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Acetyl-L-Carnitine for the Treatment of NRTI-Associated Peripheral Neuropathy

Primary Purpose

HIV Infections, Peripheral Nervous System Diseases

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Acetyl-L-carnitine
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring Acetylcarnitine, Dideoxynucleosides, Epidermis, Biopsy, Immunohistochemistry, Nerve Fibers, Treatment Experienced

Eligibility Criteria

13 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: HIV-1 infection Viral load <= 10,000 copies/ml within 60 days of entry On stable antiretroviral medication for 8 weeks prior to entry and plan on staying on current regimen for the duration of the study Currently taking at least one dideoxynucleoside analogue. Patients discontinuing their dideoxynucleoside analogues or changing their antiretroviral regimen after entry will remain on study drug and continue with the study requirements and evaluation visits. No significant systemic antiretroviral toxicity Evidence of predominantly sensory neuropathy, as determined from an examination by a neurologist Ongoing neuropathy of any duration Negative pregnancy test performed at screening and within 24 hours of study entry Agree not to become pregnant or to impregnate; agree to use acceptable methods of contraception Exclusion Criteria: ALC or similar drug within 90 days of entry Active AIDS-defining opportunistic infection (OI) or OI-defining condition within 30 days prior to entry Any condition or history of any condition, other than that related to HIV infection or antiretroviral therapy, that would add confusion to the diagnosis of dideoxynucleoside analogue-associated DSPN Pregnancy or breast-feeding Active malignancy Seizure disorder or history of seizure within 90 days of entry Current or history of bipolar disorder Certain drugs within 30 days of study entry Addition of certain pain medication during the 60 days prior to study entry Allergy/sensitivity to study drug or its formulations Any condition that, in the opinion of the site investigator, would interfere with the study requirements Myelopathy Use of investigational agents that are not FDA-approved within 30 days of study entry, except when approved by the study chair. Investigational antiretroviral drugs available through expanded access or through AACTG trials will be allowed if they do not conflict with study criteria.

Sites / Locations

  • Stanford CRS
  • The Ponce de Leon Ctr. CRS
  • Univ. of Hawaii at Manoa, Leahi Hosp.
  • Northwestern University CRS
  • Cook County Hosp. CORE Ctr.
  • Johns Hopkins Adult AIDS CRS
  • Washington U CRS
  • Beth Israel Med. Ctr., ACTU
  • Weill Med. College of Cornell Univ., The Cornell CTU
  • University of Washington AIDS CRS
  • Puerto Rico-AIDS CRS

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
December 3, 2002
Last Updated
October 28, 2021
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Neurologic AIDS Research Consortium (NARC)
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1. Study Identification

Unique Protocol Identification Number
NCT00050271
Brief Title
Acetyl-L-Carnitine for the Treatment of NRTI-Associated Peripheral Neuropathy
Official Title
An Open-Label, Dose-Escalation Pilot Study of Acetyl-L-Carnitine for the Treatment of Dideoxynucleoside-Associated Distal Symmetric Peripheral Neuropathy
Study Type
Interventional

2. Study Status

Record Verification Date
October 2021
Overall Recruitment Status
Completed
Study Start Date
undefined (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
January 2007 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Neurologic AIDS Research Consortium (NARC)

4. Oversight

5. Study Description

Brief Summary
The purpose of this study is to determine if acetyl-L-carnitine (ALC) reduces pain, numbness, and tingling in the feet and legs of patients with nucleoside reverse transcriptase inhibitor (NRTI)-associated peripheral neuropathy. Another purpose is to determine if ALC is safe and tolerable in HIV patients who have taken certain anti-HIV drugs.
Detailed Description
Distal symmetric peripheral neuropathy (DSPN) is the most frequent neurologic complication of HIV infection and its treatments. NRTIs, particularly dideoxy-NRTIs, represent a significant risk factor for developing neuropathy. To date, there are no effective treatments for DSPN. Studies of nonneuronal tissues indicate a beneficial effect of ALC in HIV-1 seropositive individuals, but the role of ALC levels in patients with DSPN is unclear. Despite conflicting data, carnitine and its derivatives are still commonly used. Patients will have a screening visit and visits at entry and Weeks 6, 12, 18, and 24. Patients are required to fast (no food or drink except water) for 4-12 hours for the screening visit, entry visit, and at Weeks 12 and 24. Targeted physical examinations, blood chemistries, liver function tests, HIV-1 RNA, CD4/CD8 cell counts, hematology, and lactate assessments will be done. Patients will also have a small skin biopsy at entry and Week 24. Patients will begin with 1 tablet of ALC twice daily and escalate dosage to a target dose of 3 tablets daily. They will remain on the 3-tablet dose or a maximum tolerated dose for the duration of the study (24 weeks).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections, Peripheral Nervous System Diseases
Keywords
Acetylcarnitine, Dideoxynucleosides, Epidermis, Biopsy, Immunohistochemistry, Nerve Fibers, Treatment Experienced

