The Effect of Vitamin D Supplementation on Calcium Excretion in Thalassemia: a Dose Response Study

This study is not yet open for participant recruitment. (see Contacts and Locations)
Verified April 2011 by Weill Medical College of Cornell University
Sponsor:
Information provided by:
Weill Medical College of Cornell University
ClinicalTrials.gov Identifier:
NCT01323608
First received: March 24, 2011
Last updated: April 18, 2011
Last verified: April 2011
  Purpose

The purpose of this pilot study is to determine the effect of various doses of vitamin D supplementation on vitamin D stores and calcium excretion in the urine in subjects with Thalassemia Major (TM). Subjects with TM are routinely placed on vitamin D supplements because they frequently have osteoporosis (a condition in which bone tissue thins and loses density and strength) and low vitamin D stores. The amount of vitamin D supplementation that is required to raise vitamin D stores in optimal levels is not known in TM, and will be determined in this study. Finally, a recent study in TM has linked blood vitamin D levels to urine calcium excretion, which is a risk factor for kidney stones. Therefore, we want to determine changes in calcium excretion with various vitamin D doses and with increasing vitamin D stores. We plan to test 3 doses of vitamin D for 3 months in children and adults with TM. Changes in vitamin D blood levels and urinary calcium will be determined. The results of this pilot study will be used in future studies that will examine the effect of various doses of vitamin D supplementation in the treatment of osteoporosis in TM.


Condition Intervention Phase
Thalassemia Major
Drug: Vitamin D3
Drug: Placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Diagnostic
Official Title: The Effect of Vitamin D Supplementation on Calcium Excretion in Thalassemia: a Dose Response Study

Resource links provided by NLM:


Further study details as provided by Weill Medical College of Cornell University:

Primary Outcome Measures:
  • Vitamin D Dose Response Curve [ Time Frame: 3 Months ] [ Designated as safety issue: Yes ]
    To perform a dose response curve for vitamin D supplementation study and determine the relationship between vitamin D doses and serum 25OHD concentrations and urinary calcium excretion in children and adults with TM.


Secondary Outcome Measures:
  • Vitamin D Dose Response Curve [ Time Frame: 3 Months ] [ Designated as safety issue: Yes ]
    To determine changes in serum calcium and PTH concentrations with various vitamin D doses


Estimated Enrollment: 40
Study Start Date: June 2011
Estimated Study Completion Date: December 2014
Estimated Primary Completion Date: June 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: Placebo Drug: Placebo
Placebo
Experimental: Low Vitamin D Group
Subjects in this group will receive the equivalent of 400 IU/day.
Drug: Vitamin D3
Vitamin D3 will be given at the equivalent of the following doses: 400, 1000, and 2000 IU/day.
Experimental: Intermediate Vitamin D group Drug: Vitamin D3
Vitamin D3 will be given at the equivalent of the following doses: 400, 1000, and 2000 IU/day.
Experimental: High Vitamin D Group Drug: Vitamin D3
Vitamin D3 will be given at the equivalent of the following doses: 400, 1000, and 2000 IU/day.

  Hide Detailed Description

Detailed Description:

Specific Aim: To determine the effect of various doses of vitamin D supplementation on serum concentration of 25 hydroxy vitamin D (25OHD) and urinary calcium excretion in adults and children with TM.

Hypothesis: Vitamin D supplementation at doses that result in serum 25OHD levels >30 ng/ml result in high rates of hypercalciuria (i.e. increased urinary calcium excretion) in children and adults with TM.

The pilot study will be performed at Weill Cornell Medical College, Payson 695.

  • Children and adults with TM, will be divided into 4 groups: "standard" vitamin D dose (equivalent to 400 IU/day), "intermediate" vitamin D dose (equivalent to 1000 IU/day), "high" vitamin D dose (equivalent to 2,000 IU/day) and a "placebo" group that will receive an inactive ingredient. 10 subjects will be assigned to each group. The duration of the study will be 3 months.
  • While some studies found no difference between vitamin D2 and D3, others suggest that vitamin D3 may be more advantageous in restoring 25 OHD concentrations. For these reasons, vitamin D3 will be used in this protocol.
  • Study schedule with study interventions and frequencies is set out below (see table). All 4 groups will adhere to the same schedule. After obtaining consent, subjects will have a "Baseline Visit", which will include: 1) a complete physical examination; 2) laboratory evaluation that includes measurement of 25OHD, which is the major circulating form of vitamin D and reflects the body's vitamin D stores. Additional blood and urine samples will be obtained for measurement of urinary calcium excretion and serum Calcium and parathyroid hormone (PTH); and 3) Dietary calcium intake questionnaire. 4) Start of study medication.
  • Subjects will then return every 2-4 weeks for routine blood transfusions and as required for the management of Thalassemia. To ensure compliance, study medications will be administered by study personnel during these routine visits. Vitamin D supplies will be packaged according to one week worth requirement, i.e. as 1,000 IU/day x 7days=7,000 IU for the "intermediate" vitamin D group. The dose that will be administered during these visits will depend on the interval between transfusions, i.e. 7,000 IU x 2weeks, for a subject of the "intermediate" dose who is transfused every two weeks.
  • At the end of 3 month treatment, subjects will have a final visit, that is also scheduled to coincide with a routine transfusion visit. Subjects will have the same evaluation and procedures as in "Baseline Visit" : 1) a complete physical examination; 2) fasting laboratory evaluation that includes measurement of 25OHD, urinary calcium excretion and serum Calcium and PTH; and 3) Dietary calcium intake questionnaire.
  • Subjects will be asked to take calcium supplementation at the dose of 500 mg daily for the 6-8 year old and 1,000 mg daily for the 9-18 year old subjects. This intervention will ensure adequate calcium intake in both groups.

