Treatment of Nonalcoholic Steatohepatitis With Pioglitazone
Status:
Completed
Trial end date:
2004-03-01
Target enrollment:
Participant gender:
Summary
This study will evaluate the effectiveness of pioglitazone, a new diabetes medicine, on
decreasing insulin resistance and improving liver disease in patients with nonalcoholic
steatohepatitis (NASH). NASH is a chronic liver disease with unknown cause that involves fat
accumulation and inflammation in the liver, leading to liver cirrhosis in 10 to 15 percent of
patients and significant liver scarring in another 30 percent. Although similar to a
condition that affects people who drink excessive amounts of alcohol, NASH occurs in people
who drink only minimal or no alcohol. It is most often seen in patients with insulin
resistance. Pioglitazone decreases insulin resistance and improves blood lipid (fat) levels,
so that it may improve liver disease in NASH.
Patients with NASH 18 years of age or older may be eligible for this study. Candidates will
be screened with a medical history and physical examination and routine blood tests. They
will see a dietitian for counseling on diet and weight reduction, if needed. They will stop
taking any medications for liver disease and take a daily multivitamin pill. After 2 months,
those eligible for participation will be enrolled in the study.
Participants will be admitted to the Clinical Center for 2 to 3 days for a complete medical
history, physical examination, blood tests, urinalysis, chest X-ray, electrocardiogram,
abdominal ultrasound and a liver biopsy. After the diagnosis of NASH is confirmed, the
following procedures will be performed:
- Echocardiography - imaging test using sound waves shows the heart structure and function
- Resting metabolic rate - measures amount of oxygen (and calories) used to maintain body
functions at rest. While lying down, the patient wears a clear plastic hood over the
head for 20 minutes while the amount of oxygen used is measured.
- Magnetic resonance imaging (MRI) scans - shows the size of the liver and other organs.
The patient lies on a table in a metal cylinder that contains a magnetic field (the
scanner) for no more than 30 minutes while the organs are imaged.
- Dual energy X-ray absorptiometry (DEXA) scan measures whole body composition, including
amount of fat. The patient lies under an X-ray scanning machine for about 2 minutes.
- Oral glucose tolerance test (OGTT) - measures blood sugar and insulin levels. The
patient drinks a very sweet drink containing glucose (sugar), after which blood samples
are collected at various intervals during the 3-hour test. The blood is drawn through a
catheter (thin plastic tube) placed in the arm before the test begins.
- Intravenous glucose tolerance test (IVGTT) - determines how the tissues respond to
insulin and glucose. Glucose is injected into a vein, followed by a short infusion of
insulin. Blood samples are collected through a catheter at various intervals during the
3-hour test.
When the above procedures are completed, patients start taking pioglitazone by mouth once a
day for 48 weeks, keeping track of the medication and any side effects. They will be seen at
the clinic every 2 weeks for the first month and then every 4 weeks for the rest of the
treatment period. The visits will include an interview and examination by a physician and
blood draw for laboratory tests. Female patients will have a pregnancy test at each clinic
visit. At the end of the treatment period patients will be admitted to the Clinical Center
for a repeat medical evaluation that will include the procedures described above.
Phase:
Phase 2
Details
Lead Sponsor:
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)