Patients Requiring Home Parenteral Nutrition
Conditions
Brief summary
The aim of the trial is to investigate safety and tolerability of an Omega-3-FA-enriched lipid emulsion in adult patients with chronic intestinal failure in need of long-term HPN. It is aimed to show non-inferiority of the lipid emulsion Lipidem (investigational test product) in comparison to the lipid emulsion Lipofundin MCT (investigational reference product) with regard to liver function.
Interventions
Lipoplus i.v. lipid emulsion for parenteral nutrition
Lipofundin MCT 20% i.v. lipid emulsion for parenteral nutrition
Sponsors
Study design
Eligibility
Inclusion criteria
Inclusion: * Signed informed consent available * Male or female patients ≥ 18 years of age * Patients with chronic intestinal failure receiving HPN including lipids in whom the parenteral macronutrients have not been changed by more than 10% for at least 3 months * Patients receiving ≥ 3.0 g lipids/kg body weight per week Exclusion: * Persistent high total bilirubin values in medical history of last 6 months (\> 40µmol/l) * Patients in whom PN was interrupted for longer than 4 continuous weeks in the preceding 6 months * Patients with history of cancer and anti-cancer treatment within the last 2 years * Hypersensitivity to egg, fish, peanut or soya-bean protein or to any of the active substances or excipients * Patients treated in the past or currently with Teduglutide * Contraindications to investigational products (if available from medical records) including: * Severe hyperlipidemia, including severe hypertriglyceridaemia (≥1000 mg/dl or 11.4 mmol/l) * Severe coagulopathy * Intrahepatic cholestasis * Severe hepatic insufficiency * Severe renal insufficiency in absence of renal replacement therapy * Acute thromboembolic events * Fat embolism * Aggravating haemorrhagic diatheses * Metabolic acidosis * General contraindications to parenteral nutrition (if available from medical records) including: * Unstable circulatory status with vital threat (states of collapse and shock) * Acute phase of cardiac infarction or stroke * Unstable metabolic conditions (e.g. decompensated diabetes mellitus, severe sepsis, coma of unknown origin) * Inadequate cellular oxygen supply * Disturbances of the electrolyte and fluid balance (e.g. hypokalaemia and hypotonic dehydration) * Acute pulmonary edema * Decompensated cardiac insufficiency * Positive test for HIV, Hepatitis B or C (from medical history) * Known or suspected drug or alcohol abuse * Patients who are unwilling or mentally and/or physically unable to adhere to study procedures * Participation in another interventional clinical trial in parallel or within three months prior to the start of this clinical trial * Any medical condition that in the opinion of the investigator might put the subject at risk or interfere with patients participation For women with childbearing potential (i.e. females who are not chemically or surgically sterile or females who are not post-menopausal) * Women of childbearing potential tested positive on standard pregnancy test (urine dipstick) * Lactation * Women of childbearing potential who do not agree to apply adequate contraception * Persons of legal age who are the subject of a legal protection measure or who are unable to express their consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change of Liver Function Parameters From Baseline to Visit 2 | 8 weeks | Changes will be expressed as the sum of the N(0.1)- transformed differences of bilirubin, ALT and AST (from Baseline to Visit 2), i.e. for all three parameters each change of the value is subtracted by the mean change of the respective parameter. This difference is divided by the standard deviation of the change, which results in a unitless normalised value. All values for the 3 liver parameters (bilirubin, ALT and AST) will be added. The final sum reflects the change of liver function parameters. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Alanine Transaminase (ALT) | 8 weeks | Change from baseline |
| Aspartate Transaminase (AST) | 8 weeks | Change from baseline |
