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CholestasisPhase 3NCT02357576

Standard Lipid Therapy vs IVFE Minimization for Prevention of PNALD

A Phase 3 study testing Intralipid 20% I.V. Fat Emulsion in people with Cholestasis, run by University of Michigan at 5 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Parenteral nutrition-associated cholestasis (PNAC) and liver disease (PNALD) are associated with significant morbidity and mortality in neonates and is felt to be exacerbated by soybean-based lipid emulsions. Much research is currently being directed at identifying ways to reduce this risk. Read more about this study

Who is it for?
Ages Up to 1 year
Conditions the study is for
Cholestasis
What is being tested?
Intralipid 20% I.V. Fat Emulsion
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
22 participants
Where
5 sitesUnited States
Study dates
21 May 2016to 8 Nov 2019
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Up to 1 year
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • neonates and infants who are at least 28 weeks corrected gestational age at the time of enrollment who are parenteral nutrition (PN) naive
  • current direct bilirubin <2 mg/dL
  • any of the following conditions:
  • meconium ileus and peritonitis
  • gastroschisis
  • omphalocele >4cm or with liver herniated outside of the abdominal cavity
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  • necrotizing enterocolitis requiring surgical intervention
  • volvulus
  • intestinal atresia with >50% bowel loss

Who cannot join

  • weight <1 kg
  • metabolic pathway defect which is associated with liver dysfunction in the neonatal period, including: hereditary fructose intolerance, galactosemia due to transferase deficiency and neonatal tyrosinemia, and/or disorder of lipid metabolism
  • hepatic insufficiency as documented by either a biopsy with cirrhosis and/or marked aberration in synthetic function
  • renal failure
  • primary or secondary liver disease, regardless of liver function (includes hepatitis)
  • use of extracorporeal membrane oxygenation (ECMO)
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  • suspected congenital obstruction of the hepatobiliary tree
  • documented active infection which may be communicable, including infections hepatitis or HIV
  • previous receipt of choleretic agents
  • currently receiving phenobarbital or other barbiturates
  • history of PNAC
  • direct bilirubin >=2 mg/dL at time of enrollment
  • congenital or acquired anomaly which will require major cardiovascular surgery
  • major congenital or chromosomal anomaly
  • hypoxic ischemic encephalopathy
  • congenital defect of the brain
  • major seizure disorder

Trial locations and contacts

5 sites in 1 country.

5 sites in 1 country

United States5 sites
  • University of Michigan

    Ann Arbor, Michigan, 48109

  • University of Colorado/Children's Hospital Colorado

    Aurora, Colorado, 80045

  • University of Florida

    Gainesville, Florida, 32601

  • Primary Children's Hospital

    Salt Lake City, Utah, 84132

  • Seattle Children's Hospital

    Seattle, Washington, 98105

Other trials in United States

About this study

Official title: Phase 3 Study of Standard Lipid Therapy Versus Intravenous Fat Emulsion Minimization for the Prevention of Parenteral Nutrition-Associated Liver Disease

Parenteral nutrition-associated cholestasis (PNAC) and liver disease (PNALD) are associated with significant morbidity and mortality in neonates and is felt to be exacerbated by soybean-based lipid emulsions. Much research is currently being directed at identifying ways to reduce this risk. Reduction of the dose of soybean-based lipid given as a component of parenteral nutrition is one possible strategy. In this study we will compare standard dosing of soybean-based lipid (up to 3/kg/day) with a minimized dose (1 g/kg/day) and evaluate for the development of cholestasis and adequate growth between the two groups. Longterm followup will include an assessment of neurodevelopmental outcomes at 12 and 24 months of age.

Funding source - FDA OOPD

Conditions
Cholestasis
Being tested
Intralipid 20% I.V. Fat Emulsion
Medical subject headings
Cholestasis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Intralipid 20% I.V. Fat EmulsionDrug

Study groups in NCT02357576
Study groupRoleWhat they receive
Reduced LipidExperimentalSubjects will receive a minimized dose (1 g/kg/day) of the soybean-based lipid component of parenteral nutrition.
Receives: Drug: Intralipid 20% I.V. Fat Emulsion
Standard LipidActive comparatorSubjects will receive the standard dose (up to 3 g/kg/day) of the soybean-based lipid component of parenteral nutrition.
Receives: Drug: Intralipid 20% I.V. Fat Emulsion

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Rate of Rise of Direct Bilirubin as a Function of Time

    The rate of rise (change over time) of direct bilirubin was compared between the two groups at different time points.

