Efficacy Assessment of Systematic Treatment With Folinic Acid and Thyroid Hormone on Psychomotor Development of Down Syndrome Young Children (ACTHYF)
Evaluation of the following in very young children with Down syndrome:
- the efficacy of systematic treatment with L-thyroxine at controlled doses (clinically and by ultrasensitive thyreostimulating hormone (TSH) assay),
- the efficacy of systematic folinic acid treatment at a dose of 1 mg/kg/o.i.d,
- any interaction between these two treatments.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Paris, France, 75015
- Institut Jerome Lejeune
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- patient with a karyotype demonstrating homogeneous, free or Robertsonian translocation trisomy 21
- patient having undergone a cardiac ultrasound not demonstrating any severe heart disease
- patient aged 6 to 18 months at inclusion
Exclusion Criteria:
- congenital hypothyroidism
- hypothyroidism demonstrated by laboratory tests (TSH > 7mUI/l)
- presenting or having presented hyperthyroidism
- presenting or having presented leukaemia
- presenting or having presented West syndrome or any other form of epilepsy or unstable neurological disease
- presenting or having presented signs of central nervous system distress: stroke, postoperative hypoxia, meningitis)
- presenting severe heart disease on cardiac ultrasound, with haemodynamic effects
- presenting non-controlled cardiac arrhythmia
- Apgar < 7 to 5 min at birth
- Gestational age < 231 days (33 gestation weeks)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Thyroxin + folinic acid
|
thyroid hormone 25microg or placebo in tablets folinic acid 5 mg or placebo in capsules
|
|
Active Comparator: Thyroxin+folinic acid placebo
|
thyroid hormone 25microg or placebo in tablets folinic acid 5 mg or placebo in capsules
|
|
Active Comparator: Thyroxin placebo+ folinic acid
|
thyroid hormone 25microg or placebo in tablets folinic acid 5 mg or placebo in capsules
|
|
Placebo Comparator: Thyroxin placebo+ folinic acid placebo
|
thyroid hormone 25microg or placebo in tablets folinic acid 5 mg or placebo in capsules
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
GMDS (Griffiths Mental Development Scale)
Time Frame: 12 months
|
GMDS for testing and estimate babies psychomotor development from birth to 2 years trough six subscales : Locomotor, Personal-social, Hearing and language, Eye-Hand coordination, Performance.Sub- and General Quotients (GDQ) standard score are based on a mean of 100 and a standard deviation of 16.
For children with delayed development, which is the case for children with Down Syndrome, Quotient tables could be not used because sub- and General quotient floors at 50.
For each subscale, a raw score was derived from the contributing items.
Total raw score was obtained by adding subscale raw scores.
Sum of all subscale raw scores was converted into a development age using correspondence table.
Subscale and global development quotients were computed by dividing the development age by the chronological age multiplied by 100.
For preterm infants, chronological age was corrected taking into account the gestational term.
Higher QD's scores show a better psychomotor development outcome
|
12 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
BL (Brunet Lezine Revised Scale)
Time Frame: 12 months
|
BL includes 4 subscales : Locomotor, Coordination, Language, Sociability.
Subscale and global developpemental quotients were computed by dividing the developpemental age by the chronological age multiplied by 100.
This kind of formula do not give a min-max outcome.
Higher QD's scores show a better psychomotor developpement outcome.
|
12 months
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Clotilde MIRCHER, MD, Institut Jerome Lejeune, Paris, France
- Study Chair: Franck STURTZ, MD, PhD, Department of Biochemistry and Molecular Genetics, Limoges University, Limoges, France
Publications and helpful links
General Publications
- Blehaut H, Mircher C, Ravel A, Conte M, de Portzamparc V, Poret G, de Kermadec FH, Rethore MO, Sturtz FG. Effect of leucovorin (folinic acid) on the developmental quotient of children with Down's syndrome (trisomy 21) and influence of thyroid status. PLoS One. 2010 Jan 11;5(1):e8394. doi: 10.1371/journal.pone.0008394.
- van Trotsenburg AS, Kempers MJ, Endert E, Tijssen JG, de Vijlder JJ, Vulsma T. Trisomy 21 causes persistent congenital hypothyroidism presumably of thyroidal origin. Thyroid. 2006 Jul;16(7):671-80. doi: 10.1089/thy.2006.16.671.
- van Trotsenburg AS, Vulsma T, van Rozenburg-Marres SL, van Baar AL, Ridder JC, Heymans HS, Tijssen JG, de Vijlder JJ. The effect of thyroxine treatment started in the neonatal period on development and growth of two-year-old Down syndrome children: a randomized clinical trial. J Clin Endocrinol Metab. 2005 Jun;90(6):3304-11. doi: 10.1210/jc.2005-0130. Epub 2005 Mar 8.
- Ellis JM, Tan HK, Gilbert RE, Muller DP, Henley W, Moy R, Pumphrey R, Ani C, Davies S, Edwards V, Green H, Salt A, Logan S. Supplementation with antioxidants and folinic acid for children with Down's syndrome: randomised controlled trial. BMJ. 2008 Mar 15;336(7644):594-7. doi: 10.1136/bmj.39465.544028.AE. Epub 2008 Feb 21.
- Sacco S, Bouis C, Gallard J, Pichot A, Blondiaux E, Marey I, Dorison N, Sturtz F, Cieuta-Walti C, Ravel A, Mircher C. Psychomotor development in infants and young children with Down syndrome-A prospective, repeated measure, post-hoc analysis. Am J Med Genet A. 2022 Mar;188(3):818-827. doi: 10.1002/ajmg.a.62587. Epub 2021 Dec 4.
- Mircher C, Sacco S, Bouis C, Gallard J, Pichot A, Le Galloudec E, Cieuta C, Marey I, Greiner-Mahler O, Dorison N, Gambarini A, Stora S, Durand S, Polak M, Baruchel A, Schlumberger E, Dewailly J, Azar-Kolakez A, Gueant-Rodriguez RM, Gueant JL, Borderie D, Bonnefont-Rousselot D, Blondiaux E, Ravel A, Sturtz FG. Thyroid hormone and folinic acid in young children with Down syndrome: the phase 3 ACTHYF trial. Genet Med. 2020 Jan;22(1):44-52. doi: 10.1038/s41436-019-0597-8. Epub 2019 Jul 8.
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimate)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Nervous System Diseases
- Neurologic Manifestations
- Neurobehavioral Manifestations
- Disease
- Congenital Abnormalities
- Genetic Diseases, Inborn
- Intellectual Disability
- Abnormalities, Multiple
- Chromosome Disorders
- Syndrome
- Down Syndrome
- Physiological Effects of Drugs
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Protective Agents
- Micronutrients
- Vitamins
- Antidotes
- Vitamin B Complex
- Hematinics
- Leucovorin
- Levoleucovorin
- Hormones
- Folic Acid
Other Study ID Numbers
Other Study ID Numbers
- IJL-AFHT-TH10
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