Efficacy of L-Ornithine L-Aspartate and Polyethylene Glycol in Cirrhotic Patients With Overt Hepatic Encephalopathy

NCT ID: NCT05920213

Last Updated: 2023-07-13

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

PHASE4

Total Enrollment

360 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-10-31

Study Completion Date

2024-04-30

Brief Summary

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The goal of this clinical trial is to compare the efficacy of L-ornithine L-aspartate and Polyethylene Glycol in Cirrhotic Patients with Overt Hepatic Encephalopathy.

Participants will be asked to fill out a few questions on proforma that will obtain demographic information as well as information relating to the patient's health. Treatments that they will receive after inclusion in the study, will be the standard treatment (Lactulose) along with additional medication as part of our research (LOLA or Polyethylene glycol).

Detailed Description

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This is a randomized control trial with the following objectives

* what is the efficacy of add-on LOLA therapy in patients of overt HE (Grade II and above) against the standard-of-care arm
* what is the efficacy of adding on polyethylene glycol (PEG) in overt HE (Grade II and above) against the standard-of-care arm

Randomization will be done using card randomization. three different color-coded cards will be kept. Any card will be randomly picked for the patient fulfilling inclusion criteria and will be treated according to the allocated treatment arm mentioned on the card

Patients will be diagnosed on the basis of Modified West Haven Criteria. For diagnosis and prognosis, the following tools will be used:

* Modified West Haven criteria and Glasgow coma scale will be used to assess the mental state.
* CLIF-C ADs and CLIF SOFA score will be used as a prognostic score for predicting mortality in hospitalized patients.
* Overt HE patients will be graded using the Hepatic encephalopathy grading instrument (HEGI).
* Child-Pugh classification and MELD scoring will be used to assess the severity of chronic liver disease and cirrhosis.

Written informed consent will be obtained from the immediate attendant of the patient. All ethical considerations will be followed.

Our research has been approved by Jinnah Sindh Medical University, Karachi. For this approval, the investigators have made every effort to ensure the confidentiality of research data collected from all our participants in this survey. The information collected will be stored with the investigators only in the form of de-identified information and will be retained in a secure place under lock and key. Any results that will be generated will be presented on a collective basis, and will not contain the participant's name or any other personal details.

Data entry and analysis will be done using SPSS Software version 23. Study analysis will be done using the principle of intention to treat. Primary and secondary outcomes will be studied among intervention and standard-of-care groups at a Confidence Interval of 95%. The chi-square test will be used to find the association of independent variables like age, gender, and HE grades with interventional therapies. Independent t-test will be used to compare mean scores between groups.

Conditions

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Hepatic Encephalopathy Stage 2 Hepatic Encephalopathy Stage 3 Hepatic Encephalopathy Stage 4

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
participants' attendants will also be masked and will give consent for the study in case the participant is admitted to the Intensive care unit and is not mentally stable to give consent.

Study Groups

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Lactulose AND LOLA

Lactulose which is the standard of care treatment will be administered with the experimental drug L-ornithine L-aspartate (LOLA).

Group Type EXPERIMENTAL

Lactulose oral solution

Intervention Type DRUG

60-120 ml per day for 5 days

L-ornithine L-aspartate

Intervention Type DRUG

30g/24 hours in 3 divided doses for 5 days

Lactulose and PEG

Lactulose which is the standard of care treatment will be administered with the experimental drug polyethylene glycol (PEG).

Group Type EXPERIMENTAL

Polyethylene Glycols

Intervention Type DRUG

280g/ 24 hours for 5 days

Lactulose oral solution

Intervention Type DRUG

60-120 ml per day for 5 days

Lactulose

This group will receive Lactulose only which is the standard of care treatment.

Group Type ACTIVE_COMPARATOR

Lactulose oral solution

Intervention Type DRUG

60-120 ml per day for 5 days

Interventions

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Polyethylene Glycols

280g/ 24 hours for 5 days

Intervention Type DRUG

Lactulose oral solution

60-120 ml per day for 5 days

Intervention Type DRUG

L-ornithine L-aspartate

30g/24 hours in 3 divided doses for 5 days

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Admitted cirrhotic patients above 18 years of age,
* diagnosed on clinical/ultrasound findings with HE (grade 2 or above) with or without precipitating factors.

Exclusion Criteria

* Patients with hepatocellular carcinoma
* severe septicemia,
* active upper gastrointestinal bleeding and in a state of shock
* presence of underlying chronic renal failure (serum creatinine \>1.5 mg/dl)
* presence of hepatorenal syndrome
* neurodegenerative disease
* patients with a head injury and drug intoxication
* acute superimposed liver injury
* advanced cardiac or pulmonary derangements
* end-stage renal disease
* pregnant or breastfeeding mothers
* patients who are on sedatives, antidepressants, or benzodiazepines
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Jinnah Postgraduate Medical Centre

OTHER_GOV

Sponsor Role lead

Responsible Party

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ZA

Associate professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Bolan Medical Complex Hospital

Quetta, Balochistan, Pakistan

Site Status

Sheikh Khalifa bin Zayed

Quetta, Balochistan, Pakistan

Site Status

Nishtar Medical Univeristy and Hospital

Multan, Punjab Province, Pakistan

Site Status

Sheikh Zayed Medical College/Hospital

Rahim Yar Khan, Punjab Province, Pakistan

Site Status

Medical ICU, Jinnah Postgraduate Medical Centre

Karachi, Sindh, Pakistan

Site Status

CMC hospital

Larkana, Sindh, Pakistan

Site Status

Countries

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Pakistan

Central Contacts

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Zeeshan Ali, FCPS

Role: CONTACT

+923211000393

Shamim Kausar, FCPS

Role: CONTACT

+923343093627

Facility Contacts

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Farhana Kayani, FCPS

Role: primary

+923323113852

Farhana Kayani, FCPS

Role: primary

+92-3323113852

Yasir Zaidi, FCPS

Role: primary

+923216332060

Muhammad Israr-ul-Haq, FCPS

Role: primary

+923332302984

Ali Haider Mugheri, FCPS

Role: primary

+923334368045

Other Identifiers

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JSMU/IRB/2022/673

Identifier Type: -

Identifier Source: org_study_id

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