- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00116558
Early Treatment of Amyotrophic Lateral Sclerosis (ALS) With Nutrition and Non-Invasive Positive Pressure Ventilation
Early Treatment of Amyotrophic Lateral Sclerosis With Nutrition and Non-Invasive Positive Pressure Ventilation
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Studies to date indicate that percutaneous endoscopic gastrostomy (PEG)-insertion of a feeding tube in the stomach-and non-invasive positive pressure ventilation (NIPPV)-mechanically assisted or generated breaths delivered through a tightly fitting nasal or facial mask-improve survival in amyotrophic lateral sclerosis (ALS), even when introduced late in the disease.
Dr. Kasarskis and his research team believe early intervention with these treatments may improve patients outcome even further. However, many issues regarding the early use of these treatments prevent the design of a phase III clinical trial to test this hypothesis. Common to both NIPPV and nutrition is a lack of a reliable indicator of early respiratory or nutritional insufficiency. With respect to nutrition, reliable and cost effective methods are needed to determine a patient's energy (i.e. caloric) requirements at different stages of the illness to establish a basis for recommending PEG on the adequacy of energy intake. For NIPPV, factors that influence acceptance and tolerability of this therapy, and measurements of early respiratory dysfunction need to be identified.
The purposes of this trial are to develop and validate strategies to improve tolerability of NIPPV, identify factors that influence acceptance of NIPPV, and evaluate measures of early respiratory failure, other than percentage of forced vital capacity (FVC). Researchers will also develop and validate methods to determine energy balance in and evaluate the nutritional status of patients with ALS that will be applicable to a multi-center phase III study of nutrition and NIPPV.
The study will be conducted at 11 other sites across the country. Some study sites will focus on the nutritional aspects of the trial while the other sites will focus on NIPPV treatment. A total of 220 patients will be studied over 2 years.
Enrollment will end on June 30, 2007. The last patient was followed clinically until June 30, 2008. The study remained open for sample analysis, data analysis, and assessment of vital status until the completion of funding on November 30, 2009.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Colorado
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Denver, Colorado, United States, 80262
- University of Colorado
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Florida
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Miami, Florida, United States, 33136
- University of Miami
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Kentucky
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Lexington, Kentucky, United States, 40536
- University of Kentucky
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Michigan
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Detroit, Michigan, United States, 48202
- Henry Ford Hospital
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New York
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New York, New York, United States, 10032
- Columbia University
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New York, New York, United States, 10003
- Beth Israel
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Syracuse, New York, United States, 13210
- SUNY
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Pennsylvania
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Hershey, Pennsylvania, United States, 17033
- Pennsylvania State University
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Philadelphia, Pennsylvania, United States, 19103
- Drexel University
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Texas
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San Antonio, Texas, United States, 78229
- University of Texas-San Antonio
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Utah
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Salt Lake City, Utah, United States, 84132
- University of Utah
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Vermont
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Burlington, Vermont, United States, 54505
- University of Vermont
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Willing and able to give informed consent.
- If women of childbearing age, must be non-lactating and surgically sterile or using an effective method of birth control (double-barrier or oral contraception) and have a negative pregnancy test.
- Minorities: All races and ethnic backgrounds.
- Disease inclusion: Clinically possible/definite/probable, or laboratory supported probable, sporadic or familial ALS according to the revised Escorial criteria.
- Onset of progressive weakness within 60 months prior to study.
- Willing to return for visits as scheduled and adhere to protocol requirements.
FVC Criteria
- NIPPV Arm: Best-sitting FVC between 50% and 95% of predicted normal.
- Nutrition Arm: Best-sitting FVC >50% of predicted normal.
Exclusion Criteria:
- Untreated or unstable hyper or hypothyroidism, untreated or unstable asthma, unstable angina, advanced liver or renal disease, advanced cancer, untreated diabetes or chronic obstructive pulmonary disease (COPD).
- Diagnosis of other motor neuron or other neurological disorder that mimics ALS.
- Diagnosis of other neurodegenerative disease (i.e., Parkinson's disease, Alzheimer's disease, etc.)
- Inflammatory bowel disease or malabsorption syndrome.
- Use of NIPPV, mechanical ventilation, or tracheostomy at the time of consent.
- Inability to adhere to study visit schedule or lack of reliable caretaker if participant requires one.
- Pregnant or lactating woman.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Early NIPPV Intervention
Participants with >80% predicted forced vital capacity (FVC).
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Early intervention with non-invasive positive pressure ventilation (NIPPV) at 80% forced vital capacity (FVC).
Other Names:
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Active Comparator: Standard of Care NIPPV
Participants with 50-74% predicted forced vital capacity (FVC).
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Standard of care non-invasive positive pressure ventilation (NIPPV) at 50% forced vital capacity (FVC).
Other Names:
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Active Comparator: Standard of Care NIPPV and Nutritional Monitoring
Participants with 50-95% forced vital capacity (FVC), and normal or impaired amyotrophic lateral sclerosis functional rating scale (ALSFRS) scores.
Participants in this group will receive standard of care NIPPV therapy but will also undergo detailed analysis of nutritional status.
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Standard of care non-invasive positive pressure ventilation (NIPPV) at 50% forced vital capacity (FVC).
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Acceptance Rate of Early Non-invasive Positive Pressure Ventilation (NIPPV) Treatment.
Time Frame: 6 weeks
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Percentage of patients attempting to use NIPPV therapy within six weeks of initial offer.
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6 weeks
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Survival With Early Versus Standard of Care NIPPV Treatment
Time Frame: one year
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Duration of patient survival
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one year
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Compliance With NIPPV Treatment
Time Frame: one month
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Number of hours of NIPPV use per month
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one month
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Total Daily Energy Expediture (TDEE) of ALS Patients
Time Frame: Duration of study (approximately 1 year)
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Total daily energy expenditure (TDEE) with be measured using the dual labeled water (DLW) method
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Duration of study (approximately 1 year)
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Tolerance of NIPPV Treatment
Time Frame: one month
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Percent of patients achieving tolerance (>4hr/night NIPPV after 2-3 week titration period) determined by actual usage data.
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one month
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Edward Kasarskis, MD, PhD, University of Kentucky
Publications and helpful links
General Publications
- Kasarskis EJ, Mendiondo MS, Matthews DE, Mitsumoto H, Tandan R, Simmons Z, Bromberg MB, Kryscio RJ; ALS Nutrition/NIPPV Study Group. Estimating daily energy expenditure in individuals with amyotrophic lateral sclerosis. Am J Clin Nutr. 2014 Apr;99(4):792-803. doi: 10.3945/ajcn.113.069997. Epub 2014 Feb 12.
- Scagnelli CN, Howard DB, Bromberg MB, Kasarskis EJ, Matthews DE, Mitsumoto HM, Simmons Z, Tandan R; ALS Nutrition-NIPPV Study Group. Hydration measured by doubly labeled water in ALS and its effects on survival. Amyotroph Lateral Scler Frontotemporal Degener. 2018 May;19(3-4):220-231. doi: 10.1080/21678421.2017.1413117. Epub 2017 Dec 15.
- Kasarskis EJ, Mendiondo MS, Wells S, Malguizo MS, Thompson M, Healey M, Kryscio RJ; ALS Nutrition/NIPPV Study Group. The ALS Nutrition/NIPPV Study: design, feasibility, and initial results. Amyotroph Lateral Scler. 2011 Jan;12(1):17-25. doi: 10.3109/17482968.2010.515225.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- R01NS045087 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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