Assessment of the Treatment of Severely Burned With Anabolic Agents on Clinical Outcomes, Recovery and Rehabilitation - Full Text View

Purpose

The purpose of the program is to study and characterize the outcome of burn injury with particular attention to improving the rehabilitation of burn survivors, including children. Various agents are assessed for effectiveness on long term burn outcome, such as growth hormone, oxandrolone, propranolol,ketoconazole, inhospital exercise and home exercise.

Condition	Intervention	Phase
Burns	Procedure: Stable Isotope Infusion Study Procedure: Collection of blood and tissues Procedure: Radiology testing: Dual-energy X-ray absorptiometry (DEXA), ultrasound, MRI Drug: Humatrope Drug: Ketoconazole Drug: Oxandrolone Drug: Propranolol Drug: Oxandrolone and propranolol combined Drug: Humatrope and propranolol combined Drug: Placebo Behavioral: Exercise--Hospital supervised intensive exercise program Behavioral: Home exercise program	Phase 2 Phase 3


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Participant, Care Provider, Investigator, Outcomes Assessor Primary Purpose: Treatment
Official Title:	Assessment of the Treatment of the Severely Burned With Anabolic Agents on Clinical Outcomes, Recovery and Rehabilitation

Resource links provided by NLM:

MedlinePlus related topics: Burns Rehabilitation

U.S. FDA Resources

Further study details as provided by The University of Texas Medical Branch, Galveston:

Primary Outcome Measures:

Outcome assessments will include measures of muscle wasting, weakness, immunosuppression chronic bone loss and decreased growth with increases in metabolic, hemodynamic, inflammatory and scarring responses. [ Time Frame: Admission to burn unit and up to 2 years post burn and yearly after that ]


