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L-Glutamine Therapy for Sickle Cell Anemia and Sickle ß0 Thalassemia

Primary Purpose

Sickle Cell Anemia, Thalassemia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
L-glutamine
Placebo
Sponsored by
Emmaus Medical, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sickle Cell Anemia focused on measuring sickle cell disease, sickle cell anemia, L-glutamine, Sickle Cell Anemia (homozygous), Sickle ß0-Thalassemia

Eligibility Criteria

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

Inclusion Criteria: To be eligible to participate in the study, a patient must meet all of the following inclusion criteria: Patient is at least five years of age. Patient has been diagnosed with sickle cell anemia or sickle ß0-thalassemia (documented by hemoglobin electrophoresis). Patient has had at least two episodes of painful crises within 12 months of the screening visit. If the patient has been treated with an anti-sickling agent within three months of the screening visit, the therapy must have been continuous for at least three months with the intent to continue for the next 14 months. Patient or the patient's legally authorized representative has given written informed consent. If the patient is a female of child-bearing potential, she agrees to practice a recognized form of birth control during the course of the study. Exclusion Criteria: If the patient meets any of the following criteria, the patient must not be enrolled: Patient has a significant medical condition that required hospitalization (other than sickle painful crisis) within two months of the screening visit. Patient has diabetes mellitus with untreated fasting blood sugar >115 mg/dL. Patient has prothrombin time International Normalized Ratio (INR) > 2.0. Patient has serum albumin < 3.0 g/dl. Patient has received any blood products within three weeks of the screening visit. Patient has a history of uncontrolled liver disease or renal insufficiency. Patient is pregnant or lactating. Patient has been treated with an experimental anti-sickling medication/treatment (except hydroxyurea) within 30 days of the screening visit. Patient has been treated with an experimental drug within 30 days of the screening visit. There are factors that would, in the judgment of the investigator, make it difficult for the patient to comply with the requirements of the study.

Sites / Locations

  • Kaiser Permanente
  • Harbor-UCLA Medical Center
  • Grady Memorial Hospital
  • University of Medicine and Dentistry, New Jersey
  • Jacobi Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

investigational product

placebo

Arm Description

L-glutamine

maltodextrin

Outcomes

Primary Outcome Measures

Number of Occurrences of Painful Sickle Cell Crises
The mean number of painful sickle crisis through week 48

Secondary Outcome Measures

Frequency of Hospitalizations for Sickle Cell Pain
The mean number of hospitalizations through week 48
Frequency of Emergency Room Visits for Sickle Cell Pain
The mean number of emergency room visits through week 48
The Effect of Oral L-glutamine on Hematological Parameters - Hemoglobin
Patient's hemoglobin will be collected at each visit.Change from Baseline will be reported at Weeks 4, 24 and 40.
The Effect of Oral L-glutamine on Hematological Parameters - Hematocrit
Patient's hematocrit will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24 and 40
The Effect of Oral L-glutamine on Hematological Parameters - Reticulocyte Count
Patient's reticulocyte count will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24 and 40
Number of Participants With Narcotic Usage
Analysis of narcotic usage was performed for the subset of patients with any narcotic use who completed the study. Changes in narcotic usage were determined by an independent consultant prior to database lock using morphine equivalents to determine relative use.
Energy Level (11-point Scale)
The patient's energy level was evaluated at each visit using an 11 point scale from 0=extremely tired to 10=extremely energetic
Patient Appetite (3-point Scale)
Patient's appetite level was evaluated at each visit using a 3 point scale: above average, average and below average. The parentages of patient at each visit whose appetite level was below, normal or above average were compared using CMH test (row mean scores) controlling for study center.
The Effect of Oral L-glutamine on Vital Signs - Blood Pressure
Patient's blood pressure will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48
The Effect of Oral L-glutamine on Vital Signs - Temperature
Patient's temperature will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48
The Effect of Oral L-glutamine on Vital Signs - Respiration
Respiration will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48
The Effect of Oral L-glutamine on Vital Signs - Pulse Rate
Patient's pulse rate will be collected at each visit, Change from Baseline will be reported at Weeks 4, 24, and 48
Effect of L-glutamine on Alcohol Use
The patient's alcohol usage will be assessed at each visit. Alcohol usage will be reported at Weeks 0, 8,16, 24, 32, 40 and 48
Effect of L-glutamine on Tobacco Use
Patient's alcohol usage will be assessed at each visit. Alcohol usage will be reported at Weeks 0, 8,16, 24, 32, 40 and 48
The Effect of Oral L-glutamine on the Number of Days Patient's Daily Activities Are Interrupted Due to Sickle Cell Pain
Percentage of days a patient's daily activities were interrupted due to sickle pain calculated at each visit. Day's interrupted will be reported at Weeks 0, 8,16, 24, 32, 40 and 48
The Effect of Oral L-glutamine on Subjective Quality of Life
The subjective quality of life was evaluated using the scoring of the RAND 36-Item Health Survey Questionnaire. The subjective quality of life (Physical functioning, Physical health, Emotional problems, Energy/Fatigue, Emotional well being, Social functioning, Pain, General health) will be reported at Baseline and Week 24 (or at time of discontinuation). The range for Physical functioning, Physical health, Emotional problems, Emotional well being and Social functioning is 0-100, with a high score denotes a better quality of life. For Energy/Fatigue, Pain and General health the range is 0-100, with a lower score denotes better quality of life.
Effect of Oral L--glutamine on Height
Height will be measured at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48
Effect of Oral L--glutamine on Weight
Weight will be measured at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48
Effect of L-glutamine on Subjective Exercise Tolerance - Minutes Patient Could Walk Without Rest
Minutes patient could walk without rest will be measured at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48.
Effect of L-glutamine on Subjective Exercise Tolerance - Minutes Patient Could Run Without Rest
Minutes patient could run without rest will be measured at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48.
Effect of L-glutamine on Subjective Exercise Tolerance - Distance Patient Could Walk Without Rest
Distance patient could walk without rest will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48.
Effect of L-glutamine on Subjective Exercise Tolerance - Distance Patient Could Run Without Rest
Distance patient could run without rest will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48.

