Reduction by Pasireotide of the Effluent Volume in High-output Enterostomy in Patients Refractory to Usual Medical Treatment
- Registration Number
- NCT02713776
- Lead Sponsor
- Hospices Civils de Lyon
- Brief Summary
During rectal or complex digestive surgery with multiple digestive resections and anastomosis, the creation of enterostomy is a common procedure. In France, it is estimated that 20000 patients have an ileostomy and 16000 new digestive stomas are formed each year with approximately 30% of enterostomy. Enterostomy might sometimes give high-output not controlled with usual medical treatment (e.g loperamide ± codeine) and exposes the patients to important hydro-electrolytic loss leading to a risk for dehydration, electrolyte abnormalities and acute renal failure. This risk implies parenteral correction which may extend hospital stay and delay home return.
Somatostatin analogues (octreotide, lanreotide and pasireotide) could reduce digestive secretions and decrease digestive peristalsis. Nevertheless, somatostatin analogues are not routinely used for the treatment of patients with high-output enterostomy and their efficacy in the indication (off-label) was only tested in small case series. Pasireotide (SOM230, SIGNIFOR®) is currently indicated for the treatment of patients with Cushing's disease for whom surgery is not an option or for whom surgery has failed.
As the efficacity of pasireotide in patients with high-output enterostomy refractory to usual medical treatment associated with an oral fluid restriction has never been demonstrated before, there is a need to perform a pilot, double-blind, randomized, placebo-controlled trial evaluating its impact on reduction of the effluent volume.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 57
- Male and Female patients ≥ 18 years old ;
- Patients who underwent an intestinal surgery with enterostomy repair in the three weeks preceding the inclusion ;
- Patients with high-output ileostomy or jejunostomy > 1000 ml/24h ;
- Patients with failure of treatment combining oral fluid restriction and loperamide (up to 8 capsules/24h) +/- codeine syrup (10 mg x 3/24h) during 5 days ;
- Patients who gave its written informed consent to participate to the study ;
- Patients affiliated to a social insurance regime.
- Male and Female patients < 18 years old ;
- Patients who did not give its written informed consent to participate to the study ;
- Patients who received somatostatin analogues during the month before inclusion ;
- Patients with symptomatic cholelithiasis or acute or chronic pancreatitis ;
- Patients with uncontrolled diabetes (with HbA1c (glycated hemoglobin) > 8%) ;
- Patients who are hypothyroid and not on adequate replacement therapy ;
- Patients who have congestive heart failure (NYHA (New York Heart Association) Class III or IV), unstable angina, sustained ventricular tachycardia, ventricular fibrillation, advanced heart block or a history of clinically significant bradycardia or acute myocardial infarction within the 6 months preceding randomization ;
- Patients with history of syncope or family history of idiopathic sudden death ;
- Patients with screening or baseline (predose) : QT interval corrected for heart rate using Fridericia's correction (QTcF) QTcF > 450 msec (male), QTcF > 460 msec (female) (QT interval corrected for heart rate using Fridericia's correction) ;
- Patients with not corrected hypokalaemia and/or hypomagnesaemia ;
- Patients with liver disease such as cirrhosis, chronic active hepatitis, or chronic persistent hepatitis, or patients with alanine transaminase/aspartate transaminase (ALT/AST) > 2 x Upper Limit of Normal (ULN), serum bilirubin > 2 x ULN ;
- Patients with Child-Pugh C cirrhosis ;
- Female patients who are pregnant or lactating, or are of childbearing potential and not practicing a medically acceptable method of birth control ;
- Patients with abnormal coagulation (PT and/or APTT elevated by 30% above normal limits) or patients receiving anticoagulants that affect PT (prothrombin time) or activated partial thromboplastin time (APTT) ;
- Patients with known hypersensitivity to somatostatin analogues or any other component of the pasireotide LAR ;
- Patients under guardianship ;
- Patients nonaffiliated to a social insurance regime.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Placebo Placebo by subcutaneous injection twice a day during 3 days and 1 intramuscular injection of placebo on Day 4 morning. Pasireotide Pasireotide Pasireotide 0.9 mg by subcutaneous injection twice a day during 3 days and 1 intramuscular injection of pasireotide Long Acting Release (LAR) 60mg on Day 4 morning.
- Primary Outcome Measures
Name Time Method Compare the efficacy of pasireotide versus placebo in reduction of high-output Evaluated 72 hours after first injection of treatment Decrease of enterostomy output (ml/24H)within the 72 hours after first injection of treatment
- Secondary Outcome Measures
Name Time Method Estimate the success rate of pasireotide and placebo 1 week after first injection of treatment Number of normal renal function patients in both arms with an enterostomy output than 800 millimeters (mL) /24h within a week after first injection of treatment allowing discontinuation of intravenous perfusion.
Incidence of treatment - Emergent Adverse Events during treatment (4 days), one week, two weeks, three weeks and one month after treatment Nature, number and grade of adverse events observed throughout the study
Compare the incidence of premature closure of stoma due to high-output with pasireotide versus placebo 2 months after enterostomy creation Rate of premature closure of stoma due to high-output (before 2 months after creation) in both arms
Evaluate the economic impact of pasireotide in this indication 2 months from the inclusion of the patient in the study Costs of taking care of patients from French Public Health Insurance perspective in both arms
Compare the decrease in the length of hospitalization with pasireotide versus placebo 1 month after the end of treatment Duration of hospitalization in days in both arms
Trial Locations
- Locations (14)
Centre Leon Berard
🇫🇷Lyon, France
Centre Hospitalier Lyon Sud
🇫🇷Pierre-Bénite, France
Chu Albert Michallon
🇫🇷La Tronche, France
Bordeaux Chu - Hopital Haut-Leveque
🇫🇷Pessac, France
Hopital Saint Antoine
🇫🇷Paris, France
Hopital Beaujon
🇫🇷Clichy, France
Institut Regional Du Cancer Val D'Aurelle
🇫🇷Montpellier, France
Chu Rouen Ch. Nicolle
🇫🇷Rouen, France
Chu Caremeau
🇫🇷Nîmes, France
Chu Estaing
🇫🇷Clermont-Ferrand, France
Chu Amiens-Picardie
🇫🇷Amiens, France
Hôpital Claude HURIEZ - CHRU Lille
🇫🇷Lille, France
Chu Marseille - Hopital Nord
🇫🇷Marseille, France
Toulouse - Chu Purpan
🇫🇷Toulouse, France