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Use of Tirosint®-SOL or Tablet Formulations of Levothyroxine in Pediatric Patients With Congenital Hypothyroidism (CH)

Primary Purpose

Congenital Hypothyroidism

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Tirosint®-SOL
Levothyroxine Sodium
Sponsored by
IBSA Institut Biochimique SA
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Congenital Hypothyroidism

Eligibility Criteria

1 Day - 9 Months (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male and female patient aged 0 to 9 months
  • Primary CH diagnosis with elevated TSH and low T4, requiring treatment with LT4, under either of the following conditions:

    • Neonates newly diagnosed with primary CH and needing to initiate LT4 therapy, or
    • Infants previously diagnosed with primary CH and who are already on LT4 therapy for at least 4 weeks;
  • Provide and comply with the informed consent.

Exclusion Criteria:

  • Preterm neonates with a gestational age < 37 weeks;
  • Low birth weight and very low birth weight neonates (weight < 2.5 kg);
  • Neonates in neonatal intensive care units or requiring admission to NICU or neonates/infants hospitalized or requiring hospitalization;
  • CH diagnosis > 4 weeks after delivery (for newly diagnosed neonates only);
  • Diagnosis of primary gastrointestinal disease:

    • Gastroesophageal reflux requiring medical therapy (beyond thickening of formula or position);
    • Anatomic defects (e.g. intestinal atresia, malrotation, tracheoesophageal fistula, pyloric stenosis, Hirschsprung's disease, gastroschisis);
    • Dietary allergy (e.g. cow's milk protein allergy);
    • Malabsorption related to cystic fibrosis, celiac disease and others;
    • Necrotizing enterocolitis requiring surgical resection;
  • Known or suspected adrenal insufficiency (e.g. congenital adrenal hyperplasia, hypopituitarism);
  • Diagnosis of congenital cardiac disease, cardiac insufficiency or risk for cardiac failure;
  • Diagnosis of chromosomopathy;
  • Diagnosis of central hypothyroidism;
  • Hypersensitivity to glycerol;
  • Concomitant anticonvulsant medications, liothyronine, combination of LT4 and liothyronine, thyroid extracts and/or chronic or long-term use of systemic glucocorticoids
  • History of nonadherence with medication or medical visit schedule; or
  • Any condition for which, participation would not be in the best interest of the patient or that could limit protocol specified assessments.

Sites / Locations

  • Children's Hospital of Los AngelesRecruiting
  • CHOC Children's HospitalRecruiting
  • University of California San FranciscoRecruiting
  • Yale UniversityRecruiting
  • Children's Hospital of Atlanta
  • Ann & Robert H. Lurie Children's Hospital of ChicagoRecruiting
  • Boston Children's HospitalRecruiting
  • Children's Mercy Hospital and ClinicsRecruiting
  • Icahn School of Medicine at Mount SinaiRecruiting
  • Children's Hospital Medical CenterRecruiting
  • Children's Hospital of PhiladelphiaRecruiting
  • Cook Children's Health Care SystemsRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Treatment

Control

Arm Description

Tirosint®-SOL (levothyroxine sodium) oral solution (IBSA Pharma Inc.) at the following strengths: 25, 37.5, 44, 50, 62.5, 75, 88, 100 mcg.

Crushed levothyroxine sodium tablets

Outcomes

Primary Outcome Measures

LT4 dose required to maintain TSH in target range (unit: mcg/kg/day)
The LT4 dose is calculated based on the daily LT4 dose (mcg) used in the time period preceding the visit (or the average daily dose on a weekly basis if more than one strength is used over the course of the week) and the body weight (kg) measured during the visit.
Hormonal (TFTs) profile for TSH
TSH (unit mU/L)
Hormonal (TFTs) profile for FT4
FT4 (unit ng/dL)
Hormonal (TFTs) profile for TT4
TT4 (unit µg/dL)
Parent/caregiver reports of satisfaction and ease of administration preferences
Parents Satisfaction Questionnaire is a study-specific tool measuring coping and mental well-being and satisfactions. Score: 1-Strongly disagree, 2-Disagree, 3-Neutral, 4-Agree, 5-Strongly agree. The minimum score of 1 is worse outcome and maximum score of 5 is best outcome.
Subject acceptance of the treatment (CareCAT)
Caregiver Administered Children's Acceptance Tool (CareCAT) is a 5-point nominal scale used to assess the acceptance of oral medicines in infants and toddlers who are unable to verbally give their opinion about a medicine (Blume 2018). Scale: 1-Swallows well, 2-Refusal, 3-Spitting Up, 4-Vomiting, 5-Medication not taken. The minimum score of 1 is best outcome and maximum score of 5 is worse outcome.