    Measured: 12 weeks

Secondary outcomes (19)
  1. Prevalence of Parenteral Nutrition-associated Cholestasis (PNAC) (Direct Bilirubin ≥2 mg/dL)

    The number of participants who had a direct bilirubin ≥2 mg/dL were compared between the standard and reduced lipid groups. Bilirubin data was collected from baseline until 7 days after PN has been discontinued, but not to exceed a total of 12 weeks.

    Measured: 12 weeks

  2. Prevalence of Severe Parenteral Nutrition-associated Cholestasis (PNAC) (Direct Bilirubin ≥4 mg/dL in Subjects on Parenteral Nutrition for at Least 2 Weeks)

    The number of participants with severe PNAC defined as a direct bilirubin ≥4 mg/dL were compared between the standard and reduced lipid groups. Bilirubin data was collected from baseline until 7 days after PN has been discontinued, but not to exceed a total of 12 weeks.

    Measured: 12 weeks

  3. The Time to Development of PNAC

    The time to development was compared between the standard and reduced lipid groups.

    Measured: 12 weeks

  4. The Time to Development of Severe PNAC

    The time to development from randomization was compared between the standard and reduced lipid groups.

    Measured: 12 weeks

  5. Peak Total Bilirubin Level

    The peak (highest) total bilirubin collected from each subject from after week 1 to end of treatment. This was compared between the standard and reduced lipid groups.

    Measured: 12 weeks

  6. Peak Direct Bilirubin Level

    The peak (highest) direct bilirubin collected from each subject from after week 1 to end of treatment. This was compared between the standard and reduced lipid groups.

    Measured: 12 weeks

  7. The Prevalence of Essential Fatty Acid Deficiency (EFAD)

    The number of participants who experienced EFAD was compared between the standard and reduced lipid groups.

    Measured: 12 weeks

  8. Adequacy of Growth as Evaluated by Z-scores for Weight

    Z-scores were compared between subjects in the two treatment groups by week. Z-scores are the number of standard deviations above (positive value) or below (negative value) the median on the FENTON and WHO growth charts. Fenton scores were used for infants born <37 weeks gestation. WHO scores were used for infants born at ≥37 weeks gestation.

    Measured: 12 weeks

  9. Adequacy of Growth as Evaluated by Z-scores for Height

    Z-scores were compared between subjects in the two treatment groups. Z-scores are the number of standard deviations above (positive value) or below (negative value) the median on the FENTON and WHO growth charts. Fenton scores were used for infants born <37 weeks gestation. WHO scores were used for infants born at ≥37 weeks gestation.

    Measured: 12 weeks

  10. Adequacy of Growth as Evaluated by Z-scores for Head Circumference

    Z-scores were compared between subjects in the two treatment groups. Z-scores are the number of standard deviations above (positive value) or below (negative value) the median on the FENTON and WHO growth charts. Fenton scores were used for infants born <37 weeks gestation. WHO scores were used for infants born at ≥37 weeks gestation.

    Measured: 12 weeks

  11. Adverse Events, as Defined by Any Episode of Sepsis and Catheter-related Blood Stream Infections

    The number of episodes were compared between the standard and reduced lipid groups of suspected sepsis episodes, NEC, or catheter-related blood stream infections.

    Measured: 12 weeks

  12. Bayley Scales for Infant and Toddler Development (BSID-III) at One Year

    The Bayley Scales of Infant and Toddler Development (BSID-III) is designed to assess developmental functioning of infants and toddlers, ages 1 month to 42 months. The instrument includes five distinct scales, of which three scales and associated subscales are utilized for the purposes of this study: cognitive, language (receptive and expressive communication) and motor (fine motor and gross motor). Raw scores are converted to scaled scores using age-standardized norm. The cognitive scaled scores range from 1-19. 1 is a low score and 19 is a high score. The Language scaled scores are calculated by adding the Receptive Communication scores ranging from 1-19 and the Expressive communication scores ranging from 1-19 to give the Language Scaled score of 2-38. The Motor scaled scores are calculated by adding the Fine Motor scores ranging from 1-19 and the Gross Motor scores ranging from 1-19 to give the Motor scaled ranging from 2-38. Higher scores are better than lower scores.

