Autosomal Recessive Polycystic Kidney Disease (ARPKD)
Conditions
Keywords
ARPKD, Tolvaptan, Polycystic Kidney Disease, Autosomal Recessive Polycystic Kidney Disease, Renal Cysts, Nephromegaly, Oligohydramnios, Anhydramnios
Brief summary
The primary objective of this study is to evaluate the effect of tolvaptan on the need for renal replacement therapy in pediatric subjects with autosomal recessive polycystic kidney disease (ARPKD)
Detailed description
Tolvaptan has been demonstrated to delay the decline of kidney function in adults with rapidly progressing ADPKD (CKD stages 1 to 3), a closely related indication to ARPKD, as measured by estimated glomerular filtration rate (eGFR) and Total Kidney Volume (TKV). The trial will be the first trial of tolvaptan in a pediatric ARPKD population. Participants in this study will be assigned to tolvaptan for 24 months and closely monitored over the course of the study.
Interventions
Tolvaptan suspension will be administered orally or via nasogastric tube at doses of 0.15 mg/kg once daily in the AM, 0.30 mg/kg once daily in the AM, 0.5 mg/kg once daily in the AM, 0.75 mg/kg split dose (0.5 mg/kg AM and 0.25 mg/kg 8 hours later), and 1 mg/kg split dose (0.67 mg/kg AM and 0.33 mg/kg 8 hours later) based on age. Treatment duration is 2 years.
Sponsors
Otsuka Pharmaceutical Development & Commercialization, Inc.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
4 Weeks to 12 Weeks
Healthy volunteers
No
Inclusion criteria
1. Male or female subjects between 28 days and \< 12 weeks of age, inclusive at the time of enrollment. 2. Must have clinical and imaging features that are consistent with a diagnosis of ARPKD with all the following characteristics: * Nephromegaly (\> 2 standard deviations from age-appropriate standard via ultrasound) * Multiple renal cysts * History of oligohydramnios or anhydramnios 3. Ability for parent or guardian to provide written, informed consent prior to initiation of any trial-related procedures, and ability, in the opinion of the principal investigator, to comply with all the requirements of the trial.
Exclusion criteria
1. Premature birth (≤ 32 weeks gestational age) 2. Anuria or RRT, defined as intermittent or continuous hemodialysis, peritoneal dialysis, hemofiltration, hemodiafiltration or history of kidney transplantation 3. Evidence of syndromic conditions associated with renal cysts (other than ARPKD) 4. Abnormal liver function tests including ALT and AST, \> 1.2 × ULN 5. Parents with renal cystic disease 6. Need for chronic diuretic use 7. Cannot be monitored for fluid balance 8. Has or at risk of having sodium and potassium electrolyte imbalances 9. Has or at risk of having significant hypovolemia as determined by investigator 10. Clinically significant anemia, as determined by investigator 11. Severe systolic dysfunction defined as ejection fraction \< 14% 12. Serum sodium levels \< 130 mmol/L or \>145 mmol/L 13. Taking any other experimental medications 14. Require ventilator support 15. Taking medications known to induce CYP3A4 16. Having an infection including viral that would require therapy disruptive to IMP dosing 17. Platelet count \<50,000 µL 18. Significant Portal Hypertension 19. Bladder dysfunction or difficulty voiding 20. Taking vasopressin agonist 21. Having concomitant illness or taking medications that are likely to confound endpoint assessments. 22. History of cholangitis 23. Received or scheduled to receive a liver transplant
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The percentage of subjects that will have Renal Replacement Therapy (RRT) by 1 year of age. | From Enrollment to 1 year of age |
Secondary
| Measure | Time frame |
|---|---|
| Rate of change of eGFR by Schwartz formula from pre-treatment to after 2 years of treatment | From Enrollment to 2 years of age |
| Palatability of the suspension formulation as assessed by a parent questionnaire immediately after and within 15-20 minutes after the first oral dose | From Enrollment to 2 years of age |
| Acceptance of the suspension formulation as assessed by a parent questionnaire immediately after and within 15-20 minutes after the first oral dose | From Enrollment to 2 years of age |
Outcome results
None listed