Hepatorenal Syndrome Type I and Type II
Conditions
Keywords
hepatorenal syndrome
Brief summary
Hepatorenal syndrome (HRS) is a life-threatening condition marked by rapid decline in kidney function in patients with liver cirrhosis or fulminant liver failure. Vasodilation in the gastrointestinal region is largely thought to contribute to the disease. LJPC-501 is a vasoconstrictor that may restore proper circulation and kidney function in patients with HRS.
Detailed description
Vasoconstrictors are considered a promising approach to treat HRS due to the significant vasodilation of the splanchnic circulation that contributes to systemic arterial underfilling and leads to functional decline of the kidney in these patients. Vasoconstrictors currently in use are associated with reduced organ perfusion and have marginal effect on sodium excretion. The vasoconstrictor angiotensin II has been shown to produce significant sodium excretion and urine output in patients with cirrhosis and ascites, supporting its potential utility in the treatment of HRS.
Interventions
DRUGLJPC-501
Patients will receive LJPC-501 at titrated doses, with a starting range from 1 to 100 ng/kg/min, by continuous infusion on Days 1 through 5. In Group 1, drug doses will be titrated to 5, 15, and 25 ng/kg/min, after which doses will be titrated in multiples of 25 ng/kg/min. In Groups 2-5, drug doses will be titrated by 25 ng/kg/min. Dose titrations will occur every 2 hours until a MAP of 110 mmHg is reached, maximum urine output is achieved, or a dose of 250 ng/kg/min is achieved. Dosing will then continue at the maximum dose achieved through Day 5.
Sponsors
La Jolla Pharmaceutical Company
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients with HRS, as defined by the International Ascites Club \[1\]: * Cirrhosis with ascites * Serum creatinine \> 1.5 mg/dL * No improvement of serum creatinine (decrease to a level of ≤ 1.5 mg/dL) after at least 2 days with diuretic withdrawal and volume expansion with albumin * Absence of shock * No current or recent treatment with nephrotoxic drugs * Absence of parenchymal kidney disease, as indicated by proteinuria \> 500 mg/day, microhematuria (\> 50 red blood cells per high power field) and/or abnormal renal ultrasonography Or patients with HRS due to acute alcoholic hepatitis 2. Patient is able to undergo a reliable neurologic exam, as determined by the investigator 3. Patient or legal surrogate is willing and able to provide written informed consent 4. Patient is willing and able to comply with all protocol requirements
Exclusion criteria
1. Evidence of shock 2. Current or recent treatment with nephrotoxic drugs 3. Use of midodrine, octreotide, or other vasopressors within 48 hours of screening 4. Current treatment with dialysis 5. Serum creatinine \> 7 mg/dL 6. Active cardiovascular disease within 3 months of screening 7. History of transient ischemic attacks or prior stroke 8. History of organ transplant 9. Ongoing infection requiring intravenous administration of antibiotics (patients with documented infections considered by the Investigator to be controlled within 48 hours of screening may be permitted in the study upon consultation with the Sponsor's Medical Monitor) 10. Participation in a clinical trial within 30 days of screening 11. Patient unlikely to survive more than 72 hours in the opinion of the investigator 12. Patient is pregnant or planning to become pregnant during study
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Adverse events through 5 days of treatment | 5 days |
Secondary
| Measure | Time frame |
|---|---|
| Maximum Tolerated Dose | 5 days |
| Effects on serum creatinine through 5 days of treatment | 5 days |
| Effects on urine output through 5 days of treatment | 5 days |
| Effects on sodium excretion through 5 days of treatment | 5 days |
| Effects on ascites through 5 days of treatment | 5 days |
Other
| Measure | Time frame |
|---|---|
| Change in biomarkers of disease activity from baseline on Day 5 | baseline and Day 5 |
Countries
United States
Outcome results
None listed