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| Name | Class |
|---|---|
| American Heart Association | OTHER |
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There are currently very few proven pharmacologic options available for these patients. The recent discovery of transient receptor potential vanilloid (TRPV) channels, particularly TRPV2 channels, in the cardiovascular system is promising as a potential pathway for pharmacologic intervention for Fontan patients. Probenecid, a drug best known as a treatment for gout or as a penicillin adjunct, acts as a TRPV2 agonist and has recently become the subject of study as a model therapy for the treatment of cardiomyopathy due to its positive inotropic and lusitropic effects. The purpose of this pilot study is to determine if probenecid will improve magnetic resonance (MRI) parameters of systolic and/or diastolic dysfunction as well as associated symptoms in patients with a Fontan circulation. The investigators will quantitatively assess functional improvement with pre- and post-treatment cardiopulmonary exercise testing.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Probenecid | Experimental | the study medication (probenecid) as well as a placebo. |
|
| Placebo | Placebo Comparator | placebo compared to probenecid |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Probenecid | Drug | This is a cross-over pilot study where participants will receive both the study medication (probenecid), as well as a placebo to see if the study medication improves magnetic resonance parameters of systolic and diastolic dysfunction that occurs in the Fontan population. |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in End Diastolic and End Systolic Volume as Measured by Standard and Advanced MRI Parameters | Determine if Fontan patients treated with probenecid for four weeks will experience increased systolic and diastolic function (as measured via standard and advanced MRI parameters) compared with four weeks of placebo. Participants will be assigned to either the placebo arm or study medication arm for the first four weeks. They will then undergo a four week wash out period. Finally, participants will be placed into the study arm that they were not assigned to in the first four weeks when they return for the last four weeks of study participation. There will be four MRI scans over the course of the 12 week study period. | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in Exercise Performance (VO2 Absolute) as Determined by Completing Four Graded Exercise Tests Utilizing a Cycle Ergometer Ramp Protocol; Pre and Post Study Drug and Placebo Administration. | Determine if Fontan patients treated with probenecid for four weeks will experience improved exercise performance compared with four weeks of placebo as measured by a maximal graded exercise test. Participants will complete a graded maximal cycle ergometer test at each of their four study visits. |
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Inclusion Criteria:
≥ 12 years old
Single ventricle congenital heart disease status post Fontan procedure.
Impaired ventricular function as assessed by preexisting echocardiographic studies and any available MRI studies.
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cincinnati Childrens Hospital Medical Center | Cincinnati | Ohio | 45229 | United States |
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Each patient came in for a baseline assessment visit. At the end of the baseline visit they received either probenecid or placebo. They took the medication for a month and then returned for the second visit. A washout period occurred for a month and then study patients returned for visit three where they received either probenecid or placebo; whichever was not received during visit one. This medication was taken for a month and then patients returned for the final visit.
This was a prospective randomized, placebo-controlled cross-over pilot study of up to 22 patients who have had a prior Fontan operation for single ventricle physiology who are ≥ 10 years old. Each patient completed a total of four study visits over the course of a 4 month period.
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| ID | Title | Description |
|---|---|---|
| FG000 | Probenecid, and Then Placebo | All patients will have a baseline assessment immediately preceding initiation of probenecid or placebo. This will include a physical exam to assess any clinical symptoms, review of cardiac symptoms, blood work, pregnancy test for those girls/women of child bearing potential, PEDS QL questionnaire completion, exercise testing and MRI, as described in detail below. Patients will then receive either probenecid or placebo for 28(±7 days) of treatment according to their randomization group, after which the same testing will be repeated. Following 28(±7 days) of washout, patients will undergo the same testing procedures as during the first period of study but with the alternate treatment. To assist in achieving congruence between clinical testing performed and desired pre-intervention testing, we will coordinate with each patient and his/her cardiologist prior to the clinical visit. Patients will receive a one month supply of oral probenecid therapy with the following dosing regimen:
During the placebo treatment arm, patients will receive 28(±7 days) of placebo therapy. Oral placebo therapy will be twice daily, with an identical dosing regimen as the placebo. |
| FG001 | Placebo, and Then Probenecid | All patients will have a baseline assessment immediately preceding initiation of probenecid or placebo. This will include a physical exam to assess any clinical symptoms, review of cardiac symptoms, blood work, pregnancy test for those girls/women of child bearing potential, PEDS QL questionnaire completion, exercise testing and MRI, as described in detail below. Patients will then receive either probenecid or placebo for 28(±7 days) of treatment according to their randomization group, after which the same testing will be repeated. Following 28(±7 days) of washout, patients will undergo the same testing procedures as during the first period of study but with the alternate treatment. To assist in achieving congruence between clinical testing performed and desired pre-intervention testing, we will coordinate with each patient and his/her cardiologist prior to the clinical visit. Patients will receive a one month supply of oral probenecid therapy with the following dosing regimen:
