Medical-economic Evaluation of the Care of Refractory Ascites by Implantation of Alfapump® Device in Cirrhotic Patients

NCT ID: NCT03506893

Last Updated: 2025-03-30

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

RECRUITING

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-07-17

Study Completion Date

2027-05-31

Brief Summary

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The hypothesis is that the Alfapump® strategy would be more effective in terms of QALYs generated , and that the cost of Alfapump® device and its implantation will be totally or partially offset by the reduction in the number of evacuating parentheses performed and the reduction in the number of complications in patients with refractory ascites awaiting liver transplantation or not. On the other hand, given the difference in the clinical profiles of these two populations (whether or not they are awaiting transplantation), these two populations will be study separately

Evaluation of the medical-economic impact at 1 year of the two therapeutic strategies: implantation of Alfapump® versus repeated evacuating paracentesis in cirrhotic patients with refractory ascites without scheduled liver transplantation.

Detailed Description

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Refractory ascites is one of the complications associated with portal hypertension in the cirrhotic patient. To date, its treatment consists of evacuating punctures, performed in day hospitalisation, whose frequency is adapted to the rate of ascites synthetis. Paracentesis, which does not affect the mechanisms of ascites formation, contributes to protein catabolism and undernutrition. They also have an inconvenience linked to the gesture, making frequent hospital stays necessary. For all these reasons, the patient's quality of life is diminished. The Alfapump® system is a new method for the treatment of refractory ascites. It is a completely internalized medical device, implanted under the skin, which mobilizes ascites from the peritoneal cavity to the bladder, where ascites is eliminated by urinary tract.

Conditions

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Ascites Paracentesis Cirrhosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Alphapump

Alfapump® device implantation under general anesthesia (30-45 minutes)

Group Type EXPERIMENTAL

Alphapump

Intervention Type DEVICE

Alfapump® device: a completely internalized medical device, implanted under the skin, which mobilizes ascites from the peritoneal cavity to the bladder where they are eliminated by the urinary tract.

Medical device marked CE, used in the indication provided for marking

Ascites puncture

Iterative paracentesis compensated for by albumin infusions in ambulatory care.

Group Type ACTIVE_COMPARATOR

Ascites puncture

Intervention Type PROCEDURE

Hospitalizations for evacuating ascites are performed at least twice a month and can be up to 2 times a week. A clinical and biological examination is carried out at each visit.

Interventions

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Alphapump

Alfapump® device: a completely internalized medical device, implanted under the skin, which mobilizes ascites from the peritoneal cavity to the bladder where they are eliminated by the urinary tract.

Medical device marked CE, used in the indication provided for marking

Intervention Type DEVICE

Ascites puncture

Hospitalizations for evacuating ascites are performed at least twice a month and can be up to 2 times a week. A clinical and biological examination is carried out at each visit.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patient with refractory ascites who has had a minimum of 5 paracentesis in the last 3 months.
* Patient with an estimated life expectancy of at least 6 months on the day of inclusion.
* Patient with contraindication to the application of a TIPS or who has expressed a refusal of the procedure or a non-functional TIPS
* Patient affiliated with or in receipt of social security
* Informed and written consent signed by the patient.

Exclusion Criteria

* Local or systemic infection in the month preceding the procedure
* Hepatocellular carcinoma with palliative care
* MELD Score \> 18
* Child Pugh C Score \> 10
* Creatinine Clearance \< 50 ml/mn
* Digestive hemorrhage or episode of hepatic encephalopathy within two weeks prior to device insertion
* Contraindication to general anesthesia
* Contraindication to implant surgery of the device:

* Obstructive urological impairment
* Partitioning of ascites
* Coagulopathy
* Persons referred to in Articles L1121-5 to L1121-8 of the CSP (corresponding to all protected persons: pregnant woman, parturient, breastfeeding mother, person deprived of liberty by judicial or administrative decision, person subject to a legal protection measure).
* Patient currently participating in other clinical research or who participated in a clinical trial within one month prior to inclusion.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Grenoble

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marie-Noelle HILLERET, MD

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Grenoble

Locations

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Amiens-Picardie University Hospital

Amiens, , France

Site Status RECRUITING

Chu Angers

Angers, , France

Site Status RECRUITING

Jean MINJOZ Univesity Hospital

Besançon, , France

Site Status RECRUITING

Haut-Lévêque Hospital

Bordeaux, , France

Site Status NOT_YET_RECRUITING

Beaujon Hospital

Clichy, , France

Site Status RECRUITING

Grenoble University Hospital

Grenoble, , France

Site Status RECRUITING

LA PITIE SALPETRIERE Univesity Hospital

Paris, , France

Site Status RECRUITING

Chu Poitiers

Poitiers, , France

Site Status NOT_YET_RECRUITING

Chu Pontchaillou

Rennes, , France

Site Status RECRUITING

Toulouse University Hospital

Toulouse, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Sandra DAVID-TCHOUDA, MD

