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Report for Clinical Trial NCT00063232

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

Treatment of Nonalcoholic Steatohepatitis With Metformin

Nonalcoholic Steatohepatitis (NASH) is associated with progressive liver disease, fibrosis, and cirrhosis. Although the cause of NASH is unknown, it is often associated with obesity, type 2 diabetes, and insulin resistance. At present, there are no approved treatments for NASH patients, but an experimental approach has focused on improving their insulin sensitivity. Metformin is one of the most commonly used medications for the treatment of diabetes. The purpose of this study is to determine whether the medical problems of NASH patients, specifically liver damage, improves when their insulin sensitivity is enhanced with metformin. The study will last 3 to 5 years and will enroll up to 30 patients. Participants will undergo a complete medical examination, a series of lab tests, and a liver biopsy. They will then start taking a single 500-mg tablet of metformin once a day for 2 weeks, then the same dosage twice a day for 2 more weeks, if they tolerate the first dosage. The dosage will increase to 1,000 mg twice a day for the remaining 44 weeks of the study. After 1 year, participants will undergo a repeat medical examination and liver biopsy.

NCT00063232 Hepatitis
MeSH: Hepatitis Fatty Liver Non-alcoholic Fatty Liver Disease
HPO: Hepatic steatosis Hepatitis

1 Interventions

Name: Metformin

Description: After complete medical evaluation and liver biopsy, patients who qualified for therapy were started on metformin in an initial dose of 500 mg once daily. After 2 weeks, the dose was increased to 500 mg twice daily and after 4 weeks to the full dose of 1000 mg twice daily. Subsequent dose reductions were carried out based on tolerance, with particular attention to gastrointestinal upset and abdominal bloating. Patients were seen in the out-patient clinic, had a brief medical history and examination and routine blood tests at 2 and 4 weeks after enrolment and every 4 weeks thereafter. The oral and intravenous glucose tolerance tests were repeated after 40 and 44 weeks respectively and liver biopsy and imaging tests at 48 weeks. Metformin was discontinued after 48 weeks in patients without diabetes on the pre-treatment evaluation.

Type: Drug


Primary Outcomes

Description: Patients under went liver biopsy, metabolic profiling and imaging studies before and at the end 48 weeks of metformin (2000 mg/day) therapy. The primary endpoint is a three point improvement in the histological NASH activity index with a decrease in at least two of the component scores and no worsening of fibrosis or increase in Mallory bodies.

Measure: Change in the Histological NASH Activity Index at 48 Weeks Compared With Baseline (Number of Participants in Each Change Category)

Time: from baseline to 48 Weeks

Secondary Outcomes

Description: Alanine transaminase <42 U/L is considered normal

Measure: Change in Serum Alanine Aminotransferase (ALT) Levels From Baseline (Number of Participants in Each Change Category)

Time: from baseline to 48 weeks

Description: HOMA-IR is calculated from Fasting Glucose and Fasting Insulin

Measure: Change in Insulin Sensitivity (Glucose Tolerance, Homeostatic Model Assessment of Insulin Resistence (HOMA-IR)) From Baseline

Time: from baseline to 48 weeks

Purpose: Treatment


There are 2 SNPs

SNPs


1 C282Y

7. Hemochromatosis as defined by presence of 3+ or 4+ stainable iron on liver biopsy and homozygosity for C282Y or compound heterozygosity for C282Y/H63D. --- C282Y ---


2 H63D

7. Hemochromatosis as defined by presence of 3+ or 4+ stainable iron on liver biopsy and homozygosity for C282Y or compound heterozygosity for C282Y/H63D. --- C282Y --- --- H63D ---



HPO Nodes


HPO:
Hepatic steatosis
Genes 137
ATP7B LDLRAP1 MPV17 CLPB APOE APOB SLC40A1 POLG HNF1B COA8 ABCG8 BSCL2 HFE GPD1 BCS1L CIDEC ACAD9 LYRM4 AGPAT2 LMNA LMNB2 PRDM16 CAV1 FOS LMNA TYMP LIPE RERE BCS1L MPV17 BSCL2 CIDEC MCCC1 ACADM PLIN1 SLC25A13 HADHB ETFA CAV1 XRCC4 CPT1A FBP1 PCK1 PTRH2 CEP19 RMND1 LMNA GABRD POLR3A TMEM199 NSMCE2 PPARG ADK ACAD9 LIPA TFAM NGLY1 PMM2 HNRNPA1 VPS33A AKT2 POLD1 MARS1 DDOST TRAPPC11 ETFB ACADVL BSCL2 ALMS1 LMNA LARS1 CPT2 CBS CARS2 COX15 NDUFAF1 LRPPRC ALDOB PCSK9 HNRNPA2B1 TRMU PGM1 NSMCE2 CPT2 LIPE ACOX1 LDLR CYP7A1 MRPL44 PCK2 DNAJC19 LMNA FARSB ABHD5 CAVIN1 PNPLA2 HADH ZMPSTE24 ETFDH ALMS1 PNPLA2 SLC22A5 PHKG2 AGPAT2 DGUOK ATP6AP1 COG6 ABHD5 HADHA PHKA2 SLC40A1 TARS2 LMNA TRAPPC11 PPARG MRPS7 KCNAB2 ACADL HADH SLC25A13 ACADM VCP HNF4A PLIN1 PPARG EARS2 SAR1B CAVIN1 SLC25A13 HSD17B4 DNAJC19 RRM2B SKI CYP19A1 IARS1 POLG ABCG5
Hepatitis
Genes 90
CD247 CTNNB1 ATP7B CASP10 PIEZO1 GUSB BLNK SHPK CYP7A1 IL17RA IGF2R CASP8 SH2D1A SLC25A15 BTK BTK C4B CD79B VPS33B XIAP SERPINA1 PIK3R1 GLIS3 POU2AF1 CIITA FOXP3 TPP2 RFX5 CIITA RASGRP1 RFXANK SLC25A15 AXIN1 TCF4 CD3D TP53 IL12A PRKCD CD40LG BTK IGHM IL17RC ALMS1 TRAF3IP2 KRT8 FAS LRRC8A FAS IL17F XIAP SPIB C1S RFX5 RFXAP MST1 TTC7A COG8 SKIV2L VIPAS39 IGLL1 PDGFRL TNFSF15 HSD3B7 CD3E AMACR ATP7B FASLG RFXANK IL12RB1 TCF3 CD79A KRT18 IRF5 MET PIK3CA MMEL1 ITCH TBX19 IL21R AIRE RFXAP TTC7A CLEC7A GPR35 ATP7A CYP7B1 STAT1 PGM1 APC TNPO3