- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02197702
Vitamin D in Preschoolers With Viral-induced Asthma (DIVA)
Vitamin D In the Prevention of Viral-induced Asthma of Preschoolers: a Randomised Controlled Trial (RCT)- (DIVA)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
IMPORTANT NOTE: Due to receiving a 2-year partial funding enabling only a single-centre pilot trial, rather than an adequately-powered multicentre study, the primary outcome was modified post hoc for the overall change from baseline in total serum 25OHD during the study as well as at 3.5 and 7 months, similar to our previous pilot study.(NCT01999907) Post hoc secondary outcomes included the group difference in the proportion of children with total 25OHD ≥75 nmol/L at 3.5 and 7 months and in the rate of oral corticosteroid courses per child. Other a priory specified outcomes included the proportion of children with hypercalciuria (Ca:Cr) >1.25 (1-2 years), >1 (2-5 years) nmol/nmol at any point in time; proportion of children with ≥1 exacerbation requiring rescue oral steroids (former primary outcome); number of emergency department (ED) visits; intensity and duration of asthma symptoms and cumulative use of rescue ß2-agonist use, documented on Asthma Flare-up Diary for Young Children (ADYC); the impact of parents' functional status during exacerbations ascertained on the Effect of a child's asthma flare-up on parents; and duration of URTI.
Based on this analysis of this new post-hoc primary outcome, we have changed the intervention and the primary outcome and obtained funding for a new large multicentre study NCT03365687. it is thus important to share the results of this current trial with other investigators
PRIOR REPORTED DESCRIPTION Design: A multicenter triple-blind randomized parallel-group, placebo-controlled trial of vitamin D3 supplementation. Children aged 1-5 years with (i) physician-diagnosed asthma, predominantly triggered by upper respiratory tract infections (URTIs), (ii) ≥4 reported URTIs in the past year, and (iii) ≥1 exacerbation requiring OCS (a recognised marker of moderate and severe exacerbations) in the past 6 months or ≥2 in the past 12 months, will be randomly allocated to one of two treatments in blocks of 4-6, stratified on recruitment site: Intervention group (n=432)-100,000 IU oral vitamin D3; control group (n=432)-identical placebo, for 2 oral doses, 3.5 months apart. Co-intervention with asthma therapy (preventive or pre-emptive ICS) will be left to the discretion of the physician and documented. Children will be followed every 3.5 months as per usual practice, with a home visit 10 days after each bolus, during which urine and blood will be sampled for urinary calcium:creatinine ratio, serum vitamin D, markers of calcium metabolism, and mechanistic exploration. A validated diary will serve to document the intensity and severity of exacerbations. In two sites, preschool lung function will be documented (if ≥ 3yrs). Outcomes: Primary endpoint-number of exacerbations requiring rescue oral corticosteroids (OCS) per child, documented by medical and pharmacy records. Secondary outcomes: duration and severity of exacerbations (symptoms & β2-agonist use, by diary; emergency visits, by medical records), parental functional status (by validated instrument), asthma therapy intensification and health care and direct costs (by health records & parent reports). Safety, mechanistic, exploratory outcomes: hypercalciuria, calcium metabolism, excess vitamin D, change in serum gene expression at 10 days (first 25 patients); and change from baseline at 7 months in preschool lung function (2 sites). Based on 3 published RCTs, a sample of 432 per arm (400+7.5% attrition) will provide 80% power (2-tailed alpha of 5%) to detect a 25% reduction in number of exacerbations requiring OCS/child (0.55 vs. 0.4125).
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Locations
-
-
Quebec
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Montreal, Quebec, Canada, H3T1C5
- CHU Sainte Justine
-
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- age 1-5 years
- physician-diagnosed asthma as per the Global Initiative for Asthma (GINA) guidelines
- URTIs as the main asthma trigger (parental report)
- ≥4 URTIs in the past 12 months (parental report)
- ≥1 asthma exacerbation requiring rescue oral corticosteroids (OCS) in the past 6 months or ≥2 in the past 12 months
Exclusion Criteria:
- intake or intention to use more than 400 IU/day of vitamin D supplement
- extreme prematurity (<28 weeks gestation)
- infants <12 months of age
- no vitamin D supplementation when breast-fed
- recent (<1 year) immigrants from a region at high risk of rickets
- children with vitamin D restrictive diets e.g. vegans
- other chronic respiratory disease (broncho-pulmonary dysplasia; cystic fibrosis)
- condition(s) that alter calcium or vitamin D metabolism/absorption (hypo/hyperparathyroidism, kidney/liver disease, inflammatory bowel disease)
- medications that interfere with vitamin D metabolism (anti-epileptics, diuretics, antacids, anti-fungal drug)
- vitamin D supplementation >1000 IU/ day in last 3 months
- anticipated difficult follow-up (unable to attend clinic visits; plan to leave the province).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: PREVENTION
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: QUADRUPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo
2 ml identical placebo taken by mouth at baseline and 3.5 months.
|
Two doses of identical placebo (2 mL) given 3.5 months part, once in the fall, once in the winter
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Active Comparator: Vitamin D
Vitamin D (100,000IU) given in a 2 ml oral dose at baseline and 3.5months.