All labs will be processed at the CTSC Core Lab. Study meds will be distributed by the central pharmacy. Investigational drug will be administered by study personnel during the transfusion visits to ensure compliance.

Eligible subjects will be assigned to a study group following a block type of enrollment. To ensure an equal, or near equal sex and age distribution, study groups will be matched according to sex and age. Half of the subjects in each group will be composed of pediatric subjects and the other half will be composed of adult subjects.

Study Schedule and Procedures:

  • Baseline visit: Physical Exam, 25OHD, Intact PTH & Serum Calcium, 24 hr & spot urine collection for Ca/Crea, Calcium intake questionnaire, Vitamin D Supplementation/Placebo.
  • Every 2-4 weeks: Administration of Vitamin D/Placebo
  • 3 Month Visit: Physical Exam, 25OHD, Intact PTH & Serum Calcium, 24 hr & spot urine collection for Ca/Crea, Calcium intake questionnaire, and Vitamin D Supplementation/ Placebo.

Primary study endpoint:

Changes in 25OHD concentrations and calcium excretion with the various vitamin D3 doses will be determined at the end of the study and constitute the primary endpoints.

  Eligibility

Ages Eligible for Study:   6 Years to 60 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Thalassemia Major (TM)
  • 25 OHD: 15-29 ng/ml
  • Age 6 to 60 years
  • Albumin corrected serum Calcium: Normal (8.5-10.5 mg/dl)

Exclusion Criteria:

  • Other thalassemia syndromes
  • 25 OHD concentrations < 15 ng/ml or ≥30 ng/ml
  • Subjects younger than 6 years
  • Hypoparathyroidism
  • Abnormal albumin corrected serum Ca (i.e. total calcium <8.5 or > 10.5 mg/dl)
  • Medications that may adversely affect vitamin D metabolism (anticonvulsants) or absorption
  • End stage renal, heart, or liver disease
  • History of Nephrolithiasis or Nephrocalcinosis
  • Diseases associated with hypercalciuria (ie. Sarcoidosis, Cushing syndrome, and Wilson disease to name a few)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01323608

Contacts
Contact: Maria Vogiatzi, MD 212-746-3462 mvogiatz@med.cornell.edu
Contact: Patricia J Giardina, MD 212-746-3415 pjgiardi@med.cornell.edu

Locations
United States, New York
Weill Cornell Medical College Not yet recruiting
New York, New York, United States, 10065
Contact: Maria Vogiatzi, MD    212-746-3462    mvogiatz@med.cornell.edu   
Contact: Patricia J Giardina, MD    212-746-3415    pjgiardi@med.cornell.edu   
Principal Investigator: Maria Vogiatzi, MD         
Sponsors and Collaborators
Weill Medical College of Cornell University
Investigators
Principal Investigator: Maria Vogiatzi, MD Weill Medical College of Cornell University
  More Information

No publications provided

Responsible Party: Maria Vogiatzi, MD, Weill Cornell Medical College
ClinicalTrials.gov Identifier: NCT01323608     History of Changes
Other Study ID Numbers: 1102011521
Study First Received: March 24, 2011
Last Updated: April 18, 2011
Health Authority: United States: Institutional Review Board

Keywords provided by Weill Medical College of Cornell University:
Thalassemia
hypercalciuria
vitamin D
To conduct a pilot study to determine the effect of various doses of
vitamin D supplementation on vitamin D stores and their association with calcium excretion

Additional relevant MeSH terms:
Beta-Thalassemia
Thalassemia
Anemia
Anemia, Hemolytic
Anemia, Hemolytic, Congenital
Genetic Diseases, Inborn
Hematologic Diseases
Hemoglobinopathies
Cholecalciferol
Ergocalciferols
Vitamin D
Vitamins
Bone Density Conservation Agents
Growth Substances
Micronutrients
Pharmacologic Actions
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on October 20, 2014