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Curcumin for Pediatric Nonalcoholic Fatty Liver Disease

Primary Purpose

NAFLD - Nonalcoholic Fatty Liver Disease, NASH - Nonalcoholic Steatohepatitis

Status
Withdrawn
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
phosphatidylcholine-curcumin complex supplement
Placebo curcumin capsule
Sponsored by
Columbia University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for NAFLD - Nonalcoholic Fatty Liver Disease focused on measuring Pediatric, NAFLD - nonalcoholic fatty liver disease, Curcumin, Fatty liver

Eligibility Criteria

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

Inclusion Criteria:

  • Age 8-17 years at initial screening interview
  • Histological evidence of NAFLD with or without fibrosis and a NAFLD activity score (NAS) of ≥3, on a liver biopsy obtained no more than 730 days prior to enrollment
  • Serum ALT at screening ≥ 50 IU/L

Exclusion Criteria:

  • Significant alcohol consumption or inability to reliably quantify alcohol intake
  • Use of drugs historically associated with NAFLD (amiodarone, methotrexate, systemic glucocorticoids, tetracyclines, tamoxifen, estrogens at doses greater than those used for hormone replacement, anabolic steroids, valproic acid, other known hepatotoxins) for more than 2 consecutive weeks in the past year prior to randomization
  • New treatment with vitamin E or metformin started in the past 90 days or plans to alter the dose or stop over the next the 24 weeks. A stable dose is acceptable.
  • Prior or planned bariatric surgery
  • Uncontrolled diabetes (HbA1c 9.5% or higher within 30 days prior to enrollment)
  • Presence of cirrhosis on liver biopsy
  • Stage 2 Hypertension or >140 systolic or >90 diastolic at screening
  • Current daily use of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Platelet counts below 100,000 /mm3
  • Clinical evidence of hepatic decompensation (serum albumin < 3.2 g/dL, international normalized ratio (INR) >1.3, direct bilirubin >1.3 mg/dL, history of esophageal varices, ascites, or hepatic encephalopathy)
  • Evidence of chronic liver disease other than NAFLD:

    • Biopsy consistent with histological evidence of autoimmune hepatitis
    • Serum hepatitis B surface antigen (HBsAg) positive.
    • Serum hepatitis C antibody (anti-HCV) positive.
    • Iron/total iron binding capacity (TIBC) ratio (transferrin saturation) > 45% with histological evidence of iron overload
    • Alpha-1-antitrypsin (A1AT) phenotype/genotype ZZ or SZ
    • Wilson's disease
  • History of biliary diversion
  • History of kidney disease and/or estimated glomerular filtration rate (eGFR) < than 60 mL/min/1.73 m2 using Schwartz Bedside GFR Calculator for Children isotope dilution mass spectroscopy (IDMS)-traceable
  • Known Human Immunodeficiency Virus (HIV) infection
  • Active, serious medical disease with life expectancy less than 5 years
  • Active substance abuse including inhaled or injected drugs, in the year prior to screening
  • Pregnancy, planned pregnancy, potential for pregnancy and unwillingness to use effective birth control during the trial, breast feeding
  • Participation in any clinical/investigational trial within the prior 150 days and during the study.
  • Any other condition which, in the opinion of the investigator, would impede compliance or hinder completion of the study
  • Inability to swallow capsules
  • Known allergy to curcumin or any of its components
  • Failure of parent or legal guardian to give informed consent or subject to give informed assent

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Active Comparator

    Active Comparator

    Placebo Comparator

    Arm Label

    Curcumin 500mg capsules

    Curcumin 1000mg capsules

    Placebo curcumin capsules

    Arm Description

    Dose will be 500mg daily phosphatidylcholine-curcumin complex supplement, orally for 24 weeks

    Dose will be1g daily of phosphatidylcholine-curcumin complex supplement, orally for 24 weeks

    Dose will be matching placebo capsules daily, orally for 24 weeks

    Outcomes

    Primary Outcome Measures

    Change in serum alanine aminotransferase (ALT) from baseline.
    ALT value in U/L

