Octreotide Therapy in Children and Young Adults With Prader-Willi Syndrome (PWS)

Prader-Willi Syndrome Clinical Trial

Official title:

Investigation of the Developmental, Nutritional and Hormonal Regulation of Ghrelin in Children and Young Adults With Prader-Willi Syndrome (PWS): Octreotide Intervention Sub-study

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT00399893
• Other study ID #: Pro00005426
• Secondary ID: Protocol #000054
• Status: Terminated
• Phase: N/A
• First received: November 14, 2006
• Last updated: June 25, 2014
• Start date: December 2006
• Est. completion date: September 2010

Study information

• Verified date: June 2014
• Source: Duke University
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to investigate over a 6 month period the effect of octreotide therapy on food intake, sense of hunger, body weight, body composition, efficiency of burning calories, biomarkers of weight regulation and growth hormone markers in children and young Adults with Prader-Willi Syndrome(PWS).

Description:

Obesity continues to be a prevalent health concern affecting every race of the American population. According to data from the World Health Organization, 54% of U.S. adults are overweight (body mass index (BMI) >25 kg/m2 ) and 22% are obese (BMI >30 kg/m2) (1). In addition, 25% of U.S. children are overweight or obese (1). Studies show that obese children are likely to become obese adults (2-5). Also, recent studies report significant years of life lost due to the impact of being an obese adult (6, 7). Thus, insights into the pathogenesis of childhood obesity and preventative measures are needed to combat the inevitable increase in worldwide incidence of obesity and its associated co-morbidities. Recent studies have identified a new gastroenteric hormone, ghrelin, as a long-term regulator of energy balance in humans (12). Ghrelin is a 28 amino acid acylated peptide which is an endogenous ligand of the growth hormone secretagogue receptor (GHS-R), a hypothalamic G-protein-coupled receptor (13). Enteroendocrine cells (X/A-like cells) of the stomach are the major site of ghrelin synthesis, although a minor proportion of ghrelin synthesis occurs in other sites such as the hypothalamus, pituitary, duodenum, jejunum and lung (14) (15, 16).

The hypothesis that hyperghrelinemia causes some of the features of PWS predicts that this disorder will be ameliorated (partially or completely) by lowering ghrelin levels. We have recently shown that the somatostatin agonist, octreotide, suppresses ghrelin levels in humans. If octreotide remains effective in longer term studies, the drug may become an adjuvant therapy, in addition to growth hormone, to control the insatiable appetite and morbid obesity seen in this condition.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 5
• Est. completion date: September 2010
• Est. primary completion date: April 2009
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 5 Years to 21 Years

Eligibility

Inclusion Criteria:

• Diagnosis of PWS confirmed by chromosome analysis

• Ages 5 years to 21 years

• BMI for age = (greater-than or equal to)85th percentile

• Written informed consent and assent obtained and willingness to comply with the study schedule and procedures

• Free T4, Thyroid stimulating hormone (TSH) values in the normal range (either endogenous or with thyroxine replacement)

Exclusion Criteria:

• Patients with any other clinically significant disease that would have an impact on body composition, including diabetes mellitus, chronic inflammatory bowel disease, chronic severe liver or kidney disease or neurologic disorders

• Concomitant use of an investigational drug or Octreotide in the past year

• Use of steroids for longer than 7 days within the past 30 days

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Prader-Willi Syndrome
• Syndrome

Intervention

Drug:
• Octreotide
Octreotide to be administered by subcutaneous injection three times daily
• Placebo
Placebo to be administered by subcutaneous injection three times daily while on study

Locations

Country	Name	City	State
United States	Duke University Medical Center	Durham	North Carolina

Sponsors (4)

Lead Sponsor	Collaborator
Duke University	National Center for Research Resources (NCRR), National Institutes of Health (NIH), Novartis

Country where clinical trial is conducted

United States, 

References & Publications (1)

Haqq AM, Stadler DD, Rosenfeld RG, Pratt KL, Weigle DS, Frayo RS, LaFranchi SH, Cummings DE, Purnell JQ. Circulating ghrelin levels are suppressed by meals and octreotide therapy in children with Prader-Willi syndrome. J Clin Endocrinol Metab. 2003 Aug;88(8):3573-6. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Participants With Decrease in Fasting Total Ghrelin	Number of participants showing a decrease in Fasting total ghrelin from baseline to 6 months of treatment with Octreotide or placebo	6 months	No
Primary	Number of Participants With Decrease in Weight From Baseline to 6 Months	Number of participants who had a decrease in weight from baseline to 6 months of Octreotide or placebo therapy	6 months	No
Primary	Number of Participants With Decreased BMI Z-score From Baseline to 6 Months	Number of participants with decreased BMI z-score from baseline to 6 months of Octreotide or Placebo therapy	6 months	No
Primary	Number of Participants With Decreased Skin-fold Measurements From Baseline to 6 Months	Number of participants with decreased skin-fold measurements from baseline to 6 months of Octreotide or Placebo therapy	6 months	No
Primary	Number of Participants With Decrease in Hunger and Food Intake	Measured by hunger and hyperphagia by questionnaires and parent-reported 72-hour food recall from baseline to 6 months. Multiple questionnaires consisting of a battery of free text answer questions and food diaries are combined in order to make a behavioral assessment of the participants food state of hunger and food intake. There is no defined scale for this assessment. Each participants responses and parent responses are combined.	6 months	No
Primary	Number of Participants With Improved Insulin Regulation From Baseline to 6 Months	Number of participants with improved Insulin regulation from baseline to 6 months of Octreotide or Placebo therapy. Insulin regulation was measured by immunochemiluminescent assay.	6 months	No
Primary	Number of Participants With Improved Adiponectin Regulation From Baseline to 6 Months	Number of participants with improved Adiponectin regulation from baseline to 6 months of Octreotide or Placebo therapy	6 months	No
Primary	Number of Participants With Improved Leptin Regulation From Baseline to 6 Months	Number of participants with improved Leptin regulation from baseline to 6 months of Octreotide or Placebo therapy	6 months	No
Primary	Number of Participants With Improved Peptide YY (PYY) Regulation From Baseline to 6 Months	Number of participants with improved Peptide YY (PYY) regulation from baseline to 6 months of Octreotide or Placebo therapy	6 months	No
Secondary	Number of Participants With Decreased Body Composition From Baseline to 6 Months by BOD POD®	Number of participants with decreased body-composition as Measured by BOD POD® body composition tracking system from baseline to 6 months of Octreotide or Placebo therapy	6 months	No
Secondary	Number of Participants With Decreased Body-composition From Baseline to 6 Months by DEXA	Number of participants with decreased body-composition as Measured by Dual Energy X-ray Absorptiometry (DEXA) scan from baseline to 6 months of Octreotide or Placebo therapy	6 months	No