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Withdrawn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
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
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
NCT ID
NCT04109742
First Posted
September 23, 2019
Last Updated
September 21, 2021
Sponsor
Columbia University
Collaborators
Thorne HealthTech, Inc
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
We'll reach out to this number within 24 hrs