Compassionate Use of Omegaven in the Treatment of Parenteral Nutrition Induced Hepatic Injury

Liver Disease Clinical Trial

Official title:

Compassionate Use of Omegaven in the Treatment of Parenteral Nutrition Induced Hepatic Injury

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02010034
• Other study ID #: STU 112010-159
• Status: Completed
• Phase: N/A
• Start date: August 2013
• Est. completion date: February 5, 2019

Study information

• Verified date: February 2019
• Source: Children's Medical Center Dallas
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study is being done to determine if an investigational study drug called Omegaven can help to improve liver disease thought to be caused by Total Parenteral Nutrition (TPN). TPN is intravenous feeding (IV feeding tube) that provides patients the nutrients when they are unable to drink fluid or eat food by mouth.

Description:

PAtients with direct bilirubin >2gm/dL and short bowel syndrome are eligible for enrollment. Omegaven at 1gm/kg/day will be administered via central venous line instead of standard lipid preparations.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 15
• Est. completion date: February 5, 2019
• Est. primary completion date: February 5, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 2 Months to 10 Years

Eligibility

Inclusion Criteria:

1. Patients must be 2 months -10 years of age

2. Patients who are PN dependent (unable to meet nutritional needs solely by enteral nutrition) and are expected to require PN for at least another 30 days

3. Patients considered eligible for study participation must have parenteral nutrition associated liver disease (PNALD) as defined by a direct bilirubin of >2.0mg/dL. Other causes of liver disease should be excluded. A liver biopsy is not necessary for treatment

4. 2 consecutive direct bilirubin test results >2.0mg/dl

5. The patient must have failed standard therapies to prevent the progression of liver disease such as surgical treatment, cyclic TPN, avoiding overfeeding, reduction/removal of copper and manganese from TPN, advancement of enteral feeding, and use of ursodiol (Actigall)

6. Subjects who are currently under treatment for PNALD with Compassionate Use Omegaven and have a direct Bilirubin of< 2, but who remain TPN dependent and require continued therapy with Omegaven

Exclusion Criteria:

1. Other known causes of chronic liver disease (hepatitis C, cystic fibrosis, biliary atresia and alpha 1 anti-trypsin deficiency)

2. Enrollment in any other clinical trial involving an investigational agent (unless approved by the designated physicians on the multidisciplinary team)

3. The parent, guardian, or child is unwilling to provide consent or assent

4. Allergy to any fish product, egg protein, and/or previous allergy to Omegaven

5. Active coagulopathies characterized by on-going bleeding or by a requirement for clotting factor replacement such as fresh frozen plasma or cryoprecipitate to maintain homeostasis

6. Impaired lipid metabolism or severe hyperlipidemia with or without pancreatitis

7. Unstable diabetes mellitus

8. Stroke/embolism

9. Collapse and shock

10. Undefined coma status

11. Active infection at time of initiation of Omegaven® up until such time as child is afebrile with stable vital signs and one negative 48 hour culture

Related Conditions & MeSH terms

• Impaired Liver Function
• Liver Disease
• Liver Diseases
• Parenteral Nutrition Associated Liver Disease

Intervention

Drug:
• Omegaven
Omegaven will be used in place of soy oil Intralipid

Locations

Country	Name	City	State
United States	Children's Medical Center of Dallas	Dallas	Texas

Sponsors (1)

Lead Sponsor	Collaborator
Children's Medical Center Dallas

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Bilirubin in mg/dL	PN associated liver disease can be reversed or its progression halted by using a parenteral fat emulsion prepared from fish oil as measured by normalization of serum levels of hepatic enzymes and bilirubin; 1. after reaching bilirubin levels >2mg/dl, subjects receiving Omegaven will reach a bilirubin level < 2mg/dL faster that patients receiving conventional fat emulsions.	12 weeks
Secondary	Number of participants with adverse events	a. After starting Omegaven on PN, the rate of fatty acid deficiencies and imbalances will be as low as before Omegaven. Also, the rate of triglyceride events >400mg/dL with Omegaven will be similar to that seen with PN administration with soy oil Intralipid.; B. PN containing Omegaven will be safe for patients with respect to the risk of unexpected bleeding, coagulopathies, and other adverse events.	12 weeks