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Effects of an Antioxidant-Enriched Multivitamin Supplement on Inflammation and Oxidative Stress in Cystic Fibrosis (AquADEKs-2)

Primary Purpose

Cystic Fibrosis

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
AquADEKs-2
control multivitamin
Sponsored by
University of Colorado, Denver
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cystic Fibrosis focused on measuring Antioxidants, Vitamins, Inflammation, Oxidative stress

Eligibility Criteria

10 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female ≥10 years of age
  • Documentation of a Cystic Fibrosis (CF) diagnosis as evidenced by 1 or more clinical features consistent with the CF phenotype and 1 or more of the following criteria:

    • Sweat chloride equal to or greater than 60 milliequivalent (mEq/L) by quantitative pilocarpine iontophoresis test (QPIT)
    • 2 well-characterized mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene
  • Pancreatic insufficiency documented by having a spot fecal elastase-1 (FE-1) ≤ 100μg/g in a stool sample done either historically or at the screening visit
  • Clinically stable with no significant changes in health status within 2 weeks prior to randomization
  • Forced expiratory volume over one second (FEV1) ≥ 40 and ≤ 100% of predicted for age based on the Wang (males < 18 years,females < 16 years) or Hankinson (males ≥ 18 years, females ≥ 16 years) standardized equations at the screening visit
  • Weight ≥ 30 kg at the screening visit
  • Able to perform repeatable, consistent efforts in pulmonary function testing
  • Able to tolerate sputum induction with 3% hypertonic saline and to expectorate with induction
  • Written informed consent (and assent when applicable) obtained from subject or subject's legal representative
  • Ability to swallow softgel capsules

Exclusion Criteria:

  • Subjects being treated with ivacaftor (Kalydeco™)
  • Liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), or gamma-glutamyl transferase (GGT) > 3 times the upper limits of normal at the screening visit
  • Use of antibiotics (oral, iv, and/or inhaled) for acute respiratory symptoms within 2 weeks prior to randomization
  • Active treatment for allergic bronchopulmonary aspergillosis (ABPA)
  • Current use of oral corticosteroids in doses exceeding the equivalent of 10 mg prednisone/day or 20 mg prednisone every other day
  • Active treatment for nontuberculous mycobacterial (NTM) infection
  • Initiation of any new chronic therapy (e.g., ibuprofen, Pulmozyme®, hypertonic saline,azithromycin,Tobramycin Inhalation solution (TOBI®), Cayston® within 8 weeks prior to randomization
  • Unwilling to discontinue current oral vitamin and antioxidant supplementation (e.g.,AquADEKs®, another source of β-carotene, vitamin A, vitamin E or tocopherols,vitamins D or K, n-acetylcysteine, glutathione, CoQ10, other over-the-counter antioxidant) for the duration of the study
  • Use of vitamins (other than control vitamin) or antioxidants within 4 weeks prior to randomization
  • Daily use of > 2 cans of Boost or Pulmocare dietary supplement formulas
  • Known hypersensitivity to oral AquADEKs®
  • For women of child bearing potential:

    1. positive pregnancy test at Visit 1 or at Visit 2, or
    2. lactating or
    3. unwilling to practice a medically acceptable form of contraception (acceptable forms of contraception: abstinence, hormonal birth control, intrauterine device, or barrier method plus a spermicidal agent)
  • Subject unlikely to complete the study as determined by the Investigator
  • Any condition that the Investigator believes would interfere with the intent of this study or would make participation not in the best interest of the subject
  • Use of investigational therapies within 4 weeks prior to randomization
  • Current tobacco smoker
  • Current use of anticoagulant medications
  • Severe malnutrition based either on having a BMI less than the 5th percentile for subjects < 18 years of age or a body mass index (BMI) less than 18 kg/m2 for subjects > 18 years of age.
  • Subjects with poorly controlled CF-related diabetes on active insulin therapy, defined as having a Glycosylated Hemoglobin (HgbA1c) ≥ 7.5% at the most recent historic evaluation of HgbA1c

