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Effect of Obesity on Proton Pump Inhibitors (LiverLabPPI)

Primary Purpose

Pediatric Obesity, NAFLD, GERD

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Pantoprazole
Midazolam injection
Sponsored by
Children's Mercy Hospital Kansas City
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pediatric Obesity

Eligibility Criteria

6 Years - 21 Years (Child, Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • 6-21 years of age
  • Obese and non-obese individuals

    • BMI ≥10th percentile for age (6-20 years of age)
    • BMI ≥18.5 (>20 years of age)
  • Otherwise healthy; or otherwise healthy with diagnosis of GERD, NAFLD, chronic abdominal pain or obesity, according to report of medical history and/or review of the medical record
  • Receiving or not receiving pantoprazole or lansoprazole for routine medical care
  • MRI Hoop Test Clearance

Exclusion Criteria:

  • Unable or unwilling to give written permission/assent/consent
  • For PO Study Drug: Any anatomic abnormality of the GI tract as defined by history, PE, or radiographic findings, including Bariatric surgery, Nissen fundoplication or equivalent surgery.
  • For IV Study Drug: Any anatomic abnormality of the GI tract as defined by history, PE, or radiographic findings, except Bariatric surgery, Nissen fundoplication or equivalent surgery.
  • For subjects undergoing weight management, treatment in the last 7 days with proton pump inhibitors omeprazole, esomeprazole, dexlansoprazole, or grapefruit juice.
  • For subjects not undergoing weight management, treatment in the last 7 days with medications known to clinically significantly inhibit (e.g., omeprazole, esomeprazole, fluoxetine, fluvoxamine, ketoconazole, ticlopidine, felbamate, trazodone, valproic acid, topiramate) or induce (e.g., phenobarbital, carbamazepine, phenytoin) CYP2C19; and those known at therapeutic doses to significantly inhibit (e.g., erythromycin, clarithromycin, grapefruit juice, verapamil, diltiazem, cimetidine, ketoconazole) or induce (e.g., oxcarbazepine, carbamazepine, phenytoin, phenobarbital, St. John's Wort, rifampin, rifapentine) or CYP3A4 activity in the last 7 days.
  • Unable to have blood drawn for the screening lab tests
  • Unable or unwilling to fast overnight prior to the study session
  • Unable to have blood drawn for the screening lab tests
  • If taking lansoprazole or pantoprazole for clinical purposes, unable or unwilling to abstain from that PPI for 3 days prior to PK visit when the PPI is not the same as the study drug for that PK visit
  • Metal in the body or any foreign bodies that precludes MRI sequencing
  • Claustrophobia
  • Exceeds 500lbs or 227 kg in Body Weight
  • Demonstrated adverse reaction to previous pantoprazole or PPI exposure
  • Impaired hepatic activity as determined by routine liver function testing and defined as values ≥ 5 times the age-specific upper limit of normal (ULN) for AST, ALT, total bilirubin >2.0mg/dl, alkaline phosphatase ≥ 5 times the age-specific ULN
  • Impaired renal function defined as creatinine ≥ 3 times the age-specific ULN
  • Females of child-bearing age who are pregnant or breast-feeding
  • Any known infection with hepatitis B, C, or human immunodeficiency virus (HIV)

Sites / Locations

  • Children's Mercy Kansas CityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

In Weight Management Program

Not in Weight Management Program

Arm Description

Evaluate the effect of liver fat on pharmacology of PPI's, and if applicable midazolam

Evaluate the effect of liver fat on drug metabolism of PPI's, and if applicable midazolam

Outcomes

Primary Outcome Measures

plasma pharmacokinetics of pantoprazole
plasma maximum peak concentration (Cmax)
plasma pharmacokinetics of pantoprazole
area under the concentration time curve (AUC)
plasma pharmacokinetics of pantoprazole
time to maximum peak concentration (tmax)
plasma pharmacokinetics of pantoprazole
half-life (t 1/2)
plasma pharmacokinetics of pantoprazole
volume of distribution (Vd)
plasma pharmacokinetics of pantoprazole
clearance (CL)

Secondary Outcome Measures

pharmacodynamics
concentration of gastric acid using pH probe test
safety of pantoprazole: incidence of reported and gastrointestinal adverse events
incidence of reported and gastrointestinal adverse events
pharmacokinetics of midazolam, if medication received to ease discomfort of pH probe study
plasma concentrations of midazolam
urinary metabolites
urine concentrations of pantoprazole and midazolam and their metabolites

Full Information

First Posted
January 27, 2020
Last Updated
January 16, 2023
Sponsor
Children's Mercy Hospital Kansas City
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1. Study Identification

Unique Protocol Identification Number
NCT04248335
Brief Title
Effect of Obesity on Proton Pump Inhibitors
Acronym
LiverLabPPI
Official Title
Physiologic Determinants of PPI Disposition in Children
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 3, 2018 (Actual)
Primary Completion Date
December 31, 2024 (Anticipated)
Study Completion Date
December 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Children's Mercy Hospital Kansas City

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This longitudinal study tests the hypothesis that obesity affects drug pharmacology of acid suppression medications in children.
Detailed Description
The purpose of this research study is to see how the body breaks down certain medicines. Many medicines are broken down in the liver. The liver is an organ in the belly. A person's age, size, genetics (DNA), and the health of their liver decide how quickly the body breaks down medicines and how much medication a person needs to take. Everybody's liver has some fat in it, but the amount of fat is different from person to person. The purpose of this study is to see if the amount of fat in the liver affects how quickly acid suppression medications start and stop working and get removed from the body.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pediatric Obesity, NAFLD, GERD