Full Information

First Posted
August 1, 2005
Last Updated
January 11, 2021
Sponsor
Emmaus Medical, Inc.
Collaborators
FDA Office of Orphan Products Development
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1. Study Identification

Unique Protocol Identification Number
NCT00125788
Brief Title
L-Glutamine Therapy for Sickle Cell Anemia and Sickle ß0 Thalassemia
Official Title
A Phase II, Prospective, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Multicenter Study of L Glutamine Therapy for Sickle Cell Anemia and Sickle ß0-Thalassemia
Study Type
Interventional

2. Study Status

Record Verification Date
December 2020
Overall Recruitment Status
Completed
Study Start Date
March 2004 (undefined)
Primary Completion Date
July 2008 (Actual)
Study Completion Date
July 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Emmaus Medical, Inc.
Collaborators
FDA Office of Orphan Products Development

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this research is to evaluate the effects of L-glutamine as a therapy for sickle cell anemia and sickle ß0-thalassemia. as evaluated by the number of occurrences of sickle cell crises.
Detailed Description
The primary purpose of this study is to evaluate the effectiveness of oral L-glutamine in the therapy of sickle cell anemia and sickle ß0-thalassemia. The secondary purpose is to assess the effect of L-glutamine frequency of hospitalizations for sickle cell pain, frequency of emergency room visits for sickle cell pain; energy and appetite levels; narcotics usage. Methodology: By site, patients will be randomized to L-glutamine or placebo in a 1:1 ratio after a 4-week screening period. Patients will undergo 48 weeks of treatment with dosing BID orally, with dose calculated according to patient weight. Patient visits will occur every 4 weeks. After 48 weeks of treatment, dose will be tapered to zero within 3 weeks. A final evaluation visit will occur 2 weeks after last dose.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sickle Cell Anemia, Thalassemia
Keywords
sickle cell disease, sickle cell anemia, L-glutamine, Sickle Cell Anemia (homozygous), Sickle ß0-Thalassemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
70 (Actual)

