Retinopathy of Prematurity Clinical Trial
Official title:
Single-Dose Intravenous Inositol Pharmacokinetics in Preterm Infants
This pilot study was a randomized, placebo-controlled, clinical trial to measure changes in blood and urine levels of inositol in premature infants at high risk for retinopathy of prematurity (ROP) following a single intravenous dose of inositol. Based on previous studies, the premise is that maintaining inositol concentrations similar to those occurring naturally in utero will reduce the rates of ROP and bronchopulmonary dysplasia in premature infants. The objective was to evaluate the single-dose pharmacokinetics and safety of different amounts of intravenous myo-inositol (provided by Ross Products Division, Abbott Laboratories) in very low birth weight neonates, in preparation for a future Phase III multi-center randomized controlled trial. This study enrolled 74 infants at high risk for retinopathy at 9 NICHD Neonatal Research Network sites, and randomly assigned them to receive either 60mg/kg of 5% inositol, 120 mg/kg of 5% inositol, 60 mg/kg of 5% glucose (the placebo), or 120 mg/kg of 5% glucose.
Retinopathy of prematurity (ROP) is an abnormal growth of the blood vessels in the eye that
occurs primarily in very premature infants. Eye development occurs normally in the womb; in
infants born prematurely, however, the blood vessels must finish developing outside the
protective environment of the uterus. Retinopathy of prematurity (also known as retrolental
fibroplasia) is a leading cause of blindness and other vision impairments (myopia,
strabismus, and amblyopia) in children, both in developed and developing countries.
Inositol is a naturally-occurring sugar alcohol produced by the placenta and is present in
high levels in fetal blood throughout pregnancy in humans and other animals. Serum levels
fall rapidly after birth, although this fall is moderated in infants who receive breast
milk. Two randomized trials have shown that intravenous inositol supplementation in the
first week significantly reduced death, bronchopulmonary dysplasia (BPD), and retinopathy.
One study of oral supplements was less convincing, but also supported reduction of
retinopathy.
This pilot study evaluated the half-life pharmacokinetics of a single-dose of myo-inositol
(provided by Ross Products Division, Abbott Laboratories) in very low birth weight infants,
looking at changes in blood and urine inositol levels. The premise is that maintaining
inositol concentrations similar to those occurring naturally in utero will reduce the rates
of retinopathy and bronchopulmonary dysplasia in premature infants. Results from this study
will be used to select the doses for a subsequent multi-dose pilot study, and for the
planned large multi-center trials.
In this study, nine NICHD Neonatal Research Network sites enrolled 74 infants of less than
30 weeks gestation and randomly assigned them to receive either 60mg/kg of 5% inositol, 120
mg/kg of 5% inositol, 60 mg/kg of 5% glucose (the placebo), or 120 mg/kg of 5% glucose.
Concentrations of inositol were measured in both blood and urine to determine population
pharmacokinetic parameters for these infants.
Stratification: Enrolled infants were stratified by age with 37 infants of 23 0/7 to 26 6/7
weeks in one group and 37 infants of 27 0/7 to 29 6/7 weeks in a second group.
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