THOP2: Study of Thyroid Hormones in Prematures

Sponsor

New York Medical College (Other)

Overall Status

Withdrawn

CT.gov ID

NCT02103998

Collaborator

National Institute of Neurological Disorders and Stroke (NINDS) (NIH)

Enrollment

Location

Arms

Anticipated Duration (Months)

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The investigators hypothesize that continuous infusion of 4 µg/Kg/day T4 with 30 µg/Kg/day oral potassium iodide (KI) for 42 days from birth will reduce by 30% or more (from an estimated 30% to 21%) the proportion of extremely low gestational age subjects with a composite endpoint of "cerebral palsy (CP) or a Bayley III Composite Cognitive Score < 85" at 36 months corrected postnatal age (CA).

Condition or Disease	Intervention/Treatment	Phase
Transient Hypothyroxinemia of Prematurity (THOP)	Drug: thryoid hormone T4 + oral potassium iodide (KI) for 42 days Drug: D5W - 5% dextrose water	Phase 3

Detailed Description

This study is a Phase III multicenter, masked, placebo controlled randomized clinical trial (RCT) of thyroid hormone supplementation in premature infants. Survival for extremely low gestational age neonates (ELGAN; 24 - 28 weeks) has risen to >80% over the past 40 years yet cognitive delays or cerebral palsy (CP) still affect 30% of survivors. Since more than 25,000 ELGANs are born each year in the United States, a major priority in newborn medicine must be to translate the gains in survival into gains in healthy survival without the current high frequency of impairments. Transient hypothyroxinemia of prematurity (THOP) occurs in 50% of ELGANs and is strongly associated as an independent risk factor with lower IQ scores, behavioral abnormalities and CP in ELGANs. Prior evidence suggested a benefit from replacement therapy but studies were underpowered to prove this. The current project extends the findings of our Phase 1 trial (THOP1; R01-NS45109) where four thyroid hormone regimens were tested. We showed that continuous infusion of 4 µg/Kg/day thyroxine x 42d could safely correct transient hypothyroxinemia without markedly lowering TSH - creating a "biochemical euthyroid" state. THOP2 is designed to test the primary hypothesis that compared to placebo, thyroid hormone supplementation from birth will reduce from 30% to 21% the proportion of subjects with a composite endpoint of "CP or a Bayley III Cognitive Score < 85." A Secondary hypothesis is that hormone treatment will improve other measures of cognitive and executive function or attention as assessed by: i) Bayley III Parent Interview for Adaptive Behavior and the BRIEF-P (Behavioral Rating Inventory of Executive Function-Preschool Version) and ii) the frequency of screening positive on the Modified Checklist for Autism in Toddlers (M-CHAT). We plan to enroll 1,224 subjects over a 19.8 month period at 14 centers to obtain 388 surviving toddlers at 36 months corrected age in each of two arms. The current application describes the scientific basis of the proposed overall clinical trial; it is linked to a cluster application creating a Data Monitoring and Analysis Coordinating Center (DCC) at Michigan State University (MSU). The additional societal cost from CP in an affected person's lifetime is estimated at $1 million; the costs of mental retardation are even higher. If this trial shows that an inexpensive intervention can reduce the risks of CP and mental retardation by 30% in ELGANs, we estimate the overall savings from preventing more than 2,000 such cases (9% of 25,000) at about $2 billion per year.

Study Design

Study Type:

Interventional

Actual Enrollment :

0 participants

Allocation:

Randomized

Intervention Model:

Single Group Assignment

Masking:

Triple (Participant, Care Provider, Investigator)

Primary Purpose:

Treatment

Official Title:

Phase III Study of Thyroid Hormones in Prematures

Anticipated Study Start Date :

Jul 1, 2020

Anticipated Primary Completion Date :

May 1, 2025

Anticipated Study Completion Date :

May 1, 2026

Arms and Interventions

Arm	Intervention/Treatment
Experimental: T4 + KI Continuous infusion of 4 µg/Kg/day T4 with 30 µg/Kg/day oral potassium iodide (KI) for 42 days	Drug: thryoid hormone T4 + oral potassium iodide (KI) for 42 days Continuous infusion of 4 µg/Kg/day T4 with 30 µg/Kg/day oral potassium iodide (KI) for 42 days Other Names: levothyroxin postassium iodide
Placebo Comparator: D5W - 5% dextrose water Receive the same volume as study drug but as D5W placebo	Drug: D5W - 5% dextrose water Equivalent volume of infusion as study drug Other Names: Standard hospital pharmacy solution

Arm

Intervention/Treatment

Experimental: T4 + KI

Continuous infusion of 4 µg/Kg/day T4 with 30 µg/Kg/day oral potassium iodide (KI) for 42 days

Drug: thryoid hormone T4 + oral potassium iodide (KI) for 42 days

Continuous infusion of 4 µg/Kg/day T4 with 30 µg/Kg/day oral potassium iodide (KI) for 42 days

Other Names:

levothyroxin

postassium iodide

Placebo Comparator: D5W - 5% dextrose water

Receive the same volume as study drug but as D5W placebo

Drug: D5W - 5% dextrose water

Equivalent volume of infusion as study drug

Other Names:

Standard hospital pharmacy solution

Outcome Measures

Primary Outcome Measures

Compare incidence of a COMPOSITE endpoint of "cerebral palsy (CP) or a Bayley III Composite Cognitive Score < 85" at 36 months corrected postnatal age (CA). [36 months]
Bayley III Cognitive Score and a standardize ELGAN-type neurological exam (Kuban) plus a Palisano assessment of function

Secondary Outcome Measures

Compare measures of cognitive and executive function and attention. [36 months corrected age]
As assessed by the following tests: The mean scores of the Bayley III Parent Interview for Adaptive Behavior and the BRIEF-P (Behavioral Rating Inventory of Executive Function-Preschool Version). The frequency of screening positive on the Modified Checklist for Autism in Toddlers (M-CHAT).

Eligibility Criteria

Criteria

Ages Eligible for Study:

1 Hour to 24 Hours

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

Neonates 24 0/7 to 27 6/7 weeks gestational age
inborn or transferred; < 24 hours old

Exclusion Criteria:

Maternal or congenital thyroid disease or
Maternal substance abuse by history at the time of birth (heroin or cocaine)
Major congenital or surgical malformations of neonate
Known chromosomal anomalies detected by antepartum testing or direct physical examination
Absence of parental consent or treating physician assent
A concurrent clinical trial with another randomized drug
Death expected < 48h vi) Another concern by the treating physician that either mandates or prohibits study treatment such as known adverse drug interaction
mother < 18 years old at delivery