Pasireotide LAR in Severe Polycystic Liver Disease
Condition: Somatostatin Analogs; Polycystic Liver Disease; Autosomal Dominant Polycystic Kidney Disease; Autosomal Dominant Polycystic Liver Disease
MeSH terms: Cysts; Arthrogryposis; Liver Diseases; Kidney Diseases; Polycystic Kidney Diseases; Polycystic Kidney, Autosomal Dominant
Intervention: Pasireotide LAR; Placebo
Intervention description: Injectible, 60mg per month; To be injected once per month
Intervention MeSH terms: Pasireotide
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Investigator)
Enrollment: 48.0
Sex: All
Minimum age: 18 Years
Maximum age: 100 Years
Healthy volunteers: No
Keywords: Polycystic Liver Disease; Autosomal dominant polycystic kidney disease; Autosomal dominant polycystic liver disease; Somatostatin analogs; Pasireotide LAR; SOM230

Summary:

      The purpose of this study is to compare SOM230 treatment to placebo. The investigators will
      also assess the efficacy and safety of SOM230 in reducing total liver volume and improving
      quality of life.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Male or female Age ≥ 18 years.

          -  Diagnosis of PLD associated with ADPKD (meeting the Modified Ravine's criteria) or
             isolated ADPLD (defined by the criteria described by Reynolds et al)

          -  Severe PLD defined as a liver volume >4000mL or symptomatic disease due to mass
             effects from hepatic cysts (must be able to undergo MRI or CT scan to determine this).

          -  Not a candidate for or declining surgical intervention.

          -  Capable of providing informed consent.

          -  Life expectancy ≥ 12 weeks

          -  Patients with a known history of impaired fasting blood glucose (glucose >100 and
             <126) may be included at the discretion of the PI. These patients should be monitored
             closely throughout the trial and antihyperglycemic treatment adjusted as necessary.
             Patients that are deemed non eligible due to elevated glucose can be re-screened after
             adequate medical treatment.

          -  Adequate end organ function as defined by:

          -  Adequate bone marrow function:

               -  WBC ≥ 2.5 x 109/L

               -  Absolute Neutrophil Count (ANC) ≥ 1.5 x 109/L

               -  Platelets ≥ 100 x 109/L

               -  Hb ≥ 9 g/dL

          -  No evidence of significant liver disease:

               -  Serum bilirubin ≤1.5 x ULN

               -  INR < 1.3

               -  ALT and AST ≤ 2 x ULN

          -  Estimated glomerular filtration rate (eGFR) >30 ml/min/m2

          -  Serum amylase and lipase ≤ 1.5 x ULN

          -  Alkaline phosphatase ≤ 2.5 x ULN

          -  Written informed consent obtained prior to any screening procedures

          -  Willingness and ability to comply with scheduled visits, treatment plans, laboratory
             tests and other study procedures

        Exclusion Criteria:

          -  Patients will be considered ineligible for this study if they meet any of the
             following criteria:

          -  Patients with a known hypersensitivity to SST analogs or any component of the
             pasireotide LAR or SQ formulations.

          -  Patients with known malabsorption syndrome, short bowel or chologenic diarrhea not
             controlled by specific therapeutic means.

          -  Patients with abnormal coagulation (PT or a PTT elevated by 30% above normal limits).

          -  Patients on continuous anticoagulation therapy. Patients who were on anticoagulant
             therapy must complete a washout period of at least 10 days and have confirmed normal
             coagulation parameters before study inclusion.

          -  Patients with symptomatic cholelithiasis.

          -  Patients who are not biochemically euthyroid.

          -  Patients with known history of hypothyroidism are eligible if they are on adequate and
             stable re-placement thyroid hormone therapy for at least 3 months.

          -  Serum magnesium ≥ ULN

          -  QT-related exclusion criteria:

          -  QTcF at screening > 470 msec

          -  Patients with a history of syncope or family history of idiopathic sudden death

          -  Patients who have sustained or clinically significant cardiac arrhythmias

          -  Risk factors for Torsades de Pointes such as hypokalemia, hypomagnesemia, cardiac
             failure, clinically significant/symptomatic bradycardia, or high-grade AV block

          -  Patients with concomitant disease(s) that could prolong QT such as autonomic
             neuropathy (caused by diabetes, or Parkinson's disease), HIV, cirrhosis, uncontrolled
             hypothyroidism or cardiac failure

          -  Family history of long QT syndrome

          -  Concomitant medications known to prolong the QT interval.

          -  Potassium < or = to 3.5

          -  Patients who have any severe and/or uncontrolled medical conditions or other
             conditions that could affect their participation in the study such as:

          -  Patients who have Uncontrolled diabetes as defined by HbA1c>8%* despite adequate
             therapy

          -  Patients with the presence of active or suspected acute or chronic uncontrolled
             infection or with a history of immunodeficiency, including a positive HIV test result
             (ELISA and Western blot). An HIV test will not be required; however, previous medical
             history will be reviewed.

          -  Non-malignant medical illnesses that are uncontrolled or whose control may be
             jeopardized by the treatment with this study treatment.

          -  Liver disease such as cirrhosis, decompensated liver disease, chronic active hepatitis
             or chronic persistent hepatitis.

          -  Baseline ALT or AST >3x ULN

          -  Patients with life-threatening autoimmune and ischemic disorders.

          -  Uncontrolled hypertension

          -  Patients who have a history of a primary malignancy, with the exception of locally
             excised non-melanoma skin cancer and carcinoma in situ of uterine cervix. (Patients
             who have had no evidence of disease from primary cancer for 3 or more years are
             allowed to participate in the study.)

          -  History of pancreatitis

          -  Patients with a known history of hepatitis B or C

          -  Presence of Hepatitis B surface antigen (HbsAg)

          -  Presence of Hepatitis C antibody (anti-HCV)

          -  Patients with a history of, or current, alcohol misuse/abuse within the past 12 months

          -  Known gallbladder or bile duct disease, acute or chronic pancreatitis

          -  Patients who have any current or prior medical condition that may interfere with the
             conduct of the study or the evaluation of its results in the opinion of the
             Investigator or the Sponsor's Medical Monitor

          -  Use of an investigational drug within 1 month prior to dosing

          -  Patients with a history of non-compliance to medical regimens or who are considered
             potentially unreliable or will not be able to complete the entire study