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Compassionate Use of Omegaven® in the Treatment of Parenteral Nutrition Associated Hepatic Injury

This study is enrolling participants by invitation only.
Sponsor:
Collaborator:
Children's Hospital of Pittsburgh
Information provided by (Responsible Party):
Jeffrey Rudolph, University of Pittsburgh
ClinicalTrials.gov Identifier:
NCT01412359
First received: August 2, 2011
Last updated: January 21, 2014
Last verified: January 2014
  Purpose

The overall purpose of this study is to determine if replacing standard soybean oil based fat emulsions with Omegaven®, a fish oil based fat emulsion, can reverse or prevent the progression of parenteral nutrition associated cholestasis. It is a compassionate use protocol for patients who already have significant cholestasis related to parenteral nutrition.


Condition Intervention Phase
Total Parenteral Nutrition-induced Cholestasis
Drug: Omegaven®
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Compassionate Use of Omegaven® in the Treatment of Parenteral Nutrition Associated Hepatic Injury

Resource links provided by NLM:


Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
  • Primary efficacy outcome will be normalized direct bilirubin, defined as three consecutive direct bilirubin results < 2mg/dL or a direct bilirubin < 2mg/dL and weaned from total parenteral nutrition (TPN). [ Time Frame: 1 year ] [ Designated as safety issue: No ]
    Bilirubin levels will be monitored according to the standard of care for TPN dependent patients, usually weekly, for the duration of their participation in the study protocol. Duration of participation cannot be determined in advance.


Estimated Enrollment: 50
Study Start Date: June 2009
Estimated Study Completion Date: January 2015
Estimated Primary Completion Date: January 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Omegaven®
Omegaven® 10% fat emulsion 1g/kg/day to infuse via IV over a period of 12 -24 hours every day until patient no longer requires intravenous lipid emulsion, is determined ineffective, or the patient stops participating in the study for any reason.
Drug: Omegaven®
Omegaven® 10% fat emulsion 1g/kg/day to infuse via IV over a period of 12 -24 hours every day until patient no longer requires intravenous lipid emulsion, is determined ineffective, or the patient stops participating in the study for any reason.
Other Name: Intavenous fish oil emulsion

Detailed Description:

In the United States, patients dependent upon parenteral nutrition (PN) receive parenteral fat emulsions composed of soybean oils. Lipids are necessary in PN dependent patients due to their high caloric value and essential fatty acid content. Phytosterols such as those contained in soybean oil based fat emulsions are thought to have a deleterious effect on biliary secretion and they have been implicated in predisposing patients to PN associated liver disease. Children requiring prolonged courses of PN are at risk for developing PN associated liver disease. The investigators hypothesize that although soybean oil based fat emulsions prevent fatty acid deficiency, they are not cleared in a manner similar to enteral chylomicrons and therefore accumulate in the liver resulting in steatotic liver injury.

Animal studies have shown that fish oil based IV fat emulsions(IFE)which are high in eicosapentaenic and docosahexaenoic acid, reduce impairment of bile flow seen in cholestasis caused by conventional fat emulsions. Omegaven® is a fish oil based IV fat emulsion. The investigators hypothesize that administering Omegaven® in place of conventional soybean fat emulsions may reverse or prevent the progression of PN associated cholestasis and thus allow the patient to be maintained on adequate PN until he/she is able to ingest adequate nutrition enterally.

  Eligibility

Ages Eligible for Study:   2 Months to 10 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must be 2 months -10 years of age.
  • Patients who are PN dependent (unable to meet nutritional needs solely by enteral nutrition) and are expected to require PN for at least another 30 days
  • Patients considered eligible for study participation must have parenteral nutrition associated liver disease (PNALD) as defined by a direct bilirubin of >2.0mg/dL. Other causes of liver disease should be excluded. A liver biopsy is not necessary for treatment.
  • 2 consecutive direct bilirubin test results >2.0mg/dL
  • The patient must have failed standard therapies to prevent the progression of liver disease such as surgical treatment, cyclic TPN, avoiding overfeeding, reduction/removal of copper and manganese from TPN, advancement of enteral feeding, and use of ursodiol (Actigall).
  • Subjects who are currently under treatment for PNALD with Compassionate Use Omegaven and have a direct Bilirubin of< 2, but who remain TPN dependent and require continued therapy with Omegaven.

Exclusion Criteria:

  • Other known causes of chronic liver disease (hepatitis C, cystic fibrosis, biliary atresia and alpha 1 anti-trypsin deficiency)
  • Enrollment in any other clinical trial involving an investigational agent (unless approved by the designated physicians on the multidisciplinary team)
  • The parent, guardian, or child is unwilling to provide consent or assent
  • Allergy to any fish product, egg protein, and/or previous allergy to Omegaven
  • Active coagulopathies characterized by on-going bleeding or by a requirement for clotting factor replacement such as fresh frozen plasma or cryoprecipitate to maintain homeostasis
  • Impaired lipid metabolism or severe hyperlipidemia with or without pancreatitis
  • Unstable diabetes mellitus
  • Stroke/embolism
  • Collapse and shock
  • Undefined coma status
  • Active infection at time of initiation of Omegaven® up until such time as child is afebrile with stable vital signs and one negative 48 hour culture.
  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: NCT01412359

Locations
United States, Pennsylvania
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, United States, 15224
Sponsors and Collaborators
University of Pittsburgh
Children's Hospital of Pittsburgh
Investigators
Principal Investigator: Jeffrey A Rudolph, MD Medical Director, Intestinal Care and Rehabilitation, Children's Hospital of Pittsburgh of UPMC
  More Information

No publications provided

Responsible Party: Jeffrey Rudolph, Jeffrey A. Rudolph, M.D., Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh
ClinicalTrials.gov Identifier: NCT01412359     History of Changes
Other Study ID Numbers: PRO08080394
Study First Received: August 2, 2011
Last Updated: January 21, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Pittsburgh:
TPN Cholestasis

Additional relevant MeSH terms:
Cholestasis
Bile Duct Diseases
Biliary Tract Diseases
Digestive System Diseases
Fat Emulsions, Intravenous
Parenteral Nutrition Solutions
Pharmaceutical Solutions
Pharmacologic Actions
Therapeutic Uses

ClinicalTrials.gov processed this record on November 25, 2014