Theophylline Effects in the Fontan Circulation (THIEF)

Theophylline Effects in the Fontan Circulation (THIEF Pilot Study)

A single group treatment phase 2 single-arm no-masking study to assess safety and efficacy of a short-term oral treatment with theophylline (ATC-no. R03D A04) in terms of improvements in cardiorespiratory fitness, health-related quality of life, cardiac performance and respiratory function in male and female adolescents aged 16 to 25 years with a Fontan-type surgical palliation of univentricular congenital heart disease.

Study Overview

• Status: Completed
• Conditions: Congenital Heart Disease
• Intervention / Treatment: Drug: Theophylline Tablets

Detailed Description

Single-group uncontrolled single-center open-label treatment study in adolescents (age 16-25 years) with univentricular congenital heart defects surgically palliated with a Fontan-type operation. Inclusion of eligible patients from inpatient and outpatient contacts at participating departments at Oslo University Hospital Rikshospitalet.

Study inclusion visit, drug treatment, remote dose adjustment, heart rhythm monitoring, and final post-treatment assessment study visit will be performed at the clinical research ward for children, Division of Paediatric and Adolescent Medicine.

Dose adjustment decisions and heart rhythm monitoring will be effectuated by the medical monitors (pediatric cardiology, cardiology) with continuous service through the entire study period.

Study duration: approximately 6 months (depending on inclusion progress, from inclusion of first participant until final visit of last enrolled participant) Individual treatment duration: minimum 12 weeks, maximum 15 weeks or until final study visit.

Visit frequency: two study visits, at inclusion and at end of treatment period (earliest after 12 weeks of treatment and latest after 15 weeks of treatment).

Number of Participants: Ten participants with both genders represented will be enrolled and invited to the study inclusion visit to achieve an intervention group of 10 individuals starting the oral treatment. In terms of being a pilot study, the study will also help to estimate the expected fractions of evaluable and non-evaluable participant in a subsequent full scale randomized clinical trial. Evaluability means the participant absolving all included study tests during inclusion and final study visit and completing scheduled dosage control and ECG monitoring tasks.

Health measurement / observation:

At inclusion and final visit:

• Demographics, biometric data, medical history
• Quality of life assessment by questionnaire (SF-36, EQ-5D)
• Echocardiography for cardiac function assessment
• Pulmonary function test incl. diffusion capacity
• Cardiopulmonary exercise test (bicycle ergometer)
• Home-based polysomnography

During treatment phase:

• Dosage monitoring by analysis of theophylline concentration in blood sample (obtained locally) in addition to analysis of liver and renal parameters (ALT, bilirubin, creatinine), repeated on indication (after dose adjustment, in case of arrhythmic events)
• Treatment compliance and AE monitoring by symptom report in electronic participant log book in ViedocMe (part of the eCRF-database)
• ECG-monitoring (rhythm storage at least every hour) by tape-on ECG-device (ECG247®) connected to via smartphone app to an online database with 24/7 accessibility for medical monitor (1).

During early intervention phase until 5-7 days after therapeutic drug concentration is achieved, the participant will continuously use the ECG247 device. In case of symptoms (palpitations or other arrhythmia-suspect symptoms), the participant will be able to notify the medical monitor (cardiologist) for immediate review of ECG readings. After cessation of continuous ECG-monitoring, the participant will be equipped with additional ECG-tapes for symptom-initiated ECG-readings and contact with medical monitor as needed.

Drug regimen / adjustments:

After inclusion visit, the participant starts on oral study medication (theophylline depot tablets 200mg, start dose 200mg bid).

After 3-5 days, the participant visits the family physician or a nearby hospital laboratory to collect a blood sample 4-6 hours after drug intake which is shipped to OUS for analysis (serum concentration of theophylline, creatinine, ALAT, bilirubin). Target concentration of theophylline during study period is 30-80 μmol/Liter. Dose adjustments, if needed, are made by a physician at the research unit in collaboration with the PI. Dose increase or decrease depending on serum concentration and drug tolerance by 100mg steps up or down, i.e., from 200mg bid to either 100mg bid or 300mg bid (see also algorithm in section 6.5 Dose Modification). Any dosing change has to be followed by repeat blood work after 3-5 days and renewed review of theophylline concentration.

• Study Type: Interventional
• Enrollment (Actual): 10
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Thomas Moller, MD PhD; Phone Number: +4790149702; Email: thomas.moller@ous-hf.no
• Study Contact Backup: Name: Ola Gjesdal, MD PhD; Phone Number: +4790039242; Email: olgjes@ous-hf.no

Study Locations

• Norway
  • Oslo, Norway, 0424
    • Oslo University Hospital, Rikshospitalet, Department of Paediatric Cardiology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 25 years (Child, Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Participants with univentricular congenital heart disease with a Fontan-type palliation

   1. Who are able to perform all diagnostic and monitoring procedures necessary during trial period, in particular being able to perform a symptom-limited cardiopulmonary exercise test on an upright ergometer bicycle.
   2. With available hepatic imaging results (ultrasound or magnetic resonance imaging) from less than 12 months before inclusion
   3. Without biochemical indications of more than mild liver disease or liver failure (se exclusion criteria) of more than mildly reduced kidney function.
   4. Considered and assessed eligible for administration of Theo-Dur® (theophylline) as specified in the SmPC.
2. Body mass index (BMI) within the range 18.5 - 34.9 kg/m2 (inclusive).