Estimated Enrollment:	1100
Study Start Date:	January 2004
Estimated Study Completion Date:	September 2018
Estimated Primary Completion Date:	September 2018 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: 1 Humatrope subcutaneous(SQ) 0.05-0.2 mg/kg/day for up to 2 years post burn	Procedure: Stable Isotope Infusion Study 1-8 hour stable isotope infusion study to be done following each surgery. Tagged isotopes to assess uptake into blood and tissues. Procedure: Collection of blood and tissues Blood draw with each stable isotope infusion study and weekly Tissue biopsy: skin, fat, muscle at stable isotope infusion study Procedure: Radiology testing: Dual-energy X-ray absorptiometry (DEXA), ultrasound, MRI Testing to be done following every stable isotope infusion study to measure muscle, fat and bone tissues. Drug: Humatrope Humatrope (Growth Hormone) dose:0.05mg - 0.2mg/kg/day SQ daily for up to 2 years post burn injury. Other Names: recombinant human growth hormone GH rhGH Growth Hormone
Experimental: 2 Ketoconazole by mouth (PO) given twice a day throughout hospitalization for up to 2 years post burn	Procedure: Stable Isotope Infusion Study 1-8 hour stable isotope infusion study to be done following each surgery. Tagged isotopes to assess uptake into blood and tissues. Procedure: Collection of blood and tissues Blood draw with each stable isotope infusion study and weekly Tissue biopsy: skin, fat, muscle at stable isotope infusion study Procedure: Radiology testing: Dual-energy X-ray absorptiometry (DEXA), ultrasound, MRI Testing to be done following every stable isotope infusion study to measure muscle, fat and bone tissues. Drug: Ketoconazole Ketoconazole administration (or other glucocorticoid blocker--itraconazole or fluconazole) PO daily for up to 2 years post burn injury Other Names: itraconazole fluconazole
Experimental: 3 Oxandrolone PO given daily throughout hospitalization for up to 2 years post burn	Procedure: Stable Isotope Infusion Study 1-8 hour stable isotope infusion study to be done following each surgery. Tagged isotopes to assess uptake into blood and tissues. Procedure: Collection of blood and tissues Blood draw with each stable isotope infusion study and weekly Tissue biopsy: skin, fat, muscle at stable isotope infusion study Procedure: Radiology testing: Dual-energy X-ray absorptiometry (DEXA), ultrasound, MRI Testing to be done following every stable isotope infusion study to measure muscle, fat and bone tissues. Drug: Oxandrolone oxandrolone (or other anabolic steroid-testosterone or nandrolone) daily for up to 2 years post burn injury Other Names: testosterone nandrolone
Experimental: 4 Propranolol PO given daily throughout hospitalization for up to 2 years post burn	Procedure: Stable Isotope Infusion Study 1-8 hour stable isotope infusion study to be done following each surgery. Tagged isotopes to assess uptake into blood and tissues. Procedure: Collection of blood and tissues Blood draw with each stable isotope infusion study and weekly Tissue biopsy: skin, fat, muscle at stable isotope infusion study Procedure: Radiology testing: Dual-energy X-ray absorptiometry (DEXA), ultrasound, MRI Testing to be done following every stable isotope infusion study to measure muscle, fat and bone tissues. Drug: Propranolol Propranolol (or other beta adrenergic blocker--metoprolol, inderol), PO administration daily for up to 2 years post burn injury. Other Names: metroprolol inderol
Experimental: 5 Oxandrolone and propranolol PO to be given daily for up to 2 years post burn	Procedure: Stable Isotope Infusion Study 1-8 hour stable isotope infusion study to be done following each surgery. Tagged isotopes to assess uptake into blood and tissues. Procedure: Collection of blood and tissues Blood draw with each stable isotope infusion study and weekly Tissue biopsy: skin, fat, muscle at stable isotope infusion study Procedure: Radiology testing: Dual-energy X-ray absorptiometry (DEXA), ultrasound, MRI Testing to be done following every stable isotope infusion study to measure muscle, fat and bone tissues. Drug: Oxandrolone and propranolol combined Daily administration of oxandrolone and propranolol to be given for up to 2 years post burn injury. Other Names: testosterone nandrolone inderol metoprolol
Experimental: 6 Humatrope SQ and Propranolol PO to be given daily for up to 2 years post burn	Procedure: Stable Isotope Infusion Study 1-8 hour stable isotope infusion study to be done following each surgery. Tagged isotopes to assess uptake into blood and tissues. Procedure: Collection of blood and tissues Blood draw with each stable isotope infusion study and weekly Tissue biopsy: skin, fat, muscle at stable isotope infusion study Procedure: Radiology testing: Dual-energy X-ray absorptiometry (DEXA), ultrasound, MRI Testing to be done following every stable isotope infusion study to measure muscle, fat and bone tissues. Drug: Humatrope and propranolol combined Humatrope (growth hormone) and propranolol administration daily for up to 2 years post burn injury. Other Names: recombinant human growth hormone GH rhGH inderol metoprolol growth hormone
Placebo Comparator: 7 Placebo PO to be given for up to 2 years post burn	Procedure: Stable Isotope Infusion Study 1-8 hour stable isotope infusion study to be done following each surgery. Tagged isotopes to assess uptake into blood and tissues. Procedure: Collection of blood and tissues Blood draw with each stable isotope infusion study and weekly Tissue biopsy: skin, fat, muscle at stable isotope infusion study Procedure: Radiology testing: Dual-energy X-ray absorptiometry (DEXA), ultrasound, MRI Testing to be done following every stable isotope infusion study to measure muscle, fat and bone tissues. Drug: Placebo placebo to be given once a day for up to two years post burn injury. Other Name: control
Experimental: 8 Exercise--hospital supervised intensive exercise program	Procedure: Stable Isotope Infusion Study 1-8 hour stable isotope infusion study to be done following each surgery. Tagged isotopes to assess uptake into blood and tissues. Procedure: Collection of blood and tissues Blood draw with each stable isotope infusion study and weekly Tissue biopsy: skin, fat, muscle at stable isotope infusion study Procedure: Radiology testing: Dual-energy X-ray absorptiometry (DEXA), ultrasound, MRI Testing to be done following every stable isotope infusion study to measure muscle, fat and bone tissues. Behavioral: Exercise--Hospital supervised intensive exercise program intensive exercise program supervised by trained personnel in the hospital environment for six up to twelve week program. Other Names: exercise intensive exercise aerobic exercise exercise rehabilitation program hospital based exercise
Experimental: 9 Exercise--home or community based exercise program	Procedure: Stable Isotope Infusion Study 1-8 hour stable isotope infusion study to be done following each surgery. Tagged isotopes to assess uptake into blood and tissues. Procedure: Collection of blood and tissues Blood draw with each stable isotope infusion study and weekly Tissue biopsy: skin, fat, muscle at stable isotope infusion study Procedure: Radiology testing: Dual-energy X-ray absorptiometry (DEXA), ultrasound, MRI Testing to be done following every stable isotope infusion study to measure muscle, fat and bone tissues. Behavioral: Home exercise program Home intensive exercise program: training occurs in hospital then patient sent home to continue exercise program for six weeks and up to 12 weeks at home. Other Names: Home exercise intensive exercise exercise rehabilitation