Secondary Outcome Measures

Frequency of dose adjustments
Percent number of subjects (%) who need a dose adjustment in the long-term follow up phase
Growth patterns for length of body
Subject growth measurements in Length (cm) of body
Growth patterns for body weight
Subject growth measurements in Body weight (kg)
Growth patterns for head circumference
Subject growth measurements in Head circumference (cm)

Full Information

First Posted
December 21, 2021
Last Updated
July 27, 2023
Sponsor
IBSA Institut Biochimique SA
Collaborators
Cromsource
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1. Study Identification

Unique Protocol Identification Number
NCT05228184
Brief Title
Use of Tirosint®-SOL or Tablet Formulations of Levothyroxine in Pediatric Patients With Congenital Hypothyroidism (CH)
Official Title
A Randomized Comparative Study Between Liquid (Tirosint®-SOL) and Tablet Formulations of Levothyroxine in Neonates and Infants With Congenital Hypothyroidism
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 21, 2022 (Actual)
Primary Completion Date
December 2, 2024 (Anticipated)
Study Completion Date
September 12, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
IBSA Institut Biochimique SA
Collaborators
Cromsource

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

5. Study Description

Brief Summary
This is a multi-center, prospective, parallel-group, open-label, randomized clinical study in one hundred and twenty-six (126) neonates and infants diagnosed with CH. Subjects will be randomized in a 2:1 ratio to Treatment (Tirosint®-SOL) or Control (conventional therapy with levothyroxine sodium crushed tablets).
Detailed Description
Newly diagnosed neonates will be randomly assigned to start therapy with LT4 at the initial dose recommended by the Standard of Care (SOC). Infants already on LT4 therapy will continue at the same daily dose within the randomly assigned treatment group (dose adjustments are allowed, if needed based on laboratory parameters and clinical response). Once enrolled, subjects will be treated and followed for 12 months (±1.5 months), participating in 7-8 study visits, consisting of 6-7 inclinic and 1-2 (or more if follow-up visits are required) telemedicine (TM) visits. The total number of visits depends on the age at inclusion.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Congenital Hypothyroidism

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
126 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment
Arm Type
Experimental
Arm Description
Tirosint®-SOL (levothyroxine sodium) oral solution (IBSA Pharma Inc.) at the following strengths: 25, 37.5, 44, 50, 62.5, 75, 88, 100 mcg.
Arm Title
Control
Arm Type
Active Comparator
Arm Description
Crushed levothyroxine sodium tablets
Intervention Type
Drug
Intervention Name(s)
Tirosint®-SOL
Other Intervention Name(s)
levothyroxine sodium oral solution (liquid)
Intervention Description
Dosage will be according to the USPI and Standard of Care.
Intervention Type
Drug
Intervention Name(s)
Levothyroxine Sodium
Other Intervention Name(s)
levothyroxine sodium tablets
Intervention Description
Tablets will be crushed and dissolved in solution. Dosage will be according to the USPI and Standard of Care.
Primary Outcome Measure Information:
Title
LT4 dose required to maintain TSH in target range (unit: mcg/kg/day)
Description
The LT4 dose is calculated based on the daily LT4 dose (mcg) used in the time period preceding the visit (or the average daily dose on a weekly basis if more than one strength is used over the course of the week) and the body weight (kg) measured during the visit.
Time Frame
Up to 22 months based on age group
Title
Hormonal (TFTs) profile for TSH
Description
TSH (unit mU/L)
Time Frame
Up to 22 months based on age group
Title
Hormonal (TFTs) profile for FT4
Description
FT4 (unit ng/dL)
Time Frame
Up to 22 months based on age group
Title
Hormonal (TFTs) profile for TT4
Description
TT4 (unit µg/dL)
Time Frame
Up to 22 months based on age group
Title
Parent/caregiver reports of satisfaction and ease of administration preferences
Description
Parents Satisfaction Questionnaire is a study-specific tool measuring coping and mental well-being and satisfactions. Score: 1-Strongly disagree, 2-Disagree, 3-Neutral, 4-Agree, 5-Strongly agree. The minimum score of 1 is worse outcome and maximum score of 5 is best outcome.
Time Frame
Up to 22 months based on age group
Title
Subject acceptance of the treatment (CareCAT)
Description
Caregiver Administered Children's Acceptance Tool (CareCAT) is a 5-point nominal scale used to assess the acceptance of oral medicines in infants and toddlers who are unable to verbally give their opinion about a medicine (Blume 2018). Scale: 1-Swallows well, 2-Refusal, 3-Spitting Up, 4-Vomiting, 5-Medication not taken. The minimum score of 1 is best outcome and maximum score of 5 is worse outcome.
Time Frame
Up to 22 months based on age group
Secondary Outcome Measure Information:
Title
Frequency of dose adjustments
Description
Percent number of subjects (%) who need a dose adjustment in the long-term follow up phase
Time Frame
Up to 22 months based on age group
Title
Growth patterns for length of body
Description
Subject growth measurements in Length (cm) of body
Time Frame
Up to 22 months based on age group
Title
Growth patterns for body weight
Description
Subject growth measurements in Body weight (kg)
Time Frame
Up to 22 months based on age group
Title
Growth patterns for head circumference
Description
Subject growth measurements in Head circumference (cm)
Time Frame
Up to 22 months based on age group
Other Pre-specified Outcome Measures:
Title
Time to normalize TSH in neonates
Description
Time to normalize TSH into reference range (unit: days)
Time Frame
Up to 28 days
Title
Time to normalize FT4 in neonates
Description
Time to normalize FT4 into the upper half of the laboratory normal FT4 range (unit: days)
Time Frame
Up to 28 days
Title
Signs and symptoms of hypothyroidism
Description
Total number of subject experiencing hypothyroidism's signs and symptoms (N=126)
Time Frame
Up to 22 months and through 30 days post-discontinuation or until AE resolution or stabilization
Title
Signs and symptoms of hyperthyroidism
Description
Total number of subject experiencing hyperthyroidism's signs and symptoms (N=126)
Time Frame
Up to 22 months and through 30 days post-discontinuation or until AE resolution or stabilization
Title
Adverse events
Description
Assessing the total number of adverse event incidence between the study drug and the control treatment (N=126)
Time Frame
Up to 22 months and through 30 days post-discontinuation or until AE resolution or stabilization

