Steroids in Fulminant Hepatitis A in the Pediatric Age Group

NCT ID: NCT02375867

Last Updated: 2018-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

33 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-01-31

Study Completion Date

2017-09-30

Brief Summary

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Fulminant hepatic failure (FHF) in children is a potentially devastating disease. The mortality rate may reach 80-90% in the absence of liver transplantation. Liver injury is considered to be mainly immune mediated with augmentation of cytolytic pathways of infected hepatocytes. For that, it is suggested that corticosteroids modulate the activity of the disease by suppressing the immune system.

Detailed Description

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Fulminant hepatic failure (FHF) in children is a potentially devastating disease. The mortality rate may reach 80-90% in the absence of liver transplantation. FHF is the clinical manifestation of liver cell death of a critical degree with insufficient hepatocellular regeneration and characterized by coagulopathy with or without hepatic encephalopathy.

Liver injury is considered to be mainly immune mediated with augmentation of cytolytic pathways of infected hepatocytes. For that, it was suggested that corticosteroids modulate the activity of the disease by suppressing the immune system.

Conditions

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Fulminant Hepatic Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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prednisolone

This group includes patients with FHF without encephalopathy

Group Type ACTIVE_COMPARATOR

prednisolone

Intervention Type DRUG

Oral administration of 1 mg/Kg/day

methylprednisolone

This group includes patients with FHF with encephalopathy

Group Type ACTIVE_COMPARATOR

methylprednisolone

Intervention Type DRUG

Intravenous injection of 0.8 mg/kg/day

Non-intervention

FHF patients without any of the proposed intervention as controls

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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prednisolone

Oral administration of 1 mg/Kg/day

Intervention Type DRUG

methylprednisolone

Intravenous injection of 0.8 mg/kg/day

Intervention Type DRUG

Other Intervention Names

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Hostacortin-H Solumedrol

Eligibility Criteria

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Inclusion Criteria

The patient is diagnosed to have FHF, if he fulfilled all the following criteria:

1. Evidence of liver dysfunction within 8 weeks of onset of symptoms (neonates may have only deranged liver functions without overt symptoms).
2. Uncorrectable coagulopathy (6-8 hours after administration of one dose of parenteral vitamin K) with International Normalized Ratio (INR) \>1.5 in patients with hepatic encephalopathy, or INR\> 2.0 in patients without encephalopathy.
3. No evidence of chronic liver disease.

Exclusion Criteria

1\. Presence of absolute contra-indications to steroid therapy (as presence of an active gastrointestinal bleeding, renal failure, acute pancreatitis, active tuberculosis, uncontrolled diabetes and psychosis).
Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Quesna Central Hospital, Ministry Of Health, Egypt

UNKNOWN

Sponsor Role collaborator

National Liver Institute, Egypt

OTHER

Sponsor Role lead

Responsible Party

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Mostafa M. Sira

Associate Professor of Pediatric Hepatology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hanaa El-Araby, M.D.

Role: PRINCIPAL_INVESTIGATOR

Pediatric Hepatology Department, National Liver Institute, Egypt

Mostafa M Sira, M.D.

Role: STUDY_DIRECTOR

Pediatric Hepatology Department, National Liver Institute, Egypt

Haydi M Zakaria, M.Sc.

Role: STUDY_CHAIR

Quesna Central Hospital, Ministry Of Health, Egypt

Tahany A Salem, M.Sc.

Role: STUDY_CHAIR

Pediatric Hepatology Department, National Liver Institute, Egypt

Locations

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National Liver Institute

Menoufia, Menoufia, Egypt

Site Status

Countries

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Egypt

References

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Cochran JB, Losek JD. Acute liver failure in children. Pediatr Emerg Care. 2007 Feb;23(2):129-35. doi: 10.1097/PEC.0b013e3180308f4b.

Reference Type BACKGROUND
PMID: 17351416 (View on PubMed)

Bernal W, Auzinger G, Dhawan A, Wendon J. Acute liver failure. Lancet. 2010 Jul 17;376(9736):190-201. doi: 10.1016/S0140-6736(10)60274-7.

Reference Type BACKGROUND
PMID: 20638564 (View on PubMed)

Fujiwara K, Kojima H, Yasui S, Okitsu K, Yonemitsu Y, Omata M, Yokosuka O. Hepatitis A viral load in relation to severity of the infection. J Med Virol. 2011 Feb;83(2):201-7. doi: 10.1002/jmv.21958.

Reference Type BACKGROUND
PMID: 21181913 (View on PubMed)

Fujiwara K, Yasui S, Yonemitsu Y, Fukai K, Arai M, Imazeki F, Suzuki A, Suzuki H, Sadahiro T, Oda S, Yokosuka O. Efficacy of combination therapy of antiviral and immunosuppressive drugs for the treatment of severe acute exacerbation of chronic hepatitis B. J Gastroenterol. 2008;43(9):711-9. doi: 10.1007/s00535-008-2222-5. Epub 2008 Sep 20.

Reference Type BACKGROUND
PMID: 18807133 (View on PubMed)

Lahuna O, Rastegar M, Maiter D, Thissen JP, Lemaigre FP, Rousseau GG. Involvement of STAT5 (signal transducer and activator of transcription 5) and HNF-4 (hepatocyte nuclear factor 4) in the transcriptional control of the hnf6 gene by growth hormone. Mol Endocrinol. 2000 Feb;14(2):285-94. doi: 10.1210/mend.14.2.0423.

Reference Type BACKGROUND
PMID: 10674400 (View on PubMed)

Seshadri R, Feldman BM, Ilowite N, Cawkwell G, Pachman LM. The role of aggressive corticosteroid therapy in patients with juvenile dermatomyositis: a propensity score analysis. Arthritis Rheum. 2008 Jul 15;59(7):989-95. doi: 10.1002/art.23829.

Reference Type BACKGROUND
PMID: 18576304 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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NLI-FHF-S-PED

Identifier Type: -

Identifier Source: org_study_id