Growth Hormone and Exclusion Diet Therapy in Juvenile Crohn's Disease

NCT01647412 | Withdrawn Phase 2 DMC

• 1 other identifier: AAAJ8306
• Study Type: interventional
• Target: N/A
• Locations: 1 country
• Sites: 1

Brief Summary

Of the estimated one million Americans with inflammatory bowel disease (IBD), approximately 20-30% develop this condition during childhood or adolescence, most of whom have Crohn's disease (CD). It appears that some individuals are genetically susceptible to certain nutrients, causing inflammation and disturbance of their immune system, as well as disruption of the intestinal barrier. This leads to malnutrition and inhibited growth, with many patients experiencing intense abdominal pain and diarrhea. Most physicians treat the disease with drugs that suppress the immune system and decrease the inflammatory process. Although these drugs frequently induce remission, most patients experience a subsequent return of symptoms and fail to catch up on their growth. Additionally, serious side effects are associated with these drugs. Individuals genetically prone to CD are believed to have a leaky gut that allows substances to pass through the intestinal wall and react with the underlying immune system. Furthermore, those nutrients that are toxic to these individuals pass through the decreased intestinal barrier triggering an extreme immune response. Nutrients that have been implicated include grains, except rice, dairy products, and any food containing carrageenan. Excluding these nutrients from the diet has been shown to beneficial for CD patients. Certain nutraceuticals, such as curcumin and omega-3 fatty acids, have been shown to provide anti-inflammatory effects in IBD patients. In addition, the administration growth hormone (GH), has been shown to alleviate symptoms, by enhancing the repair of the intestinal epithelium, preventing toxic antigens from reaching the underlying lamina propria. Previous studies and case reports provide incomplete evidence that exclusion diet with nutraceuticals (DNT) and GH lead to sustained long term remission in juvenile CD, discontinuation of other CD drugs, and catch up growth. This study is designed to test this hypothesis. Patients in the treatment group will be treated with DNT and GH, while continuing to receive medications from their physician while the control group will receive DNT, placebo injections instead of GH. We predict that the treatment group will show greater improvement than the control group.

Conditions

Crohn's Disease

Keywords

Crohn's disease; Inflammatory Bowel Disease; Growth Hormone; Nutraceuticals

Outcome Measures

Primary Outcomes (1)

• Proportion of Patients in remission

  The proportion of patients in remission in each group will be assessed and compared to each other in order to demonstrate efficacy of treatment. Remission will be assessed by a change in the patients PCDAI score to below 10.

  26 weeks and 52 weeks

Secondary Outcomes (1)

• Bone Mineral Density (BMD)

  Baseline and 52 weeks

Study Arms (2)

Growth Hormone, Exclusion Diet, and Nutraceutical therapy

ACTIVE COMPARATOR

The experimental group will receive the exclusion diet and nutraceutical therapy (DNT) and daily subcutaneously administered recombinant human growth hormone (rhGH) for the first 26 weeks. After 26 weeks this group will continue on the exclusion diet nutraceutical therapy for the remaining 26 weeks of the study.

Drug: Growth Hormone; Dietary Supplement: Nutraceutical Combination; Other: Exclusion Diet

rhGH placebo, Exclusion diet, and nutraceutical therapy

PLACEBO COMPARATOR

The experimental group will receive the exclusion diet and nutraceutical therapy (DNT) and daily subcutaneously administered placebo injections for the first 26 weeks. After 26 weeks this group will continue on the exclusion diet and nutraceutical therapy for the remaining 26 weeks of the study.

Dietary Supplement: Nutraceutical Combination; Other: Exclusion Diet; Other: Placebo Growth Hormone

Interventions

Growth Hormone DRUG

Humatrope will be administered daily to patients in a dose of .18-.20 mg/kg/week.