    Secondary Outcome Measures

    Relative change in ALT compared to baseline ALT
    ALT value in U/L
    Proportion of patients achieving normalization of ALT
    ALT value in U/L
    Change in serum aspartate aminotransferase (AST)
    AST value in U/L
    Change in serum gamma-glutamyl transpeptidase (GGT)
    GGT value in U/L
    Change in ALT at 12 weeks compared to baseline ALT
    ALT value in U/L
    Change in Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) compared to baseline
    is an equation which indicates the degree of insulin resistance, where higher scores equate to greater insulin resistance. HOMA-IR is calculated as fasting (Glucose (mmol/L) x insulin (pmol/L))/22.5. A HOMA-IR value >2.0 in prepubertal children and >2.6 in pubertal children, may be considered a warning sign for pediatricians to further investigate insulin resistance
    Change in Weight
    kilograms (kg)
    Change in Waist circumference
    centimeters (cm)
    Change in Waist to Hip ratio
    ratio of the circumference of the waist to that of the hips. This is calculated as waist measurement divided by hip measurement (W ÷ H).
    Change in Body-mass Index Z- Score
    Body mass index z-scores is calculated using age, gender, height and weight and calculated using 2000 CDC Growth Charts for norms.
    Change in serum lipids compared to baseline
    lipid profiles
    Change in High Sensitivity C-Reactive Protein (hsCRP) compared to baseline
    serum marker of inflammation (mg/L)
    Change in Pediatric Quality of Life Inventory (PedsQL) Score scores compared to baseline
    Pediatric Quality of Life Inventory (PedsQL) version 4.0 is completed by both the child and parent/caregiver, and is composed of 23 items comprising 4 dimensions: Physical Functioning, Emotional Functioning, Social Functioning, and School Functioning. Scores are transformed on a scale from 0 to 100, with higher scores indicating better health-related quality of life. Physical Health Summary Score =Physical Functioning Scale Score. Psychosocial Health Summary Score = Sum of items over the number of items answered in the Emotional, Social, and School Functioning Scales.
    Change in Intrahepatic fat content and liver stiffness
    Hepatic fat content and liver stiffness will be measured by CAP and VCTE (Fibroscan®)
    Change in frequency of adverse events compared to baseline
    Numbers of adverse events reported

    Full Information

    First Posted
    September 23, 2019
    Last Updated
    September 21, 2021
    Sponsor
    Columbia University
    Collaborators
    Thorne HealthTech, Inc
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04109742
    Brief Title
    Curcumin for Pediatric Nonalcoholic Fatty Liver Disease
    Official Title
    Curcumin for Pediatric Nonalcoholic Fatty Liver Disease: A Pilot Randomized Controlled Trial
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    September 2021
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    Lack of funding
    Study Start Date
    December 9, 2019 (Actual)
    Primary Completion Date
    April 22, 2020 (Actual)
    Study Completion Date
    April 22, 2020 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Columbia University
    Collaborators
    Thorne HealthTech, Inc

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    Yes
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This is a single-center, randomized, double-blinded, placebo-controlled, parallel treatment groups phase 2a study of curcumin for pediatric nonalcoholic fatty liver disease (NAFLD).
    Detailed Description
    30 subjects ages 8-17y, with biopsy-proven NASH/NAFLD (≤ 730 days prior to registration and a NAFLD Activity Score (NAS) of ≥3) and serum ALT at screening ≥ 50 IU/L at enrollment. Eligible participants will receive curcumin 500 mg, 1.0 g or placebo for 24 weeks, randomized 1:1:1. The primary outcome of the study will determine whether 24 weeks of curcumin supplementation compared to matching placebo improves measures of nonalcoholic fatty liver disease (NAFLD) as determined by relative improvement in serum ALT from baseline. The hypothesis is that curcumin will significantly decrease ALT relative to placebo in children with NAFLD.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    NAFLD - Nonalcoholic Fatty Liver Disease, NASH - Nonalcoholic Steatohepatitis
    Keywords
    Pediatric, NAFLD - nonalcoholic fatty liver disease, Curcumin, Fatty liver

