Randomized Study of Acetylcysteine in Patients With Acute Liver Failure Not Caused by Acetaminophen

Completed · Phase 3 · Has a placebo group

Conditions studied: Acute Liver Failure

In brief

OBJECTIVES: I. Determine the safety and efficacy of a short course (72 hours) of intravenous acetylcysteine in patients with acute liver failure for whom no antidote or specific treatment is available.

Key facts

Study ID: NCT00004467
Run by: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
People needed: 173
Starts: 1998-06-01
Expected to finish: 2006-11-01
Last updated by the study team: 2017-10-13

Who can join

Age: 18 and older, up to 70. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

This is a phase III blinded study, which will involve approximately 200 patients. For this purpose, acute liver failure will be defined as onset of any mental status alteration and coagulopathy (INR > 1.5) within 26 weeks of onset of a hepatitic illness, with no evidence of underlying chronic liver disease. Eligible patients will be those admitted to study site hospital intensive care units with acute liver failure and who can be evaluated and started on treatment within the first 24 hours of hospitalization or those who evolve to altered mentation if already in the hospital. All subjects will be between 18 and 70 years. Patients transferred from referring hospitals to a study site may be considered for enrollment, provided that no other specific treatment protocol has begun, and that no liver support device (bioartificial liver (BAL), extracorporeal liver assist device (ELAD), transgenic pig perfusion) has been used or is contemplated. Use of fresh frozen plasma infusions will not disqualify patients from participation.

You may not qualify if…

Patients less than age 18 or over 70 years of age.
ALF patients where acetaminophen or mushroom poisoning is assessed or Suspected to be a significant contributing or sole cause of the illness. Both these diagnoses require specific antidote therapy, including NAC in the case of acetaminophen, rather than randomized or non-specific treatment.
Patients with a diagnosis of shock liver (ischemic hepatopathy), since the overall outcome for these patients in largely determined by the underlying etiology of the condition leading to shock. Heat stroke is not excluded.
Acute liver failure of pregnancy or the HELLP syndrome (pregnancy associated hemolysis and coagulopathy). The effect of NAC on the fetus or the mother has not been determined; in addition, pregnancy-related liver diseases usually mandate rapid delivery of the infant.
ALF thought secondary to intrahepatic malignancy. Patients with hepatic malignancy experiencing ALF have 100% mortality and are not transplant candidates.
Patients who exhibit signs of cerebral herniation at the time of enrollment.
Patients who demonstrate the presence of intractable arterial hypotension (arterial systolic blood pressure equal to or below 70 mmHg) present, or require inotropic drugs at the time of enrollment.
Severe sepsis (temperature >39o C and/or significant bacteremia) present at the time of enrollment.
In general, acute liver failure (ALF) patients comprise somewhat more women than men, but there is no preponderance of any racial group, other than that expected on the basis of geographic differences. No exclusion will be made on the basis of race, ethnic group or gender. Criteria for inclusion of women and minorities will be those established in the NIH guidelines. Each study site will provide for review a log of patients considered for the NAC study with no identifiers, yielding only gender and age, race and reason for not participating as a check on gender or ethnic bias.

Where it is running

University of Alabama at Birmingham — Birmingham, Alabama, United States
Mayo Clinic — Scottsdale, Arizona, United States
University of California Los Angeles — Los Angeles, California, United States
University of California Davis — Sacramento, California, United States
University of California San Diego — San Diego, California, United States
University of California San Francisco — San Francisco, California, United States
Mayo Clinic — Jacksonville, Florida, United States
Northwestern University Medical School — Chicago, Illinois, United States
Massachusetts General Hospital — Boston, Massachusetts, United States
University of Michigan Health Systems — Ann Arbor, Michigan, United States
Mayo Clinic — Rochester, Minnesota, United States
Washington University School of Medicine — St Louis, Missouri, United States
University of Nebraska Medical Center — Omaha, Nebraska, United States
Mount Sinai Medical Center, NY — New York, New York, United States
New York Presbyterian Hospital — New York, New York, United States
Duke University Medical Center — Durham, North Carolina, United States
Oregon Health Sciences University — Portland, Oregon, United States
University of Pennsylvania — Philadelphia, Pennsylvania, United States
Albert Einstein Medical Center — Philadelphia, Pennsylvania, United States
University of Pittsburgh Medical Center — Pittsburgh, Pennsylvania, United States
Medical University of South Carolina — Charleston, South Carolina, United States
University of Texas Southwestern Medical Center at Dallas — Dallas, Texas, United States
Baylor University Medical Center — Dallas, Texas, United States
Virginia Commonwealth University — Richmond, Virginia, United States
University of Washington Medical Center — Seattle, Washington, United States

Full record on ClinicalTrials.gov

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