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Metformin in Obese Children and Adolescents (MetVoorMin)
An Efficacy, Safety and Pharmacokinetic Study on the Short-term and Long-term Use of Metformin in Obese Children and Adolescents
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
The prevalence of obesity in children and adolescents is increasing rapidly and is associated with significant medical and psychosocial consequences persisting into adulthood.
Obesity may lead to metabolic complications, such as insulin resistance, which can progress via impaired fasted glucose and impaired glucose tolerance to type 2 diabetes mellitus (T2DM) and to the development of micro- and macro-vascular complications.
Metformin, an oral anti-diabetic licensed for T2DM for adults and children from 10 years onwards, is already used off label in obese children and adolescents with insulin resistance, even though the specific effects of metformin in these obese children and adolescents have not been elucidated, particularly upon long-term use.
The rationale for this study is based on the hypothesis that metformin may reduce body mass index (BMI), insulin resistance and percentage of body-fat in obese children and adolescents with insulin resistance. Further more it is anticipated that metformin may delay the progression to T2DM and thereby micro- and macro-vascular complications in obese children and adolescents with insulin resistance.
Studietype
Inschrijving (Werkelijk)
Fase
- Fase 3
Contacten en locaties
Studie Locaties
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's Hertogenbosch, Nederland
- Jeroen Bosch Hospital
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Nieuwegein, Nederland, 3430EM
- St. Antonius Hospital
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- Age ≥ 10 and ≤ 16 years at study entry
- Caucasian descent
- Obesity defined as BMI-SDS > 2.3
- Insulin resistance defined as HOMA-IR ≥ 3.4.
- An obtained informed consent from subjects and parents/caregivers.
Exclusion Criteria:
- Presence of T2DM (American Diabetes Association criteria)
- Presence of endocrine disorders with steroid therapy
- Suspicion of polycystic ovarium syndrome;
- Height < -1.3 SD of target height;
- Syndrome disorders with or without mental retardation;
- Use of anti-hyperglycaemic drugs;
- Pregnancy (pregnancy test will be performed, if applicable);
- (History of) alcohol abuse;
- Impaired renal and/or hepatic function (defined as GFR < 80 ml/min. GFR=40 x length (cm) / serumcreatinin (μmol/l and ALAT >150% of normal value for age);
- Use of ritonavir; use of ACE inhibitors;
- Insufficient knowledge of the Dutch language.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Verdrievoudigen
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
|
Actieve vergelijker: Metformin
Metformin with lifestyle intervention during 18 months
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Oral administration, 500 mg daily at week 1.
Every week metformin dosage increases with 500 mg, to a maximum dose of 1000 mg bid.
This maximum dose will be administered till the end of the study.
Andere namen:
Lifestyle intervention: 18 months physical therapy and dietary advice
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Placebo-vergelijker: Placebo
Placebo and lifestyle intervention during 18 months
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Lifestyle intervention: 18 months physical therapy and dietary advice
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Change in BMI from baseline
Tijdsspanne: 18 months and 36 months
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Change in BMI after part 1 (double blind) and part 2 ( follow-up)
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18 months and 36 months
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Change in Insulin resistance from baseline
Tijdsspanne: 3; 6; 9; 12; 15; 18; 24; 30 and 36 months
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calculated by the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR).
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3; 6; 9; 12; 15; 18; 24; 30 and 36 months
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Renal and hepatic function
Tijdsspanne: 3; 6; 9; 12; 15; 18; 24; 30 and 36 months
|
creatinine and alat
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3; 6; 9; 12; 15; 18; 24; 30 and 36 months
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Tolerability
Tijdsspanne: 3; 6; 9; 12; 15; 18; 24; 30 and 36 months
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The amount of reported adverse effects, in relation to the achieved dose level.
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3; 6; 9; 12; 15; 18; 24; 30 and 36 months
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Pharmacokinetics (PK)-parameters: clearance (ml/min)
Tijdsspanne: 9 months
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Clearance where applicable expressed per body weight, age category, Tanner Stage and gender, clearance will be determined with a two-compartment pharmacokinetic model using non linear mixed effect modelling.
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9 months
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Body fat percentage
Tijdsspanne: 0, 9, 18 and 36 months
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0, 9, 18 and 36 months
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|
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Physical fitness
Tijdsspanne: 0, 9, 18 and 36 months
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0, 9, 18 and 36 months
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Quality of life
Tijdsspanne: 0, 9, 18 and 36 months
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0, 9, 18 and 36 months
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Long term efficacy
Tijdsspanne: 36 months
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Based on BMI and HOMA-IR values
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36 months
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Long-term safety
Tijdsspanne: 36 months
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Renal and hepatic function after 36 months of metformin use
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36 months
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Long-term tolerability
Tijdsspanne: 36 months
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The amount of adverse effects after 36 months
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36 months
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Microvascular complications
Tijdsspanne: 36 months
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Measured as micro-albuminuria
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36 months
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Macrovascular complications
Tijdsspanne: 36 monthts
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Measured with Pulse Wave Velocity and Augmentation Index.
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36 monthts
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Development of T2DM
Tijdsspanne: 36 months
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36 months
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PK-parameters: volume of distribution (liters)
Tijdsspanne: 9 months
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Volume of distribution, where applicable expressed per body weight, age category, Tanner Stage and gender, volume of distribution will be determined with a two-compartment pharmacokinetic model using non linear mixed effect modelling.
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9 months
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Medewerkers en onderzoekers
Sponsor
Medewerkers
Onderzoekers
- Hoofdonderzoeker: Marja MJ van der Vorst, MD, PhD, St. Antonius Hospital
Publicaties en nuttige links
Algemene publicaties
- van Rongen A, van der Aa MP, Matic M, van Schaik RHN, Deneer VHM, van der Vorst MM, Knibbe CAJ. Increased Metformin Clearance in Overweight and Obese Adolescents: A Pharmacokinetic Substudy of a Randomized Controlled Trial. Paediatr Drugs. 2018 Aug;20(4):365-374. doi: 10.1007/s40272-018-0293-1.
- van der Aa MP, Hoving V, van de Garde EM, de Boer A, Knibbe CA, van der Vorst MM. The Effect of Eighteen-Month Metformin Treatment in Obese Adolescents: Comparison of Results Obtained in Daily Practice with Results from a Clinical Trial. J Obes. 2016;2016:7852648. doi: 10.1155/2016/7852648. Epub 2016 Dec 22.
- van der Aa MP, Elst MA, van Mil EG, Knibbe CA, van der Vorst MM. METFORMIN: an efficacy, safety and pharmacokinetic study on the short-term and long-term use in obese children and adolescents - study protocol of a randomized controlled study. Trials. 2014 Jun 5;15:207. doi: 10.1186/1745-6215-15-207.
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- Metformin 2011-6
- 2010-023980-17 (EudraCT-nummer)
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