Expanded Access of Omegaven IV Fat Emulsion to Infants and Children With PNALD

Total Parenteral Nutrition-induced Cholestasis Clinical Trial

Official title:

Expanded Access of Omegaven IV Fat Emulsion (Fish Oil Infusion) to Infants and Children With Parenteral Nutrition-associated Liver Disease

Clinical Trial Details — Status: Approved for marketing

Administrative data

• NCT number: NCT02929303
• Other study ID #: K5900315
• Status: Approved for marketing

Study information

• Verified date: February 2019
• Source: Advocate Health Care
• Contact: n/a
• Is FDA regulated: No
• Study type: Expanded Access

Clinical Trial Summary

This is an expanded access protocol for use of intravenous fish oil infusion, Omegaven, in infants and children with parenteral nutrition associated liver disease (PNALD) to decrease elevated liver enzymes and direct bilirubin.

This study aims to describe the response of PNALD after use of Omegaven by normalization of serum levels of liver enzymes and bilirubin.

Description:

The etiology of parenteral nutrition associated liver disease (PNALD) is currently considered multifactorial. Available treatment options for this disease process are limited and have achieved moderate success at best. Unlike conventional intravenous fat emulsions, Omegaven™ is comprised solely of fish oils containing primarily omega-3 fatty acids. The investigators hypothesize that administering Omegaven™ to patients with PNALD in place of conventional fat emulsion may reverse cholestasis allowing patients to be maintained on adequate PN until they are able to ingest adequate nutrition enterally.

Recruitment information / eligibility

• Status: Approved for marketing
• Enrollment: 0
• Gender: All
• Age group: N/A to 17 Years

Eligibility

Inclusion Criteria:

1. Pediatric patients aged 0 - 18 yrs

2. Patients will be PN dependent (unable to meet nutritional needs solely by enteral nutrition). It will be assumed that patients will require parenteral nutrition for at least 30 days from the inclusion into the study.

3. Patients must have parenteral nutrition associated liver disease (PNALD) as defined as a direct bilirubin of 2mg/dl or more. Other causes of liver disease should be excluded. A liver biopsy is not necessary for treatment.

4. 2 consecutive direct bilirubins > 2.0 mg/dl. one week apart.

5. Signed patient informed consent.

6. The patient must have utilized standard therapies as clinically appropriate to prevent the progression of his/her liver disease. Such therapies could include surgical treatment, cyclic PN, avoiding overfeeding, reduction/removal of copper and manganese from PN, advancement of enteral feeding, and the use of ursodiol (i.e.,Actigall).

Exclusion Criteria:

1. Documented cause of chronic liver disease other than parenteral nutrition associated liver disease.

2. An allergy to any seafood product, egg protein, and/or previous allergy to Omegaven.

3. Active coagulopathy characterized by ongoing bleeding or by a requirement for clotting factor replacement (e.g. fresh frozen plasma or cryoprecipitate) to maintain homeostasis.

4. Impaired lipid metabolism or severe hyperlipidemia with or without pancreatitis.(e.g. (triglycerides > 1000mg/dl while receiving intralipid 1g/kg/day or less)

5. Unstable diabetes mellitus or hyperglycemia (Blood glucose >200 mg/dL) at the time of initiation of Omegaven

6. Currently being treated for stroke, embolism, collapse and shock, myocardial infarction.

7. Cholestasis due to any reason other than parenteral associated liver disease

8. Active new infection at time of initiation of Omegaven

9. Hemodynamic instability (e.g. receiving vasopressors) at time of initiation of Omegaven.

10. The patient may not be enrolled in any other clinical trial involving an investigational agent (unless approved by the designated physicians on the multidisciplinary team).

11. Known pregnancy.

Related Conditions & MeSH terms

• Cholestasis
• Total Parenteral Nutrition-induced Cholestasis

Intervention

Drug:
• Omegaven IV lipid emulsion
Therapy is started at a dose of 1 gm/kg/day over 12 hrs. Omegaven may be infused via a central or peripheral IV. If additional fat calories are needed they will be provided by the enteral route.

Locations

Country	Name	City	State
United States	Advocate Children's Hospital	Park Ridge	Illinois

Sponsors (1)

Lead Sponsor	Collaborator
Hector Hernandez

Country where clinical trial is conducted

United States, 

References & Publications (2)

Sant'Anna AM, Altamimi E, Clause RF, Saab J, Mileski H, Cameron B, Fitzgerald P, Sant'Anna GM. Implementation of a multidisciplinary team approach and fish oil emulsion administration in the management of infants with short bowel syndrome and parenteral n — View Citation

Soden JS, Lovell MA, Brown K, Partrick DA, Sokol RJ. Failure of resolution of portal fibrosis during omega-3 fatty acid lipid emulsion therapy in two patients with irreversible intestinal failure. J Pediatr. 2010 Feb;156(2):327-31. doi: 10.1016/j.jpeds.20 — View Citation