Glucocorticoids for Acute Drug Induced Liver Injury With Hyperbilirubinemia

NCT ID: NCT06922669

Last Updated: 2025-12-18

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

232 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-06-24

Study Completion Date

2027-09-30

Brief Summary

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Drug-induced liver injury (DILI) can lead to potentially fatal complications, such as acute liver failure and even death. In clinical practice, glucocorticoids have been considered in some cases of DILI, especially patients with hyperbilirubinemia. However, the available evidence remains controversial and its quality is also very limited. Herein, a multicenter randomized controlled trial (RCT) has been designed to explore the efficacy and safety of glucocorticoids in patients with acute DILI and hyperbilirubinemia.

Detailed Description

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Overall, 232 patients with acute DILI with hyperbilirubinemia will be enrolled. They will be randomly assigned at a ratio of 1:1 to the conventional treatment alone or combined with glucocorticoids groups. The primary endpoint is the improvement of DILI after treatment on second week. Secondary endpoints include the improvement of DILI on fourth week, rates of progressive liver injury, liver failure, liver transplantation, survival, and adverse events. Exploratory endpoints will assess the beneficial population and changes of inflammatory factors following glucocorticoid treatment.

Conditions

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Drug Induced Liver Injury

Keywords

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Drug induced liver injury liver failure glucocorticoids clinical trial Hyperbilirubinemia

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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Glucocorticoids group

Glucocorticoids step-down therapy combined with conventional treatment.

Group Type EXPERIMENTAL

Methylprednisolone

Intervention Type DRUG

Initially, an intravenous dose of 1 mg/kg/day of methylprednisolone will be administered for one week, with the possibility of extending treatment to two weeks if necessary. Following this, participants will receive oral methylprednisolone tablets, starting at a dose of 40 mg/day. The oral dosage will be gradually tapered based on the participants' condition over a period of 1 to 3 months.

Magnesium isoglycyrrhizinate

Intervention Type DRUG

It is suitable for patients with hepatocellular or mixed DILI. A daily dose of 0.15g to 0.2g

Glutathione

Intervention Type DRUG

It is suitable for patients with hepatocellular or mixed DILI. A daily dose of 1.2g to 1.8g

Silymarin

Intervention Type DRUG

It is suitable for patients with hepatocellular or mixed DILI. The dosage is 140 mg, taken 2 to 3 times per day.

Polyene Phosphatidylcholine

Intervention Type DRUG

It is suitable for patients with hepatocellular or mixed DILI. The dosage is 228mg-456mg, taken 3 times per day.

Ursodeoxycholic acid capsules

Intervention Type DRUG

It is suitable for patients with cholestatic or mixed DILI. A daily dose of 10mg-15mg/kg/day.

Ademetionine 1,4-Butanedisulfonate

Intervention Type DRUG

It is suitable for patients with cholestatic or mixed DILI. A daily dose of 0.5g to 1g.

Plaslna exchange

Intervention Type PROCEDURE

It is suitable for patients whose condition continues to worsen or even develop to liver failure.

Liver transplantation

Intervention Type PROCEDURE

It is suitable for patients whose condition continues to worsen or even develop to liver failure.

Conventional treatment

Only conventional treatment according to the Chinese practice guidelines regarding the management of DILI.

Group Type ACTIVE_COMPARATOR

Magnesium isoglycyrrhizinate

Intervention Type DRUG

It is suitable for patients with hepatocellular or mixed DILI. A daily dose of 0.15g to 0.2g

Glutathione

Intervention Type DRUG

It is suitable for patients with hepatocellular or mixed DILI. A daily dose of 1.2g to 1.8g

Silymarin

Intervention Type DRUG

It is suitable for patients with hepatocellular or mixed DILI. The dosage is 140 mg, taken 2 to 3 times per day.

Polyene Phosphatidylcholine

Intervention Type DRUG

It is suitable for patients with hepatocellular or mixed DILI. The dosage is 228mg-456mg, taken 3 times per day.

Ursodeoxycholic acid capsules

Intervention Type DRUG

It is suitable for patients with cholestatic or mixed DILI. A daily dose of 10mg-15mg/kg/day.

Ademetionine 1,4-Butanedisulfonate

Intervention Type DRUG

It is suitable for patients with cholestatic or mixed DILI. A daily dose of 0.5g to 1g.

Plaslna exchange

Intervention Type PROCEDURE

It is suitable for patients whose condition continues to worsen or even develop to liver failure.

Liver transplantation

Intervention Type PROCEDURE

It is suitable for patients whose condition continues to worsen or even develop to liver failure.

Interventions

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Methylprednisolone

Initially, an intravenous dose of 1 mg/kg/day of methylprednisolone will be administered for one week, with the possibility of extending treatment to two weeks if necessary. Following this, participants will receive oral methylprednisolone tablets, starting at a dose of 40 mg/day. The oral dosage will be gradually tapered based on the participants' condition over a period of 1 to 3 months.

Intervention Type DRUG

Magnesium isoglycyrrhizinate

It is suitable for patients with hepatocellular or mixed DILI. A daily dose of 0.15g to 0.2g

Intervention Type DRUG

Glutathione

It is suitable for patients with hepatocellular or mixed DILI. A daily dose of 1.2g to 1.8g

Intervention Type DRUG

Silymarin

It is suitable for patients with hepatocellular or mixed DILI. The dosage is 140 mg, taken 2 to 3 times per day.

Intervention Type DRUG

Polyene Phosphatidylcholine

It is suitable for patients with hepatocellular or mixed DILI. The dosage is 228mg-456mg, taken 3 times per day.

