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Efficacy and Safety of Testosterone Therapy in Improving Sarcopenia in Men With Cirrhosis.

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Спонсори
Institute of Liver and Biliary Sciences, India

Ключови думи

Резюме

- Study Population- Patient with cirrhosis with any aetiology with sarcopenia visiting ILBS OPD/IPDs who are willing to visit ILBS gymnasium twice weekly for first month.
- Study Design- A Prospective Randomized Controlled Trial
- Study Period- Study will be conducted at ILBS from April 2019 to Oct 2019
- Sample Size:As shown by Eva Roman et al - in cirhotics with sarcopenia exercise increases mean lean appendicular mass , by 0.38 kg (14 patients, p < 0.03), and Sinclair et al has shown testosterone (22 patients, p <0.05)) to increase mean Appendicular lean mass by +1.69 kg - for 10% increase in APLM
- we need to enroll 40 patients in each arm, and considering a los to follow up approx.10% , will require minimum 44 patients in each arm
- We will therefore enroll and randomize 100 patients with 50 in each arm.
Intervention - Testosterone Supplementation - Intramuscular Testosterone Undecanoate 1000 Mg (4 ml volume in oily base) will be injected into the upper, outer quadrant of the buttock at 0, 6, 12,16,20, 24 weeks according to manufacturer recommendations.
Monitoring and assessment - On every visit patient will be inquired or evaluated for side effects like local site pain or hematoma , hypertension, headache, allergic reactions, acne, nausea , mood swings, pedal edema , breast enlargement and others.

Дати

Последна проверка: 05/31/2019
Първо изпратено: 06/18/2019
Очаквано записване подадено: 06/18/2019
Първо публикувано: 06/23/2019
Изпратена последна актуализация: 08/19/2019
Последна актуализация публикувана: 08/20/2019
Действителна начална дата на проучването: 07/03/2019
Приблизителна дата на първично завършване: 06/29/2020
Очаквана дата на завършване на проучването: 06/29/2020

Състояние или заболяване

Liver Cirrhosis

Интервенция / лечение

Drug: Standard Medical Treatment +Intramuscular Testosterone + Exerc

Drug: Standard Medical Treatment

Other: Exercise

Фаза

-

Групи за ръце

ArmИнтервенция / лечение
Experimental: Standard Medical Treatment +Intramuscular Testosterone + Exerc
Intramuscular Testosterone Undecanoate 1000 Mg (4 ml volume in oily base) will be injected into the upper, outer quadrant of the buttock at 0, 6, 12,16,20, 24 weeks according to manufacturer recommendations
Drug: Standard Medical Treatment +Intramuscular Testosterone + Exerc
Intramuscular Testosterone Undecanoate 1000 Mg (4 ml volume in oily base) will be injected into the upper, outer quadrant of the buttock at 0, 6, 12,16,20, 24 weeks according to manufacturer recommendations
Active Comparator: Standard Medical Treatment+Exercise
Standard Medical Treatment +Exercise

Критерии за допустимост

Възрасти, отговарящи на условията за проучване 18 Years Да се 18 Years
Полове, допустими за проучванеAll
Приема здрави доброволциДа
Критерии

Inclusion Criteria:

- Men with cirrhosis of any etiology

- Sarcopenia

- CTP 6-12

Exclusion Criteria:

- Hepatocellular carcinoma

- Other known malignancy,

- CTP > 12

- Acute liver injury

- Prostate disease,

- Known hypersensitivity to testosterone therapy,

- Polycythaemia (haematocrit >55%),

- Uncontrolled hypertension (>160/90 mmHg despite treatment),

- Uncontrolled obstructive sleep apnoea,

- Severe renal dysfunction (estimated glomerular filtration rate <30ml/min)

- Uncontrolled epilepsy, migraine, or significant cardiac insufficiency (New York Heart Association class III or IV or LVEF < 45-50%.

- CKD (Chronic Kidney Disease) - eGFR (Glomerular Filtration Rate) <60%

- Platelet count below 30,000 or taking warfarin

- Failure to give consent.

Резултат

Първични изходни мерки

1. Increase in Lean Appendicular Muscle Mass by more than 10% in both groups [24 weeks]

Вторични изходни мерки

1. Improvement by 10 % in Hand Grip strength in both groups [24 weeks]

2. Improvement by 10 % in6 minute walk distance in both groups [24 weeks]

3. Improvement by 10 % in the increased bone and muscle mass in both groups [24 weeks]

4. Improvement by 10 % L3 Skeletal Muscle Index in both groups. [24 weeks]

5. Improvement by 10 % in serum ammonia levels in both groups [24 weeks]

6. Improvement by 10 % in muscle fibres on Biopsy in both groups • [24 weeks]

7. Reduction in Myostatin level in both groups [24 weeks]

8. Improvement in MELD scores in both groups [24 weeks]

9. Decrease in mortality over 6 months in both groups [24 weeks]

10. Changes in HBA1C level in both groups [24 weeks]

11. Reduction in requirement of hospital admissions in both groups [24 weeks]

12. Decrease in TNF alpha levels in both groups [24 weeks]

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