Growth Hormone, Exclusion Diet, and Nutraceutical therapy

Nutraceutical Combination DIETARY_SUPPLEMENT

Also known as: Jarrow Curcumin oral capsule bid, Jarrow Max DHA (Fish oil) oral capsule daily, Culturelle Probiotics oral capsule tw, Intestive oral capsule bid, Nutrient 950 without Iron (Multivitamin) oral capsule daily

Growth Hormone, Exclusion Diet, and Nutraceutical therapy; rhGH placebo, Exclusion diet, and nutraceutical therapy

Exclusion Diet OTHER

Patients on the exclusion diet will adhere from consumption of all grain, corn, dairy, and carrageenan containing products.

Growth Hormone, Exclusion Diet, and Nutraceutical therapy; rhGH placebo, Exclusion diet, and nutraceutical therapy

Placebo Growth Hormone OTHER

rhGH placebo, Exclusion diet, and nutraceutical therapy

Eligibility Criteria

• Age: 10 Years - 17 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Ability to provide written informed consent
• Age 10-17 years
• Diagnosis of CD as determined by standard clinical, radiological, and pathological criteria
• Clinical evidence of CD for more than 2 years
• Moderate to severely active CD, as defined by a PCDAI score \> 30 and \< 65
• May continue use of aminosalicylates, antibiotics, immunomodulators, including azathioprine, 6-mercaptopurine and methotrexate, as well as the monoclonal antibody drug, infliximab, if prescribed for at least 4 months and receiving stable doses for at least 2 months prior to baseline visit
• May continue the use of prednisone if prescribed for at least 6 weeks prior to baseline visit
• Meets the following hematological and biochemical requirements:
• HGB \> 8.5 g/dl
• WBC \> 3.5 x 109/L
• Neut. \> 1.5 x 109
• Plats \> 100 x 109/L
• SGOT \& Alk Phos not \> 2 times the upper limit of normal

You may not qualify if:

• Acute critical illness
• Acute, chronic, or latent infection
• Active neoplasia and/or history of neoplastic disease of any origin other than basal cell carcinoma that has been removed
• Evidence of a systemic disorder unrelated to CD involving hepatic, gastrointestinal, pulmonary, cardiac, renal, hematologic, endocrine, central or peripheral nervous systems
• Use of parenteral corticosteroids or corticotrophin within 2 months of baseline visit
• Use of another investigational agent within 3 months of baseline visit
• Long-term anti-coagulant therapy or use of any anti-coagulant medication, including NSAIDs or ASA, within 2 weeks of screening visit
• Pregnancy (positive pregnancy test)
• Positive stool culture for enteric pathogens, pathogenic ova, parasites or clostridium difficile toxin
• Any condition that the investigator believes would pose significant harm to the subject if the investigational therapy were initiated
• Diagnosis of short bowel syndrome and also on TPN
• Presence of an ostomy, symptomatic stenosis or ileal stricture, or severe intestinal stricture, proctocolectomy, total colectomy or stoma
• Patients in imminent need of surgery due to active gastrointestinal bleeding fixed stenosis, intermittent obstruction or obstructive event within 2 months prior to screening.
• Patients who underwent CD surgery within 2 months of screening

Sponsors & Collaborators

• Columbia University: lead

Study Sites (1)

Columbia University Department of Clinical Genetics

New York, New York, 10032, United States

Location

MeSH Terms

Conditions

Crohn Disease; Inflammatory Bowel Diseases

Interventions

Growth Hormone; BID protein, human; Fish Oils; Iron; Geritol; Elimination Diets

Condition Hierarchy (Ancestors)

Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Intestinal Diseases

Intervention Hierarchy (Ancestors)

Pituitary Hormones, Anterior; Pituitary Hormones; Peptide Hormones; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Peptides; Amino Acids, Peptides, and Proteins; Oils; Lipids; Metals, Heavy; Elements; Inorganic Chemicals; Transition Elements; Metals; Diet; Nutritional Physiological Phenomena; Diet, Food, and Nutrition; Physiological Phenomena

Study Officials

• Alfred E Slonim, MD

  Columbia University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 19, 2012
• First Posted: July 23, 2012
• Study Start: March 1, 2012
• Last Updated: April 13, 2015

Record last verified: 2015-04

Locations

US (1)