Nitazoxanide Plus Lactulose Versus Lactulose Alone Treatment of Hepatic Encephalopathy

NCT ID: NCT02464124

Last Updated: 2017-08-21

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

UNKNOWN

Clinical Phase

PHASE2/PHASE3

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-01-31

Study Completion Date

2017-12-31

Brief Summary

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Hepatic encephalopathy (HE) is a reversible neuropsychiatric syndrome associated with chronic and acute liver dysfunction. It is characterized by cognitive and motor deficits of varying severity.

Treatment options include lactulose administered orally or by nasogastric tube or enema, non-absorbable antibiotics, and protein-restricted diets.

Nitazoxanide is an oral agent indicated for the treatment of infectious diarrhea caused by Crytpsporidiumparvum and Giardia lamblia. Basu and colleagues presented a pilot prospective study at the 2008 American Association for the Study of Liver Diseases meeting showing clinical improvement in HE among cirrhotic patients who received nitazoxanide and lactulose.

Detailed Description

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Hepatic encephalopathy (HE) is a reversible neuropsychiatric syndrome associated with chronic and acute liver dysfunction. It is characterized by cognitive and motor deficits of varying severity.

Hepatic encephalopathy is caused by accumulation of nitrogenous substances, primarily ammonia, in the blood. In advanced stages it is referred to as hepatic coma which may be preceded by seizures. The treatment goal is to reduce nitrogen load from the GI tract and to improve central nervous system (CNS) status.

Treatment options include lactulose administered orally or by nasogastric tube or enema, non-absorbable antibiotics, and protein-restricted diets.

Lactulose is nonabsorbable disaccharides that are currently used as first line agents for the treatment of HE. Its action is thought to beconversion to lactic acid and acetic acid resulting in acidification of the gut lumen. This favors conversion of ammonia (NH3) to ammonium (NH4+), which is relatively membrane impermeable, and inhibits ammoniagenic coliform bacteria.

Nitazoxanide is an oral agent indicated for the treatment of infectious diarrhea caused by Crytpsporidiumparvum and Giardia lamblia. Basu and colleagues presented a pilot prospective study at the 2008 American Association for the Study of Liver Diseases meeting showing clinical improvement in HE among cirrhotic patients who received nitazoxanide and lactulose.

Mantry and colleagues showed that the number of hospitalizations and the duration of hospital stays were shortened for patients receiving combination therapy compared with those receiving lactulose monotherapy.

Conditions

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Encephalopathy, Hepatic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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lactulose plus nitazoxanide

* Nitazoxanide dosing: 500 mg tablets twice daily
* Lactulose dosing: 30-60 mL PO TID with goal 2-3 semisoft stools per day

Group Type EXPERIMENTAL

Nitazoxanide

Intervention Type DRUG

• Nitazoxanide dosing: 500 mg tablets twice daily

Lactulose

Intervention Type DRUG

• Lactulose dosing: 30-60 mL PO TID with goal 2-3 semisoft stools per day

Lactulose alone

Lactulose dosing: 30-60 mL PO TID with goal 2-3 semisoft stools per day

Group Type ACTIVE_COMPARATOR

Lactulose

Intervention Type DRUG

• Lactulose dosing: 30-60 mL PO TID with goal 2-3 semisoft stools per day

Interventions

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Nitazoxanide

• Nitazoxanide dosing: 500 mg tablets twice daily

Intervention Type DRUG

Lactulose

• Lactulose dosing: 30-60 mL PO TID with goal 2-3 semisoft stools per day

Intervention Type DRUG

Other Intervention Names

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Alenia, Nitclean, Parazoxanide Laxolac, Duphlac

Eligibility Criteria

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Inclusion Criteria

Age 18-70 years

Cirrhosis, defined by a combination of any of the following:

* Laboratory findings
* Endoscopic results
* Ultrasound
* Histology Overt hepatic encephalopathy

Exclusion Criteria

* • Creatinine\>1.5 mg/dl

* Alcohol use within prior 4 weeks
* Non-hepatic metabolic encephalopathy
* Hepatocellular carcinoma
* Degenerative CNS disease
* Any significant psychiatric illness or other medical comorbidity
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Tanta University

OTHER

Sponsor Role collaborator

Sherief Abd-Elsalam

OTHER

Sponsor Role lead

Responsible Party

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Sherief Abd-Elsalam

sponsor investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Asem Elfert, Prof

Role: PRINCIPAL_INVESTIGATOR

hepatology dept-Tanta

Sherief Abd-Elsalam, lecturer

Role: STUDY_DIRECTOR

hepatology dept-Tanta

Samah Soliman, lecturer

Role: STUDY_CHAIR

hepatology dept-Tanta

Walaa elkhalawany, lecturer

Role: STUDY_CHAIR

hepatology dept-Tanta

Rehab elsheshtawi, lecturer

Role: STUDY_CHAIR

hepatology dept-Tanta

Mennat-Allah Elsawaf, lecturer

Role: STUDY_CHAIR

hepatology dept-Tanta

Locations

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Tanta university - faculty of medicine

Tanta, Elgharbia, Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Sherief Abd-elsalam, lecturer

Role: CONTACT

00201095159522

Sherief Abd-elsalam, lecturer

Role: CONTACT

00201095159522

Facility Contacts

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Sherief Abdelsalam, lecturer

Role: primary

00201095159522

Other Identifiers

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Hepatic encephalopathy

Identifier Type: -

Identifier Source: org_study_id

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