Sites / Locations

  • University Medical Center
  • Children's Hospital Colorado
  • The Nemours Children's Clinic
  • Children's Hospital of Michigan
  • University of Minnesota Children's Hospital
  • Women and Children's Hospital of Buffalo
  • Cincinnati Children's Hospital Medical Center
  • Rainbow Babies and Children's Hospital
  • Nationwide Children's Hospital
  • Penn State Milton S. Hershey Medical Center
  • Children's Hospital of Pittsburgh of UPMC
  • Vanderbilt University Medical Center
  • The University of Texas Southwestern Medical Center at Dallas
  • University of Wisconsin Hospital Center
  • Children's Hospital of Wisconsin

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

AquADEKs-2

Control multivitamin

Arm Description

Two control multivitamin softgel capsules will be taken orally on a once daily basis with pancreatic enzymes and a glass of milk or fat-containing meal for 4 weeks for the screening run in period. For those subjects randomized to the AquADEKs-2 arm, two AquADEKs-2 softgel capsules will be taken orally on a once daily basis with pancreatic enzymes and a glass of milk or fat-containing meal for 16 weeks.

Two control multivitamin softgel capsules will be taken orally on a once daily basis with pancreatic enzymes and a glass of milk or fat-containing meal for 4 weeks for the screening run in period for all participants and for 16 weeks for those randomized to this comparative therapy.

Outcomes

Primary Outcome Measures

Change in Sputum Myeloperoxidase (MPO) Level
The primary outcome is the difference in 16 week mean change in log10 sputum myeloperoxidase levels between the AquADEKs-2 arm and the Control Multivitamin arm.

Secondary Outcome Measures

Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs)
Incidence is defined as the number and percentage of participants with at least one event over the 18 week follow-up period.
Rate of Adverse Events (AEs) and Serious Adverse Events (SAEs)
Rate is defined as the number of events per participant follow-up week.
Change in Lung Function
Absolute Change in Forced Expiratory Volume over one second (FEV1) % predicted between Baseline and Week 16. Global Lung Initiative equations were used to calculate FEV1 %predicted.
Change in Growth Endpoints
Absolute change in Body Mass Index (BMI) (kg/m^2) between Baseline and Week 16.
Time to First Pulmonary Exacerbation
Median time to first pulmonary exacerbation (PEx) between baseline (Visit 2) and end of follow up (Week 18)
Number of Pulmonary Exacerbations
The total number of PEx between baseline (Visit 2) and end of follow up (Week 18).
Number of Participants With Pulmonary Exacerbations
Number (%) with at least one protocol-defined PEx between baseline (Visit 2) and end of follow up (Week 18).
Number of Participants Hospitalized
Number (%) of participants with at least one hospitalization between Baseline (Visit 2) and end of follow up (Week 18).

Full Information

First Posted
May 17, 2013
Last Updated
June 19, 2017
Sponsor
University of Colorado, Denver
Collaborators
Cystic Fibrosis Foundation, Yasoo Health
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1. Study Identification

Unique Protocol Identification Number
NCT01859390
Brief Title
Effects of an Antioxidant-Enriched Multivitamin Supplement on Inflammation and Oxidative Stress in Cystic Fibrosis
Acronym
AquADEKs-2
Official Title
A Multi-Center, Randomized, Controlled, Double-Blind Study of the Effects of an Antioxidant-Enriched Multivitamin Supplement on Inflammation and Oxidative Stress in Cystic Fibrosis Patients
Study Type
Interventional

2. Study Status

Record Verification Date
June 2017
Overall Recruitment Status
Completed
Study Start Date
June 2013 (undefined)
Primary Completion Date
April 2015 (Actual)
Study Completion Date
July 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Colorado, Denver
Collaborators
Cystic Fibrosis Foundation, Yasoo Health