| AST/ALT Ratio | 8 weeks | Change from baseline |
| Alkaline Phosphatase (ALP) | 8 weeks | Change from baseline |
| Gamma-glutamyl Transpeptidase (GGT) | 8 weeks | Change from baseline |
| White Blood Cells (WBCs) | 8 weeks | Change from baseline |
| Red Blood Cells (RBCs) | 8 weeks | Change from baseline |
| Hemoglobin (Hb) | 8 weeks | Change from baseline |
| Platelets | 8 weeks | Change from baseline |
| International Normalized Ratio (INR) (if Not Possible Prothrombin Time [PT = Quick-value] is Accepted) | 8 weeks | Change from baseline |
| Activated Partial Thromboplastin Time (aPTT) | 8 weeks | Change from baseline |
| Hematocrit (Hct) | 8 weeks | Change from baseline |
| Blood Glucose | 8 weeks | Change from baseline |
| Sodium | 8 weeks | Change from baseline |
| Chloride | 8 weeks | Change from baseline |
| Bilirubin | 8 weeks | Change from baseline |
| Calcium | 8 weeks | Change from baseline |
| Magnesium | 8 weeks | Change from baseline |
| Phosphate | 8 weeks | Change from baseline |
| Serum Creatinine | 8 weeks | Change from baseline |
| Triglycerides | 8 weeks | Change from baseline |
| Cholesterol | 8 weeks | Change from baseline |
| High-density Lipoprotein (HDL) | 8 weeks | Change from baseline |
| Low-density Lipoprotein (LDL) | 8 weeks | Change from baseline |
| C-reactive Protein (CRP) | 8 weeks | Change from baseline |
| α-Tocopherol/Vitamin E (Facultative if Routinely Assessed) | 8 weeks | Change from baseline |
| Triene:Tetraene Ratio in Plasma, Reduction From Baseline | 8 weeks | Derived from fatty acid pattern in plasma |
| Adverse Events | 8 weeks | Number of adverse events (including serious adverse events) |
| BMI | 8 weeks | Body mass index Change from baseline |
| Prothrombin Time (PT) | 8 weeks | Change from baseline |
| Potassium | 8 weeks | Change from baseline |
Countries
France, Italy, Netherlands, Poland, United Kingdom
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Lipidem i.v. lipid emulsion containing fractionated fish oil (n-3 fatty acid triglycerides)
Lipidem: Lipoplus i.v. lipid emulsion for parenteral nutrition | 38 |
| Lipofundin MCT i.v. lipid emulsion
Lipofundin MCT 20%: Lipofundin MCT 20% i.v. lipid emulsion for parenteral nutrition | 34 |
| Total | 72 |
Baseline characteristics
| Characteristic | Lipofundin MCT | Total | Lipidem |
|---|---|---|---|
| Age, Continuous | 52.44 years STANDARD_DEVIATION 15.5 | 51.22 years STANDARD_DEVIATION 15.6 | 50.13 years STANDARD_DEVIATION 15.82 |
| Race/Ethnicity, Customized Black or African American | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Missing | 2 Participants | 4 Participants | 2 Participants |
| Race/Ethnicity, Customized Native Hawaiian/Other Pacific | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 31 Participants | 66 Participants | 35 Participants |
| Region of Enrollment France | 11 participants | 21 participants | 10 participants |
| Region of Enrollment Italy | 3 participants | 5 participants | 2 participants |
| Region of Enrollment Netherlands | 3 participants | 7 participants | 4 participants |
| Region of Enrollment Poland | 16 participants | 36 participants | 20 participants |
| Region of Enrollment United Kingdom | 1 participants | 3 participants | 2 participants |
| Sex: Female, Male Female | 24 Participants | 40 Participants | 16 Participants |
| Sex: Female, Male Male | 10 Participants | 32 Participants | 22 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 40 | 0 / 34 |
| other Total, other adverse events | 15 / 40 | 12 / 34 |
| serious Total, serious adverse events | 5 / 40 | 3 / 34 |
Outcome results
Change of Liver Function Parameters From Baseline to Visit 2
Changes will be expressed as the sum of the N(0.1)- transformed differences of bilirubin, ALT and AST (from Baseline to Visit 2), i.e. for all three parameters each change of the value is subtracted by the mean change of the respective parameter. This difference is divided by the standard deviation of the change, which results in a unitless normalised value. All values for the 3 liver parameters (bilirubin, ALT and AST) will be added. The final sum reflects the change of liver function parameters.