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Day
Maximum Age & Unit of Time
9 Months
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female patient aged 0 to 9 months Primary CH diagnosis with elevated TSH and low T4, requiring treatment with LT4, under either of the following conditions: Neonates newly diagnosed with primary CH and needing to initiate LT4 therapy, or Infants previously diagnosed with primary CH and who are already on LT4 therapy for at least 4 weeks; Provide and comply with the informed consent. Exclusion Criteria: Preterm neonates with a gestational age < 37 weeks; Low birth weight and very low birth weight neonates (weight < 2.5 kg); Neonates in neonatal intensive care units or requiring admission to NICU or neonates/infants hospitalized or requiring hospitalization; CH diagnosis > 4 weeks after delivery (for newly diagnosed neonates only); Diagnosis of primary gastrointestinal disease: Gastroesophageal reflux requiring medical therapy (beyond thickening of formula or position); Anatomic defects (e.g. intestinal atresia, malrotation, tracheoesophageal fistula, pyloric stenosis, Hirschsprung's disease, gastroschisis); Dietary allergy (e.g. cow's milk protein allergy); Malabsorption related to cystic fibrosis, celiac disease and others; Necrotizing enterocolitis requiring surgical resection; Known or suspected adrenal insufficiency (e.g. congenital adrenal hyperplasia, hypopituitarism); Diagnosis of congenital cardiac disease, cardiac insufficiency or risk for cardiac failure; Diagnosis of chromosomopathy; Diagnosis of central hypothyroidism; Hypersensitivity to glycerol; Concomitant anticonvulsant medications, liothyronine, combination of LT4 and liothyronine, thyroid extracts and/or chronic or long-term use of systemic glucocorticoids History of nonadherence with medication or medical visit schedule; or Any condition for which, participation would not be in the best interest of the patient or that could limit protocol specified assessments.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Claudia Scarsi Perler
Phone
+41583601635
Email
claudia.scarsi@ibsa.ch
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Giuseppe Mautone
Organizational Affiliation
IBSA Head of R&D Scientific Affairs
Official's Role
Study Director
Facility Information:
Facility Name
Children's Hospital of Los Angeles
City
Los Angeles
State/Province
California
ZIP/Postal Code
90027
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Juliana Austin, MD
Facility Name
CHOC Children's Hospital
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amrit Bhangoo, MD
Facility Name
University of California San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Maya Lodish, MD
Facility Name
Yale University
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06511
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Catherine Dinauer, MD
Facility Name
Children's Hospital of Atlanta
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30329
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kristina Cossen, MD
Facility Name
Ann & Robert H. Lurie Children's Hospital of Chicago
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Laura Torchen, MD
Facility Name
Boston Children's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jessica Smith, MD
Facility Name
Children's Mercy Hospital and Clinics
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64111
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Matthew Feldt, MD
Facility Name
Icahn School of Medicine at Mount Sinai
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Joan Han, MD
Facility Name
Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nana Jones, MD
Facility Name
Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Andy Bauer, MD
Facility Name
Cook Children's Health Care Systems
City
Fort Worth
State/Province
Texas
ZIP/Postal Code
76104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Paul Thornton, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Use of Tirosint®-SOL or Tablet Formulations of Levothyroxine in Pediatric Patients With Congenital Hypothyroidism (CH)

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