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Cirrhosis Due to Hepatitis BPhase 3CABERNCT04543643

Endoscopic and Microbiological Assessment of the Effect of Carvedilol Combined With Berberine on GOV in Cirrhosis

A Phase 3 study testing Carvedilol and Berberine in people with Cirrhosis Due to Hepatitis B and Cirrhosis Due to Hepatitis C, run by Tianjin Second People's Hospital at 1 site in China.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Carvedilol has been shown to be more potent in decreasing portal hypertension to propranolol. A lot of studies have shown that the imbalance of flora and the progress of portal hypertension are mutually causal. Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Carvedilol and Berberine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
288 participants
Where
1 siteChina
Study dates
1 Nov 2021to 31 Oct 2023
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • HBV-related or/and HCV-related liver cirrhotic patients based on pathology or clinical diagnosis;
  • Antiviral therapy;
  • Male or Female;
  • ES showed the presence of esophageal and gastric varices and / or red signs;
  • Child-Pugh < 10, and meld < 29;
  • Signature of informed consent.

Who cannot join

  • • Used antibiotics, prebiotics, probiotics and proton pump inhibitors within 2 weeks;
  • Any contra-indications to beta-blockers including asthma, chronic obstructive pulmonary disease, allergic rhinitis, NYHA (New York Heart Association) class IV heart failure, atrioventricular block, sinus bradycardia (HR < 50 / min), cardiogenic shock, hypotension (SBP < 85mmHg), sick sinus syndrome, insulin dependent diabetes, peripheral vascular disease;
  • Unstable high blood pressure and long-term engagement in driving;
  • Any malignancy that affects survival, excluding the cured;
  • Patients with portal thrombosis;
  • PT extension greater than 4 seconds, PLT<30×10^9/L;
Show all 13Show fewer
  • Pregnant and lactating patients;
  • History of surgery for portal hypertension;History of prior EVL (endoscopic variceal ligation) or sclerotherapy, history of surgery for portal hypertension including portosystemic shunts, disconnection and spleen resection and transjugular intrahepatic portosystemic shunt;
  • Patients with severe diseases of vital organs such as heart, lung, kidney, brain, blood and nervous system;
  • Allergic to carvedilol and berberine;
  • Severe systemic diseases;
  • hemolytic anemia and lack of glucose - 6 - phosphate dehydrogenase patients
  • Refusal to participate in the study.

Trial locations and contacts

1 site in 1 country.

Han Ping, bachelor contact

13652139315

13652139315@163.com

Li Jia, professor contact

13302106853

18622663700@163.com

China1 site
  • Tianjin Second People's Hospital

    Tianjin, Tianjin Municipality, 300192

    Han Ping, bachelor, +8613652139315, 13652139315@163.com

    Li Jia, professor, +86133021006853, 18622663700@163.com

Other trials in China

About this study

Official title: Endoscopic and Microbiological Assessment of the Effect of Carvedilol Combined With Berberine on GOV in Cirrhosis: a Prospective Cohort Study

Carvedilol has been shown to be more potent in decreasing portal hypertension to propranolol. A lot of studies have shown that the imbalance of flora and the progress of portal hypertension are mutually causal. Berberine can regulate the intestinal flora.In this study, we evaluated the effect of carvedilol and berberine on reducing portal vein pressure by observing the changes of endoscopy,endoscopic ultrasonography and intestinal flora.

