Safety and Tolerability of Pirfenidone in Acute Pancreatitis
Evaluation of Pirfenidone as a Therapy in Patients With Predicted Moderate to Severe Acute Pancreatitis
University of Alabama at Birmingham
60 participants
Aug 1, 2023
INTERVENTIONAL
Conditions
Summary
The goal of the current pilot clinical trial is to evaluate the safety and tolerability of pirfenidone in patients with predicted moderately severe and severe acute pancreatitis. Pirfenidone is currently approved by FDA for the treatment of idiopathic pulmonary fibrosis. Now, over 5 years of data has accumulated demonstrating safety of its use in humans. The investigators' preclinical data suggest that pirfenidone is very effective in reducing the severity of acute pancreatitis in animal models. Following are the objectives of the proposed clinical trial: Primary Objective: * To evaluate the safety and tolerability of pirfenidone, compared to placebo, in patients predicted to have moderately severe or severe AP. * To evaluate the efficacy of pirfenidone in reducing the laboratory markers of inflammation and improving patient reported outcome measures. Secondary Objective: \- To evaluate the efficacy of pirfenidone in reducing the severity of acute pancreatitis, as measured by well-defined endpoints.
Eligibility
Inclusion Criteria12
- Patients 18 - 85 years of age
- Admitted to hospital for AP, defined by at least 2 of the following 3:
- amylase or lipase values, or both, that are greater than 3 times the upper limit of normal values
- characteristic cross-sectional imaging
- typical upper abdominal pain- acute onset of a persistent, severe, epigastric pain often radiating to the back
- Patients identified, approached, and consented to administer study medication or placebo within 48 hours of diagnosis of AP.
- Predicted to have MSAP or SAP by presence of one or more of the following criteria
- APACHE II ≥ 8
- Modified Glasgow or Imrie score ≥ 3
- CRP \> 150 mg/dL
- PASS score \> 140 at or within 48 hrs. of admission
- CT or MRI imaging suggesting pancreatic and/or peri-pancreatic necrosis
Exclusion Criteria32
- Age \< 18 or \> 85 years
- Body weight \> 200 kg
- Presentation to the medical attention \> 48 h after diagnosis of AP
- Inability to recruit, randomize and start the allocated treatment within 48h of start of pain
- Ongoing AP or diagnosis of AP in previous 30 days
- Chronic pancreatitis
- Known hypersensitivity to pirfenidone
- AST/ALT ≥ 2 times the upper normal limit.
- Alkaline phosphatase ≥ 2 times the upper normal limit
- Bilirubin higher than upper normal limit
- Moderate to severe heart failure and/or coronary heart disease (New York Heart Association (NYHA) Functional Class III/IV)
- On home oxygen or home mechanical ventilation
- Advanced liver disease
- Paralytic ileus or significant nausea and vomiting
- Chronic Diarrhea
- Immunosuppressive disorder or on immunosuppressive medications
- Active or advanced malignancy
- Known cancer that is end-stage with ongoing palliative care or for which palliative care is appropriate
- Known established infection prior to the onset of acute pancreatitis
- Known history of infective hepatitis
- Known live vaccines or therapeutic infectious agents within one month of admission
- Known pregnancy or lactation at the time of admission
- Ongoing photosensitivity and rash
- Women of childbearing potential who are not on oral or injectable contraceptives or IUDs and do not consent to practice abstinence for period of 4 weeks.
- Known to be currently participating in a trial testing any investigational medicinal product or participation in a clinical study involving a medicinal product in the last three months
- Alcohol or substance abuse in the past 2 years
- Family or personal history of long QT syndrome ( \> 500 msec)
- Medications like fluvoxamine or sildanefil
- Significant photosensitivity or new rash
- Renal disease with GFR \< 30
- Any condition other than above that, in the opinion of the investigator, is likely to result in the death of the patient within the next 2 years
- Any condition that, in the opinion of the investigator, might be significantly exacerbated by the known side effects associated with the administration of pirfenidone
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Interventions
Patients in the pirfenidone treatment arm will be given pirfenidone 267mg tablet, tid for 1 day followed by dose escalation to two 267 mg tablet tid for 6 days. Thus, the treatment will be for total of 7 days or till patients develop an adverse event that requires their participation in the study to be stopped.
The placebo tablets will be an exact replica of the pirfenidone tablet.
Locations(2)
View Full Details on ClinicalTrials.gov
For the most up-to-date information, visit the official listing.
NCT05350371