N-acetylcysteine in Non-Acetaminophen Pediatric Acute Liver Failure
|Acute Liver Failure Hepatic Encephalopathy||Drug: N-acetylcysteine Drug: Placebo||Phase 3|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
|Official Title:||A Multi-center Study of the Safety and Efficacy of N-acetylcysteine in the Treatment of Acute Liver Failure in Pediatric Patients Not Caused by Acetaminophen.|
- Survival [ Time Frame: One year following randomization ]Spontaneous survival without transplant plus survival following transplantation
- Spontaneous Recovery [ Time Frame: One year following randomization ]Survival without liver transplantation
- Cumulative Percent Incidence of Transplantation by 1 Year [ Time Frame: Within 1 year of randomization ]
- Length of Hospital Stay [ Time Frame: Randomization to hospital discharge ]
- Categorized Length of ICU Stay [ Time Frame: Within 7 days of randomization ]The length of ICU stay was categorized as number of days in ICU within 7 days of randomization, unless participant either died or received an LTx within this time period. Special categories were created for these cases.
- Number of Organ Systems Failing [ Time Frame: Within 7 days of randomization ]
- Highest Coma Grade of Hepatic Encephalopathy [ Time Frame: Within 7 days of randomization ]West Haven Criteria for hepatic encephalopathy (Grade 0 - IV ) is used for participants > 3 year of age. Coma grade IV indicates a participant who is comatose , with no reflexes, is decerebrate and has abnormal EEG changes with very slow delta activity. For participants less than 3 years the Whittington Scale was used. The Whittington scale does not use EEG changes and has only 3 levels, early (grades I and II), Mid (III) with somnolence, stupor, combativeness and Late (IV) for participants who are comatose with absent reflexes and decerebrate or decorticate posturing.
- Infectious Complication [ Time Frame: Within 7 days of randomization ]
|Study Start Date:||January 2000|
|Study Completion Date:||October 2010|
|Primary Completion Date:||September 2009 (Final data collection date for primary outcome measure)|
Active Comparator: N-acetylcysteine (NAC)
Eligible children were adaptively allocated by age (less than 2 years of age or at least 2 years old) and hepatic encephalopathy (grade 0-1 or 2-4) to receive N-acetylcysteine (150 mg/kg/d) in 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive days
The study drug is administered as a continuous infusion at a dose of 150 mg/kg/day for up to 7 days following entry into the study. The infusion is discontinued at the time of death, liver transplant or discharge.
Other Name: Mucomyst
Placebo Comparator: placebo
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and hepatic encephalopathy (grade 0-1 or 2-4) to receive 5% dextrose (D5W) infused over 24 hours for up to 7 consecutive
Eligible children were adaptively allocated within strata defined by age (less than 2 years of age or at least 2 years old) and hepatic encephalopathy (grade 0-1 or 2-4) to receive N-acetylcysteine (150 mg/kg/d) in 5% dextrose (D5W) and water or placebo consisting of an equal volume of D5W alone. Volumes were adjusted for small children. Study medications were infused over 24 hours for up to 7 consecutive days in a dedicated line without other medications. Treatment was stopped earlier than 7 days in the case of hospital discharge, liver transplantation, or death within 7 days of randomization.
Other Name: dextrose in water
The Pediatric Acute Liver Failure (PALF) Study Group to identify, characterize, and develop management strategies for infants, children and adolescents who present with acute liver failure. The PALF study group includes 20 sites (17 in the United States, 2 in the United Kingdom, and 1 in Canada). The primary objective of the Pediatric Acute Liver Failure (PALF) study is to collect, maintain, analyze, and report clinical, epidemiological, and outcome data in children with ALF, including information derived from biospecimens.
Patients enrolled in the PALF study registry were able to enroll in the NAC study providing they met the additional required inclusion/exclusion criteria.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00248625
Show 20 Study Locations
|Principal Investigator:||Robert H Squires, M.D.||Children's Hospital of Pittsburgh, University of Pittsburgh|