Time frame: 8 weeks
Population: Full Analysis Set
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Change of Liver Function Parameters From Baseline to Visit 2 | 0.0606 normalized sum- no unit | Standard Deviation 3.0876 |
| Lipofundin MCT | Change of Liver Function Parameters From Baseline to Visit 2 | -0.0703 normalized sum- no unit | Standard Deviation 1.8063 |
Activated Partial Thromboplastin Time (aPTT)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Activated Partial Thromboplastin Time (aPTT) | 0.02 seconds | Standard Deviation 3.85 |
| Lipofundin MCT | Activated Partial Thromboplastin Time (aPTT) | 0.97 seconds | Standard Deviation 7.69 |
Adverse Events
Number of adverse events (including serious adverse events)
Time frame: 8 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Lipidem | Adverse Events | 31 Adverse events |
| Lipofundin MCT | Adverse Events | 25 Adverse events |
Alanine Transaminase (ALT)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Alanine Transaminase (ALT) | 0.06 µkat/L | Standard Deviation 0.6 |
| Lipofundin MCT | Alanine Transaminase (ALT) | 0.01 µkat/L | Standard Deviation 0.25 |
Alkaline Phosphatase (ALP)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Alkaline Phosphatase (ALP) | 0.13 µkat/L | Standard Deviation 0.66 |
| Lipofundin MCT | Alkaline Phosphatase (ALP) | -0.15 µkat/L | Standard Deviation 1.46 |
Aspartate Transaminase (AST)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Aspartate Transaminase (AST) | -0.03 µkat/L | Standard Deviation 0.38 |
| Lipofundin MCT | Aspartate Transaminase (AST) | -0.00 µkat/L | Standard Deviation 0.21 |
AST/ALT Ratio
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | AST/ALT Ratio | 0.53 Ratio | Standard Deviation 1 |
| Lipofundin MCT | AST/ALT Ratio | 0.89 Ratio | Standard Deviation 2.52 |
Bilirubin
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Bilirubin | 0.36 µmol/L | Standard Deviation 3.34 |
| Lipofundin MCT | Bilirubin | 0.04 µmol/L | Standard Deviation 3.26 |
Blood Glucose
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Blood Glucose | 0.43 mmol/L | Standard Deviation 0.94 |
| Lipofundin MCT | Blood Glucose | -0.14 mmol/L | Standard Deviation 1.33 |
BMI
Body mass index Change from baseline
Time frame: 8 weeks
Population: Full Analysis Set
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | BMI | 0.4 kg/m^2 | Standard Deviation 0.7 |
| Lipofundin MCT | BMI | 0.2 kg/m^2 | Standard Deviation 0.7 |
Calcium
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Calcium | -0.01 mmol/L | Standard Deviation 0.15 |
| Lipofundin MCT | Calcium | -0.01 mmol/L | Standard Deviation 0.1 |
Chloride
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Chloride | -0.19 mmol/L | Standard Deviation 3.33 |
| Lipofundin MCT | Chloride | -0.15 mmol/L | Standard Deviation 4.08 |
Cholesterol
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Cholesterol | 0.01 mmol/L | Standard Deviation 0.39 |
| Lipofundin MCT | Cholesterol | 0.02 mmol/L | Standard Deviation 0.71 |
C-reactive Protein (CRP)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | C-reactive Protein (CRP) | 37.16 nmol/L | Standard Deviation 160.03 |
| Lipofundin MCT | C-reactive Protein (CRP) | -24.65 nmol/L | Standard Deviation 209.18 |
Gamma-glutamyl Transpeptidase (GGT)
Change from baseline
Time frame: 8 weeks
Population: Safety Set
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Gamma-glutamyl Transpeptidase (GGT) | 0.02 µkat/L | Standard Deviation 0.38 |
| Lipofundin MCT | Gamma-glutamyl Transpeptidase (GGT) | -0.11 µkat/L | Standard Deviation 1.64 |
Hematocrit (Hct)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Hematocrit (Hct) | -0.00 L/L | Standard Deviation 0.03 |
| Lipofundin MCT | Hematocrit (Hct) | -0.01 L/L | Standard Deviation 0.03 |
Hemoglobin (Hb)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Hemoglobin (Hb) | 0.52 g/L | Standard Error 8.82 |