8. Arms, Groups, and Interventions

Arm Title
investigational product
Arm Type
Experimental
Arm Description
L-glutamine
Arm Title
placebo
Arm Type
Placebo Comparator
Arm Description
maltodextrin
Intervention Type
Drug
Intervention Name(s)
L-glutamine
Other Intervention Name(s)
oral L-glutamine
Intervention Description
Approximately 0.3 g/kg total daily dose of L-glutamine will be orally administered (over two doses), with a maximum total daily dose of 30 grams.
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
maltodextrin
Intervention Description
Approximately 0.3 g/kg total daily dose of maltodextrin placebo will be orally administered (over two doses), with a maximum total daily dose of 30 grams.
Primary Outcome Measure Information:
Title
Number of Occurrences of Painful Sickle Cell Crises
Description
The mean number of painful sickle crisis through week 48
Time Frame
From Week 0 through Week 48 (cumulative)
Secondary Outcome Measure Information:
Title
Frequency of Hospitalizations for Sickle Cell Pain
Description
The mean number of hospitalizations through week 48
Time Frame
From Week 0 through Week 48 (cumulative)
Title
Frequency of Emergency Room Visits for Sickle Cell Pain
Description
The mean number of emergency room visits through week 48
Time Frame
From Week 0 through Week 48 (cumulative)
Title
The Effect of Oral L-glutamine on Hematological Parameters - Hemoglobin
Description
Patient's hemoglobin will be collected at each visit.Change from Baseline will be reported at Weeks 4, 24 and 40.
Time Frame
Baseline, Weeks 4, 24 and 40
Title
The Effect of Oral L-glutamine on Hematological Parameters - Hematocrit
Description
Patient's hematocrit will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24 and 40
Time Frame
Baseline, Weeks 4, 24, and 40
Title
The Effect of Oral L-glutamine on Hematological Parameters - Reticulocyte Count
Description
Patient's reticulocyte count will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24 and 40
Time Frame
Baseline, Weeks 0, 4, 24, 40
Title
Number of Participants With Narcotic Usage
Description
Analysis of narcotic usage was performed for the subset of patients with any narcotic use who completed the study. Changes in narcotic usage were determined by an independent consultant prior to database lock using morphine equivalents to determine relative use.
Time Frame
Week 24, Week 48
Title
Energy Level (11-point Scale)
Description
The patient's energy level was evaluated at each visit using an 11 point scale from 0=extremely tired to 10=extremely energetic
Time Frame
Collected at Week 0, 8, 16, 24, 32, 40, 48
Title
Patient Appetite (3-point Scale)
Description
Patient's appetite level was evaluated at each visit using a 3 point scale: above average, average and below average. The parentages of patient at each visit whose appetite level was below, normal or above average were compared using CMH test (row mean scores) controlling for study center.
Time Frame
Collected at Week 0, 8, 16, 24, 32, 40, 48
Title
The Effect of Oral L-glutamine on Vital Signs - Blood Pressure
Description
Patient's blood pressure will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48
Time Frame
Baseline, Weeks 4, 24, and 48
Title
The Effect of Oral L-glutamine on Vital Signs - Temperature
Description
Patient's temperature will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48
Time Frame
Baseline, Weeks 4, 24, and 48
Title
The Effect of Oral L-glutamine on Vital Signs - Respiration
Description
Respiration will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48
Time Frame
Baseline, Weeks 4, 24, and 48
Title
The Effect of Oral L-glutamine on Vital Signs - Pulse Rate
Description
Patient's pulse rate will be collected at each visit, Change from Baseline will be reported at Weeks 4, 24, and 48
Time Frame
Baseline, Weeks 4, 24, and 48
Title
Effect of L-glutamine on Alcohol Use
Description
The patient's alcohol usage will be assessed at each visit. Alcohol usage will be reported at Weeks 0, 8,16, 24, 32, 40 and 48
Time Frame
Weeks 0, 8,16, 24, 32, 40 and 48
Title
Effect of L-glutamine on Tobacco Use
Description
Patient's alcohol usage will be assessed at each visit. Alcohol usage will be reported at Weeks 0, 8,16, 24, 32, 40 and 48
Time Frame
Weeks 0, 8,16, 24, 32, 40 and 48
Title
The Effect of Oral L-glutamine on the Number of Days Patient's Daily Activities Are Interrupted Due to Sickle Cell Pain
Description
Percentage of days a patient's daily activities were interrupted due to sickle pain calculated at each visit. Day's interrupted will be reported at Weeks 0, 8,16, 24, 32, 40 and 48
Time Frame
Weeks 0, 8,16, 24, 32, 40 and 48
Title
The Effect of Oral L-glutamine on Subjective Quality of Life
Description