Role: CONTACT

+33 476 76 71 86

Sandrine MASSICOT

Role: CONTACT

+33 476 76 88 60

Facility Contacts

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Eric NGUYEN-KHAC, MDPhD

Role: primary

Rachida FAHEM

Role: backup

+333 22 08 88 67

Frédéric OBERTI, MD PHD

Role: primary

Pierre CELEA

Role: backup

Thierry THEVENOT, MDPhD

Role: primary

Emilie MUEL

Role: backup

+333 81 66 84 96

Victor DE LEDINGHEN, MD PhD

Role: primary

Maude CHARBONNIER

Role: backup

+335 57 65 63 11

Claire FRANCOZ, MD

Role: primary

Vanessa ESNAULT

Role: backup

+33 140 87 50 64

Marie-Noelle HILLERET, MD

Role: primary

+334 76 76 62 57

Dominique THABUT, MDPHD

Role: primary

Florence BERGERON

Role: backup

Valentin ROLLE, MD PHD

Role: primary

Laetitia ROULEAU

Role: backup

Edouard BARDOU-JACQUET, MDPHD

Role: primary

0299284298

Solange SEGUIN

Role: backup

0299289889

Christophe BUREAU, MD PhD

Role: primary

+335 61 77 22 63

References

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Bellot P, Welker MW, Soriano G, von Schaewen M, Appenrodt B, Wiest R, Whittaker S, Tzonev R, Handshiev S, Verslype C, Moench C, Zeuzem S, Sauerbruch T, Guarner C, Schott E, Johnson N, Petrov A, Katzarov K, Nevens F, Zapater P, Such J. Automated low flow pump system for the treatment of refractory ascites: a multi-center safety and efficacy study. J Hepatol. 2013 May;58(5):922-7. doi: 10.1016/j.jhep.2012.12.020. Epub 2013 Jan 11.

Reference Type BACKGROUND
PMID: 23318604 (View on PubMed)

Bureau C, Adebayo D, Chalret de Rieu M, Elkrief L, Valla D, Peck-Radosavljevic M, McCune A, Vargas V, Simon-Talero M, Cordoba J, Angeli P, Rosi S, MacDonald S, Malago M, Stepanova M, Younossi ZM, Trepte C, Watson R, Borisenko O, Sun S, Inhaber N, Jalan R. Alfapump(R) system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study. J Hepatol. 2017 Nov;67(5):940-949. doi: 10.1016/j.jhep.2017.06.010. Epub 2017 Jun 21.

Reference Type BACKGROUND
PMID: 28645737 (View on PubMed)

Stirnimann G, Berg T, Spahr L, Zeuzem S, McPherson S, Lammert F, Storni F, Banz V, Babatz J, Vargas V, Geier A, Stallmach A, Engelmann C, Trepte C, Capel J, De Gottardi A. Treatment of refractory ascites with an automated low-flow ascites pump in patients with cirrhosis. Aliment Pharmacol Ther. 2017 Nov;46(10):981-991. doi: 10.1111/apt.14331. Epub 2017 Sep 21.

Reference Type BACKGROUND
PMID: 28940225 (View on PubMed)

Sola E, Sole C, Gines P. Management of uninfected and infected ascites in cirrhosis. Liver Int. 2016 Jan;36 Suppl 1:109-15. doi: 10.1111/liv.13015.

Reference Type BACKGROUND
PMID: 26725907 (View on PubMed)

Thomas MN, Sauter GH, Gerbes AL, Stangl M, Schiergens TS, Angele M, Werner J, Guba M. Automated low flow pump system for the treatment of refractory ascites: a single-center experience. Langenbecks Arch Surg. 2015 Dec;400(8):979-83. doi: 10.1007/s00423-015-1356-1. Epub 2015 Nov 13.

Reference Type BACKGROUND
PMID: 26566989 (View on PubMed)

Stepanova M, Nader F, Bureau C, Adebayo D, Elkrief L, Valla D, Peck-Radosavljevic M, McCune A, Vargas V, Simon-Talero M, Cordoba J, Angeli P, Rossi S, MacDonald S, Capel J, Jalan R, Younossi ZM. Patients with refractory ascites treated with alfapump(R) system have better health-related quality of life as compared to those treated with large volume paracentesis: the results of a multicenter randomized controlled study. Qual Life Res. 2018 Jun;27(6):1513-1520. doi: 10.1007/s11136-018-1813-8. Epub 2018 Feb 19.

Reference Type BACKGROUND
PMID: 29460201 (View on PubMed)

Other Identifiers

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38RC17.109

Identifier Type: -

Identifier Source: org_study_id

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