A Phase 3 interventional study of Albutein 20% and SMT in Decompensated Cirrhosis and Ascites, sponsored by Grifols Therapeutics LLC. Completed at 66 sites in 14 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-06-06.
Sponsored by Grifols Therapeutics LLC · Phase 3, Interventional, and Treatment
This is a phase 3, multicenter, randomized, controlled, parallel-group, and open-label clinical study to evaluate the efficacy of standard medical treatment (SMT) + Albutein 20% administration versus SMT alone in participants with decompensated cirrhosis and ascites. The study population will consist of participants being discharged after hospitalization for acute decompensation of liver cirrhosis with ascites (or with prior history of ascites requiring diuretic therapy) with or without acute-on-chronic liver failure (ACLF) at admission or during hospitalization but without ACLF at discharge.
Exclusion Criteria:
Participants received Albutein 20%, at a dose of 1.5 grams/kilograms (g/kg), based on their body weight (maximum 100 grams per participant), as an intravenous (IV) infusion on Day 1, followed by the same dose of Albutein 20% every 10±2 days along with standard medical treatment (SMT) administered as per institution standards for the management of decompensated cirrhosis up to 12 months.
Drug: Albutein 20% · Other: SMT
Participants received SMT up to 12 months as per institution standards for the management of decompensated cirrhosis.
Other: SMT
Injectable solution
Participants received SMT according to institution standards for the management of decompensated cirrhosis.
Time to Liver Transplantation or Death Through 1 Year After Randomization: Percentage of Participants With an Event
Time to one-year transplant-free survival was calculated as earlier of \[(date of liver transplantation or date of death) - randomization date + 1\] for participants who died or had liver transplant within the analysis period of 361 days. Participants who neither died nor had liver transplant within analysis period had their time to event censored at earlier of date of last contact or cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on liver transplantation and death, these events if reported by cut-off Day 361, were considered for the endpoint. The percentage of participants with events are presented. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 361) / (number of participants in the ITT group)\].
Time frame: Up to Day 361
Time to Liver Transplantation or Death Through 3 Months After Randomization: Percentage of Participants With an Event
Time to 3-months transplant-free survival was calculated as earlier of \[(date of liver transplantation or date of death) - randomization date + 1\] for participants who died or had liver transplant within the analysis period of 91 days. Participants who neither died nor had liver transplant within analysis period had their time to event censored at earlier of date of last contact or cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on liver transplantation and death, these events if reported by cut-off Day 91, were considered for the endpoint. The percentage of participants with events are presented. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 91) / (number of participants in the ITT group)\].
Time frame: Up to Day 91
Time to Liver Transplantation or Death Through 6 Months After Randomization: Percentage of Participants With an Event
Time to 6-months transplant-free survival was calculated as earlier of \[(date of liver transplantation or date of death) - randomization date + 1\] for participants who died or had liver transplant within the analysis period of 181 days. Participants who neither died nor had liver transplant within analysis period had their time to event censored at earlier of date of last contact or cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on liver transplantation and death, these events if reported by cut-off Day 181, were considered for the endpoint. The percentage of participants with events are presented. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 181) / (number of participants in the ITT group)\].
Time frame: Up to Day 181
Time to Death Through 3 Months After Randomization: Percentage of Participants With an Event
Time to 3-months survival was calculated as the earlier of \[(date of death) - randomization date + 1\] for those participants who died within the analysis period of 91 days. Participants who did not die within the analysis period were censored at the earlier of the date of last contact or analysis cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on death, these events if reported before the analysis cut-off Day 91 of this endpoint, were considered. The percentage of participants with events (death) without censoring participants who underwent liver transplantation within the analysis period were reported. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 91) / (number of participants in the ITT group)\].
Time frame: Up to Day 91
Time to Death Through 6 Months After Randomization: Percentage of Participants With an Event
Time to 6-months survival was calculated as the earlier of \[(date of death) - randomization date + 1\] for those participants who died within the analysis period of 181 days. Participants who did not die within the analysis period were censored at the earlier of the date of last contact or analysis cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on death, these events if reported before the analysis cut-off Day 181 of this endpoint, were considered. The percentage of participants with events (death) without censoring participants who underwent liver transplantation within the analysis period were reported. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 181) / (number of participants in the ITT group)\].
Time frame: Up to Day 181
Time to Death Through 1 Year After Randomization: Percentage of Participants With an Event
Time to 1 year survival was calculated as the earlier of \[(date of death) - randomization date + 1\] for those participants who died within the analysis period of 361 days. Participants who did not die within the analysis period were censored at the earlier of the date of last contact or analysis cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on death, these events if reported before the analysis cut-off Day 361 of this endpoint, were considered. The percentage of participants with events (death) without censoring participants who underwent liver transplantation within the analysis period were reported. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 361) / (number of participants in the ITT group)\].
