Terlipressin Infusion in Variceal Hemorrhage (TT)

Aga Khan University

Status and phase: Unknown; Phase 3

Conditions: Terlipressin Adverse Reaction

Treatments: Drug: Terlipressin Injectable Product

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT04028505

5209-Med-ERC-18

Details and patient eligibility

About

Randomized, open label study of intravenous terlipressin infusion vs. bolus for the treatment of variceal hemorrhage. 24 hour regimen consisting of intravenous terlipressin will be used either at a rate of 0.5mg/hour or 2mg bolus every 4 hourly. Participants will be randomized into intervention and control arm using block randomization by computer generated random numbers. Efficacy will be assessed by clinical improvement in symptoms and signs of GI bleed. To assess safety, frequency and degree of adverse reactions will be observed. Periodic assessments until 5 days will be done consisting of physical examination, safety assessments, vital signs and lab tests.

Full description

Randomized, open label trial, conducted on patients admitted with acute variceal hemorrhage at The Aga Khan University Hospital, Karachi (AKUH). Patients will be followed in clinic after discharge to assess survival for 6 weeks.

Intravenous terlipressin will be obtained from Clinical Trials Unit, AKUH pharmacy in standard IV infusion form. Following complete clinical and laboratory evaluation, assessing the patient for eligibility, informed consent will be obtained from all the participants who are willing to be part of this study. After obtaining the informed consent, study participants will be randomized into the intervention arm (continuous infusion of Terlipressin) or the control arm (bolus form of Terlipressin). Participants who are randomized to the intervention arm will be administered a continuous infusion of Terlipressin at a rate of 0.5mg/hour for the first 24 hours. Participants randomized into the control group will be administered a bolus form of Terlipressin at a rate of 2mg every six hourly for the first 24 hours respectively. In case of weekends/public holidays intravenous terlipressin will be obtained from the main pharmacy of AKUH.

The trial will be conducted in in-patient units of AKUH where eligible patients are admitted. It may include emergency room, special care unit and general ward. Moreover, patients will be followed up by phone calls and in outpatient's clinics to assess survival six weeks post discharge.

Enrollment: 128 estimated patients

Sex: All

Ages: 18 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Age between 18 to 60 years
2. Either gender
3. A diagnosis of liver cirrhosis;
4. Initial presentation with acute gastroesophageal variceal bleeding
5. Willing to provide informed consent to participate in the study (by study subject or next of kin)

Exclusion criteria

1. Age < 18 or > 60 years
2. Not willing to provide consent due to any reason
3. No liver cirrhosis
4. Acute upper gastrointestinal bleeding unrelated to varices;
5. Use of somatostatin or octreotide.
6. Hepatocellular Carcinoma (HCC)outside Milan's criteria
7. Advance cardiovascular, pulmonary or renal disease (e.g. asthma, hypertension, arrhythmia, renal insufficiency)
8. History of hypersensitivity to Terlipressin
9. Pregnancy
10. Patients already admitted at AKUH who develop upper GI bleed during admission.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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128 participants in 2 patient groups

Terlipressin Continuous Infusion

Experimental group

Description:

Standard of care being given at AKUH + Continuous infusion of Terlipressin (Terlipressin Injectable Product) at a rate of 0.5mg/hour for the first 24 hours

Treatment:

Drug: Terlipressin Injectable Product

Terlipressin Bolus Infusion

Active Comparator group

Description:

Standard of care being given at AKUH + Bolus infusion of Terlipressin (Terlipressin Injectable Product) at a frequency of 2mg every six hourly for first 24 hours

Treatment:

Drug: Terlipressin Injectable Product