The Antibiotic Rifampin to Reduce High Levels of Blood and Urine Calcium in IIH
Primary Purpose
Idiopathic Infantile Hypercalcemia - Mild Form
Status
Unknown status
Phase
Phase 1
Locations
Canada
Study Type
Interventional
Intervention
Rifampin 150 mg, 300 mg capsules and 25 mg/mL oral suspension
Sponsored by
About this trial
This is an interventional treatment trial for Idiopathic Infantile Hypercalcemia - Mild Form focused on measuring CYP24A1, Nephrocalcinosis, Hypercalcemia, Hypercalcuria
Eligibility Criteria
Inclusion Criteria:
- all patients between 6 months- 17 years of age with the clinical phenotype of idiopathic infantile hypercalcemia
- Biochemical evidence of this disorder: Serum calcium>upper limit of the reference age for range; high, 1,25 (OH)D; reduced PTH, reduced 24,25(OH)2D, and suppresses 24,1,25 (OH)2D, normal serum creatinine, AST, and ALT with or without
- biallelic inactivating mutations of CYP24A1
- mutations in newly published genes which are shown during the course of the study to cause an inappropriate increase in 1,25 (OH)2D
Exclusion Criteria:
- Allergy to rifampin or related medications
- Pregnancy or breastfeeding
- Significant cardiac, hepatic, or endocrine comorbidities
- Taking any medications/foods known to interact with CYP3A4 or 1,25 (OH)D
- Parents or guardians or subjects who in the opinion of the Investigator may be non compliant with study schedules or procedures
- Other comorbidities considered unsuitable by the investigator, including TB
Sites / Locations
- The Hospital for Sick ChildrenRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Rifampin
Arm Description
All subjects
Outcomes
Primary Outcome Measures
Change in Serum Calcium
Measured at baseline and every 2 months (8 weeks)
Change in Serum Parathyroid Hormone
measured at baseline and every 2 months ( 8 weeks)
Change in Urinary calcium excretion
Measured at baseline and every 2 months( 8 weeks)
Secondary Outcome Measures
Nephrocalcinosis
Renal ultrasound performed before and after treatment
Full Information
NCT ID
NCT03384121
First Posted
December 13, 2017
Last Updated
August 30, 2021
Sponsor
The Hospital for Sick Children
Collaborators
Children's Hospital of Philadelphia, Canadian Institutes of Health Research (CIHR), Cures Within Reach
1. Study Identification
Unique Protocol Identification Number
NCT03384121
Brief Title
The Antibiotic Rifampin to Reduce High Levels of Blood and Urine Calcium in IIH
Official Title
Rifampin to Reduce Elevated Levels of Blood and Urine Calcium in Patients With Idiopathic Infantile Hypercalcemia
Study Type
Interventional
2. Study Status
Record Verification Date
August 2021
Overall Recruitment Status
Unknown status
Study Start Date
February 22, 2018 (Actual)
Primary Completion Date
December 31, 2021 (Anticipated)
Study Completion Date
December 31, 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
The Hospital for Sick Children
Collaborators
Children's Hospital of Philadelphia, Canadian Institutes of Health Research (CIHR), Cures Within Reach
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Idiopathic infantile hypercalcemia(IIH) is a rare,genetic disorder of mineral metabolism. Biallelic loss of functions mutations of CYP24A1, the gene encoding the 24-hydroxylase enzyme that represents the principal pathway for inactivation of vitamin D metabolites, cause the most common and severe form of IIH.Investigators have preliminary data supporting a novel therapeutic approach to suggest rifampin as an investigational drug to induce over-expression of CYP3A4, an important enzyme that provides an alternate catabolic pathway for inactivation of vitamin D metabolites. In this study, investigators will recruit 5 patients with biallelic inactivating mutations of CYP24A1. Participants will be followed prospectively for a total 6-11 months. This will include 2 months of observation, 2 months of receiving the starting dose of rifampin, followed by 2 month washout phase. Efficacy of the starting dose of rifampin will be determined prior to proceeding only in non responders to the escalation dose of rifampin 10mg/kg/day.
