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This is a controlled, observational clinical study initiated by investigators to investigate the efficacy and safety of sulfasalazine in the treatment of cirrhosis in patients with cirrhosis. Four cohorts were planned: primary biliary cirrhosis, hepatitis B and C cirrhosis, and alcoholic cirrhosis. The four groups were divided into experimental group and control group, and the experimental group: each group of patients was orally treated sulfasalazine for 12 months, taken three times a day, each time taking 0.5g. The control group did not take sulfasalazine. After 12 months, Observe changes in patients' biochemical and imaging indicators, liver stiffness values, fecal microbiota, and metabolites before and after the use of sulfasalazine.
This study is a controlled and observational clinical study initiated by the investigators to study the efficacy and safety of sulfasalazine in the treatment of cirrhosis in patients with cirrhosis, and to observe changes in patients' biochemical and imaging indicators, liver stiffness values, fecal microbiota, and metabolites before and after the use of sulfasalazine.
Four cohorts were planned to be included in this study:
Cohort A: Differences in cirrhosis changes with the addition of sulfasalazine to UDCA in PBC patients with an inadequate response to UDCA and treatment-naïve PBC patients.
Cohort B: Differences in changes in cirrhosis in patients with viral hepatitis B cirrhosis compared with the addition of sulfasalazine to antiviral (if possible, the same antiviral) therapy.
Cohort C: Differences in changes in cirrhosis in patients with viral hepatitis C cirrhosis compared with the addition of sulfasalazine to antiviral (if possible, the same antiviral) therapy.
Cohort D: Differences in differences in changes in cirrhosis compared with sulfasalazine in patients with alcoholic hepatitis cirrhosis.
Treatment options:
Patients with PBC who did not respond adequately to UDCA: 30 patients with poor response to treated PBC continued to take UDCA, 30 patients with poor response to treated PBC received UDCA+SASP (0.5 g orally three times daily), and 30 patients with poor response received SASP (0.5 g orally three times daily) for 12 months and were followed up for 12 months.
Treatment-naïve PBC patients: 30 treatment-naïve PBC patients took UDCA, and 30 treatment-naïve PBC patients took UDCA+SASP (0.5 g orally three times a day) for 12 months and followed up for 12 months.
Treatment group of hepatitis B (hepatitis C) viral liver cirrhosis: 60 patients with hepatitis B (hepatitis C) viral cirrhosis were collected (using the same dose of antiviral drugs), 30 patients with hepatitis B (hepatitis C) viral cirrhosis took antiviral drugs, and 30 patients with hepatitis B (hepatitis C) virus cirrhosis were treated with sulfasalazine (0.5g three times a day) on the basis of taking antiviral drugs, and follow-up observation was observed for 12 months.
Treatment group of alcoholic hepatitis cirrhosis: 60 patients with alcoholic cirrhosis were collected, 30 patients with alcoholic cirrhosis did not take antifibrotic drugs, 30 cases of alcoholic cirrhosis took sulfasalazine (0.5g three times a day), and follow-up observation was observed for 12 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cohort A:Patients with PBC were treated with sulfasalazine | Experimental | PBC treatment group:
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| Cohort B:Patients with HBV were treated with sulfasalazine | Experimental | Cohort B: 60 cases with hepatitis B cirrhosis were collected , 30 cases continued the current treatment(people with hepatitis B cirrhosis continue to take antivirals), and 30 patients were taking sulfasalazine for 12 months of follow-up observation. During 12 months of treatment, at the time of enrollment and the 1st/3rd/6th/9th/12th months, the liver function, fecal flora, liver fibrosis and immune related indexes were detected. |
