A Safety and Efficacy Study to Determine if Giving Intravenous Fish Oil Helps Children With Liver Disease

Cholestasis Clinical Trial

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Official title:

Omegaven and Parenteral Nutrition Associated Cholestasis

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT00969332
• Other study ID #: 09-02-079-02
• Status: Terminated
• Phase: Phase 2
• Start date: August 2009
• Est. completion date: February 12, 2019

Study information

• Verified date: February 2020
• Source: University of California, Los Angeles
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

Description:

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.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 62
• Est. completion date: February 12, 2019
• Est. primary completion date: January 12, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A to 18 Years

Eligibility

Inclusion Criteria:

• 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)

Exclusion Criteria:

• 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

• Diabetes

• 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

Related Conditions & MeSH terms

• Cholestasis

Intervention

Drug:
• Omegaven
0.5 g/kg/d intravenous every day for 2 days, then 1 g/kg/d intravenous everyday

Locations

Country	Name	City	State
United States	University of California, Los Angeles	Los Angeles	California

Sponsors (1)

Lead Sponsor	Collaborator
University of California, Los Angeles

Country where clinical trial is conducted

United States, 

References & Publications (4)

Calkins KL, DeBarber A, Steiner RD, Flores MJ, Grogan TR, Henning SM, Reyen L, Venick RS. Intravenous Fish Oil and Pediatric Intestinal Failure-Associated Liver Disease: Changes in Plasma Phytosterols, Cytokines, and Bile Acids and Erythrocyte Fatty Acids — View Citation

Calkins KL, Dunn JC, Shew SB, Reyen L, Farmer DG, Devaskar SU, Venick RS. Pediatric intestinal failure-associated liver disease is reversed with 6 months of intravenous fish oil. JPEN J Parenter Enteral Nutr. 2014 Aug;38(6):682-92. doi: 10.1177/0148607113 — View Citation

Ong ML, Venick RS, Shew SB, Dunn JCY, Reyen L, Grogan T, Calkins KL. Intravenous Fish Oil and Serum Fatty Acid Profiles in Pediatric Patients With Intestinal Failure-Associated Liver Disease. JPEN J Parenter Enteral Nutr. 2019 Aug;43(6):717-725. doi: 10.1 — View Citation

Wang C, Venick RS, Shew SB, Dunn JCY, Reyen L, Gou R, Calkins KL. Long-Term Outcomes in Children With Intestinal Failure-Associated Liver Disease Treated With 6 Months of Intravenous Fish Oil Followed by Resumption of Intravenous Soybean Oil. JPEN J Paren — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Time to Reversal of Parenteral Nutrition Associated Cholestasis	weeks	24 weeks, death, transplant, or discontinuation of Parenteral Nutrition (whichever comes first)
Secondary	Death	expiration	24 weeks, transplant, or discontinuation of Parenteral Nutrition (whichever comes first)
Secondary	Number of Participants Who Underwent a Transplant	includes isolated liver or multi-visceral transplant including liver graft	24 weeks, death, or discontinuation of Parenteral Nutrition (whichever comes first)
Secondary	Time to Full Enteral Feeds	discontinuation of parenteral nutrition	24 weeks, death, transplant, or discontinuation of Parenteral Nutrition (whichever comes first)
Secondary	Growth Z-scores	Weight Z-scores at the end of the study. Formula used: (weight at end of study-average weight of reference population)/standard deviation of weight of reference population.; The Z-score indicates the number of standard deviations away from the mean. A weight Z-score of 0 is equal to the mean with negative numbers indicating values lower than the mean and positive values higher. A weight Z-score	24 weeks, death, transplant, or discontinuation of Parenteral Nutrition (whichever comes first)
Secondary	Platelet Counts at the End of the Study - Risk of Bleeding	platelet counts at the end of the study	24 weeks, death, transplant, or discontinuation of Parenteral Nutrition (whichever comes first)
Secondary	Number of Participants With Essential Fatty Acid Deficiency	triene:tetraene ratio less than 0.2	24 weeks, death, transplant, or discontinuation of Parenteral Nutrition (whichever comes first)
Secondary	Markers of Inflammation	Serum Cytokines - interleukin-8	24 weeks, death, or discontinuation of Parenteral Nutrition (whichever comes first)
Secondary	Markers of Sterol Metabolism	Serum Phytosterols - stigmasterol	24 weeks, death, or discontinuation of Parenteral Nutrition (whichever comes first)
Secondary	Markers of Bile Acid Metabolism	Serum Bile acids - total chenodeoxycholic acid	24 weeks, death, or discontinuation of Parenteral Nutrition (whichever comes first)
Secondary	Markers of Fatty Acid Metabolism	Erythrocyte fatty acid - Docosahexaenoic Acid	24 weeks, death, or discontinuation of Parenteral Nutrition (whichever comes first)