3. Contraceptive use by women is not under any national / local regulations in Norway.

   1. Male participants: no restrictions.
   2. Female participants: female participants should have a negative pregnancy test at inclusion and they receive information prior to consent that onset of pregnancy during treatment period has to be reported to the study team and leads to exclusion.
4. Capable of giving signed informed consent as described in Appendix 1 which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.

For participants < 18 years, all (both) parents or caregivers with parental responsibilities have to sign the consent form in addition to the participant.

Exclusion Criteria:

1. Current or previous (last 12 months) tachyarrhythmia which has been cause of medical investigation or hospitalization.

2. Heart rhythm during inclusion visit other than:

   • sinus rhythm or regular supraventricular rhythm (visible P-waves) regardless P-wave angle
   • nodal rhythm
   • isolated extra beats (supraventricular or ventricular) of a frequency considered clinically non-significant
3. Systemic hypertension (systolic or diastolic blood pressure above 95 percentile)

4. Biochemical signs of more than mild liver disease or liver failure indicated by one of the following:

   1. INR > 1.5 in the absence of warfarin treatment,
   2. ALAT more than twice the upper normal limit
   3. Bilirubin more than twice the upper normal limit
5. Imaging signs from the recent 12 months indicating more than mild Fontan-associated liver disease, indicated by imaging findings that need further diagnostic work-up to rule out hepato-cellular carcinoma

6. Biochemical indication of more than mildly reduced kidney function indicated by:

   a. Creatinine > 150 μmol/L (male) or > 120 μmol/L (female)

7. Pregnancy
8. Inherited forms of galactose intolerance (Lapp lactase deficiency or glucose-galactose malabsorption
9. Hypersensitivity to theophylline
10. Current treatment with pulmonary vasodilator medication (sildenafil, tadalafil, udenafil, bosentan, ambrisentan, macicentan, or any prostacyclin derivate)
11. Ongoing pharmacological treatment with the risk of drug-drug interactions. (Examples: cimetidine, quinolone derivates like enoxacin, ciprofloxacin, perfloxacin, viloxazine, macrolide antibiotics like erythromycin, troleandomycin, allopurinol, propranolol, disulfiram, isoniazid, oral contraceptives, flu vaccine, mexiletine, nifedipine, norfloxacin, ranitidin, tiabendazol, verapamil, fluvoxamine, carbamazepine, felodipine, phenobarbital, phenytoin, rifampicin, lithium, ketamine, glucagon)
12. Pregnancy or breastfeeding

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Treatment; 12 week oral treatment (theophylline)	Drug: Theophylline Tablets; 12 week oral treatment; Other Names: ATC R03D A04

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility and safety - adverse events	Frequency of treatment emerged AE/SAE	12 weeks
Cardiorespiratory fitness	Difference in oxygen uptake at anaerobic/ventilatory threshold pre/post treatment	12 weeks
Feasibility and safety - tolerability	Freedom from participant dropout based on tolerability of the study intervention	12 weeks
Feasibility and safety - drug dosing	Number of participants requiring dose reduction after first serum concentration	12 weeks
Feasibility and safety - arrhythmia	Freedom of arrhythmogenic side effects of the study treatment leading to patient dropout	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cardiac performance	Ventricular function as assessed by echocardiography at rest pre/post treatment	12 weeks
Respiratory function	Diffusion capacity pre/post treatment	12 weeks
Sleep disordered breathing	Change in Apnea Hypopnea Index during home-based sleep study pre-/post-treatment	12 weeks
Health-related quality-of-life	Difference inn total scores from EQ-5D-5L questionnaires pre/post treatment (single digit score (0-5 = "no problems" to "extreme problems") for five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression))	12 weeks
Health-related quality-of-life (SF 36)	Difference inn total scores from SF-36 questionnaire pre/post treatment (36 items scored scored on a 0 to 100 range so that the lowest and highest possible scores are 0 and 100 respectively)	12 weeks

Collaborators and Investigators

• Sponsor: Oslo University Hospital
• Collaborators: South-Eastern Norway Regional Health Authority; Norwegian Health Association; Norwegian Association for Children with Congenital Heart Disease
• Investigators: Principal Investigator: Thomas Möller, MD PhD, Oslo University Hospital

Publications and helpful links

Helpful Links

• EU Clinical Trials database, use search term "theophylline"

Study record dates

Study Major Dates

• Study Start (Actual): February 9, 2023
• Primary Completion (Actual): September 15, 2023
• Study Completion (Actual): September 15, 2023

Study Registration Dates

• First Submitted: January 16, 2023
• First Submitted That Met QC Criteria: January 30, 2023
• First Posted (Actual): February 8, 2023

Study Record Updates

• Last Update Posted (Actual): September 21, 2023
• Last Update Submitted That Met QC Criteria: September 18, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Keywords: Quality of life; Cardiac function; Cardiorespiratory fitness; Pulmonary function; Fontan circulation
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Congenital Abnormalities; Cardiovascular Abnormalities; Heart Diseases; Heart Defects, Congenital; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Vasodilator Agents; Autonomic Agents; Peripheral Nervous System Agents; Enzyme Inhibitors; Purinergic Antagonists; Purinergic Agents; Bronchodilator Agents; Anti-Asthmatic Agents; Respiratory System Agents; Phosphodiesterase Inhibitors; Purinergic P1 Receptor Antagonists; Theophylline
• Other Study ID Numbers: EU CT 2022-500301-41-00

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No