Detailed Description:

The University of Texas Medical Branch(UTMB) project improves outcomes for severely burned children by instituting and evaluating two modifications to traditional rehabilitation: (1) an intensive rehabilitation program including active resistance exercise; (2) long term administration of anabolic agents.

Effectiveness is assessed by comparison with functional outcomes achieved in traditional outpatient rehabilitation programs. Results indicate improvement in strength, endurance and bone density with these modifications. The project also maintains a longitudinal database that includes measures of cardiopulmonary function, growth and maturation, bone density, range of motion, and psychosocial adjustment.

Eligibility


Ages Eligible for Study:	up to 80 Years (Child, Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Burn 30% Total Body Surface Area (TBSA) or greater
Ages 0-80 yrs
Negative pregnancy test
Informed consent

Exclusion Criteria:

Untreated malignancy, known history of AIDS, ARC, HIV
Recent history of myocardial infarction (6 wks)
Tuberculosis, arthritis, cirrhosis, hyperlipidemia, bone or endocrine diseases, autoimmune diseases
Chronic glucocorticoid or non steroidal anti inflammatory drug therapy
Diabetes mellitus prior to burn injury
Renal insufficiency (defined by creatinine >3.0 mg/dl)
Hepatic disease (bilirubin > 3.0 mg/dl)

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: NCT00675714

Contacts


Contact: David N Herndon, MD	409-770-6731	dherndon@utmb.edu
Contact: Cathy L Reed, BSN	409-770-6987	ca2reed@utmb.edu

Locations


United States, Texas
University of Texas Medical Branch	Recruiting
Galveston, Texas, United States, 77551
Contact: David N Herndon, MD 409-770-6731 dherndon@utmb.edu
Contact: Cathy L Reed, BSN 409-770-6987 ca2reed@utmb.edu
Principal Investigator: David N Herndon, MD
Sub-Investigator: Oscar E Suman, PhD
Sub-Investigator: Celeste FInnerty, PhD

Sponsors and Collaborators

The University of Texas Medical Branch, Galveston

U.S. Department of Education

National Institutes of Health (NIH)

National Institute of General Medical Sciences (NIGMS)

Investigators


Study Director:	David N Herndon, MD	University of Texas

More Information

Additional Information:

University of Texas web page to describe funded program This link exits the ClinicalTrials.gov site

burn care web site includes information on funded grant project This link exits the ClinicalTrials.gov site

Publications:

Alloju SM, Herndon DN, McEntire SJ, Suman OE. Assessment of muscle function in severely burned children. Burns. 2008 Jun;34(4):452-9. doi: 10.1016/j.burns.2007.10.006. Epub 2008 Feb 20.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Herndon DN, Voigt CD, Capek KD, Wurzer P, Guillory A, Kline A, Andersen CR, Klein GL, Tompkins RG, Suman OE, Finnerty CC, Meyer WJ, Sousse LE. Reversal of Growth Arrest With the Combined Administration of Oxandrolone and Propranolol in Severely Burned Children. Ann Surg. 2016 Sep;264(3):421-8. doi: 10.1097/SLA.0000000000001844.