Read the detailed description

There is a higher risk of esophageal and gastric varices bleeding in cirrhosis patients with moderate and severe esophageal and gastric varices. Once there is a high mortality rate of esophageal and gastric varices bleeding, it will cause great losses to the family and society. Therefore, it is of great social and economic significance to prevent esophageal and gastric varices bleeding through economic and effective methods. As the third generation of NSBB, carvedilol is more effective in reducing HVPG than propranolol, which is recommended by Baveno VI as the first-line drug for EVB primary prevention. A lot of studies have shown that the imbalance of flora and the progress of portal hypertension are mutually causal. The application of carvedilol can reduce the pressure of portal vein, and when the portal hypertension is improved, the imbalance of intestinal mucosal barrier and flora will also be changed. Berberine can regulate the intestinal flora, which is safe and effective in clinical application. Gastroscopy is still the main method of screening varicose veins. We can determine whether there is GOV in patients and evaluate the risk of varicose vein bleeding. However, gastroscopy can only observe the situation in the digestive tract lumen, and ultrasound endoscopy can scan the outside of the tube wall, so as to more comprehensively evaluate the change of portal hypertension. The purpose of this study is to apply endoscopic ultrasonography to the whole process of the study, which can be used as a more sensitive means to observe the changes of portal hypertension, and to systematically evaluate the continuous changes of portal hypertension. It provides a theoretical basis and measurement means for a more comprehensive and scientific evaluation of portal hypertension.In this study, the patients with GOV who need primary prevention were randomly divided into two groups. Carvedilol or carvedilol combined with berberine were given for 12 months respectively. The degree of varicose vein relief was judged by ES and EUS, and the changes of oral and intestinal flora were detected at the same time To understand the possible mechanism of carvedilol and berberine in reducing portal hypertension.

Being tested
Carvedilol, Berberine
Keywords
gastroesophageal varices, cirrhosis, carvedilol, berberine, Endoscopic ultrasonography, gut microbiota, portal hypertension
Medical subject headings
Fibrosis, Hypertension, Portal

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CarvedilolDrug

    As the third generation of NSBB, carvedilol is more effective in reducing HVPG than propranolol, which is recommended by Baveno VI as the first-line drug for EVB primary prevention.

  • BerberineDrug

    Berberine can regulate the intestinal flora, which is safe and effective in clinical application.

Study groups in NCT04543643
Study groupRoleWhat they receive
Carvedilol+ berberineExperimentalCarvedilol is started at a dose of 6.25 mg once per day. After 1 week, this will increased to a dose of 6.25 mg twice daily per day if systolic blood pressure does not fall below 85mm Hg and HR 55/min. Berberine is started at a dose of 0.3g twice per day.
Receives: Drug: Carvedilol; Drug: Berberine
CarvedilolActive comparatorCarvedilol is started at a dose of 6.25 mg once per day. After 1 week, this will increased to a dose of 6.25 mg twice daily per day if systolic blood pressure does not fall below 85 mm Hg and HR 55/min.
Receives: Drug: Carvedilol

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The progression Incidence of esophageal varices

    progression of esophagogastric varices under gastroscopy and/or endoscopic ultrasound

    Measured: 1 year

Secondary outcomes (2)
  1. The incidence of liver cirrhosis decompensation

    the occurrence of decompensating events in cirrhosis (decompensating is defined as gastrointestinal bleeding, ascites, or significant hepatic encephalopathy, hepatorenal syndrome, associated with portal hypertension)

    Measured: 1 year

  2. HCC, death or liver transplantation

    The incidence of hepatic cellular carcinoma, death or liver transplantation

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Sep 2020
  2. Study start1 Nov 2021 (estimated)
  3. Primary completion31 Oct 2023 (estimated)
  4. Study completion31 Oct 2023 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Parallel Assignment
Masking
None (open label)
Enrolment
288 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04543643
Sponsor's protocol ID
Tianjin2PH
Acronym
CABER
Status last verified
Oct 2021
First submitted
3 Sep 2020
Last updated
25 Oct 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med. 1988 Oct 13;319(15):983-9. doi: 10.1056/NEJM198810133191505.

    PubMed 3262200
  • Carbonell N, Pauwels A, Serfaty L, Fourdan O, Levy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004 Sep;40(3):652-9. doi: 10.1002/hep.20339.

    PubMed 15349904
  • Wang X, Lin SX, Tao J, Wei XQ, Liu YT, Chen YM, Wu B. Study of liver cirrhosis over ten consecutive years in Southern China. World J Gastroenterol. 2014 Oct 7;20(37):13546-55. doi: 10.3748/wjg.v20.i37.13546.

    PubMed 25309085
  • de Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015 Sep;63(3):743-52. doi: 10.1016/j.jhep.2015.05.022. Epub 2015 Jun 3. No abstract available.