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Model Description
    The comparison of two different doses (500mg/qd and 1g/qd) of a phosphatidylcholine-curcumin complex supplement, to matching placebo
    Masking
    ParticipantCare ProviderInvestigator
    Masking Description
    Participants, investigators, clinical staff, and data monitoring committee will not have knowledge of the interventions assigned to individual participants.
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Curcumin 500mg capsules
    Arm Type
    Active Comparator
    Arm Description
    Dose will be 500mg daily phosphatidylcholine-curcumin complex supplement, orally for 24 weeks
    Arm Title
    Curcumin 1000mg capsules
    Arm Type
    Active Comparator
    Arm Description
    Dose will be1g daily of phosphatidylcholine-curcumin complex supplement, orally for 24 weeks
    Arm Title
    Placebo curcumin capsules
    Arm Type
    Placebo Comparator
    Arm Description
    Dose will be matching placebo capsules daily, orally for 24 weeks
    Intervention Type
    Drug
    Intervention Name(s)
    phosphatidylcholine-curcumin complex supplement
    Other Intervention Name(s)
    Meriva®
    Intervention Description
    a dietary curcumin supplement given at two different doses
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo curcumin capsule
    Intervention Description
    matching placebo to active curcumin capsules
    Primary Outcome Measure Information:
    Title
    Change in serum alanine aminotransferase (ALT) from baseline.
    Description
    ALT value in U/L
    Time Frame
    24 weeks
    Secondary Outcome Measure Information:
    Title
    Relative change in ALT compared to baseline ALT
    Description
    ALT value in U/L
    Time Frame
    24 weeks
    Title
    Proportion of patients achieving normalization of ALT
    Description
    ALT value in U/L
    Time Frame
    24 weeks
    Title
    Change in serum aspartate aminotransferase (AST)
    Description
    AST value in U/L
    Time Frame
    24 weeks
    Title
    Change in serum gamma-glutamyl transpeptidase (GGT)
    Description
    GGT value in U/L
    Time Frame
    24 weeks
    Title
    Change in ALT at 12 weeks compared to baseline ALT
    Description
    ALT value in U/L
    Time Frame
    12 weeks
    Title
    Change in Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) compared to baseline
    Description
    is an equation which indicates the degree of insulin resistance, where higher scores equate to greater insulin resistance. HOMA-IR is calculated as fasting (Glucose (mmol/L) x insulin (pmol/L))/22.5. A HOMA-IR value >2.0 in prepubertal children and >2.6 in pubertal children, may be considered a warning sign for pediatricians to further investigate insulin resistance
    Time Frame
    24 weeks
    Title
    Change in Weight
    Description
    kilograms (kg)
    Time Frame
    24 weeks
    Title
    Change in Waist circumference
    Description
    centimeters (cm)
    Time Frame
    24 weeks
    Title
    Change in Waist to Hip ratio
    Description
    ratio of the circumference of the waist to that of the hips. This is calculated as waist measurement divided by hip measurement (W ÷ H).
    Time Frame
    24 weeks
    Title
    Change in Body-mass Index Z- Score
    Description
    Body mass index z-scores is calculated using age, gender, height and weight and calculated using 2000 CDC Growth Charts for norms.
    Time Frame
    24 weeks
    Title
    Change in serum lipids compared to baseline
    Description
    lipid profiles
    Time Frame
    24 weeks
    Title
    Change in High Sensitivity C-Reactive Protein (hsCRP) compared to baseline
    Description
    serum marker of inflammation (mg/L)
    Time Frame
    24 weeks
    Title
    Change in Pediatric Quality of Life Inventory (PedsQL) Score scores compared to baseline
    Description
    Pediatric Quality of Life Inventory (PedsQL) version 4.0 is completed by both the child and parent/caregiver, and is composed of 23 items comprising 4 dimensions: Physical Functioning, Emotional Functioning, Social Functioning, and School Functioning. Scores are transformed on a scale from 0 to 100, with higher scores indicating better health-related quality of life. Physical Health Summary Score =Physical Functioning Scale Score. Psychosocial Health Summary Score = Sum of items over the number of items answered in the Emotional, Social, and School Functioning Scales.
    Time Frame
    24 weeks
    Title
    Change in Intrahepatic fat content and liver stiffness
    Description
    Hepatic fat content and liver stiffness will be measured by CAP and VCTE (Fibroscan®)
    Time Frame
    24 weeks
    Title
    Change in frequency of adverse events compared to baseline
    Description
    Numbers of adverse events reported
    Time Frame
    24 weeks
    Other Pre-specified Outcome Measures:
    Title
    Plasma concentrations of curcumin and active metabolites from baseline to 24 weeks.
    Description
    Pharmacokinetic analysis
    Time Frame
    Day 0 pre-dose and 1, 2, 4, 6, 8 hours post-dose; Day 14; Day 28; Day 84 and Day 168
    Title
    Change in interleukin 6 (IL-6)
    Description
    cytokine protein involved in the pro-inflammatory and anti-inflammatory response
    Time Frame
    24 weeks
    Title
    Change in interleukin 8 (IL-8)
    Description
    cytokine protein involved in the pro-inflammatory and anti-inflammatory response
    Time Frame
    24 weeks
    Title
    Change in (TNF-a) Tumor Necrosis Factor alpha
    Description
    cytokine protein involved in the pro-inflammatory and anti-inflammatory response
    Time Frame
    24 weeks
    Title
    Change in Plasminogen Activator Inhibitor (PAI-1)
    Description
    cytokine protein involved in the pro-inflammatory and anti-inflammatory response
    Time Frame
    24 weeks
    Title
    Change in adiponectin
    Description
    cytokine protein involved in the pro-inflammatory and anti-inflammatory response
    Time Frame
    24 weeks

