Compassionate Treatment of Patients With Inborn Errors of Bile Acid Metabolism With Cholic Acid

Study Overview
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Brief Summary
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OBJECTIVES: I. To Evaluate the therapeutic efficacy of cholic acid during provision of compassionate treatment to patients with identified inborn errors of bile acid synthesis and metabolism II. To assess the safety and tolerability of cholic acid

Detailed Description
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Investigational Plan: A Phase III, open label, single arm, nonrandomized, non-comparative, compassionate treatment study of cholic acid in the treatment of defects of bile acid metabolism. The study was begun with a single study site at Cincinnati Children's Hospital Medical Center (CCHMC), but in 2005 was expanded so that compassionate treatment could be provided to additional patients who had been identified with inborn errors of bile metabolism through the center's screening/diagnostic program. Patients who were screened were contacted and evaluated with respect to the inclusion/exclusion criteria. Signed informed consent by the patient and/or parents/legal guardian was obtained as soon as it is confirmed that the patient met inclusion/exclusion criteria and the parents/guardian would agree for the child to participate in the study. The primary interventions for the study were: Administration of study drug. Collection of baseline physical exam, vital signs, blood and urine samples for laboratory tests. Collection of periodic physical exam, vital signs, blood and urine samples for laboratory tests during the period of administration of the study drug. Collection of any adverse event information. Time and Events Schedule: Baseline: Confirm eligibility Obtain written informed consent from patient and/or parents/legal guardian Collect demographic data and disease and medication history, including family history Baseline and Ongoing: Obtain body weight Record adverse events Obtain blood and urine samples for laboratory tests Initiate study drug therapy & monitor study drug therapy and adjust dose as needed

Official Title
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Investigation in the Pathogenesis of Liver Disease in Patients With Inborn Errors of Bile Acid Metabolism

Conditions
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Infantile Refsum's Disease, Zellweger Syndrome, Adrenoleukodystrophy, Peroxisomal Disorders, Cholestasis

Intervention / Treatment
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* Drug: Cholic Acids


Participation Criteria
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Eligibility Criteria
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PROTOCOL ENTRY CRITERIA: --Disease Characteristics-- Clinical or biochemical evidence of liver disease, unexplained fat-soluble vitamin malabsorption, or peroxisomal dysfunction that compromises bile acid biosynthesis Inclusion criteria for enrollment were: Infants < age 3 months Children presenting for evaluation of cholestasis defined as a conjugated bilirubin > 2mg/dl or increased serum bile acids Older subjects of any age with cholestatic liver disease if urine screens suggested that they had inborn errors of bile acid metabolism Confirmation of a diagnosis of an inborn error of bile acid synthesis based upon urine analysis by FAB-MS to determine whether specific abnormalities in bile acid synthesis are indicated The patient and/or parent/legal guardian must have signed the written informed consent document before study start. The patient must be willing and able to comply with all study assessments and procedures.
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 |
| --- | --- |
| Other: Cholic Acid<br> | Drug: Cholic Acids<br>* 10-15 mg/kg body weight/day taken orally.<br>* Other names: Cholic Acid Capsules;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Excretion of Atypical Bile Acids in Urine by Category | Patients with excretion of atypical bile acids in urine by category, from worst status before treatment (baseline, BL) to best status on treatment (OT) | Baseline, then every 1, 3, or 6 months (depending on protocol version) for an average of 2.8 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Liver Function Tests (LFTs) Measured in Serum | Patients with elevations of liver function tests (alanine transaminase [ALT], aspartate transaminase [AST]) measured as multiples of the upper limit of normal (ULN) at baseline (worst value) and on treatment (best value) | Baseline, then every 1, 3, or 6 months (depending on protocol version) for an average of 2.8 years | 
| Liver Histology | Patients (number, percentage) with pathological findings for qualitative (the presence of inflammation, fibrosis, necrosis, giant cells and cholestasis) and quantitative (the degrees of the aforementioned histologic features) liver histopathology at baseline (BL) and on treatment (OT). | At baseline (if no historical data were available) and between 1 and 6 months following treatment start. | 
| Height and Weight | Change in height/weight percentiles from baseline (worst value) to the best on-treatment value, based on CDC (Centres for Disease Control and Prevention, US) growth chart percentiles | Baseline, then every 1, 3, or 6 months (depending on protocol version) for an average of 2.8 years | 
| Adverse Events | Number of patients with any adverse event | Baseline, then every 1, 3, or 6 months (depending on protocol version) for an average of 2.8 years |