Detailed Description
Idiopathic infantile hypercalcemia(IIH) is a rare,genetic disorder of mineral metabolism characterized by severe hypercalcemia and/or hypercalciuria, suppressed serum levels of parathyroid hormone (PTH), elevated levels of the active vitamin D metabolite, 1,25(OH)2D, and nephrocalcinosis. Biallelic loss of functions mutations of CYP24A1, the gene encoding the 24-hydroxylase enzyme that represents the principal pathway for inactivation of vitamin D metabolites, cause the most common and severe form of IIH.
Investigators have preliminary data supporting a novel therapeutic approach to suggest rifampin as an investigational drug to induce over-expression of CYP3A4, an important P450 microsomal enzyme that is expressed in the liver and intestine. When CYP3A4 is induced, the increased enzyme activity provides an alternative catabolic pathway for inactivation of vitamin D metabolites. The purpose of this study is to obtain results and support for an open label, escalating dose study to assess the effect, safety, and tolerability of once daily oral rifampin for two months in participants with IIH due to inactivating mutations in CYP24A1.
In this study, Investigators will recruit 5 patients with biallelic inactivating mutations of CYP24A1. Participants will be followed prospectively for a total 6-11 months. This will include 2 months of observation, 2 months of receiving the starting dose of rifampin, followed by 2 month washout phase. Efficacy of the starting dose of rifampin will be determined prior to proceeding only in non responders to the escalation dose of rifampin 10mg/kg/day. In addition to determining if this treatment is efficacious in reducing elevated serum and urinary calcium in patients, it will be determined if there is a dose effect of rifampin. As well, detailed measurements of vitamin D metabolites will determine if rifampin reduces hypercalcemia through increased CYP3A4 activity.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Idiopathic Infantile Hypercalcemia - Mild Form
Keywords
CYP24A1, Nephrocalcinosis, Hypercalcemia, Hypercalcuria
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
This is a phase 1 pilot study whereby all participants start the study at a starting dose 5mg/kg/day (at study visit 2) for two months, and those that do not respond to 5mg/kg/day, otherwise known as non-responders, will receive a higher dose of 10 mg/kg/day (at study visit 4) for another two months. Recruited patients will be followed prospectively for a total of 6-11 months. This will include 2 months of observation, 2 months of receiving the starting dose of rifampin of 5mg/kg/day with a maximum dose of 600mg/day followed by a 2 month washout phase. The efficacy of the starting dose of rifampin will be determined prior to proceeding only in non-responders to the higher dose of 10 mg/kg/day with a maximum dose of 600 mg/day.
Masking
None (Open Label)
Allocation
N/A
Enrollment
5 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Rifampin
Arm Type
Experimental
Arm Description
All subjects
Intervention Type
Drug
Intervention Name(s)
Rifampin 150 mg, 300 mg capsules and 25 mg/mL oral suspension
Other Intervention Name(s)
Rifadin, Rofact, Rifampicin
Intervention Description
Starting Dose (V2): 5 mg/kg/day (max 600mg/day) orally for 2 months followed by a 2 month washout period V4: After washout period, only Non-responders will escalate dose to 10 mg/kg/day (max 600mg/day) orally for 2 months
Primary Outcome Measure Information:
Title
Change in Serum Calcium
Description
Measured at baseline and every 2 months (8 weeks)
Time Frame
40 weeks
Title
Change in Serum Parathyroid Hormone
Description
measured at baseline and every 2 months ( 8 weeks)
Time Frame
40 weeks
Title
Change in Urinary calcium excretion
Description
Measured at baseline and every 2 months( 8 weeks)
Time Frame
40 weeks
Secondary Outcome Measure Information:
Title
Nephrocalcinosis
Description
Renal ultrasound performed before and after treatment
Time Frame
40 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
6 Months
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
all patients between 6 months- 17 years of age with the clinical phenotype of idiopathic infantile hypercalcemia
Biochemical evidence of this disorder: Serum calcium>upper limit of the reference age for range; high, 1,25 (OH)D; reduced PTH, reduced 24,25(OH)2D, and suppresses 24,1,25 (OH)2D, normal serum creatinine, AST, and ALT with or without
biallelic inactivating mutations of CYP24A1
mutations in newly published genes which are shown during the course of the study to cause an inappropriate increase in 1,25 (OH)2D
Exclusion Criteria:
Allergy to rifampin or related medications
Pregnancy or breastfeeding
Significant cardiac, hepatic, or endocrine comorbidities
Taking any medications/foods known to interact with CYP3A4 or 1,25 (OH)D
Parents or guardians or subjects who in the opinion of the Investigator may be non compliant with study schedules or procedures
Other comorbidities considered unsuitable by the investigator, including TB
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yesmino Elia, MSc
Phone
416-813-7654
Ext
201518
Email
yesmino.elia@sickkids.ca
First Name & Middle Initial & Last Name or Official Title & Degree
Michelle Furman, BMSc
Phone
416-813-7654
Ext
228985
Email
michelle.furman@sickkids.ca
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Etienne Sochett, MD
Organizational Affiliation
The Hospital for Sick Children
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Hospital for Sick Children
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 1X8
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Etienne Sochett, MD
Phone
416-813-6218
Email
etienne.sochett@sickkids.ca
First Name & Middle Initial & Last Name & Degree
Yesmino Elia, Msc.
