Efficacy of To Be Marketed (TBM) Cholic Acid Capsules Used to Treat Children With Inborn Errors of Bile Acid Synthesis

Study Overview
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Brief Summary
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This is a study in a small population of children who have inborn errors of bile acid synthesis who are currently taking established doses of the currently used cholic acid capsules prepared at the Cincinnati Children's Hospital Pharmacy. The study is designed to compare the efficacy of these currently used capsules with the efficacy of the same treatment provided in a cholic acid capsule that is made by a company that will be marketed after FDA approval. At baseline, patients receive established doses of cholic acid capsules prepared at the Cincinnati Children's Hospital Medical Center Pharmacy. During the study, patients receive the same treatment provided in the to-be-marketed (TBM) cholic acid capsule. Hence, patients serve as their own controls, with baseline values presenting the reference value (CCHMC cholic acid capsule) and values after 30 days treatment presenting the value for the investigational treatment (TBM cholic acid capsule).

Detailed Description
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Bile acids are end products of cholesterol metabolism. Individuals with inborn errors of bile acid synthesis lack the enzymes needed to synthesize the primary bile acids cholic acid and chenodeoxycholic acid (CDCA). These conditions are serious and account for approximately 1% of cases presenting as idiopathic cholestatic liver disease. The liver disease associated with these inborn errors in bile acid synthesis is progressive and, if untreated, may lead to death from cirrhosis and liver failure. Monotherapy with cholic acid is considered the most appropriate therapeutic strategy to treat inborn errors in bile acid synthesis because it provides a stimulus for bile flow and inhibits endogenous production and accumulation of potentially hepatotoxic and cholestatic bile acid precursors, while additionally facilitating the absorption of fats and fat-soluble vitamins. At therapeutic doses, adverse effects are not generally observed and as such, cholic acid has become the treatment of choice at the Cincinnati Children's Hospital since 1994. This study will bridge data on the effectiveness of a standardized manufactured preparation to data obtained from patients originally treated with the currently used cholic acid capsules formulated in the CCHMC Pharmacy before being switched to the manufactured preparation.

Official Title
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Open Label, Single Center, Nonrandomized Study Comparing Efficacy of To Be Marketed Cholic Acid With That of the Currently Used Formulation of Cholic Acid Capsules Used to Treat Children With Inborn Errors of Bile Acid Synthesis

Conditions
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Inborn Errors of Bile Acid Synthesis

Intervention / Treatment
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* Drug: Cholic acid


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: must have stable transaminase levels within 2 times the upper limits of the normal range. must have a diagnosis of an inborn error of bile acid synthesis. must have signed the written informed consent/assent document before study start. must be currently receiving currently used cholic acid therapy under IND 45,470. must be willing and able to comply with all study assessments and procedures. must be able to make two visits (Visit 1 and Visit 2) to the study site. Exclusion Criteria: is not currently receiving cholic acid therapy for inborn errors of bile acid synthesis under IND 45,470. is unable or unwilling to comply with study requirements.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cholic Acid Capsule<br>Manufactured cholic acid capsules | Drug: Cholic acid<br>* The IUPAC name for cholic acid is 3 alpha,7alpha,12 alpha-trihydroxy-5 beta-cholanoic acid. The international nonproprietary name (INN) is cholic acid. Each patient will be given a box containing a 1 month supply of study drug. Each bottle will contain 90 capsules; each capsule will contain either 50 or 250 mg of manufactured cholic acid depending upon the child's weight. The study drug will be taken orally, in divided doses (as determined by the investigator), for a total daily dose of 10-15 mg/kg body weight. Parents of infants and young children who are unable to swallow the TBM cholic acid capsule will be instructed to sprinkle the contents of the capsule over 1-2 teaspoons of plain applesauce and feed it to the child.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Serum Transaminases | Concentration of serum alanine transaminase (ALT) and aspartate transaminase (AST) | At baseline and after 30 days of treatment | 
| Serum and Urine Bile Acids | Concentration of bile acids in serum (S) and urine (U). (abbreviations: chol.=cholenoic; monohydro=monohydroxy; dihydro=monohydro) | At baseline (BL) and after 30 days of treatment (D30) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse Events | Total number of patients with any adverse events | Total of 30 days, i.e. from the time point the patients entered into the study up to the end of treatment | 
| Blood Pressure | Systolic blood pressure (SBP) and diastolic blood pressure (DBP) | At baseline and after 30 days of treatment | 
| Physical Examination | Total number of patients with abnormal findings from general physical examination | At baseline (BL) and after 30 days of treatment (D30) | 
| Total Bilirubin | Concentration of total bilirubin in serum | At baseline and after 30 days of treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Inborn Errors, Bile Acid, Pediatrics, Liver Disease