Diaz EC, Herndon DN, Lee J, Porter C, Cotter M, Suman OE, Sidossis LS, Børsheim E. Predictors of muscle protein synthesis after severe pediatric burns. J Trauma Acute Care Surg. 2015 Apr;78(4):816-22. doi: 10.1097/TA.0000000000000594.

Kraft R, Herndon DN, Finnerty CC, Cox RA, Song J, Jeschke MG. Predictive Value of IL-8 for Sepsis and Severe Infections After Burn Injury: A Clinical Study. Shock. 2015 Mar;43(3):222-7. doi: 10.1097/SHK.0000000000000294.

Patel P, Sallam HS, Ali A, Chandalia M, Suman O, Finnerty CC, Herndon DN, Abate N. Changes in fat distribution in children following severe burn injury. Metab Syndr Relat Disord. 2014 Dec;12(10):523-6. doi: 10.1089/met.2014.0098. Epub 2014 Sep 11.

Chondronikola M, Meyer WJ, Sidossis LS, Ojeda S, Huddleston J, Stevens P, Børsheim E, Suman OE, Finnerty CC, Herndon DN. Predictors of insulin resistance in pediatric burn injury survivors 24 to 36 months postburn. J Burn Care Res. 2014 Sep-Oct;35(5):409-15. doi: 10.1097/BCR.0000000000000017.

Hardee JP, Porter C, Sidossis LS, Børsheim E, Carson JA, Herndon DN, Suman OE. Early rehabilitative exercise training in the recovery from pediatric burn. Med Sci Sports Exerc. 2014 Sep;46(9):1710-6. doi: 10.1249/MSS.0000000000000296.

Finnerty CC, Ali A, McLean J, Benjamin N, Clayton RP, Andersen CR, Mlcak RP, Suman OE, Meyer W, Herndon DN. Impact of stress-induced diabetes on outcomes in severely burned children. J Am Coll Surg. 2014 Apr;218(4):783-95. doi: 10.1016/j.jamcollsurg.2014.01.038. Epub 2014 Jan 24.

Finnerty CC, Herndon DN. Is propranolol of benefit in pediatric burn patients? Adv Surg. 2013;47:177-97. Review.

Finnerty CC, Mabvuure NT, Ali A, Kozar RA, Herndon DN. The surgically induced stress response. JPEN J Parenter Enteral Nutr. 2013 Sep;37(5 Suppl):21S-9S. doi: 10.1177/0148607113496117.

Ray S, Ju X, Sun H, Finnerty CC, Herndon DN, Brasier AR. The IL-6 trans-signaling-STAT3 pathway mediates ECM and cellular proliferation in fibroblasts from hypertrophic scar. J Invest Dermatol. 2013 May;133(5):1212-20. doi: 10.1038/jid.2012.499. Epub 2013 Jan 10.

Kraft R, Herndon DN, Finnerty CC, Hiyama Y, Jeschke MG. Association of postburn fatty acids and triglycerides with clinical outcome in severely burned children. J Clin Endocrinol Metab. 2013 Jan;98(1):314-21. doi: 10.1210/jc.2012-2599. Epub 2012 Nov 12.

Herndon DN, Rodriguez NA, Diaz EC, Hegde S, Jennings K, Mlcak RP, Suri JS, Lee JO, Williams FN, Meyer W, Suman OE, Barrow RE, Jeschke MG, Finnerty CC. Long-term propranolol use in severely burned pediatric patients: a randomized controlled study. Ann Surg. 2012 Sep;256(3):402-11.