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Factorial Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
150 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
In Weight Management Program
Arm Type
Experimental
Arm Description
Evaluate the effect of liver fat on pharmacology of PPI's, and if applicable midazolam
Arm Title
Not in Weight Management Program
Arm Type
Experimental
Arm Description
Evaluate the effect of liver fat on drug metabolism of PPI's, and if applicable midazolam
Intervention Type
Drug
Intervention Name(s)
Pantoprazole
Intervention Description
single-dose administration
Intervention Type
Drug
Intervention Name(s)
Midazolam injection
Intervention Description
single-dose administration
Primary Outcome Measure Information:
Title
plasma pharmacokinetics of pantoprazole
Description
plasma maximum peak concentration (Cmax)
Time Frame
5 years
Title
plasma pharmacokinetics of pantoprazole
Description
area under the concentration time curve (AUC)
Time Frame
5 years
Title
plasma pharmacokinetics of pantoprazole
Description
time to maximum peak concentration (tmax)
Time Frame
5 years
Title
plasma pharmacokinetics of pantoprazole
Description
half-life (t 1/2)
Time Frame
5 years
Title
plasma pharmacokinetics of pantoprazole
Description
volume of distribution (Vd)
Time Frame
5 years
Title
plasma pharmacokinetics of pantoprazole
Description
clearance (CL)
Time Frame
5 years
Secondary Outcome Measure Information:
Title
pharmacodynamics
Description
concentration of gastric acid using pH probe test
Time Frame
5 years
Title
safety of pantoprazole: incidence of reported and gastrointestinal adverse events
Description
incidence of reported and gastrointestinal adverse events
Time Frame
5 years
Title
pharmacokinetics of midazolam, if medication received to ease discomfort of pH probe study
Description
plasma concentrations of midazolam
Time Frame
5 years
Title
urinary metabolites
Description
urine concentrations of pantoprazole and midazolam and their metabolites
Time Frame
5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: 6-21 years of age Obese and non-obese individuals BMI ≥10th percentile for age (6-20 years of age) BMI ≥18.5 (>20 years of age) Otherwise healthy; or otherwise healthy with diagnosis of GERD, NAFLD, chronic abdominal pain or obesity, according to report of medical history and/or review of the medical record Receiving or not receiving pantoprazole or lansoprazole for routine medical care MRI Hoop Test Clearance Exclusion Criteria: Unable or unwilling to give written permission/assent/consent For PO Study Drug: Any anatomic abnormality of the GI tract as defined by history, PE, or radiographic findings, including Bariatric surgery, Nissen fundoplication or equivalent surgery. For IV Study Drug: Any anatomic abnormality of the GI tract as defined by history, PE, or radiographic findings, except Bariatric surgery, Nissen fundoplication or equivalent surgery. For subjects undergoing weight management, treatment in the last 7 days with proton pump inhibitors omeprazole, esomeprazole, dexlansoprazole, or grapefruit juice. For subjects not undergoing weight management, treatment in the last 7 days with medications known to clinically significantly inhibit (e.g., omeprazole, esomeprazole, fluoxetine, fluvoxamine, ketoconazole, ticlopidine, felbamate, trazodone, valproic acid, topiramate) or induce (e.g., phenobarbital, carbamazepine, phenytoin) CYP2C19; and those known at therapeutic doses to significantly inhibit (e.g., erythromycin, clarithromycin, grapefruit juice, verapamil, diltiazem, cimetidine, ketoconazole) or induce (e.g., oxcarbazepine, carbamazepine, phenytoin, phenobarbital, St. John's Wort, rifampin, rifapentine) or CYP3A4 activity in the last 7 days. Unable to have blood drawn for the screening lab tests Unable or unwilling to fast overnight prior to the study session Unable to have blood drawn for the screening lab tests If taking lansoprazole or pantoprazole for clinical purposes, unable or unwilling to abstain from that PPI for 3 days prior to PK visit when the PPI is not the same as the study drug for that PK visit Metal in the body or any foreign bodies that precludes MRI sequencing Claustrophobia Exceeds 500lbs or 227 kg in Body Weight Demonstrated adverse reaction to previous pantoprazole or PPI exposure Impaired hepatic activity as determined by routine liver function testing and defined as values ≥ 5 times the age-specific upper limit of normal (ULN) for AST, ALT, total bilirubin >2.0mg/dl, alkaline phosphatase ≥ 5 times the age-specific ULN Impaired renal function defined as creatinine ≥ 3 times the age-specific ULN Females of child-bearing age who are pregnant or breast-feeding Any known infection with hepatitis B, C, or human immunodeficiency virus (HIV)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Veronica Williams, RN, CCRC
Phone
8169836083
Email
vwilliams@cmh.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Jaylene D Weigel
Phone
8167011359
Email
jaydweigel@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Valentina Shakhnovich, MD
Organizational Affiliation
Children's Mercy Hospital Kansas City
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's Mercy Kansas City
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64108
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Veronica Williams
Phone
861-983-6083
Email
vwilliams@cmh.edu
First Name & Middle Initial & Last Name & Degree
Jaylene D Weigel
Phone
8167011359
Email
jweigel@cmh.edu

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Deidentified experimental data may be shared with institutional collaborators outside of CMH and if it is determined that biological samples obtained from study participants must be transferred to institutions outside of CMH for the purpose of confirmatory analyses, appropriate inter-institutional material transfer agreements will first be executed. As this is a pediatric study, minimal blood volumes are being collected and we do not anticipate that biological samples will be available to share with the outside community upon completion of the study, beyond those samples that may be required for confirmatory analyses.

Learn more about this trial

Effect of Obesity on Proton Pump Inhibitors

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