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| Cohort C:Patients with HCV were treated with sulfasalazine | Experimental | Cohort C: 60 cases with hepatitis C cirrhosis were collected,30 cases continued the current treatment(people with hepatitis C cirrhosis continue to take antivirals), and30 patients were taking sulfasalazine for 12 months of follow-up observation. During 12 months of treatment, at the time of enrollment and the 1st/3rd/6th/9th/12th months, the liver function, fecal flora, liver fibrosis and immune related indexes were detected. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sulfasalazine enteric-coated tablets | Drug | Sulfasalazine enteric-coated tablets Cohort A: PBC treatment group: (1) PBC patients with poor response to UDCA after treatment: 30 patients continued to take UDCA(13-15mg/kg), 30 patients took UDCA(13-15mg/kg)+SASP (0.5g orally three times a day), 30 patients took SASP (0.5g orally three times a day) for 12 months of follow-up observation. During 12 months of treatment, at the time of enrollment and the 1st/3rd/6th/9th/12th months, the liver function, fecal flora, liver fibrosis and immune related indexes were detected. (2) Newly treated PBC patients: 30 patients took UDCA(13- 15mg/kg) and 30 patients took UDCA(13-15mg/kg)+SASP (0.5g orally three times a day) for 12 months of follow-up observation. During 12 months of treatment, at the time of enrollment and the 1st/3rd/6th/9th/12th months, the liver function, fecal flora, liver fibrosis and immune related indexes were detected. |
| Measure | Description | Time Frame |
|---|---|---|
| Hepatic fibrosis | The changes of liver fibrosis | baseline,1,3,6,9,12 months after treatment and 1 month after the end of treatment. |
| Serum alkaline phosphatase (ALP) | Serum alkaline phosphatase (ALP) level | baseline,1,3,6,9,12 months after treatment and 1 month after the end of treatment. |
| Serum γ-glutamyl transpeptidase (GGT) | Serum γ-glutamyl transpeptidase (GGT) level | baseline,1,3,6,9,12 months after treatment and 1 month after the end of treatment. |
| Serum bilirubin | Serum bilirubin level | baseline,1,3,6,9,12 months after treatment and 1 month after the end of treatment. |
| Serum bile acids | Serum bile acids level | baseline,1,3,6,9,12 months after treatment and 1 month after the end of treatment. |
| Serum aspartate aminotransferase(AST) | Serum aspartate aminotransferase(AST) level | baseline,1,3,6,9,12 months after treatment and 1 month after the end of treatment. |
| Serum alanine aminotransferase (ALT) | Serum alanine aminotransferase (ALT) level | baseline,1,3,6,9,12 months after treatment and 1 month after the end of treatment. |
| Measure | Description | Time Frame |
|---|---|---|
| The gut microbiota and metabolites. | The levels of changes in gut microbiota and metabolites. | baseline,1,3,6,9,12 months after treatment and 1 month after the end of treatment. |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in immune cells | Th1 cells (CD3 + CD4 + IFN-γ +) , Th2 cells (CD3 + CD4 + IL-4 +) , Th17 cells (CD3 + CD4 + IL-17 +) , Treg cells (CD3 + CD4 + CD25 + CD127low) ,Tfh cells (CD3+CD4+CXCR5+CD127highCD25low), Tfh1 cells (CXCR3 + CCR6- on the basis of Tfh) , Tfh2 cells (CXCR3-CCR6- on the basis of Tfh) , Tfh17 cells (CXCR3-CCR6+ on the basis of Tfh) , Tfr cells (CD4+CXCR5+CD127lowCD25high),activated CD8 + T cells (CD3 + CD8 + CD38 +) , B cells(CD3-CD19+),B regulatory cells(CD3-CD19 + CD24highCD38), Plasma cells(CD20lowCD27highCD38high based on B cells ). |
Inclusion Criteria:
A:Patients with PBC cirrhosis PBC patients who have been treated and show an inadequate response to UDCA:(1) according to the biochemical response criteria for 2021 PBC, Enrolled patients need to meet the criteria of ALP ≥1.67 × ULN as a poor biochemical response to UDCA after 12 months of UDCA treatment; (2) meeting the diagnostic criteria for primary cholangitis (PBC) , i.e. meeting at least two of the following criteria: 1.indicators of cholestasis such as elevated Alkaline phosphatase; 2.Anti-mitochondrial antibody AMA or AMA-m2 positive, or if AMA negative, PBC-specific antibodies (anti-GP210 Andor anti-SP100) positive .3 liver biopsy consistent with PBC; Patients with newly diagnosed primary cholangitis (PBC-RRB- met the diagnostic criteria of at least two of the following): 1.indicators of cholestasis such as elevated Alkaline phosphatase; 2.Anti-mitochondrial antibody AMA or AMA-m2 positive, or if AMA negative, PBC-specific antibodies (anti-GP210 Andor anti-SP100) positive 3. liver biopsy consistent with PBC; B:Patients with hepatitis B cirrhosis Diagnosis of hepatitis B cirrhosis based on clinical history, histology or imaging.
