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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
The Hospital for Sick Children
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Idiopathic Infantile Hypercalcemia - Mild Form focused on measuring CYP24A1, Nephrocalcinosis, Hypercalcemia, Hypercalcuria

Eligibility Criteria

6 Months - 17 Years (Child)All SexesDoes not accept healthy volunteers

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

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
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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
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The Antibiotic Rifampin to Reduce High Levels of Blood and Urine Calcium in IIH

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