Phone
416-813-7654
Ext
1518
Email
yesmino.elia@sickkids.ca
First Name & Middle Initial & Last Name & Degree
Etienne Sochett, MD
12. IPD Sharing Statement
Plan to Share IPD
Undecided
Citations:
PubMed Identifier
13070618
Citation
LIGHTWOOD R, STAPLETON T. Idiopathic hypercalcaemia in infants. Lancet. 1953 Aug 1;265(6779):255-6. doi: 10.1016/s0140-6736(53)90187-1. No abstract available.
Results Reference
background
PubMed Identifier
13175473
Citation
CREERY RD, NEILL DW. Idiopathic hypercalcaemia in infants with failure to thrive. Lancet. 1954 Jul 17;267(6829):110-4. doi: 10.1016/s0140-6736(54)90094-x. No abstract available.
Results Reference
background
PubMed Identifier
15498883
Citation
Masuda S, Byford V, Arabian A, Sakai Y, Demay MB, St-Arnaud R, Jones G. Altered pharmacokinetics of 1alpha,25-dihydroxyvitamin D3 and 25-hydroxyvitamin D3 in the blood and tissues of the 25-hydroxyvitamin D-24-hydroxylase (Cyp24a1) null mouse. Endocrinology. 2005 Feb;146(2):825-34. doi: 10.1210/en.2004-1116. Epub 2004 Oct 21.
Results Reference
background
PubMed Identifier
21675912
Citation
Schlingmann KP, Kaufmann M, Weber S, Irwin A, Goos C, John U, Misselwitz J, Klaus G, Kuwertz-Broking E, Fehrenbach H, Wingen AM, Guran T, Hoenderop JG, Bindels RJ, Prosser DE, Jones G, Konrad M. Mutations in CYP24A1 and idiopathic infantile hypercalcemia. N Engl J Med. 2011 Aug 4;365(5):410-21. doi: 10.1056/NEJMoa1103864. Epub 2011 Jun 15.
Results Reference
background
PubMed Identifier
22112808
Citation
Dauber A, Nguyen TT, Sochett E, Cole DE, Horst R, Abrams SA, Carpenter TO, Hirschhorn JN. Genetic defect in CYP24A1, the vitamin D 24-hydroxylase gene, in a patient with severe infantile hypercalcemia. J Clin Endocrinol Metab. 2012 Feb;97(2):E268-74. doi: 10.1210/jc.2011-1972. Epub 2011 Nov 23.
Results Reference
background
PubMed Identifier
14031980
Citation
KENNY FM, ACETO T Jr, PURISCH M, HARRISON HE, HARRISON HC, BLIZZARD RM. Metabolic studies in a patient with idiopathic hypercalcemia of infancy. J Pediatr. 1963 Apr;62:531-7. doi: 10.1016/s0022-3476(63)80010-4. No abstract available.