The subjective quality of life was evaluated using the scoring of the RAND 36-Item Health Survey Questionnaire. The subjective quality of life (Physical functioning, Physical health, Emotional problems, Energy/Fatigue, Emotional well being, Social functioning, Pain, General health) will be reported at Baseline and Week 24 (or at time of discontinuation). The range for Physical functioning, Physical health, Emotional problems, Emotional well being and Social functioning is 0-100, with a high score denotes a better quality of life. For Energy/Fatigue, Pain and General health the range is 0-100, with a lower score denotes better quality of life.
Time Frame
Baseline and Week 24 (or at time of discontinuation)
Title
Effect of Oral L--glutamine on Height
Description
Height will be measured at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48
Time Frame
Baseline, Weeks 4, 24, and 48
Title
Effect of Oral L--glutamine on Weight
Description
Weight will be measured at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48
Time Frame
Baseline, Weeks 4, 24 and 48
Title
Effect of L-glutamine on Subjective Exercise Tolerance - Minutes Patient Could Walk Without Rest
Description
Minutes patient could walk without rest will be measured at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48.
Time Frame
Baseline, Weeks 4, 24, and 48.
Title
Effect of L-glutamine on Subjective Exercise Tolerance - Minutes Patient Could Run Without Rest
Description
Minutes patient could run without rest will be measured at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48.
Time Frame
Baseline, Weeks 4, 24, and 48.
Title
Effect of L-glutamine on Subjective Exercise Tolerance - Distance Patient Could Walk Without Rest
Description
Distance patient could walk without rest will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48.
Time Frame
Baseline, Weeks 4, 24, and 48.
Title
Effect of L-glutamine on Subjective Exercise Tolerance - Distance Patient Could Run Without Rest
Description
Distance patient could run without rest will be collected at each visit. Change from Baseline will be reported at Weeks 4, 24, and 48.
Time Frame
Baseline, Weeks 4, 24, and 48.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
5 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: To be eligible to participate in the study, a patient must meet all of the following inclusion criteria: Patient is at least five years of age. Patient has been diagnosed with sickle cell anemia or sickle ß0-thalassemia (documented by hemoglobin electrophoresis). Patient has had at least two episodes of painful crises within 12 months of the screening visit. If the patient has been treated with an anti-sickling agent within three months of the screening visit, the therapy must have been continuous for at least three months with the intent to continue for the next 14 months. Patient or the patient's legally authorized representative has given written informed consent. If the patient is a female of child-bearing potential, she agrees to practice a recognized form of birth control during the course of the study. Exclusion Criteria: If the patient meets any of the following criteria, the patient must not be enrolled: Patient has a significant medical condition that required hospitalization (other than sickle painful crisis) within two months of the screening visit. Patient has diabetes mellitus with untreated fasting blood sugar >115 mg/dL. Patient has prothrombin time International Normalized Ratio (INR) > 2.0. Patient has serum albumin < 3.0 g/dl. Patient has received any blood products within three weeks of the screening visit. Patient has a history of uncontrolled liver disease or renal insufficiency. Patient is pregnant or lactating. Patient has been treated with an experimental anti-sickling medication/treatment (except hydroxyurea) within 30 days of the screening visit. Patient has been treated with an experimental drug within 30 days of the screening visit. There are factors that would, in the judgment of the investigator, make it difficult for the patient to comply with the requirements of the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yutaka Niihara, MD
Organizational Affiliation
CEO, Emmaus Medical, Inc
Official's Role
Principal Investigator
Facility Information:
Facility Name
Kaiser Permanente
City
Bellflower
State/Province
California
ZIP/Postal Code
90706
Country
United States
Facility Name
Harbor-UCLA Medical Center
City
Torrance
State/Province
California
ZIP/Postal Code
90502
Country
United States
Facility Name
Grady Memorial Hospital
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30303
Country
United States
Facility Name
University of Medicine and Dentistry, New Jersey
City
New Brunswick
State/Province
New Jersey
ZIP/Postal Code
08903
Country
United States
Facility Name
Jacobi Medical Center
City
Bronx
State/Province
New York
ZIP/Postal Code
10461
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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L-Glutamine Therapy for Sickle Cell Anemia and Sickle ß0 Thalassemia

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