Clinical trial NCT01085760: A Pilot Study of Vancomycin or Metronidazole in Patients With Primary Sclerosing Cholangitis
Official title: A Pilot Study of Vancomycin or Metronidazole in Patients With Primary Sclerosing Cholangitis
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: Primary Sclerosing Cholangitis
Lead sponsor: Mayo Clinic
Sponsor class: OTHER
Collaborators: name: PSC Partners Seeking a Cure
First posted: 2010-03-12
Enrollment: 35
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to determine whether Vancomycin or Metronidazole is safe and beneficial in the treatment of Primary Sclerosing Cholangitis.

Detailed description: In this protocol, we propose the assessment of potential beneficial effects of the antibiotics vancomycin and metronidazole on liver biochemistries, liver related symptoms and Mayo risk score in patients with PSC. The patients will be randomized into four groups of ten patients: one group will receive low dose vancomycin, one group will receive high dose vancomycin, one group will receive low dose metronidazole and one group will receive high dose metronidazole. Each group will be treated for three months.

Eligibility criteria: Inclusion Criteria:

* Diagnosis of PSC established by alkaline phosphatase \>1.5 times and/or two fold elevation of liver transaminases (AST and/or ALT) for at least 6 months duration.
* Cholangiography demonstrating intrahepatic and/or extrahepatic biliary obstruction, beading, or narrowing consistent with PSC.
* Both genders.
* Age ≥ 18 years old and \< than 75 years old.
* Patient's informed consent for study participation.

Exclusion Criteria:

* Treatment with systematic antibiotics, azulfidine, ursodeoxycholic acid, corticosteroids, colchicine, methotrexate, azathioprine, cyclosporine, chlorambucil, budesonide, pentoxifylline, tacrolimus, silymarin or prednisone in the preceding three months.
* Active drug or alcohol use.
* Prior history of allergic reactions to the antibiotics which will be used in the study.
* Any condition that, in the opinion of the investigator, would interfere with the patients' ability to complete the study safely or successfully.
* Evidence of decompensated liver disease such as recurrent variceal bleeding, refractory ascites or spontaneous hepatic encephalopathy.
* Anticipated need for transplantation in one year (Mayo survival model \<80% one-year survival without transplant).
* Findings highly suggestive of liver disease of other etiology such as chronic alcoholic liver disease, chronic hepatitis B or C infection, hemochromatosis, Wilson's disease, 1-antitrypsin deficiency, non-alcoholic steatohepatitis, primary biliary cirrhosis or secondary sclerosing cholangitis.
* Pregnancy or current lactation. Subjects becoming pregnant during the study will be withdrawn.

Primary outcomes:
measure: Change From Baseline in Alkaline Phosphatase Following 12 Weeks of Treatment
timeFrame: baseline, 12 weeks
Secondary outcomes:
measure: Change From Baseline in Total Bilirubin Following 12 Weeks Treatment
timeFrame: baseline, 12 weeks
measure: Change From Baseline in Mayo PSC Risk Score Following 12 Weeks of Treatment
timeFrame: baseline, 12 weeks
measure: Change From Baseline in C-Reactive Protein Following 12 Weeks of Treatment
timeFrame: baseline, 12 weeks
Other outcomes:
Locations:
city: Rochester
country: United States
facility: Mayo Clinic
state: Minnesota
Study officials:
affiliation: Mayo Clinic
name: Jayant A Talwalkar, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Tabibian JH, Weeding E, Jorgensen RA, Petz JL, Keach JC, Talwalkar JA, Lindor KD. Randomised clinical trial: vancomycin or metronidazole in patients with primary sclerosing cholangitis - a pilot study. Aliment Pharmacol Ther. 2013 Mar;37(6):604-12. doi: 10.1111/apt.12232. Epub 2013 Feb 5.