Results Reference
background
PubMed Identifier
2995910
Citation
Pronicka E, Kulczycka H, Rowinska E, Konopinska A, Kansy J, Lorenc R. [Idiopathic hypercalcemia as a syndrome of hypersensitivity to vitamin D3 in 19 infants]. Pediatr Pol. 1985 Apr;60(4):288-94. No abstract available. Polish.
Results Reference
background
PubMed Identifier
13674824
Citation
SMITH DW, BLIZZARD RM, HARRISON HE. Idiopathic hypercalcemia; a case report with assays of vitamin D in the serum. Pediatrics. 1959 Aug;24(2):258-69. No abstract available.
Results Reference
background
PubMed Identifier
24518185
Citation
Wolf P, Muller-Sacherer T, Baumgartner-Parzer S, Winhofer Y, Kroo J, Gessl A, Luger A, Krebs M. A Case of "Late-Onset" Idiopathic Infantile Hypercalcemia Secondary to Mutations in the CYP24A1 Gene. Endocr Pract. 2014 May;20(5):e91-5. doi: 10.4158/EP13479.CR.
Results Reference
background
PubMed Identifier
26731879
Citation
Tray KA, Laut J, Saidi A. Idiopathic Infantile Hypercalcemia, Presenting in Adulthood--No Longer Idiopathic Nor Infantile: Two Case Reports and Review. Conn Med. 2015 Nov-Dec;79(10):593-7.
Results Reference
background
PubMed Identifier
23293122
Citation
Nesterova G, Malicdan MC, Yasuda K, Sakaki T, Vilboux T, Ciccone C, Horst R, Huang Y, Golas G, Introne W, Huizing M, Adams D, Boerkoel CF, Collins MT, Gahl WA. 1,25-(OH)2D-24 Hydroxylase (CYP24A1) Deficiency as a Cause of Nephrolithiasis. Clin J Am Soc Nephrol. 2013 Apr;8(4):649-57. doi: 10.2215/CJN.05360512. Epub 2013 Jan 4.
Results Reference
background
PubMed Identifier
26117226
Citation
Cools M, Goemaere S, Baetens D, Raes A, Desloovere A, Kaufman JM, De Schepper J, Jans I, Vanderschueren D, Billen J, De Baere E, Fiers T, Bouillon R. Calcium and bone homeostasis in heterozygous carriers of CYP24A1 mutations: A cross-sectional study. Bone. 2015 Dec;81:89-96. doi: 10.1016/j.bone.2015.06.018. Epub 2015 Jun 25.
Results Reference
background
PubMed Identifier
15544953
Citation
Prosser DE, Jones G. Enzymes involved in the activation and inactivation of vitamin D. Trends Biochem Sci. 2004 Dec;29(12):664-73. doi: 10.1016/j.tibs.2004.10.005.
Results Reference
background
PubMed Identifier
15128933
Citation
Cheng JB, Levine MA, Bell NH, Mangelsdorf DJ, Russell DW. Genetic evidence that the human CYP2R1 enzyme is a key vitamin D 25-hydroxylase. Proc Natl Acad Sci U S A. 2004 May 18;101(20):7711-5. doi: 10.1073/pnas.0402490101. Epub 2004 May 5.
Results Reference
background
PubMed Identifier
20059333
Citation
Bergwitz C, Juppner H. Regulation of phosphate homeostasis by PTH, vitamin D, and FGF23. Annu Rev Med. 2010;61:91-104. doi: 10.1146/annurev.med.051308.111339.
Results Reference
background
PubMed Identifier
15040831
Citation
Shimada T, Hasegawa H, Yamazaki Y, Muto T, Hino R, Takeuchi Y, Fujita T, Nakahara K, Fukumoto S, Yamashita T. FGF-23 is a potent regulator of vitamin D metabolism and phosphate homeostasis. J Bone Miner Res. 2004 Mar;19(3):429-35. doi: 10.1359/JBMR.0301264. Epub 2003 Dec 29.
Results Reference
background
PubMed Identifier
12964423
Citation
Levine MA. Normal mineral homeostasis. Interplay of parathyroid hormone and vitamin D. Endocr Dev. 2003;6:14-33. doi: 10.1159/000072764. No abstract available.