C:Patients with hepatitis C cirrhosis Diagnosis of hepatitis C cirrhosis based on clinical history, histology or imaging.
D:Alcoholic hepatitis cirrhosis Diagnosis of alcoholic cirrhosis based on clinical history, histology, or imaging.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mingli Peng, Doctor | Contact | +8613512362906 | 300618@cqmu.edu.cn | |
| Yinghua Lan, Doctor | Contact | +8613796050629 | 306346@hospital.cqmu.edu.cn |
| Name | Affiliation | Role |
|---|---|---|
| Mingli Peng, Doctor | The Second Affiliated Hospital of Chongqing Medical University | Study Chair |
| Yinghua Lan, Doctor | Doctor | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Chongqing Medical University | Recruiting | Chongqing | Chongqing Municipality | 400000 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31819247 | Result | Gulamhusein AF, Hirschfield GM. Primary biliary cholangitis: pathogenesis and therapeutic opportunities. Nat Rev Gastroenterol Hepatol. 2020 Feb;17(2):93-110. doi: 10.1038/s41575-019-0226-7. Epub 2019 Dec 9. | |
| 33141955 | Result | Lv T, Chen S, Li M, Zhang D, Kong Y, Jia J. Regional variation and temporal trend of primary biliary cholangitis epidemiology: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2021 Jun;36(6):1423-1434. doi: 10.1111/jgh.15329. Epub 2020 Dec 6. |
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| Cohort D:Patients with alcoholic liver fibrosis/cirrhosis were treated with sulfasalazine | Experimental | 60 cases with alcoholic cirrhosis were collected , 30 cases continued the current treatment and 30 patients were taking sulfasalazine for 12 months of follow-up observation. During 12 months of treatment at the time of enrollment and the 1st/3rd/6th/9th/12th months, the liver function, fecal flora, liver fibrosis and immune related indexes were detected. |
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| Sulfasalazine enteric-coated tablets | Drug | Cohort B:60 cases with hepatitis B cirrhosis were collected from each group, 30 cases continued the current treatment, and 30 patients were taking SASP (0.5g orally three times a day) for 12 months of follow-up observation. During 12 months of treatment, at the time of enrollment and the 1st/3rd/6th/9th/12th months, the liver function, fecal flora, liver fibrosis and immune related indexes were detected. |
|
| Sulfasalazine enteric-coated tablets | Drug | Cohort C:Patients with HCV were treated with sulfasalazine Cohort C: 60 cases with hepatitis C cirrhosis were collected,30 cases continued the current treatment(people with hepatitis C cirrhosis continue to take antivirals), and30 patients were taking SASP (0.5g orally three times a day) for 12 months of follow-up observation. During 12 months of treatment, at the time of enrollment and the 1st/3rd/6th/9th/12th months, the liver function, fecal flora, liver fibrosis and immune related indexes were detected. |
|
| Sulfasalazine enteric-coated tablets | Drug | Cohort D:Patients with alcoholic liver fibrosis/cirrhosis were treated with sulfasalazine 60 cases with alcoholic cirrhosis were collected , 30 cases continued the current treatment and 30 patients were taking SASP (0.5g orally three times a day) for 12 months of follow-up observation. During 12 months of treatment, at the time of enrollment and the 1st/3rd/6th/9th/12th months, the liver function, fecal flora, liver fibrosis and immune related indexes were detected. |
|
| baseline,1,3,6,9,12 months after treatment and 1 month after the end of treatment. |
| Chongqing | Recruiting | Chongqing | Chongqing Municipality | 400000 | China |
|
| 34431119 | Result | Lindor KD, Bowlus CL, Boyer J, Levy C, Mayo M. Primary biliary cholangitis: 2021 practice guidance update from the American Association for the Study of Liver Diseases. Hepatology. 2022 Apr;75(4):1012-1013. doi: 10.1002/hep.32117. Epub 2021 Dec 20. No abstract available. |
| ID | Term |
|---|---|
| D008103 | Liver Cirrhosis |
| ID | Term |
|---|---|
| D008107 | Liver Diseases |
| D004066 | Digestive System Diseases |
| D005355 | Fibrosis |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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