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    Summary
    EudraCT Number:2018-004011-44
    Sponsor's Protocol Code Number:UofATURRIFIC
    National Competent Authority:UK - MHRA
    Clinical Trial Type:EEA CTA
    Trial Status:GB - no longer in EU/EEA
    Date on which this record was first entered in the EudraCT database:2020-05-28
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedUK - MHRA
    A.2EudraCT number2018-004011-44
    A.3Full title of the trial
    A randomised trial of URsodeoxycholic acid versus RIFampicin in severe early onset Intrahepatic Cholestasis of pregnancy: the TURRIFIC study, comparing their effectiveness in the reduction of pruritus.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Trial of URsodeoxycholic acid versus RIFampicin in severe early onset Intrahepatic Cholestasis of pregnancy: the TURRIFIC study
    A.3.2Name or abbreviated title of the trial where available
    TURRIFIC Protocol Version 8
    A.4.1Sponsor's protocol code numberUofATURRIFIC
    A.5.4Other Identifiers
    Name:ANZCTRNumber:ACTRN12618000332224
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorThe University Of Adelaide
    B.1.3.4CountryAustralia
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportDepartment of Health
    B.4.2CountryAustralia
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationThe University of Adelaide
    B.5.2Functional name of contact pointChief Principal Investigator
    B.5.3 Address:
    B.5.3.1Street Address72 King William Road
    B.5.3.2Town/ cityNORTH ADELAIDE
    B.5.3.3Post code5006
    B.5.3.4CountryAustralia
    B.5.4Telephone number61881617000
    B.5.5Fax number6183131406
    B.5.6E-mailbill.hague@adelaide.edu.au
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Information not present in EudraCT
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameRifampicin
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNRifampicin
    D.3.9.1CAS number 13292-46-1
    D.3.9.4EV Substance CodeAS1
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number300
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Information not present in EudraCT
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameUrsodeoxycholic acid
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNUrsodeoxycholic acid
    D.3.9.1CAS number 128-13-2
    D.3.9.4EV Substance CodeAS2
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Intrahepatic Cholestasis of Pregnancy (ICP) is an serious liver condition in pregnancy. The main symptom of this is itching. Ursodeoxycholic acid is routinely used to treat cholestasis but is not effective in reducing itch in all people who take it. Rifampcin has been used to reduce itch in people with Primary Biliary Cholangitis. This study will randomly allocate women with severe early onset ICP to receive either Ursodeoxycholic Acid, or the "Investigational drug" Rifampicin.
    E.1.1.1Medical condition in easily understood language
    ICP is a liver condition in pregnancy where women develop severe itching and high concentration of bile acid in their blood. ICP is associated with increased risk of premature delivery and stillbirth.
    E.1.1.2Therapeutic area Diseases [C] - Female diseases of the urinary and reproductive systems and pregancy complications [C13]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.1
    E.1.2Level PT
    E.1.2Classification code 10049055
    E.1.2Term Cholestasis of pregnancy
    E.1.2System Organ Class 10019805 - Hepatobiliary disorders
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.1
    E.1.2Level PT
    E.1.2Classification code 10049055
    E.1.2Term Cholestasis of pregnancy
    E.1.2System Organ Class 10019805 - Hepatobiliary disorders
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To compare treatment with Rifampicin (RIF) with the standard treatment, Ursodeoxycholic acid (UDCA) for the reduction of itch, the main symptom of the condition.
    E.2.2Secondary objectives of the trial
    1. To compare the effect of RIF treatment with UDCA treatment on short-term outcomes for both mother and baby, including the length of the pregnancy and the rates of caesarean section and preterm birth
    2. To compare the effect of RIF treatment with UDCA treatment on serum concentrations of: bile acids, transaminases (liver enzymes), and on metabolites such as serum autotaxin and progesterone sulphated metabolites, and urine glucuronidated 6α-hydroxylated BA.
    3. To assess the effect of RIF and UDCA on the metabolome (the results of breakdown of nutrients, hormones and bodily processes) and the microbiome (bacteria in/on the body)
    4. To assess the effect of treatment with RIF compared with UDCA on maternal and fetal outcomes analysed by bile acid transporter genotype.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives
    The sub-studies are fully described within the Protocol Version 8, 13 May 2020. The sub-studies cover the analysis of the serum, urine, microbiome, metabolome and genetic samples collected. These are:
    TURRIFIC tests - Biochemical and microbiological assessments
    TURRIFIC genes and viruses - Genetic and virome assessments

    Objectives: Currently ICP is diagnosed using the criteria of increased bile acids associated with itch. However, serum bile acid concentration does not always appear to be correlated with itch severity. Thus, serum and urine will be analysed to look at relationship between autotaxin, sulphated progesterone metabolites, total bile acid profile, itch and treatment with Ursodeoxycholic acid/Rifampicin. It is also not known what happens to the gut mircobiome in ICP or in response to medications for ICP. So we plaan to investigate any alterations in gut microflora diversity and abundance. Non-specific viral disease has in some cases been associated with a transient hepatitis, so we plan to investigate whether there is any involvement of viruses in the aetiology of ICP by a study of the virome (viral DNA) in the blood of participants at trial entry. Whole exome analysis of participant DNA will allow study of genes known to be associated with cholestasis, including known mutations of bile acid transporter genes, and their contribution to disease severity.