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study will be to evaluate the effects of a modified formulation of AquADEKs (AquADEKs-2) on markers of inflammation, antioxidant levels and oxidative stress. Cystic Fibrosis (CF) is a disease that affects the organs in the body such as the lungs. Some of the damage to the lungs of CF patients may be caused by something called oxidant/antioxidant imbalance and oxidative stress. Oxidation in the body is kind of what happens to an apple when it turns brown after being cut. And, just as a squeeze of lemon juice stops the oxidation of an apple, antioxidants can stop the rusting (or damage) inside our bodies by unstable oxygen molecules called free radicals. Free radicals can help fight off bacteria and viruses but too many of them do damage instead. Our bodies need antioxidants to keep things in balance so we have the right amount of free radicals. Many CF patients also have trouble digesting food and absorbing nutrients like vitamins. Many of the vitamins we rely on are antioxidants, like vitamins A, D, E, K and beta-carotene. In some people with CF, even though they take multivitamins and pancreatic enzymes, they still have low amounts of antioxidants. The investigators are looking to see if taking more vitamins and antioxidants will help CF patients. AquADEKs-2 is an investigational new drug (a drug that has not received approval by the Food and Drug Administration [FDA]). This research study is being done with the AquADEKs-2 compared to a control multivitamin. The study drug, AquADEKs-2 contains standard amounts of fat-soluble vitamins (A, D, E, K) that are contained in typical CF multivitamin supplements plus several antioxidants including beta-carotene, mixed tocopherols (different forms of vitamin E), coenzyme Q10 (CoQ10), mixed carotenoids (lutein, lycopene and zeaxanthin), and the minerals zinc and selenium. The control multivitamin contains standard amounts of vitamins A, B, D, E, and K without additional antioxidant supplementation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cystic Fibrosis
Keywords
Antioxidants, Vitamins, Inflammation, Oxidative stress

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
73 (Actual)