Intervention Type DRUG

Ursodeoxycholic acid capsules

It is suitable for patients with cholestatic or mixed DILI. A daily dose of 10mg-15mg/kg/day.

Intervention Type DRUG

Ademetionine 1,4-Butanedisulfonate

It is suitable for patients with cholestatic or mixed DILI. A daily dose of 0.5g to 1g.

Intervention Type DRUG

Plaslna exchange

It is suitable for patients whose condition continues to worsen or even develop to liver failure.

Intervention Type PROCEDURE

Liver transplantation

It is suitable for patients whose condition continues to worsen or even develop to liver failure.

Intervention Type PROCEDURE

Other Intervention Names

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Medrol Legalon Essentiale Ursofalk Transmeti Artificial liver support

Eligibility Criteria

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Inclusion Criteria

* A definite diagnosis of acute DILI;
* 5×ULN ≤ TBIL level at baseline ≤ 20×ULN;
* Age 18-80 years old;
* Sign the informed consent form.

Exclusion Criteria

* Other causes of liver injury, including viral hepatitis, cytomegalovirus infection, Epstein-Barr virus infection, Herpes virus infection, autoimmune liver disease, alcoholic liver disease, hypoxic/ischemic liver disease, Budd-Chiari syndrome, biliary tract disease, Wilson's disease, hemochromatosis, and α1-antitrypsin deficiency;
* Immune checkpoint inhibitors or gynura segetum induced DILI;
* Absolute contraindications to glucocorticoids, such as systemic mold infections or allergies;
* A history of glucocorticoid therapy within 3 months before enrollment;
* A history of diseases requiring glucocorticoid maintenance therapy, such as rheumatoid arthritis, systemic lupus erythematosus, systemic dermatomyositis, etc;
* A history of liver transplantation;
* Received artificial liver therapy before enrollment;
* Malignant tumor of the liver, bile duct, pancreas or liver metastasis
* Acute liver failure;
* Renal dysfunction, creatinine Cr≥133μmol/L;
* Neutrophil count \<1,000,000,000/L;
* Active tuberculosis;
* Severe cardiopulmonary diseases;
* Recent surgery or trauma;
* Mental illness;
* Pregnancy or lactation;
* Participated in other clinical studies within 3 months before enrollment;
* Other conditions judged by the clinician to be inappropriate for study participation.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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General Hospital of Shenyang Military Region

OTHER

Sponsor Role lead

Responsible Party

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Xingshun Qi

Director of Department of Gastroenterology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Xingshun Qi

Role: PRINCIPAL_INVESTIGATOR

Department of Gastroenterology, General Hospital of Northern Theater Command

Weifen Xie

Role: PRINCIPAL_INVESTIGATOR

Shanghai changzheng hospital, Naval Medical University

Xin Zeng

Role: PRINCIPAL_INVESTIGATOR

Shanghai East Hospital,Tongji University School of Medicine

Lu Zhou

Role: PRINCIPAL_INVESTIGATOR

General Hospital, Tianjin Medical University

Fengmei Wang

Role: PRINCIPAL_INVESTIGATOR

Tianjin First Central Hospital

Qing Ye

Role: PRINCIPAL_INVESTIGATOR

Tianjin Third Central Hospital

Yanjing Gao

Role: PRINCIPAL_INVESTIGATOR

Qilu Hospital of Shandong University

Locations

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Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area)

Shenyang, Liaoning, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Xingshun Qi

Role: CONTACT

Phone: 18909881019

Email: [email protected]

Qianqian Li

Role: CONTACT

Phone: 13940307473

Email: [email protected]

Facility Contacts

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Xingshun Qi

Role: primary

Qianqian Li

Role: backup

References

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Hou FQ, Zeng Z, Wang GQ. Hospital admissions for drug-induced liver injury: clinical features, therapy, and outcomes. Cell Biochem Biophys. 2012 Nov;64(2):77-83. doi: 10.1007/s12013-012-9373-y.

Reference Type RESULT
PMID: 22806342 (View on PubMed)

Hu PF, Wang PQ, Chen H, Hu XF, Xie QP, Shi J, Lin L, Xie WF. Beneficial effect of corticosteroids for patients with severe drug-induced liver injury. J Dig Dis. 2016 Sep;17(9):618-627. doi: 10.1111/1751-2980.12383.

Reference Type RESULT
PMID: 27426618 (View on PubMed)

Chai L, Wang R, Teschke R, Jin S, Deng J, Qi X. Successful corticosteroid therapy for severe liver injury secondary to herbal traditional Chinese medicine, Mega Defends X, assessed for causality by the updated RUCAM: A case report. Medicine (Baltimore). 2024 Aug 23;103(34):e39439. doi: 10.1097/MD.0000000000039439.

Reference Type RESULT
PMID: 39183394 (View on PubMed)

Mao Y, Ma S, Liu C, Liu X, Su M, Li D, Li Y, Chen G, Chen J, Chen J, Zhao J, Guo X, Tang J, Zhuge Y, Xie Q, Xie W, Lai R, Cai D, Cai Q, Zhi Y, Li X; Technology Committee on DILI Prevention, Management, Chinese Medical Biotechnology Association; Study Group on Drug-Induced Liver Disease, Chinese Society of Hepatology, Chinese Medical Association. Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update. Hepatol Int. 2024 Apr;18(2):384-419. doi: 10.1007/s12072-023-10633-7. Epub 2024 Feb 24.

Reference Type RESULT
PMID: 38402364 (View on PubMed)

Other Identifiers

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XHNKKY-ASDILI-RCT

Identifier Type: -

Identifier Source: org_study_id