Jeschke MG, Williams FN, Finnerty CC, Rodriguez NA, Kulp GA, Ferrando A, Norbury WB, Suman OE, Kraft R, Branski LK, Al-mousawi AM, Herndon DN. The effect of ketoconazole on post-burn inflammation, hypermetabolism and clinical outcomes. PLoS One. 2012;7(5):e35465. doi: 10.1371/journal.pone.0035465. Epub 2012 May 11.

Porro LJ, Herndon DN, Rodriguez NA, Jennings K, Klein GL, Mlcak RP, Meyer WJ, Lee JO, Suman OE, Finnerty CC. Five-year outcomes after oxandrolone administration in severely burned children: a randomized clinical trial of safety and efficacy. J Am Coll Surg. 2012 Apr;214(4):489-502; discussion 502-4. doi: 10.1016/j.jamcollsurg.2011.12.038.

Traber MG, Leonard SW, Traber DL, Traber LD, Gallagher J, Bobe G, Jeschke MG, Finnerty CC, Herndon D. α-Tocopherol adipose tissue stores are depleted after burn injury in pediatric patients. Am J Clin Nutr. 2010 Dec;92(6):1378-84. doi: 10.3945/ajcn.2010.30017. Epub 2010 Sep 29.

Branski LK, Herndon DN, Barrow RE, Kulp GA, Klein GL, Suman OE, Przkora R, Meyer W 3rd, Huang T, Lee JO, Chinkes DL, Mlcak RP, Jeschke MG. Randomized controlled trial to determine the efficacy of long-term growth hormone treatment in severely burned children. Ann Surg. 2009 Oct;250(4):514-23. doi: 10.1097/SLA.0b013e3181b8f9ca.


Responsible Party:	The University of Texas Medical Branch, Galveston
ClinicalTrials.gov Identifier:	NCT00675714 History of Changes
Other Study ID Numbers:	04-157 NIDILRR 90DP0043-03-00 P50GM060338 ( US NIH Grant/Contract Award Number )
Study First Received:	December 26, 2007
Last Updated:	May 26, 2017
Individual Participant Data
Plan to Share IPD:	No

Keywords provided by The University of Texas Medical Branch, Galveston:


anabolic agents exercise

Additional relevant MeSH terms:


Hormones Oxandrolone Testosterone Methyltestosterone Testosterone enanthate Testosterone undecanoate Testosterone 17 beta-cypionate Nandrolone Nandrolone decanoate Nandrolone phenpropionate Itraconazole Hydroxyitraconazole Fluconazole Ketoconazole Anabolic Agents	Propranolol Metoprolol Hormones, Hormone Substitutes, and Hormone Antagonists Physiological Effects of Drugs Antifungal Agents Anti-Infective Agents 14-alpha Demethylase Inhibitors Cytochrome P-450 Enzyme Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Steroid Synthesis Inhibitors Hormone Antagonists Cytochrome P-450 CYP3A Inhibitors Cytochrome P-450 CYP2C9 Inhibitors Cytochrome P-450 CYP2C19 Inhibitors

Hormones
Oxandrolone
Testosterone
Methyltestosterone
Testosterone enanthate
Testosterone undecanoate
Testosterone 17 beta-cypionate
Nandrolone
Nandrolone decanoate
Nandrolone phenpropionate
Itraconazole
Hydroxyitraconazole
Fluconazole
Ketoconazole
Anabolic Agents

Propranolol
Metoprolol
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antifungal Agents
Anti-Infective Agents
14-alpha Demethylase Inhibitors
Cytochrome P-450 Enzyme Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Steroid Synthesis Inhibitors
Hormone Antagonists
Cytochrome P-450 CYP3A Inhibitors
Cytochrome P-450 CYP2C9 Inhibitors
Cytochrome P-450 CYP2C19 Inhibitors

ClinicalTrials.gov processed this record on June 23, 2017