Time frame: Up to Day 361
Total Number of Paracenteses Through 1 Year After Randomization
Paracenteses is a medical procedure used to remove excess fluid from the abdominal cavity. For each participant, the total number of reported paracenteses on treatment was calculated. Number of paracenteses per participant while on treatment was reported.
Time frame: Up to Day 361
Number of Participants With Refractory Ascites According to the International Club of Ascites (ICA) Through 1 Year After Randomization
Refractory Ascites was defined as ascites that cannot be mobilized, or the early recurrence of which cannot be prevented because of a lack of response to sodium restriction and diuretic, or the development of diuretic-induced complications that preclude the use of an effective diuretic dosage treatment. Incidence of refractory ascites occurring on treatment was defined as any incidence that occurred with a start date/time on or after the participants date/time of randomization (for SMT Alone group) or commencement of Albutein (SMT+ Albutein 20% group) treatment.
Time frame: Up to Day 361
A total of 410 participants took part in the study at 40 investigative sites across 14 countries in Europe and the United States from 24 July 2018 to 21 May 2024.
| Milestone | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| Started | 203 | 207 |
| Completed | 110 | 105 |
| Not completed | 93 | 102 |
| Withdrew: Death | 44 | 59 |
| Withdrew: Withdrawal by subject | 18 | 13 |
| Withdrew: Transplantation | 18 | 12 |
| Withdrew: Lost to follow-up | 4 | 12 |
| Withdrew: Physician decision | 4 | 3 |
| Withdrew: Adverse event | 3 | 3 |
| Withdrew: Non-compliance with study drug | 2 | 0 |
Time to one-year transplant-free survival was calculated as earlier of \[(date of liver transplantation or date of death) - randomization date + 1\] for participants who died or had liver transplant within the analysis period of 361 days. Participants who neither died nor had liver transplant within analysis period had their time to event censored at earlier of date of last contact or cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on liver transplantation and death, these events if reported by cut-off Day 361, were considered for the endpoint. The percentage of participants with events are presented. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 361) / (number of participants in the ITT group)\].
| percentage of participants | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| Time to Liver Transplantation or Death Through 1 Year After Randomization: Percentage of Participants With an Event | 33.5 | 38.6 |
Time to 3-months transplant-free survival was calculated as earlier of \[(date of liver transplantation or date of death) - randomization date + 1\] for participants who died or had liver transplant within the analysis period of 91 days. Participants who neither died nor had liver transplant within analysis period had their time to event censored at earlier of date of last contact or cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on liver transplantation and death, these events if reported by cut-off Day 91, were considered for the endpoint. The percentage of participants with events are presented. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 91) / (number of participants in the ITT group)\].
| percentage of participants | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| Time to Liver Transplantation or Death Through 3 Months After Randomization: Percentage of Participants With an Event | 10.8 | 17.9 |
Time to 6-months transplant-free survival was calculated as earlier of \[(date of liver transplantation or date of death) - randomization date + 1\] for participants who died or had liver transplant within the analysis period of 181 days. Participants who neither died nor had liver transplant within analysis period had their time to event censored at earlier of date of last contact or cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on liver transplantation and death, these events if reported by cut-off Day 181, were considered for the endpoint. The percentage of participants with events are presented. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 181) / (number of participants in the ITT group)\].
| percentage of participants | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| Time to Liver Transplantation or Death Through 6 Months After Randomization: Percentage of Participants With an Event | 22.7 | 28.5 |
Time to 3-months survival was calculated as the earlier of \[(date of death) - randomization date + 1\] for those participants who died within the analysis period of 91 days. Participants who did not die within the analysis period were censored at the earlier of the date of last contact or analysis cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on death, these events if reported before the analysis cut-off Day 91 of this endpoint, were considered. The percentage of participants with events (death) without censoring participants who underwent liver transplantation within the analysis period were reported. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 91) / (number of participants in the ITT group)\].
| percentage of participants | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| Time to Death Through 3 Months After Randomization: Percentage of Participants With an Event | 9.4 | 14.0 |
Time to 6-months survival was calculated as the earlier of \[(date of death) - randomization date + 1\] for those participants who died within the analysis period of 181 days. Participants who did not die within the analysis period were censored at the earlier of the date of last contact or analysis cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on death, these events if reported before the analysis cut-off Day 181 of this endpoint, were considered. The percentage of participants with events (death) without censoring participants who underwent liver transplantation within the analysis period were reported. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 181) / (number of participants in the ITT group)\].