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    8 Years
    Maximum Age & Unit of Time
    17 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Age 8-17 years at initial screening interview Histological evidence of NAFLD with or without fibrosis and a NAFLD activity score (NAS) of ≥3, on a liver biopsy obtained no more than 730 days prior to enrollment Serum ALT at screening ≥ 50 IU/L Exclusion Criteria: Significant alcohol consumption or inability to reliably quantify alcohol intake Use of drugs historically associated with NAFLD (amiodarone, methotrexate, systemic glucocorticoids, tetracyclines, tamoxifen, estrogens at doses greater than those used for hormone replacement, anabolic steroids, valproic acid, other known hepatotoxins) for more than 2 consecutive weeks in the past year prior to randomization New treatment with vitamin E or metformin started in the past 90 days or plans to alter the dose or stop over the next the 24 weeks. A stable dose is acceptable. Prior or planned bariatric surgery Uncontrolled diabetes (HbA1c 9.5% or higher within 30 days prior to enrollment) Presence of cirrhosis on liver biopsy Stage 2 Hypertension or >140 systolic or >90 diastolic at screening Current daily use of nonsteroidal anti-inflammatory drugs (NSAIDs) Platelet counts below 100,000 /mm3 Clinical evidence of hepatic decompensation (serum albumin < 3.2 g/dL, international normalized ratio (INR) >1.3, direct bilirubin >1.3 mg/dL, history of esophageal varices, ascites, or hepatic encephalopathy) Evidence of chronic liver disease other than NAFLD: Biopsy consistent with histological evidence of autoimmune hepatitis Serum hepatitis B surface antigen (HBsAg) positive. Serum hepatitis C antibody (anti-HCV) positive. Iron/total iron binding capacity (TIBC) ratio (transferrin saturation) > 45% with histological evidence of iron overload Alpha-1-antitrypsin (A1AT) phenotype/genotype ZZ or SZ Wilson's disease History of biliary diversion History of kidney disease and/or estimated glomerular filtration rate (eGFR) < than 60 mL/min/1.73 m2 using Schwartz Bedside GFR Calculator for Children isotope dilution mass spectroscopy (IDMS)-traceable Known Human Immunodeficiency Virus (HIV) infection Active, serious medical disease with life expectancy less than 5 years Active substance abuse including inhaled or injected drugs, in the year prior to screening Pregnancy, planned pregnancy, potential for pregnancy and unwillingness to use effective birth control during the trial, breast feeding Participation in any clinical/investigational trial within the prior 150 days and during the study. Any other condition which, in the opinion of the investigator, would impede compliance or hinder completion of the study Inability to swallow capsules Known allergy to curcumin or any of its components Failure of parent or legal guardian to give informed consent or subject to give informed assent
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Joel E Lavine, MD, PhD
    Organizational Affiliation
    Columbia University
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No

    Learn more about this trial

    Curcumin for Pediatric Nonalcoholic Fatty Liver Disease

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