Continuous Infusion Terlipressin for Patients With Cirrhosis and Refractory Ascites

Study Overview
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Brief Summary
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Low-dose continuous infusion of terlipressin will be administered to six cirrhotic patients with refractory ascites.

Detailed Description
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Terlipressin continuous infusion will be adminstered via an ambulatory pump initially for 7 days in a clinical pharmacology unit. Serial blood draws for pharmacokinetic analysis will be performed to determine steady state concentration of both terlipressin and 8-lysine-vasopressin during infusion. After establishing safety and tolerance of infusion for 7 days, patients will be transitioned to an outpatient setting where they will be treated with terlipressin continuous infusion for an additional 21 days, monitored daily by home care nurses. A total of 6 patients will be treated. Monitoring will include successful management of ascites, with reduction in paracentesis procedures and decreased ascites fluid volume, further supported by improvement in renal function.

Official Title
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Safety and Efficacy of Low-dose Terlipressin Delivered by Continuous Intravenous Infusion in Patients With Cirrhosis and Ascites Refractory to, or Intolerant of, Diuretic Therapy, Requiring Large Volume Paracentesis

Conditions
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Ascites Hepatic, Cirrhosis

Intervention / Treatment
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* Drug: Terlipressin acetate continuous infusion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with cirrhosis and refractory ascites who required 3 or more large volume (4 liters and more) paracenteses in the previous 60 days Exclusion Criteria: Ascites with causes other than cirrhosis such as nephrogenic ascites or malignant ascites due to peritoneal carcinomatosis Total bilirubin > 5 mg/dL Blood clotting International normalized ratio (INR) > 2.5 Serum creatinine > 2.0 mg/dL Current or recent (within 3 months of consent) renal dialysis Hepatic encephalopathy grade 3 or 4 Superimposed acute liver failure/injury due to factors other than alcoholic hepatitis, including acute viral hepatitis, drugs, medications (e.g., acetaminophen), or other toxins (e.g., mushroom [Amanita] poisoning) Current or recent treatment (within 7 days) with octreotide, midodrine, vasopressin, dopamine or other vasopressors Respiratory failure requiring positive airway pressure devices or intubation SIRS/sepsis episode in the previous 28 days from consent Episode of spontaneous bacterial peritonitis or gastrointestinal hemorrhage within 28 days of consent Ongoing documented or suspected infection Severe cardiovascular disease that are contraindication to terlipressin therapy such as advanced arteriosclerosis, arrhythmia, coronary insufficiency or uncontrolled hypertension Findings suggestive of organic renal disease (severe proteinuria/hematuria, or abnormal renal ultrasound suggestive of obstructive or other renal pathology) Severe comorbidity that in the opinion of the Investigator would affect short-term prognosis and/or disallow safe participation in the trial (such as for example, severe anemia or pancytopenia, advanced neoplasia, hepatocellular carcinoma [confirmed with serum alpha1-fetoprotein testing], severe chronic obstructive pulmonary disease or asthma) Alcoholics who have not been abstinent for the past 6 months Transjugular intrahepatic portosystemic shunt or other surgical shunt For female patients: Confirmed pregnancy Known allergy or hypersensitivity to terlipressin Participation in other clinical research studies involving the evaluation of other investigational drugs or devices within 30 days of consent.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Open label prospective study in a cohort of 6 patients
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Terlipressin acetate continuous infusion<br>Continuous infusion of terlipressin starting at 2 mg/day over 7 days in-house and if tolerated continue treatment in the ambulatory setting for 21 days | Drug: Terlipressin acetate continuous infusion<br>* Low-dose continuous infusion of Terlipressin administered via ambulatory pump over 28 days<br>* Other names: Terlipressin;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical Safety of Terlipressin Infusion in Cirrhotic Patients With Refractory Ascites | Rate of treatment emergent adverse events assessed by physical examination and laboratory safety | 28 day treatment period and 28 day post-treatment | 
| Steady State Plasma Levels of Terlipressin and 8-lysine Vasopressin During Terlipressin Continuous Infusion at 2 mg/Day in Cirrhotic Patients With Refractory Ascites | Serial sampling for determination of Terlipressin concentration and metabolite 8-lysine vasopressin in plasma at steady state (Css) | 7 day treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Requirement of Large Volume Paracentesis With Continuous Infusion of Terlipressin | Comparison of pre-treatment and post-treatment incidence of therapeutic paracentesis and change in volume of ascites removed | 28 day post-treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Terlipressin, Terlipressin acetate