| Lipofundin MCT | Hemoglobin (Hb) | -1.75 g/L | Standard Error 8.22 |
High-density Lipoprotein (HDL)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | High-density Lipoprotein (HDL) | -0.12 mmol/L | Standard Deviation 0.19 |
| Lipofundin MCT | High-density Lipoprotein (HDL) | 0.03 mmol/L | Standard Deviation 0.23 |
International Normalized Ratio (INR) (if Not Possible Prothrombin Time [PT = Quick-value] is Accepted)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | International Normalized Ratio (INR) (if Not Possible Prothrombin Time [PT = Quick-value] is Accepted) | -0.01 Ratio | Standard Deviation 0.25 |
| Lipofundin MCT | International Normalized Ratio (INR) (if Not Possible Prothrombin Time [PT = Quick-value] is Accepted) | -0.16 Ratio | Standard Deviation 0.71 |
Low-density Lipoprotein (LDL)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Low-density Lipoprotein (LDL) | 0.07 mmol/L | Standard Deviation 0.33 |
| Lipofundin MCT | Low-density Lipoprotein (LDL) | -0.08 mmol/L | Standard Deviation 0.76 |
Magnesium
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Magnesium | 0.00 mmol/L | Standard Deviation 0.09 |
| Lipofundin MCT | Magnesium | -0.00 mmol/L | Standard Deviation 0.06 |
Phosphate
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Phosphate | -0.02 mmol/L | Standard Deviation 0.18 |
| Lipofundin MCT | Phosphate | -0.00 mmol/L | Standard Deviation 0.16 |
Platelets
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Platelets | 3.06 10^9 cells/L | Standard Deviation 41.11 |
| Lipofundin MCT | Platelets | 6.90 10^9 cells/L | Standard Deviation 50.33 |
Potassium
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Potassium | 0.06 mmol/L | Standard Deviation 0.37 |
| Lipofundin MCT | Potassium | 0.01 mmol/L | Standard Deviation 0.46 |
Prothrombin Time (PT)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Prothrombin Time (PT) | -0.8 s | Standard Deviation 1.15 |
| Lipofundin MCT | Prothrombin Time (PT) | 1.27 s | Standard Deviation 5.16 |
Red Blood Cells (RBCs)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Red Blood Cells (RBCs) | -0.02 10^12 cells/L | Standard Deviation 0.28 |
| Lipofundin MCT | Red Blood Cells (RBCs) | -0.10 10^12 cells/L | Standard Deviation 0.28 |
Serum Creatinine
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Serum Creatinine | 3.87 µmol/L | Standard Deviation 32.42 |
| Lipofundin MCT | Serum Creatinine | 0.43 µmol/L | Standard Deviation 9.23 |
Sodium
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Sodium | 0.18 mmol/L | Standard Deviation 2.67 |
| Lipofundin MCT | Sodium | -0.58 mmol/L | Standard Deviation 2.74 |
Triene:Tetraene Ratio in Plasma, Reduction From Baseline
Derived from fatty acid pattern in plasma
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Triene:Tetraene Ratio in Plasma, Reduction From Baseline | 0.011 Ratio | Standard Deviation 0.024 |
| Lipofundin MCT | Triene:Tetraene Ratio in Plasma, Reduction From Baseline | 0.008 Ratio | Standard Deviation 0.028 |
Triglycerides
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | Triglycerides | 0.10 mmol/L | Standard Deviation 0.55 |
| Lipofundin MCT | Triglycerides | 0.19 mmol/L | Standard Deviation 0.68 |
White Blood Cells (WBCs)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | White Blood Cells (WBCs) | 0.45 10^9 cells/L | Standard Deviation 1.42 |
| Lipofundin MCT | White Blood Cells (WBCs) | 0.19 10^9 cells/L | Standard Deviation 1.39 |
α-Tocopherol/Vitamin E (Facultative if Routinely Assessed)
Change from baseline
Time frame: 8 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lipidem | α-Tocopherol/Vitamin E (Facultative if Routinely Assessed) | -3.00 µmol/L] | Standard Deviation 6.6 |
| Lipofundin MCT | α-Tocopherol/Vitamin E (Facultative if Routinely Assessed) | -1.94 µmol/L] | Standard Deviation 10.99 |