the hepatic venous pressure gradient
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Assessment method [1]
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Timepoint [1]
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Baseline, after 28 days of propranolol and, when reduction in portal venous hypertension is inadequate, after 28 days of combined propranolol and rifaximin.
Patients intolerant of or with contraindications to propranolol will be studied at baseline and after 28 days of rifaximin monotherapy.
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Secondary outcome [1]
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Bacterial translocation/liver cell function, as assessmed by analysis of peripheral blood for bacterial DNA, innate immune activity and standard liver function tests.
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Assessment method [1]
299285
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Timepoint [1]
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Baseline, after 28 days of propranolol and, when reduction in portal venous hypertension is inadequate, after 28 days of combined propranolol and rifaximin.
Patients intolerant of or with contraindications to propranolol will be studied at baseline and after 28 days of rifaximin monotherapy.
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Eligibility
Key inclusion criteria
Cirrhosis
Portal hypertension
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Minimum age
18
Years
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Maximum age
70
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Propranolol treatment in the previous three months
Antibiotic treatment within the previous three months
Hepatocellular carcinoma
Inability to give informed consent
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
This is a non-randomised study
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Other
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Other design features
Active.
Patients will receive current standard of care, including oral propranolol 40 mg thrice daily. If therapeutic response is suboptimal (as described above), oral rifaximin will be added. Patients with contraindications to or intolerant of oral propranolol will be treated with oral rifaximin alone.
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Phase
Phase 2
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/10/2012
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
50
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Professor Stephen Riordan
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Address [1]
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Gastrointestinal and Liver Unit
Prince of Wales Hospital
Barker Street
Randwick NSW 2031
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Professor Stephen Riordan
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Address
Gastrointestinal and Liver Unit
Prince of Wales Hospital
Barker Street
Randwick NSW 2031
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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N/A
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Address [1]
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N/A
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Country [1]
284843
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Other collaborator category [1]
277078
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Individual
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Name [1]
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Professor Denis Wakefield
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Address [1]
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University of New South Wales
Kensington NSW 2052
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Country [1]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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South Eastern Sydney Local Health District
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Ethics committee address [1]
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Edmund Blacket Building Prince of Wales Hospital Cnr High and Avoca Streets Randwick NSW 2031
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
288077
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Approval date [1]
288077
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Ethics approval number [1]
288077
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Summary
Brief summary
Measurement of the hepatic venous pressure gradient is performed in patients with cirrhosis to assess for portal hypertension and monitor effectiveness of portal venous pressure-lowering therapies. These include treatment with the non-selective beta-blocker, propranolol, while the broad-spectrum antibiotic, rifaximin, has also been shown to be effective. Whether these treatments to reduce portal venous hypertension in patients with cirrhosis are also associated with reduced bacterial translocation from the intestine and whether reduced bacterial translocation, in turn, results in amelioration of liver dameg are currently unknown. The aim of this study is to meaure markers of bacterial translocation and liver damage in patients with portal venous hypertension complicating cirrhosis who are undergoing hepatic venous pressure gradient measurement at baseline and after four weeks of propranolol therapy. Should the portal venous pressure not be improved satisfactorily after treatment with propranolol alone, then rifaximin will be added and the portal venous pressure and markers of bacterial translocation and liver damage will be reassessed after a further 28 days. Patients intolerant of or with contraindications to propranolol will be studied at baseline and after 28 days of rifaximin monotherapy.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Professor Stephen Riordan
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Address
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Gastrointestinal and Liver Unit
Prince of Wales Hospital
Barker Street
Randwick NSW 2031
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Country
17980
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Australia
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Phone
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+ 61 2 9382 3100
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Fax
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Email
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Stephen.Riordan@@SESIAHS.HEALTH.NSW.GOV.AU
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Contact person for scientific queries
Name
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Professor Stephen Riordan
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Address
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Gastrointestinal and Liver Unit
Prince of Wales Hospital
Barker Street
Randwick NSW 2031
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Country
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Australia
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Phone
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+ 61 2 9382 3100
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Fax
8908
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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