8. Arms, Groups, and Interventions

Arm Title
AquADEKs-2
Arm Type
Experimental
Arm Description
Two control multivitamin softgel capsules will be taken orally on a once daily basis with pancreatic enzymes and a glass of milk or fat-containing meal for 4 weeks for the screening run in period. For those subjects randomized to the AquADEKs-2 arm, two AquADEKs-2 softgel capsules will be taken orally on a once daily basis with pancreatic enzymes and a glass of milk or fat-containing meal for 16 weeks.
Arm Title
Control multivitamin
Arm Type
Active Comparator
Arm Description
Two control multivitamin softgel capsules will be taken orally on a once daily basis with pancreatic enzymes and a glass of milk or fat-containing meal for 4 weeks for the screening run in period for all participants and for 16 weeks for those randomized to this comparative therapy.
Intervention Type
Drug
Intervention Name(s)
AquADEKs-2
Other Intervention Name(s)
Antioxidant-enriched multivitamin supplement
Intervention Description
AquADEKs-2 contains standard amounts of fat-soluble vitamins (A, D, E, K) that are contained in typical CF multivitamin supplements plus several antioxidants including beta-carotene, mixed tocopherols (different forms of vitamin E), coenzyme Q10 (CoQ10), mixed carotenoids (lutein, lycopene and zeaxanthin), and the minerals zinc and selenium.
Intervention Type
Dietary Supplement
Intervention Name(s)
control multivitamin
Intervention Description
The control multivitamin contains standard (standard for CF multivitamin supplements) amounts of vitamins A, B, D, E, and K without added antioxidants.
Primary Outcome Measure Information:
Title
Change in Sputum Myeloperoxidase (MPO) Level
Description
The primary outcome is the difference in 16 week mean change in log10 sputum myeloperoxidase levels between the AquADEKs-2 arm and the Control Multivitamin arm.
Time Frame
Baseline (Visit 2) to Week 16 (Visit 4)
Secondary Outcome Measure Information:
Title
Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs)
Description
Incidence is defined as the number and percentage of participants with at least one event over the 18 week follow-up period.
Time Frame
18 weeks follow up
Title
Rate of Adverse Events (AEs) and Serious Adverse Events (SAEs)
Description
Rate is defined as the number of events per participant follow-up week.
Time Frame
18 weeks follow up
Title
Change in Lung Function
Description
Absolute Change in Forced Expiratory Volume over one second (FEV1) % predicted between Baseline and Week 16. Global Lung Initiative equations were used to calculate FEV1 %predicted.
Time Frame
Baseline (Visit 2) to Week 16
Title
Change in Growth Endpoints
Description
Absolute change in Body Mass Index (BMI) (kg/m^2) between Baseline and Week 16.
Time Frame
Baseline (Visit 2) to Week 16
Title
Time to First Pulmonary Exacerbation
Description
Median time to first pulmonary exacerbation (PEx) between baseline (Visit 2) and end of follow up (Week 18)
Time Frame
Baseline (Visit 2) to end of follow up (Week 18)
Title
Number of Pulmonary Exacerbations
Description
The total number of PEx between baseline (Visit 2) and end of follow up (Week 18).
Time Frame
Baseline (Visit 2) to end of follow up (Week 18)
Title
Number of Participants With Pulmonary Exacerbations
Description
Number (%) with at least one protocol-defined PEx between baseline (Visit 2) and end of follow up (Week 18).
Time Frame
Baseline (Visit 2) to end of follow up (Week 18)
Title
Number of Participants Hospitalized
Description
Number (%) of participants with at least one hospitalization between Baseline (Visit 2) and end of follow up (Week 18).
Time Frame
Baseline (Visit 2) to end of followup (Week 18)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
10 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female ≥10 years of age Documentation of a Cystic Fibrosis (CF) diagnosis as evidenced by 1 or more clinical features consistent with the CF phenotype and 1 or more of the following criteria: Sweat chloride equal to or greater than 60 milliequivalent (mEq/L) by quantitative pilocarpine iontophoresis test (QPIT) 2 well-characterized mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene Pancreatic insufficiency documented by having a spot fecal elastase-1 (FE-1) ≤ 100μg/g in a stool sample done either historically or at the screening visit Clinically stable with no significant changes in health status within 2 weeks prior to randomization Forced expiratory volume over one second (FEV1) ≥ 40 and ≤ 100% of predicted for age based on the Wang (males < 18 years,females < 16 years) or Hankinson (males ≥ 18 years, females ≥ 16 years) standardized equations at the screening visit Weight ≥ 30 kg at the screening visit Able to perform repeatable, consistent efforts in pulmonary function testing Able to tolerate sputum induction with 3% hypertonic saline and to expectorate with induction Written informed consent (and assent when applicable) obtained from subject or subject's legal representative Ability to swallow softgel capsules Exclusion Criteria: Subjects being treated with ivacaftor (Kalydeco™) Liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), or gamma-glutamyl transferase (GGT) > 3 times the upper limits of normal at the screening visit Use of antibiotics (oral, iv, and/or inhaled) for acute respiratory symptoms within 2 weeks prior to randomization Active treatment for allergic bronchopulmonary aspergillosis (ABPA) Current use of oral corticosteroids in doses exceeding the equivalent of 10 mg prednisone/day or 20 mg prednisone every other day Active treatment for nontuberculous mycobacterial (NTM) infection Initiation of any new chronic therapy (e.g., ibuprofen, Pulmozyme®, hypertonic saline,azithromycin,Tobramycin Inhalation solution (TOBI®), Cayston® within 8 weeks prior to randomization Unwilling to discontinue current oral vitamin and antioxidant supplementation (e.g.,AquADEKs®, another source of β-carotene, vitamin A, vitamin E or tocopherols,vitamins D or K, n-acetylcysteine, glutathione, CoQ10, other over-the-counter antioxidant) for the duration of the study Use of vitamins (other than control vitamin) or antioxidants within 4 weeks prior to randomization Daily use of > 2 cans of Boost or Pulmocare dietary supplement formulas Known hypersensitivity to oral AquADEKs® For women of child bearing potential: positive pregnancy test at Visit 1 or at Visit 2, or lactating or unwilling to practice a medically acceptable form of contraception (acceptable forms of contraception: abstinence, hormonal birth control, intrauterine device, or barrier method plus a spermicidal agent) Subject unlikely to complete the study as determined by the Investigator Any condition that the Investigator believes would interfere with the intent of this study or would make participation not in the best interest of the subject Use of investigational therapies within 4 weeks prior to randomization Current tobacco smoker Current use of anticoagulant medications Severe malnutrition based either on having a BMI less than the 5th percentile for subjects < 18 years of age or a body mass index (BMI) less than 18 kg/m2 for subjects > 18 years of age. Subjects with poorly controlled CF-related diabetes on active insulin therapy, defined as having a Glycosylated Hemoglobin (HgbA1c) ≥ 7.5% at the most recent historic evaluation of HgbA1c
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Scott Sagel, MD, PhD
Organizational Affiliation
University of Colorado, Denver
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Medical Center
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85724
Country
United States
Facility Name
Children's Hospital Colorado
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
The Nemours Children's Clinic
City
Orlando
State/Province
Florida
ZIP/Postal Code
32806
Country
United States
Facility Name
Children's Hospital of Michigan
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
University of Minnesota Children's Hospital
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States
Facility Name
Women and Children's Hospital of Buffalo
City
Buffalo
State/Province
New York
ZIP/Postal Code
14222
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Facility Name
Rainbow Babies and Children's Hospital
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106
Country
United States
Facility Name
Nationwide Children's Hospital
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43205
Country
United States
Facility Name
Penn State Milton S. Hershey Medical Center
City
Hershey
State/Province
Pennsylvania
ZIP/Postal Code
17033
Country
United States
Facility Name
Children's Hospital of Pittsburgh of UPMC
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15224
Country
United States
Facility Name
Vanderbilt University Medical Center
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232-5735
Country
United States
Facility Name
The University of Texas Southwestern Medical Center at Dallas
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States
Facility Name
University of Wisconsin Hospital Center
City
Madison
State/Province
Wisconsin
ZIP/Postal Code
53792
Country
United States
Facility Name
Children's Hospital of Wisconsin
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53226
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
20961818
Citation
Sagel SD, Sontag MK, Anthony MM, Emmett P, Papas KA. Effect of an antioxidant-rich multivitamin supplement in cystic fibrosis. J Cyst Fibros. 2011 Jan;10(1):31-6. doi: 10.1016/j.jcf.2010.09.005. Epub 2010 Oct 20.
Results Reference
background
PubMed Identifier
17569601
Citation
Papas KA, Sontag MK, Pardee C, Sokol RJ, Sagel SD, Accurso FJ, Wagener JS. A pilot study on the safety and efficacy of a novel antioxidant rich formulation in patients with cystic fibrosis. J Cyst Fibros. 2008 Jan;7(1):60-7. doi: 10.1016/j.jcf.2007.05.001. Epub 2007 Jun 13.
Results Reference
background
PubMed Identifier
32622665
Citation
Jain R, Baines A, Khan U, Wagner BD, Sagel SD. Evaluation of airway and circulating inflammatory biomarkers for cystic fibrosis drug development. J Cyst Fibros. 2021 Jan;20(1):50-56. doi: 10.1016/j.jcf.2020.06.017. Epub 2020 Jul 1.
Results Reference
derived
PubMed Identifier
29688760
Citation
Sagel SD, Khan U, Jain R, Graff G, Daines CL, Dunitz JM, Borowitz D, Orenstein DM, Abdulhamid I, Noe J, Clancy JP, Slovis B, Rock MJ, McCoy KS, Strausbaugh S, Livingston FR, Papas KA, Shaffer ML. Effects of an Antioxidant-enriched Multivitamin in Cystic Fibrosis. A Randomized, Controlled, Multicenter Clinical Trial. Am J Respir Crit Care Med. 2018 Sep 1;198(5):639-647. doi: 10.1164/rccm.201801-0105OC.
Results Reference
derived

Learn more about this trial

Effects of an Antioxidant-Enriched Multivitamin Supplement on Inflammation and Oxidative Stress in Cystic Fibrosis

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