Single-Dose Intravenous Inositol Pharmacokinetics in Preterm Infants

Retinopathy of Prematurity Clinical Trial

— INS-1  

Official title:

Single-Dose Intravenous Inositol Pharmacokinetics in Preterm Infants

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00349726
• Other study ID #: NICHD-NRN-0036-1
• Secondary ID: U10HD021364U10HD
• Status: Completed
• Phase: Phase 2
• First received: July 6, 2006
• Last updated: June 19, 2017
• Start date: June 2006
• Est. completion date: December 2007

Study information

• Verified date: June 2017
• Source: NICHD Neonatal Research Network
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

Description:

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 74
• Est. completion date: December 2007
• Est. primary completion date: December 2007
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A to 6 Days

Eligibility

Inclusion Criteria:

• 23 0/7 to 26 6/7 weeks gestational age (36 infants) or

• 27 0/7 to 29 6/7 weeks gestational age (36 infants)

• 600-1500 grams birth weight

• No enteral feedings since birth at enrollment

• 3-6 days (25-132 hours) postnatal age

Note: Because of the high mortality expected in this population (15-20%), the study design (originally for 72 infants) required recruitment of a replacement subject if any infant failed to complete the four blood samples during the first week of the study.

Exclusion Criteria:

• Major congenital anomalies

• Moribund or not to be provided continued support

• Renal failure suspected (creatinine >2.5 with oliguria)

• Exchange transfusion received or expected to receive

Related Conditions & MeSH terms

• Birth Weight
• Bronchopulmonary Dysplasia
• Bronchopulmonary Dysplasia (BPD)
• Infant, Low Birth Weight
• Infant, Newborn
• Infant, Premature
• Infant, Small for Gestational Age
• Premature Birth
• Retinopathy of Prematurity

Intervention

Drug:
• Inositol lower volume
60 mg/kg (1.2ml/kg) of myo-inositol 5% given intravenously over 20 minutes.
• Inositol higher volume
120 mg/kg (2.4ml/kg) of myo-inositol 5% given intravenously over 20 minutes.
• Placebo lower volume
60 mg/kg (1.2ml/kg) of glucose 5% given intravenously over 20 minutes.
• Placebo higher volume
120 mg/kg (2.4ml/kg) of glucose 5% given intravenously over 20 minutes.

Locations

Country	Name	City	State
United States	University of New Mexico	Albuquerque	New Mexico
United States	Case Western Reserve University, Rainbow Babies and Children's Hospital	Cleveland	Ohio
United States	University of Texas Southwestern Medical Center at Dallas	Dallas	Texas
United States	Wayne State University	Detroit	Michigan
United States	Duke University	Durham	North Carolina
United States	RTI International	Durham	North Carolina
United States	Indiana University	Indianapolis	Indiana
United States	Yale University	New Haven	Connecticut
United States	Brown University, Women & Infants Hospital of Rhode Island	Providence	Rhode Island
United States	University of Rochester	Rochester	New York
United States	University of Utah	Salt Lake City	Utah

Sponsors (4)

Lead Sponsor	Collaborator
NICHD Neonatal Research Network	Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Center for Research Resources (NCRR), National Eye Institute (NEI)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Population pharmacokinetics		0-100 hours following infusion
Secondary	Adverse events during and following infusion, using a neonatal toxicity classification		Until discharge

External Links

•   NICHD Neonatal Research Network