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
27 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Acetyl-L-carnitine

10. Eligibility

Sex
All
Minimum Age & Unit of Time
13 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: HIV-1 infection Viral load <= 10,000 copies/ml within 60 days of entry On stable antiretroviral medication for 8 weeks prior to entry and plan on staying on current regimen for the duration of the study Currently taking at least one dideoxynucleoside analogue. Patients discontinuing their dideoxynucleoside analogues or changing their antiretroviral regimen after entry will remain on study drug and continue with the study requirements and evaluation visits. No significant systemic antiretroviral toxicity Evidence of predominantly sensory neuropathy, as determined from an examination by a neurologist Ongoing neuropathy of any duration Negative pregnancy test performed at screening and within 24 hours of study entry Agree not to become pregnant or to impregnate; agree to use acceptable methods of contraception Exclusion Criteria: ALC or similar drug within 90 days of entry Active AIDS-defining opportunistic infection (OI) or OI-defining condition within 30 days prior to entry Any condition or history of any condition, other than that related to HIV infection or antiretroviral therapy, that would add confusion to the diagnosis of dideoxynucleoside analogue-associated DSPN Pregnancy or breast-feeding Active malignancy Seizure disorder or history of seizure within 90 days of entry Current or history of bipolar disorder Certain drugs within 30 days of study entry Addition of certain pain medication during the 60 days prior to study entry Allergy/sensitivity to study drug or its formulations Any condition that, in the opinion of the site investigator, would interfere with the study requirements Myelopathy Use of investigational agents that are not FDA-approved within 30 days of study entry, except when approved by the study chair. Investigational antiretroviral drugs available through expanded access or through AACTG trials will be allowed if they do not conflict with study criteria.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Victor Valcour, M.D.
Organizational Affiliation
University of Hawaii
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Russell Bartt, M.D.
Organizational Affiliation
Cook County Hospital and Rush-Presbyterian St. Luke's Medical Center
Official's Role
Study Chair
Facility Information:
Facility Name
Stanford CRS
City
Palo Alto
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
The Ponce de Leon Ctr. CRS
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30308
Country
United States
Facility Name
Univ. of Hawaii at Manoa, Leahi Hosp.
City
Honolulu
State/Province
Hawaii
Country
United States
Facility Name
Northwestern University CRS
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611-3015
Country
United States
Facility Name
Cook County Hosp. CORE Ctr.
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
Johns Hopkins Adult AIDS CRS
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287-8106
Country
United States
Facility Name
Washington U CRS
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63108-2138
Country
United States
Facility Name
Beth Israel Med. Ctr., ACTU
City
New York
State/Province
New York
ZIP/Postal Code
10003
Country
United States
Facility Name
Weill Med. College of Cornell Univ., The Cornell CTU
City
New York
State/Province
New York
Country
United States
Facility Name
University of Washington AIDS CRS
City
Seattle
State/Province
Washington
ZIP/Postal Code
90033-1079
Country
United States
Facility Name
Puerto Rico-AIDS CRS
City
San Juan
ZIP/Postal Code
00936-5067
Country
Puerto Rico

12. IPD Sharing Statement

Citations:
PubMed Identifier
10882161
Citation
Wulff EA, Wang AK, Simpson DM. HIV-associated peripheral neuropathy: epidemiology, pathophysiology and treatment. Drugs. 2000 Jun;59(6):1251-60. doi: 10.2165/00003495-200059060-00005.
Results Reference
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PubMed Identifier
11684949
Citation
Simpson DM, Katzenstein D, Haidich B, Millington D, Yiannoutsos C, Schifitto G, McArthur J; AIDS Clinical Trials Group Protocol 291/860 Study Team. Plasma carnitine in HIV-associated neuropathy. AIDS. 2001 Nov 9;15(16):2207-8. doi: 10.1097/00002030-200111090-00025. No abstract available.
Results Reference
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PubMed Identifier
11781415
Citation
Polydefkis M, Yiannoutsos CT, Cohen BA, Hollander H, Schifitto G, Clifford DB, Simpson DM, Katzenstein D, Shriver S, Hauer P, Brown A, Haidich AB, Moo L, McArthur JC. Reduced intraepidermal nerve fiber density in HIV-associated sensory neuropathy. Neurology. 2002 Jan 8;58(1):115-9. doi: 10.1212/wnl.58.1.115.
Results Reference
background
PubMed Identifier
10975731
Citation
Scarpini E, Sacilotto G, Baron P, Cusini M, Scarlato G. Effect of acetyl-L-carnitine in the treatment of painful peripheral neuropathies in HIV+ patients. J Peripher Nerv Syst. 1997;2(3):250-2.
Results Reference
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Acetyl-L-Carnitine for the Treatment of NRTI-Associated Peripheral Neuropathy

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