    PubMed 26047908
  • Abadia M, Montes ML, Ponce D, Froilan C, Romero M, Poza J, Hernandez T, Fernandez-Martos R, Olveira A; "La Paz Portal Hypertension" Study Group Investigators. Management of betablocked patients after sustained virological response in hepatitis C cirrhosis. World J Gastroenterol. 2019 Jun 7;25(21):2665-2674. doi: 10.3748/wjg.v25.i21.2665.

    PubMed 31210717
  • Hammoud GM, Ibdah JA. Utility of endoscopic ultrasound in patients with portal hypertension. World J Gastroenterol. 2014 Oct 21;20(39):14230-6. doi: 10.3748/wjg.v20.i39.14230.

    PubMed 25339809
  • Hashizume M, Kitano S, Sugimachi K, Sueishi K. Three-dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension. Hepatology. 1988 Nov-Dec;8(6):1482-7. doi: 10.1002/hep.1840080603.

    PubMed 3192160
  • Huang JY, Samarasena JB, Tsujino T, Chang KJ. EUS-guided portal pressure gradient measurement with a novel 25-gauge needle device versus standard transjugular approach: a comparison animal study. Gastrointest Endosc. 2016 Aug;84(2):358-62. doi: 10.1016/j.gie.2016.02.032. Epub 2016 Mar 3.

    PubMed 26945557
  • Tripathi D, Ferguson JW, Kochar N, Leithead JA, Therapondos G, McAvoy NC, Stanley AJ, Forrest EH, Hislop WS, Mills PR, Hayes PC. Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology. 2009 Sep;50(3):825-33. doi: 10.1002/hep.23045.

    PubMed 19610055
  • Reiberger T, Ulbrich G, Ferlitsch A, Payer BA, Schwabl P, Pinter M, Heinisch BB, Trauner M, Kramer L, Peck-Radosavljevic M; Vienna Hepatic Hemodynamic Lab. Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol. Gut. 2013 Nov;62(11):1634-41. doi: 10.1136/gutjnl-2012-304038. Epub 2012 Dec 18.

    PubMed 23250049
  • Bhardwaj A, Kedarisetty CK, Vashishtha C, Bhadoria AS, Jindal A, Kumar G, Choudhary A, Shasthry SM, Maiwall R, Kumar M, Bhatia V, Sarin SK. Carvedilol delays the progression of small oesophageal varices in patients with cirrhosis: a randomised placebo-controlled trial. Gut. 2017 Oct;66(10):1838-1843. doi: 10.1136/gutjnl-2016-311735. Epub 2016 Jun 13.

    PubMed 27298379
  • Borzio M, Salerno F, Piantoni L, Cazzaniga M, Angeli P, Bissoli F, Boccia S, Colloredo-Mels G, Corigliano P, Fornaciari G, Marenco G, Pistara R, Salvagnini M, Sangiovanni A. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis. 2001 Jan-Feb;33(1):41-8. doi: 10.1016/s1590-8658(01)80134-1.

    PubMed 11303974
  • Pascual S, Such J, Esteban A, Zapater P, Casellas JA, Aparicio JR, Girona E, Gutierrez A, Carnices F, Palazon JM, Sola-Vera J, Perez-Mateo M. Intestinal permeability is increased in patients with advanced cirrhosis. Hepatogastroenterology. 2003 Sep-Oct;50(53):1482-6.

    PubMed 14571769
  • Garcia-Tsao G. Bacterial translocation: cause or consequence of decompensation in cirrhosis? J Hepatol. 2001 Jan;34(1):150-5. doi: 10.1016/s0168-8278(00)00006-4. No abstract available.

    PubMed 11211893
  • Arvaniti V, D'Amico G, Fede G, Manousou P, Tsochatzis E, Pleguezuelo M, Burroughs AK. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology. 2010 Oct;139(4):1246-56, 1256.e1-5. doi: 10.1053/j.gastro.2010.06.019. Epub 2010 Jun 14.

    PubMed 20558165

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Carvedilol and Berberine in people with Cirrhosis Due to Hepatitis B and Cirrhosis Due to Hepatitis C, run by Tianjin Second People's Hospital at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 25 Oct 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Han Ping, bachelor (13652139315, 13652139315@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The progression Incidence of esophageal varices (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04543643, which also lists 41 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Oct 2021.

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