a safety and efficacy study of mycophenolate mofetil and rilonacept in patients with alcoholic hepatitis

Conditions: Alcoholic Hepatitis

Summary: this clinical trial will test two new therapies for the treatment of alcoholic hepatitis. patients who "respond" to the current standard of care therapy for alcoholic hepatitis(corticosteroid/prednisolone therapy) after 1 week of treatment will be randomly assigned to either continue on standard therapy, or, to begin treatment with rilonacept in combination with standard therapy. patients who are "non-responders" to the current standard of care therapy after 1 week of treatment will be randomly assigned to standard of care or to begin treatment with mycophenolate mofetil in combination with standard therapy. patients will be treated for a total of 4 weeks in this clinical trial. patients will be followed for up to five months after completing therapy (6 months total).

this is a prospective, randomized trial of two experimental treatments, prednisolone + mycophenolate mofetil and prednisolone + rilonacept, in comparison with standard of care, in patients with alcoholic hepatitis. patients will start therapy with prednisolone. at day 8 response to prednisolone will be determined using the lille score. patients with a lille score ≥ 0.45 will be randomized to standard of care (continue prednisolone, stop all therapy and/or offer palliative care) or to have prednisolone continued and mycophenolate added for the next three weeks. patients with a lille score \<0.45 will be randomized to continue prednisolone alone (standard of care) or to have rilonacept added to their treatment regimen (experimental group) for the next three weeks. patients will complete follow-up visits at week 12 and week 24.

Eligibility criteria:
inclusion criteria: * history of chronic alcohol consumption (defined as \>60g ethanol/day for women and \>80g ethanol/day for men) for at least the past 5 years * less than 8 weeks between last intake of alcohol and screening * maddrey's discriminant function score (df)\>32 * willing to undergo liver biopsy for histological assessment of alcoholic hepatitis. * willing to provide liver tissue, whole blood, stool and ascitic fluid as part of a correlative study * onset of jaundice \<3 months prior to screening * age greater or equal to 18 years exclusion criteria (brief): * liver disease significantly caused by etiologies other than alcohol. * upper gi bleeding requiring transfusion within 48 hours prior to start of prednisolone (day 1) * infection that has been treated with appropriate antibiotics for less than 72 hours or which has not responded appropriately to 72 hours or more of antibiotic treatment prior to start of prednisolone (day 1) * clinical evidence of select active infections in the past 3 months (fungal, mycobacterial, cytomegalovirus (cmv), herpes, coccidioidomycosis, tuberculosis (tb) and human immunodeficiency virus (hiv)) * renal insufficiency * laboratory exclusions * hemoglobin \<7g/dl * total bilirubin \<7.5mg/dl * aspartate aminotransferase (ast) \>500 iu/ml; or ast:alanine aminotransferase (alt) ratio \< 1 * pregnant or breast-feeding or unwilling to use appropriate birth control * other clinically significant diseases (uncontrolled diabetes, severe cardiovascular or pulmonary disease, transplant recipient, recent cancer) * use of oral or systemic corticosteroids for more than 7 days during the 14 days prior to day 1 or likely use of oral or systemic corticosteroids in the first 12 weeks of the clinical trial for underlying diseases * use of select contraindicated medications * previous randomization in the trial * based on the investigators judgment, subject is not capable of complying with the study requirements.