    E.3Principal inclusion criteria
    Women will be considered eligible for inclusion into the trial with the following criteria:
    • Severe ICP (defined as pruritus with raised total serum BA ≥40 μmol/L) confirmed
    • Viable pregnancy between 14+0 and 33+6 weeks gestation inclusive
    • No known lethal fetal anomaly
    • Singleton pregnancy
    • Obstetric care in a consultant-led unit
    • Aged 18 years or over
    • Written informed consent has been obtained
    E.4Principal exclusion criteria
    A potential participant who meets any of the following criteria will be excluded from participation in this study:
    • A decision has already been made for delivery within the next 48 hours
    • There is allergy to any component of the UDCA or RIF tablets
    • The woman is taking other medication that has a significant interaction with rifampicin treatment
    • There is a multi-fetal gestation
    • There is laboratory-confirmed active hepatitis A or hepatitis B, or positive serology for hepatitis C
    • There is current pre-eclampsia (ISSHP criteria)
    • There is a known primary hepatic disorder, including α-1-antitrypsin deficiency and autoimmune hepatitis, including primary biliary cholangitis
    • The woman is on current medication causing deranged liver enzymes
    • The woman is unwilling for her baby to have standard Vitamin K administration at birth
    • The woman has previously participated in TURRIFIC
    E.5 End points
    E.5.1Primary end point(s)
    Pruritus, defined as worst itch in the previous 24 hours, assessed on a patient-reported visual analogue scale.
    E.5.1.1Timepoint(s) of evaluation of this end point
    At study entry, one week post randomisation, then monthly up to delivery, with optional assessments on a weekly basis after 28 weeks gestation.
    E.5.2Secondary end point(s)
    1. Outcomes for both mother and infant including the length of gestation and the incidence of caesarean section and preterm birth.
    2. Serum concentrations of: bile acids, transaminases, and on metabolites such as serum autotaxin and progesterone sulphated metabolites, and urine glucuronidated 6α-hydroxylated BA.
    3. Metabolome and the microbiome.
    4. Maternal and fetal outcomes analysed by bile acid transporter genotype.
    E.5.2.1Timepoint(s) of evaluation of this end point
    These numbers correspond to the secondary outcomes listed in 23-2 above.
    1. assessed at delivery
    2. to be assessed at study entry, one week post randomisation, then on a monthly basis up to delivery.
    3. to be assessed at study entry, one week post randomisation, then on a monthly basis up to delivery, one and two weeks post delivery
    4. to be assessed once for mother using sample collected at study entry, once for baby using sample collected at birth.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA8
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Finland
    Netherlands
    Sweden
    United Kingdom
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    End of trial will be at data base lock. This is so that any "data cleaning" and queries may be completed.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months4
    E.8.9.1In the Member State concerned days15
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days17
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1Number of subjects for this age range: 0
    F.1.1.1In Utero No
    F.1.1.1.1Number of subjects for this age range: 0
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.2.1Number of subjects for this age range: 0
    F.1.1.3Newborns (0-27 days) No
    F.1.1.3.1Number of subjects for this age range: 0
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.4.1Number of subjects for this age range: 0
    F.1.1.5Children (2-11years) No
    F.1.1.5.1Number of subjects for this age range: 0
    F.1.1.6Adolescents (12-17 years) No
    F.1.1.6.1Number of subjects for this age range: 0
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 108
    F.1.3Elderly (>=65 years) No
    F.1.3.1Number of subjects for this age range: 0
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male No
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women Yes
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state22
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 60
    F.4.2.2In the whole clinical trial 108
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None. ICP generally resolves quickly once the baby is delivered. In the small proportion of women who have ongoing itch, they will be able to access the current standard drug, UDCA, if prescribed by their doctor. Women taking Rifampicin will have their dosage tapered following delivery.

    G. Investigator Networks to be involved in the Trial
    G.4 Investigator Network to be involved in the Trial: 1
    G.4.1Name of Organisation East Midlands Clinical Research Network
    G.4.3.4Network Country United Kingdom
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2020-05-29
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-08-10
    P. End of Trial
    P.End of Trial StatusGB - no longer in EU/EEA
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