Results Reference
background
PubMed Identifier
26681795
Citation
Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: Metabolism, Molecular Mechanism of Action, and Pleiotropic Effects. Physiol Rev. 2016 Jan;96(1):365-408. doi: 10.1152/physrev.00014.2015.
Results Reference
background
PubMed Identifier
26251717
Citation
Dusso AS, Gomez-Alonso C, Cannata-Andia JB. The hypercalcaemia of CYP24A1 inactivation: new ways to improve diagnosis and treatment. Clin Kidney J. 2015 Aug;8(4):456-8. doi: 10.1093/ckj/sfv058. Epub 2015 Jul 6.
Results Reference
background
PubMed Identifier
24597546
Citation
Curtis KM, Aenlle KK, Roos BA, Howard GA. 24R,25-dihydroxyvitamin D3 promotes the osteoblastic differentiation of human mesenchymal stem cells. Mol Endocrinol. 2014 May;28(5):644-58. doi: 10.1210/me.2013-1241. Epub 2014 Mar 5.
Results Reference
background
PubMed Identifier
9180905
Citation
Greising DM, Schwartz Z, Posner GH, Sylvia VL, Dean DD, Boyan BD. A-ring analogues of 1, 25-(OH)2D3 with low affinity for the vitamin D receptor modulate chondrocytes via membrane effects that are dependent on cell maturation. J Cell Physiol. 1997 Jun;171(3):357-67. doi: 10.1002/(SICI)1097-4652(199706)171:33.0.CO;2-7.
Results Reference
background
PubMed Identifier
20394945
Citation
Nguyen M, Boutignon H, Mallet E, Linglart A, Guillozo H, Jehan F, Garabedian M. Infantile hypercalcemia and hypercalciuria: new insights into a vitamin D-dependent mechanism and response to ketoconazole treatment. J Pediatr. 2010 Aug;157(2):296-302. doi: 10.1016/j.jpeds.2010.02.025. Epub 2010 Apr 14.
Results Reference
background
PubMed Identifier
26251716
Citation
Sayers J, Hynes AM, Srivastava S, Dowen F, Quinton R, Datta HK, Sayer JA. Successful treatment of hypercalcaemia associated with a CYP24A1 mutation with fluconazole. Clin Kidney J. 2015 Aug;8(4):453-5. doi: 10.1093/ckj/sfv028. Epub 2015 May 25.
Results Reference
background
PubMed Identifier
22205755
Citation
Wang Z, Lin YS, Zheng XE, Senn T, Hashizume T, Scian M, Dickmann LJ, Nelson SD, Baillie TA, Hebert MF, Blough D, Davis CL, Thummel KE. An inducible cytochrome P450 3A4-dependent vitamin D catabolic pathway. Mol Pharmacol. 2012 Apr;81(4):498-509. doi: 10.1124/mol.111.076356. Epub 2011 Dec 28.
Results Reference
background
PubMed Identifier
16207822
Citation
Xu Y, Hashizume T, Shuhart MC, Davis CL, Nelson WL, Sakaki T, Kalhorn TF, Watkins PB, Schuetz EG, Thummel KE. Intestinal and hepatic CYP3A4 catalyze hydroxylation of 1alpha,25-dihydroxyvitamin D(3): implications for drug-induced osteomalacia. Mol Pharmacol. 2006 Jan;69(1):56-65. doi: 10.1124/mol.105.017392. Epub 2005 Oct 5.
Results Reference
background
PubMed Identifier
24641623
Citation
Wang Z, Wong T, Hashizume T, Dickmann LZ, Scian M, Koszewski NJ, Goff JP, Horst RL, Chaudhry AS, Schuetz EG, Thummel KE. Human UGT1A4 and UGT1A3 conjugate 25-hydroxyvitamin D3: metabolite structure, kinetics, inducibility, and interindividual variability. Endocrinology. 2014 Jun;155(6):2052-63. doi: 10.1210/en.2013-2013. Epub 2014 Mar 18.