    Measured: 1 year

  13. Bayley Scales for Infant and Toddler Development (BSID-III) at Two Years

    The Bayley Scales of Infant and Toddler Development (BSID-III) is designed to assess developmental functioning of infants and toddlers, ages 1 month to 42 months. The instrument includes five distinct scales, of which three scales and associated subscales are utilized for the purposes of this study: cognitive, language (receptive and expressive communication) and motor (fine motor and gross motor). Raw scores are converted to scaled scores using age-standardized norm. The cognitive scaled scores range from 1-19. 1 is a low score and 19 is a high score. The Language scaled scores are calculated by adding the Receptive Communication scores ranging from 1-19 and the Expressive communication scores ranging from 1-19 to give the Language Scaled score of 2-38. The Motor scaled scores are calculated by adding the Fine Motor scores ranging from 1-19 and the Gross Motor scores ranging from 1-19 to give the Motor scaled ranging from 2-38. Higher scores are better than lower scores.

    Measured: 2 years

  14. MacArthur-Bates Communicative Development Inventories (CDI)

    The MacArthur-Bates Communicative Development Inventories (CDI) are parent report instruments which capture information about children's developing abilities in early language. Scores are reported as percentiles compared to age-standardized norms. Higher scores are better than lower scores.

    Measured: 2 years

  15. Brief Infant Toddler Social Emotional Assessment (BITSEA) Part 1 of 2

    Dichotomous scores are generated based on cut-off scores, which identify subjects to be at risk. The problem scale measures behaviors of the child that if present, represent a problem. The competence scale measures behaviors of the child that if absent, represent a problem. BITSEA percentile rankings are determined from a table that has a limited range and are adjusted for age and sex. A high problem score leads to a low problem percentile. A high competence score leads to a high competence percentile. Percentile rankings for both problem and competence scores range from "4% or less" to "26% or higher". 4 is the lowest percentile score and 26 is the highest percentile score. The 25th percentile is the lower limit of the average range. Higher percentile scores are better than lower percentile scores in both problem and competence categories.

    Measured: 2 years

  16. Gross Motor Function Classification System (GMFCS)

    This classification is based on observation with a scale of 1-5. A lower number classification is better than a higher classification, with 1 being the best.

    Measured: 2 years

  17. Behavioral Assessment System for Children-Third Edition (BASC3) Part 1 of 2

    The Behavioral Assessment System for Children-Third Edition is a comprehensive set of forms that helps to understand the behaviors and emotions of children. Scores are reported as T-Scores. T-Scores range from 0-120. In a normative population, the mean of standard scores is 50, and standard deviation is 10. For Externalizing Problems T-Score, Internalizing Problems T-Score, Behavioral Symptoms Index T-Score, Clinical Probability Index T-Score, and Functional Impairment Index T-Score lower scores are better than higher scores. For these categories, higher scores are more problematic with scores between 60-70 regarded as "at risk" and scores 70 and above regarded as clinically significant and requiring further assessment and possible treatment. For Adaptive Skills T-Score, a higher score is better than a lower score. For Adaptive Skills T-Score, lower scores are more problematic with scores between 30-40 regarded as "at risk" and scores at or below 30 regarded as clinically significant.

    Measured: 2 years

  18. Behavioral Assessment System for Children-Third Edition (BASC3) Part 2 of 2

    The Behavioral Assessment System for Children-Third Edition is a comprehensive set of forms that helps to understand the behaviors and emotions of children. For Overall Executive Functioning Index, Attentional Control Index, Behavioral Control Index, and Emotional Control Index, scores are "Not Elevated" or "Elevated". Not Elevated is better than Elevated.

    Measured: 2 years

  19. Brief Infant Toddler Social Emotional Assessment (BITSEA) Part 2 of 2

    Dichotomous scores are generated based on cut-off scores, which identify subjects to be at risk. The problem scale measures behaviors of the child that if present, represent a problem. The competence scale measures behaviors of the child that if absent, represent a problem.

    Measured: 2 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Feb 2015 (estimated)
  2. Study start21 May 2016
  3. Primary completion12 Oct 2017
  4. Study completion8 Nov 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
22 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02357576
Sponsor's protocol ID
HUM00075458
Other IDs
1R01FD005085-01A1
Status last verified
Dec 2020
First submitted
2 Feb 2015
Last updated
17 Dec 2020
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Intralipid 20% I.V. Fat Emulsion in people with Cholestasis, run by University of Michigan at 5 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 17 Dec 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 23 Jan 2020). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of Rise of Direct Bilirubin as a Function of Time (time frame: 12 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Dec 2020.

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