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Angiotensin Receptor Blockade as an Anti-Fibrotic Intervention in Patients With Chronic Hepatitis C

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00930995
Recruitment Status : Withdrawn (Not Awarded)
First Posted : July 2, 2009
Last Update Posted : April 25, 2012
University of California, Davis
Information provided by:
Kaiser Permanente

Brief Summary:

Hepatitis C is the most common reason for liver transplantation in the United States and affects nearly 4 million Americans. Treatments for hepatitis C are available but are poorly tolerated and are not always effective. Morbidity and mortality from hepatitis C are related to the development and progression of hepatic fibrosis to cirrhosis and end stage liver disease. Efforts to block progression of liver disease would thus result in prevention of morbidity and mortality as well as costs incurred by the health system in the care of these conditions.

Scar tissue in the liver is secreted by a type of cell, called the stellate cell, in an activated state. This cell carries a receptor for angiotensin, a hormone, when activated. If this receptor is blocked, the cell becomes inactive and does not participate in scar tissue formation. Thus, we hypothesize that using a drug such as candesartan, which blocks angiotensin receptors, should result in less scar tissue formation in the livers of patients with hepatitis C.

Condition or disease Intervention/treatment Phase
Hepatitis C Drug: Candesartan Drug: Placebo Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Angiotensin Receptor Blockade an Anti-Fibrotic Intervention in Patients With Chronic Hepatitis C

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: A Drug: Candesartan
16mg po daily
Other Name: Atacand

Placebo Comparator: B Drug: Placebo
once daily

Primary Outcome Measures :
  1. Primary: • Stellate cell activity by alpha SMA stain quantitated by morphometry [ Time Frame: 48 weeks ]
  2. • Hepatic fibrosis by morphometry [ Time Frame: 48 weeks ]

Secondary Outcome Measures :
  1. Surrogate markers for fibrosis (liver TGF-beta levels, serum procollagen-III peptide levels) [ Time Frame: 48 weeks ]
  2. Functional status- Albumin, INR, T. Bilirubin, MELD score [ Time Frame: 48 weeks ]

Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Adults, age 21 and older
  • Patients with viral hepatitis C that are not on interferon based therapy.
  • Detectable viral load
  • Baseline biopsy within six months or willing to undergo biopsy prior to drug initiation
  • At least grade 2 inflammation on biopsy, fibrosis of stage 1 or higher
  • Willing to undergo biopsy at the end of treatment
  • No interferon for at least 6 months prior to or after initial biopsy for study

Exclusion Criteria:

  • Renal impairment defined by a serum creatinine of >1.8
  • Congestive heart failure
  • Hepatocellular cancer
  • Concurrent treatment with pentoxyfylline, steroids, interferon alpha or interferon gamma.
  • Active psychosis (affective disorders without loss of reality testing acceptable)
  • Active IV drug use
  • Prior liver transplant
  • Pregnancy
  • Decompensated cirrhosis as defined by the presence of ascites, hepatic encephalopathy or coagulopathy with an INR>1.4
  • HIV seropositivity
  • Hypotension defined by a baseline systolic blood pressure of less than 90mm of mercury
  • Contraindication to ARB use or allergy to medication
  • Treatment with potassium sparing diuretics

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00930995

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United States, California
Kaiser Permanente
Roseville, California, United States, 95661
Kaiser Permanente
Sacramento, California, United States, 95825
Sponsors and Collaborators
Kaiser Permanente
University of California, Davis
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Principal Investigator: Sripriya Subramanian, MD, MPH Kaiser Permanente
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Responsible Party: Sripriya Balasubramanian MD MPH, Kaiser Permanente Identifier: NCT00930995    
Other Study ID Numbers: CN-05SBala-01-B
First Posted: July 2, 2009    Key Record Dates
Last Update Posted: April 25, 2012
Last Verified: April 2012
Additional relevant MeSH terms:
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Hepatitis A
Hepatitis C
Hepatitis C, Chronic
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Virus Diseases
Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
Flaviviridae Infections
Hepatitis, Chronic
Antihypertensive Agents
Angiotensin II Type 1 Receptor Blockers
Angiotensin Receptor Antagonists
Molecular Mechanisms of Pharmacological Action