Results Reference
background
PubMed Identifier
23212742
Citation
Wang Z, Lin YS, Dickmann LJ, Poulton EJ, Eaton DL, Lampe JW, Shen DD, Davis CL, Shuhart MC, Thummel KE. Enhancement of hepatic 4-hydroxylation of 25-hydroxyvitamin D3 through CYP3A4 induction in vitro and in vivo: implications for drug-induced osteomalacia. J Bone Miner Res. 2013 May;28(5):1101-16. doi: 10.1002/jbmr.1839.
Results Reference
background
PubMed Identifier
1030315
Citation
Kreis B, Pretet S, Birenbaum J, Guibout P, Hazeman JJ, Orin E, Perdrizet S, Weil J. Two three-month treatment regimens for pulmonary tuberculosis. Bull Int Union Tuberc. 1976;51(1):71-5. No abstract available.
Results Reference
background
PubMed Identifier
110184
Citation
Long MW, Snider DE Jr, Farer LS. U.S. Public Health Service Cooperative trial of three rifampin-isoniazid regimens in treatment of pulmonary tuberculosis. Am Rev Respir Dis. 1979 Jun;119(6):879-94. doi: 10.1164/arrd.1979.119.6.879.
Results Reference
background
PubMed Identifier
5314737
Citation
Poole G, Stradling P, Worlledge S. Potentially serious side effects of high-dose twice-weekly rifampicin. Br Med J. 1971 Aug 7;3(5770):343-7. doi: 10.1136/bmj.3.5770.343.
Results Reference
background
PubMed Identifier
25654354
Citation
Boeree MJ, Diacon AH, Dawson R, Narunsky K, du Bois J, Venter A, Phillips PP, Gillespie SH, McHugh TD, Hoelscher M, Heinrich N, Rehal S, van Soolingen D, van Ingen J, Magis-Escurra C, Burger D, Plemper van Balen G, Aarnoutse RE; PanACEA Consortium. A dose-ranging trial to optimize the dose of rifampin in the treatment of tuberculosis. Am J Respir Crit Care Med. 2015 May 1;191(9):1058-65. doi: 10.1164/rccm.201407-1264OC.
Results Reference
background
PubMed Identifier
25942481
Citation
Thacher TD, Fischer PR, Singh RJ, Roizen J, Levine MA. CYP2R1 Mutations Impair Generation of 25-hydroxyvitamin D and Cause an Atypical Form of Vitamin D Deficiency. J Clin Endocrinol Metab. 2015 Jul;100(7):E1005-13. doi: 10.1210/jc.2015-1746. Epub 2015 May 5.
Results Reference
background
PubMed Identifier
21784054
Citation
Wang Z, Senn T, Kalhorn T, Zheng XE, Zheng S, Davis CL, Hebert MF, Lin YS, Thummel KE. Simultaneous measurement of plasma vitamin D(3) metabolites, including 4beta,25-dihydroxyvitamin D(3), using liquid chromatography-tandem mass spectrometry. Anal Biochem. 2011 Nov 1;418(1):126-33. doi: 10.1016/j.ab.2011.06.043. Epub 2011 Jul 13.
Results Reference
background
PubMed Identifier
6604257
Citation
O'Brien RJ, Long MW, Cross FS, Lyle MA, Snider DE Jr. Hepatotoxicity from isoniazid and rifampin among children treated for tuberculosis. Pediatrics. 1983 Oct;72(4):491-9.
Results Reference
background
PubMed Identifier
17021358
Citation
Saukkonen JJ, Cohn DL, Jasmer RM, Schenker S, Jereb JA, Nolan CM, Peloquin CA, Gordin FM, Nunes D, Strader DB, Bernardo J, Venkataramanan R, Sterling TR; ATS (American Thoracic Society) Hepatotoxicity of Antituberculosis Therapy Subcommittee. An official ATS statement: hepatotoxicity of antituberculosis therapy. Am J Respir Crit Care Med. 2006 Oct 15;174(8):935-52. doi: 10.1164/rccm.200510-1666ST.
Results Reference
background
Learn more about this trial
The Antibiotic Rifampin to Reduce High Levels of Blood and Urine Calcium in IIH
We'll reach out to this number within 24 hrs