Omegaven and Parenteral Nutrition Associated Cholestasis
试验速览
- 阶段
- 2 期
- 状态
- 终止
- 入组人数
- 62
- 试验地点
- 1
- 主要终点
- Time to Reversal of Parenteral Nutrition Associated Cholestasis
研究概览
简要总结
The purpose of the study is to investigate if intravenous fish oil, commercially available as Omegaven, safely and effectively reverses parenteral nutrition associated cholestasis in children.
详细描述
Infants dependent on parenteral nutrition for greater than 1 year who develop parenteral nutrition associated cholestasis will universally face mortality unless they receive a timely liver and/or small bowel transplant. Although transplant survival has improved in recent years, survival is not guaranteed, and transplant care remains costly. Alternative nutritional and pharmacological strategies are imperative to improve the clinical outcomes of infants with intestinal failure and parenteral nutrition associated cholestasis. In both animal and human studies, intravenous fish oil, a lipid emulsion rich in omega-3 fatty acids and Vitamin E, and lacking phytosterols, has been shown to ameliorate parenteral nutrition associated cholestasis and improve morbidity and mortality. The purpose of this pilot study is to investigate if Omegaven, a commercially available intravenous fish oil, at 1 g/kg/d, will safely reverse liver disease in 80 subjects with parenteral nutrition associated cholestasis. Subjects can initially receive a maximum of 6 months (24 weeks) of intravenous fish oil. If the subject re-develops liver disease and still satisfies inclusion/exclusion criteria, the intervention can be restarted. Study subjects will be compared to a historical cohort of children with Short Bowel Syndrome and parenteral nutrition associated cholestasis who have been receiving standard intravenous soybean oil for > 60 days. The fish oil cohort will be followed for a total of 5 years to determine if transplant-free mortality is reduced.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 2 Weeks 至 18 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Clinical evidence of parenteral nutrition associated cholestasis
- •Direct bilirubin greater or equal to 2 mg/dL on 2 consecutive measurements
- •Expected parenteral nutrition course greater than 30 days
- •Acquired or congenital gastrointestinal disease
- •> 2 weeks of age and < 18 years of age
- •> 60% calories from parenteral nutrition
- •Failed standard therapies to prevent progression of liver disease (Actigal, cyclic parenteral nutrition, avoidance of overfeeding, reduction/removal of copper from parenteral nutrition if elevated my laboratory analysis, advancement of enteral feeds)
排除标准
- •Inborn errors of metabolism
- •Extracorporeal Membrane Oxygenation
- •Seafood, egg, or Omegaven allergy
- •Documented case of liver disease other than Parenteral Nutrition Associated Cholestasis
- •Hemorrhagic disorder
- •Anticoagulant therapy
- •Hemodynamically unstable or in shock
- •Comatose state
- •Stroke, pulmonary embolism, recent myocardial infarction
- •Fatal chromosomal disorder
- •Enrollment in any other clinical trial involving an investigational agent
- •Patient, parent, or legal guardians unable or unwilling to give consent
- •Patient expected to be weaned from parenteral nutrition in 30 days
- •unable to tolerate necessary monitoring
- •Patient requiring aspirin or toradel or motrin
- •Patient requiring dialysis
研究组 & 干预措施
Omegaven
0.5 g/kg/d IV x 2 days, then 1 g/kg/d IV for 24 weeks or until parenteral nutrition discontinuation, death or transplant, whichever comes first. Subjects are eligible to restart Omegaven should they re-satisfy inclusion/exclusion criteria.
干预措施: Omegaven (Drug)
结局指标
主要结局
Time to Reversal of Parenteral Nutrition Associated Cholestasis
时间窗: 24 weeks, death, transplant, or discontinuation of Parenteral Nutrition (whichever comes first)
weeks
次要结局
- Number of Participants Who Underwent a Transplant(24 weeks, death, or discontinuation of Parenteral Nutrition (whichever comes first))
- Death(24 weeks, transplant, or discontinuation of Parenteral Nutrition (whichever comes first))
- Time to Full Enteral Feeds(24 weeks, death, transplant, or discontinuation of Parenteral Nutrition (whichever comes first))
- Growth Z-scores(24 weeks, death, transplant, or discontinuation of Parenteral Nutrition (whichever comes first))
- Platelet Counts at the End of the Study - Risk of Bleeding(24 weeks, death, transplant, or discontinuation of Parenteral Nutrition (whichever comes first))
- Markers of Inflammation(24 weeks, death, or discontinuation of Parenteral Nutrition (whichever comes first))
- Markers of Bile Acid Metabolism(24 weeks, death, or discontinuation of Parenteral Nutrition (whichever comes first))
- Number of Participants With Essential Fatty Acid Deficiency(24 weeks, death, transplant, or discontinuation of Parenteral Nutrition (whichever comes first))
- Markers of Sterol Metabolism(24 weeks, death, or discontinuation of Parenteral Nutrition (whichever comes first))
- Markers of Fatty Acid Metabolism(24 weeks, death, or discontinuation of Parenteral Nutrition (whichever comes first))
研究者
Kara L. Calkins, MD
Assistant Professor
University of California, Los Angeles