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Arginine and Buphenyl in Patients With Argininosuccinic Aciduria (ASA), a Urea Cycle Disorder

This study has been completed.
Sponsor:
Collaborators:
Rare Diseases Clinical Research Network
Information provided by (Responsible Party):
Children's Research Institute
ClinicalTrials.gov Identifier:
NCT00345605
First received: June 26, 2006
Last updated: November 3, 2014
Last verified: November 2014
  Purpose

Urea cycle disorders are inherited illnesses in which the body does not produce enough of the chemicals that remove ammonia, a byproduct of protein metabolism, from the blood stream. Elevated ammonia levels can lead to brain damage and death. Argininosuccinic aciduria (ASA) is a type of urea cycle disorder that is characterized specifically by high levels of argininosuccinic acid, a chemical involved in the urea cycle. People with ASA are at risk for serious liver damage, which may be due to the elevated levels of argininosuccinic acid. Sodium phenylbutyrate (Buphenyl-TM) is a drug that has been used to treat other types of urea cycle disorders. This study will evaluate whether Buphenyl-TM in conjunction with decreased arginine dose (in addition to a normal regimen of protein) will improve short-term liver function and decrease plasma citrulline and ASA levels in people with ASA.


Condition Intervention Phase
Argininosuccinic Aciduria
Amino Acid Metabolism, Inborn Errors
Urea Cycle Disorders
Drug: Sodium Phenylbutyrate
Drug: Arginine
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Crossover Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: A Randomized, Double-Blind, Crossover Study of Sodium Phenylbutyrate and Low-Dose Arginine Compared to High-Dose Arginine Alone on Liver Function, Ureagenesis and Subsequent Nitric Oxide Production in Patients With Argininosuccinic Aciduria

Resource links provided by NLM:


Further study details as provided by Children's Research Institute:

Primary Outcome Measures:
  • Measures of Liver Function: AST and ALT [ Time Frame: Measured after each 1-week treatment period ] [ Designated as safety issue: No ]
    Plasma aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were measured.

  • Measures of Liver Function: PT and PTT [ Time Frame: Measured after each 1-week treatment period ] [ Designated as safety issue: No ]
    Prothrombin time (PT) and partial thromboplastin time (PTT) were measured PT measures factors I (fibrinogen), II (prothrombin), V, VII, and X, while PTT is a performance indicator of the efficacy of the common coagulation pathways.

  • Measures of Liver Function: Coagulation Factors [ Time Frame: Measured after each 1-week treatment period ] [ Designated as safety issue: No ]
    Plasma levels of coagulation factors I and IX were used as measures of hepatic synthetic function since the treatment duration was short.

  • Measures of Liver Function: INR [ Time Frame: Measured after each 1-week treatment period ] [ Designated as safety issue: No ]
    The result (in seconds) for a prothrombin time performed on a normal individual will vary according to the type of analytical system employed. This is due to the variations between different batches of manufacturer's tissue factor used in the reagent to perform the test. The INR was devised to standardize the results. Each manufacturer assigns an ISI value (International Sensitivity Index) for any tissue factor they manufacture. The ISI value indicates how a particular batch of tissue factor compares to an international reference tissue factor. The ISI is usually between 1.0 and 2.0. The INR is the ratio of a patient's prothrombin time to a normal (control) sample, raised to the power of the ISI value for the analytical system being used.


Secondary Outcome Measures:
  • Argininosuccinic Acid Levels [ Time Frame: Measured after each 1-week treatment period ] [ Designated as safety issue: No ]
  • Arginine Levels [ Time Frame: Measured after each 1-week treatment period ] [ Designated as safety issue: No ]
  • Urea Production Rate [ Time Frame: Measured after each 1-week treatment period ] [ Designated as safety issue: No ]

Enrollment: 12
Study Start Date: February 2008
Study Completion Date: November 2012
Primary Completion Date: May 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: HDA

High Dose Arm

Wash-out then 7 days of:

Arg 500 mg/kg/d or 10 g/m2 BSA Placebo instead of NaPBA

Drug: Sodium Phenylbutyrate
None will be administered during the washout period; 500 mg/kg/day or 10 grams/m2 will be administered during the first one week treatment period in addition to arginine
Other Name: Buphenyl-TM
Drug: Arginine
Standard therapeutic dose of 500 mg/kg/day or 10 grams/2 will be administered during the washout periods, during the first one week treatment period when receiving arginine plus Buphenyl, 100 mg/kg/day or 2 grams/m2 will be administered, during the second treatment week, when receiving arginine alone, 500 mg/kg/day or 10 grams/m2 will be administered
Experimental: LDA

Low Dose Arm

Wash-out followed by 7 days of:

Arg 100 mg/kg/d or 2 g/m2 BSA NaPBA 500 mg/kg/d or 10 g/m2 BSA

Drug: Sodium Phenylbutyrate
None will be administered during the washout period; 500 mg/kg/day or 10 grams/m2 will be administered during the first one week treatment period in addition to arginine
Other Name: Buphenyl-TM
Drug: Arginine
Standard therapeutic dose of 500 mg/kg/day or 10 grams/2 will be administered during the washout periods, during the first one week treatment period when receiving arginine plus Buphenyl, 100 mg/kg/day or 2 grams/m2 will be administered, during the second treatment week, when receiving arginine alone, 500 mg/kg/day or 10 grams/m2 will be administered

Detailed Description:

The cause of liver damage in people with ASA is unknown. However, because ASA is the only urea cycle disorder that is characterized by both liver damage and elevated levels of argininosuccinic acid, researchers believe that the elevated acid levels cause the liver damage. Common treatments for urea cycle disorders include a low-protein diet and arginine supplementation, which, when combined, help to decrease ammonia levels in the blood. Buphenyl-TM may aid in lowering ammonia and argininosuccinic acid levels. Although Buphenyl-TM has been FDA-approved for use in people with some types of urea cycle disorders, there is little information on the effectiveness of the drug in children with ASA. This study will evaluate whether treatment of ASA patients with Buphenyl-TM in conjunction with lowered doses of arginine improves liver function as measured by short-term assessment of synthetic activity and the use of stable isotope tracers to assess ureagenesis and nitric oxide production.

Initially, participants in this double-blind, placebo-controlled, crossover study will undergo a 3-day washout period during which no Buphenyl-TM will be given. They will then be randomly assigned to one of two groups: either Buphenyl-TM (500 mg/kg/day or 10 grams/m2) and arginine (100 mg/kg/day or 2 grams/m2)), or arginine alone (500 mg/kg/day or 10 grams/m2). Participants will remain on this initial treatment arm for 1 week, at the conclusion of which an assessment of hepatic synthetic function, ureagenesis, and nitric oxide production will be performed. After this assessment, participants will undergo a second 3-day washout and then crossover to the other treatment arm for 1 week. At the end of the 1-week treatment period, a second assessment will be performed. During the washout period before each treatment period, no Buphenyl-TM will be administered, and arginine will be administered at the standard therapeutic dose of 500 mg/kg/day or 10 grams/2.

  Eligibility

Ages Eligible for Study:   5 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Has confirmed diagnosis of ASA by amino acid or enzyme assay
  • Has a history of adequate compliance to the diet and treatment
  • Able to take oral or G-tube medication
  • Able to perform 24 hour urine collection
  • Agrees to travel to Baylor College of Medicine
  • If female, of child bearing potential, and sexually active, agrees to use an acceptable method of birth control
  • Greater than 5 years of age

Exclusion Criteria:

  • Has a history of congestive heart failure, severe renal insufficiency, or any condition that causes sodium retention or edema
  • Currently taking Probenecid, Haloperidol, Valproate or oral corticosteroids
  • Pregnant or lactating
  • Currently being treated for an acute illness
  • Has co-morbid associations causing difficulties in the detection of hyperammonemic episodes, liver damage, or difficulties in the diet compliance
  • Has known hypersensitivity to sodium phenylbutyrate
  • Has taken any experimental medication within the last 30 days
  • Has renal insufficiency with creatinine greater than 1.5 mg/dl at screening
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00345605

Locations
United States, Texas
Baylor College of Medicine
Houston, Texas, United States, 77030
Sponsors and Collaborators
Children's Research Institute
Rare Diseases Clinical Research Network
Investigators
Principal Investigator: Brendan Lee, MD, PhD Baylor College of Medicine
  More Information

Additional Information:
Publications:
Responsible Party: Children's Research Institute
ClinicalTrials.gov Identifier: NCT00345605     History of Changes
Other Study ID Numbers: RDCRN 5102, U54HD061221
Study First Received: June 26, 2006
Results First Received: May 15, 2014
Last Updated: November 3, 2014
Health Authority: United States: Federal Government

Keywords provided by Children's Research Institute:
Argininosuccinic Acid Lyase Deficiency
ASA

Additional relevant MeSH terms:
4-phenylbutyric acid
Amino Acid Metabolism, Inborn Errors
Argininosuccinic Aciduria
Disease
Metabolism, Inborn Errors
Urea Cycle Disorders, Inborn
Brain Diseases
Brain Diseases, Metabolic
Brain Diseases, Metabolic, Inborn
Central Nervous System Diseases
Genetic Diseases, Inborn
Metabolic Diseases
Nervous System Diseases
Pathologic Processes
Antineoplastic Agents
Pharmacologic Actions
Therapeutic Uses

ClinicalTrials.gov processed this record on November 20, 2014