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Two doses of cholecalciferol 100,000 unit (2 mL) given 3.5 months apart, once in the fall, once in the winter
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline in serum 25OHD
Time Frame: During the 7-month follow-up period
|
Group difference in the adjusted change from baseline 25OHD over time and specifically at 3.5 and 7 months
|
During the 7-month follow-up period
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of children with total 25OHD ≥75 nmol/L
Time Frame: at 3.5 and 7 months
|
Group difference in the proportion of children with total 25OHD ≥75 nmol/L
|
at 3.5 and 7 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hypercalciuria
Time Frame: At any point during the 7-month follow-up period
|
Group difference in the proportion of children with ≥1 occurrence of hypercalciuria (urinary calcium: creatinine greater than 1.25mmol/mmol for children aged 1-2yrs (or greater than 1mmol/mmol for those aged 2-5yrs)
|
At any point during the 7-month follow-up period
|
Elevated serum 25-hydroxyvitamin D (25OHD)
Time Frame: At any point during the 7-month follow-up period
|
Proportion of children with ≥1 occurrence of elevated serum 25OHD (greater than 250nmol/L)
|
At any point during the 7-month follow-up period
|
Perturbation of the calcium homeostasis
Time Frame: At any point during the 7-month follow-up period
|
Proportion of children with ≥1 occurrence of a perturbation of the calcium homeostasis (serum Ca, Ph, Alkaline phosphatase), defined as outside normal laboratory values
|
At any point during the 7-month follow-up period
|
RNA expression
Time Frame: Over the 7 months after the intial dose of Vit D/Placebo
|
Group difference in the change from baseline in RNA expression measured between 0, 10 days, 3.5 months and 7 months post initial dose of Vit D/Placebo
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Over the 7 months after the intial dose of Vit D/Placebo
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Duration of URTIs
Time Frame: During an URTI during the 7-month follow-up period
|
Group difference in the duration of URTI as documented by parents at the end of each episode
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During an URTI during the 7-month follow-up period
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Viral upper respiratory tract infections (URTI)
Time Frame: During the 7-month follow-up period
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Group difference in the number of reported viral upper respiratory tract infections
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During the 7-month follow-up period
|
Emergency department visit for an asthma flare-up
Time Frame: During the 7-month follow-up period
|
Group difference in the number of emergency department visits for asthma
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During the 7-month follow-up period
|
Rescue β2-agonist use during an asthma flare-up
Time Frame: During the 7-month follow-up period
|
Group difference in the cumulative daily use of rescue β2-agonist use as documented by parents on the 'Asthma Flare-up Diary for Young CHildren' during a URTI or an asthma exacerbation
|
During the 7-month follow-up period
|
Severity of asthma symptoms during an asthma flare-up
Time Frame: During an URTI or flare-up during the 7-month follow-up period
|
Group difference in the severity on the asthma symptoms documented as the sum of daily score on the 'Asthma FLare-up DIary for Young Children' questionnaire
|
During an URTI or flare-up during the 7-month follow-up period
|
Duration of asthma symptoms during a flare-up
Time Frame: During an URTI or flare-up during the 7-month follow-up period
|
Group difference in the duration of asthma symptoms documented on the 'Asthma FLare-up DIary for Young Children' questionnaire
|
During an URTI or flare-up during the 7-month follow-up period
|
Exacerbations requiring rescue oral corticosteroids
Time Frame: During the 7-month follow-up period
|
Mean group rate of exacerbations requiring rescue oral corticosteroids/child
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During the 7-month follow-up period
|
Patients with exacerbations requiring rescue oral corticosteroids
Time Frame: During the 7-month follow-up period
|
Proportion of children with ≥1 exacerbation requiring rescue oral corticosteroids
|
During the 7-month follow-up period
|
Impact of exacerbations on caregivers' functional status
Time Frame: During an URTI or flare-up during the 7-month follow-up period
|
Group difference in the caregivers' functional status measured on the 'Effect of a child's asthma flare-up on parents' questionnaire
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During an URTI or flare-up during the 7-month follow-up period
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Impact of exacerbations on caregivers' workday lost
Time Frame: During an URTI or flare-up during the 7-month follow-up period
|
Group difference in the caregivers' number of workday lost
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During an URTI or flare-up during the 7-month follow-up period
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Francine M Ducharme, MD, St. Justine's Hospital
Publications and helpful links
General Publications
- Huey SL, Acharya N, Silver A, Sheni R, Yu EA, Pena-Rosas JP, Mehta S. Effects of oral vitamin D supplementation on linear growth and other health outcomes among children under five years of age. Cochrane Database Syst Rev. 2020 Dec 8;12(12):CD012875. doi: 10.1002/14651858.CD012875.pub2.
- Ducharme FM, Jensen M, Mailhot G, Alos N, White J, Rousseau E, Tse SM, Khamessan A, Vinet B. Impact of two oral doses of 100,000 IU of vitamin D3 in preschoolers with viral-induced asthma: a pilot randomised controlled trial. Trials. 2019 Feb 18;20(1):138. doi: 10.1186/s13063-019-3184-z.
Study record dates
Study Major Dates
Study Start
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
- Respiratory Tract Diseases
- Immune System Diseases
- Lung Diseases
- Hypersensitivity, Immediate
- Bronchial Diseases
- Lung Diseases, Obstructive
- Respiratory Hypersensitivity
- Hypersensitivity
- Asthma
- Physiological Effects of Drugs
- Micronutrients
- Vitamins
- Bone Density Conservation Agents
- Calcium-Regulating Hormones and Agents
- Vitamin D
- Cholecalciferol
Other Study ID Numbers
- DIVA
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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