| percentage of participants | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| Time to Death Through 6 Months After Randomization: Percentage of Participants With an Event | 16.7 | 23.2 |
Time to 1 year survival was calculated as the earlier of \[(date of death) - randomization date + 1\] for those participants who died within the analysis period of 361 days. Participants who did not die within the analysis period were censored at the earlier of the date of last contact or analysis cut-off date. Participants who terminated early for reasons other than death were followed up at months 3, 6, and 12 to collect information on death, these events if reported before the analysis cut-off Day 361 of this endpoint, were considered. The percentage of participants with events (death) without censoring participants who underwent liver transplantation within the analysis period were reported. The percentage of participants was calculated as \[(participants with an event up to the analysis cut-off Day 361) / (number of participants in the ITT group)\].
| percentage of participants | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| Time to Death Through 1 Year After Randomization: Percentage of Participants With an Event | 26.1 | 31.9 |
Paracenteses is a medical procedure used to remove excess fluid from the abdominal cavity. For each participant, the total number of reported paracenteses on treatment was calculated. Number of paracenteses per participant while on treatment was reported.
| paracenteses per participant | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| Total Number of Paracenteses Through 1 Year After Randomization | 1.3 ± 3.58 | 2.3 ± 5.07 |
Refractory Ascites was defined as ascites that cannot be mobilized, or the early recurrence of which cannot be prevented because of a lack of response to sodium restriction and diuretic, or the development of diuretic-induced complications that preclude the use of an effective diuretic dosage treatment. Incidence of refractory ascites occurring on treatment was defined as any incidence that occurred with a start date/time on or after the participants date/time of randomization (for SMT Alone group) or commencement of Albutein (SMT+ Albutein 20% group) treatment.
| Participants | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| Number of Participants With Refractory Ascites According to the International Club of Ascites (ICA) Through 1 Year After Randomization | 33 | 46 |
Collected over Up to 12 months. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| SMT + Albutein 20% | 53/203 (26.1%) | 52/203 (25.6%) | 51/203 (25.1%) |
| SMT Alone | 67/207 (32.4%) | 70/207 (33.8%) | 47/207 (22.7%) |
| Event | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| Gastrointestinal haemorrhageGastrointestinal disorders | 11/203 | 0/207 |
| PneumoniaInfections and infestations | 2/203 | 8/207 |
| Urinary Tract InfectionInfections and infestations | 2/203 | 7/207 |
| DeathGeneral disorders | 5/203 | 4/207 |
| SepsisInfections and infestations | 2/203 | 5/207 |
| Respiratory failureRespiratory, thoracic and mediastinal disorders | 1/203 | 5/207 |
| Septic ShockInfections and infestations | 1/203 | 4/207 |
| Incarcerated umbilical herniaGastrointestinal disorders | 0/203 | 4/207 |
| Clostridium Difficile InfectionInfections and infestations | 0/203 | 3/207 |
| EpilepsyNervous system disorders | 1/203 | 3/207 |
| Event | SMT + Albutein 20% | SMT Alone |
|---|---|---|
| AnaemiaBlood and lymphatic system disorders | 14/203 | 17/207 |
| Urinary tract infectionInfections and infestations | 13/203 | 15/207 |
| PruritusSkin and subcutaneous tissue disorders | 12/203 | 2/207 |
| HyperkalaemiaMetabolism and nutrition disorders | 11/203 | 8/207 |
| DiarrhoeaGastrointestinal disorders | 11/203 | 8/207 |
| HypokalaemiaMetabolism and nutrition disorders | 7/203 | 11/207 |
Intent-to-treat (ITT) population included all participants who were randomized.
| Age, Continuous(years) | SMT + Albutein 20% | SMT Alone | Total |
|---|---|---|---|
| Mean | 58.9 ± 10.03 | 58.7 ± 10.30 | 58.8 ± 10.16 |
| Sex: Female, Male(Participants) | SMT + Albutein 20% | SMT Alone | Total |
|---|---|---|---|
| Female | 62 | 55 | 117 |
| Male | 141 | 152 | 293 |
| Ethnicity (NIH/OMB)(Participants) | SMT + Albutein 20% | SMT Alone | Total |
|---|---|---|---|
| Hispanic or Latino | 18 | 17 | 35 |
| Not Hispanic or Latino | 185 | 190 | 375 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | SMT + Albutein 20% | SMT Alone | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 3 | 1 | 4 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 2 | 4 | 6 |
| White | 197 | 199 | 396 |
| More than one race | 0 | 1 | 1 |
| Unknown or Not Reported | 1 | 2 | 3 |
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Grifols Therapeutics LLC