During the placebo treatment arm, patients will receive 28(±7 days) of placebo therapy. Oral placebo therapy will be twice daily, with an identical dosing regimen as the placebo. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| First Intervention (4 Weeks) |
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| Wash Out Period (4 Weeks) |
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| Second Intervention (4 Weeks) |
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| ID | Title | Description |
|---|---|---|
| BG000 | Probenecid, Then Placebo | the study medication (probenecid) as well as a placebo. Probenecid: This is a cross-over pilot study where participants will receive both the study medication (probenecid), as well as a placebo to see if the study medication improves magnetic resonance parameters of systolic and diastolic dysfunction that occurs in the Fontan population. Placebo: placebo |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Changes in End Diastolic and End Systolic Volume as Measured by Standard and Advanced MRI Parameters | Determine if Fontan patients treated with probenecid for four weeks will experience increased systolic and diastolic function (as measured via standard and advanced MRI parameters) compared with four weeks of placebo. Participants will be assigned to either the placebo arm or study medication arm for the first four weeks. They will then undergo a four week wash out period. Finally, participants will be placed into the study arm that they were not assigned to in the first four weeks when they return for the last four weeks of study participation. There will be four MRI scans over the course of the 12 week study period. | Posted | Median | Inter-Quartile Range | ml | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
|
Adverse event data was collected on a per patient basis from the beginning of enrollment at consent to subject completion or withdrawal (whichever came first) up to a maximum of 16 weeks
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Probenecid | Participants in this arm were randomly assigned to receive probenecid (study medication) during the first phase, then went through a washout phase, and finally received a placebo during the last phase. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Contraindicated Medication Taken | Gastrointestinal disorders | Non-systematic Assessment | Upon medication reconciliation it was determined that a patient had taken a contraindicated medication while enrolled. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Sore Throat | General disorders | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Mary Banks | Cincinnati Children's Hospital Medical Center | 513-636-2147 | mary.banks@cchmc.org |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 15, 2018 | Jan 25, 2021 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D011339 | Probenecid |
| ID | Term |
|---|---|
| D013449 | Sulfonamides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D013450 | Sulfones |
| D013457 |
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|
| Placebo | Other | placebo |
|
| Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
| Impact of Study Medication on Exercise Capacity (Indexed VO2 [ml/kg/Min] of Single Ventricle Patients. | Determine if there is a quantitative difference in indexed VO2 max when patients have been taking the study medication (probenecid) versus a placebo. | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
| Impact of Study Medication on the MRI Ejection Fraction of Single Ventricle Patients. | Determine if there is a quantitative difference in ejection fraction when patients are taking the study medication (probenecid) versus when they are taking a placebo. | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
| Impact of Study Medication on MRI Flow Rates of the Ventricles (Cardiac Output) in Single Ventricle Patients | Determine if there is a quantitative difference in cardiac output of single ventricle patients when taking the study medication (probenecid) versus taking a placebo. | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
| Impact of Study Medication on MRI Strain Values in Single Ventricle Patients | Determine if there is a quantitative difference in longitudinal, circumferential, and radial strain MRI values when subjects take the study medication (probenecid) versus a placebo. | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
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| NOT COMPLETED |
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| BG001 | Placebo, Then Probenecid | placebo compared to probenecid Probenecid: This is a cross-over pilot study where participants will receive both the study medication (probenecid), as well as a placebo to see if the study medication improves magnetic resonance parameters of systolic and diastolic dysfunction that occurs in the Fontan population. Placebo: placebo |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Count of Participants | Participants |
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| Left ventricle dominant | Number | participants |
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| Right ventricle dominant | Number | participants |
|
This is a cross-over pilot study. Results are indicative of subject response when receiving the study medication (probenecid).
| OG001 | Placebo | This is a cross-over pilot study. Results are indicative of subject response when receiving the placebo medication. |
|
|
| Secondary | Changes in Exercise Performance (VO2 Absolute) as Determined by Completing Four Graded Exercise Tests Utilizing a Cycle Ergometer Ramp Protocol; Pre and Post Study Drug and Placebo Administration. | Determine if Fontan patients treated with probenecid for four weeks will experience improved exercise performance compared with four weeks of placebo as measured by a maximal graded exercise test. Participants will complete a graded maximal cycle ergometer test at each of their four study visits. | Max VO2 Absolute | Posted | Mean | Inter-Quartile Range | ml/min | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
|
|
|
| Secondary | Impact of Study Medication on Exercise Capacity (Indexed VO2 [ml/kg/Min] of Single Ventricle Patients. | Determine if there is a quantitative difference in indexed VO2 max when patients have been taking the study medication (probenecid) versus a placebo. | Posted | Median | Inter-Quartile Range | ml/kg/min | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
|
|
|
| Secondary | Impact of Study Medication on the MRI Ejection Fraction of Single Ventricle Patients. | Determine if there is a quantitative difference in ejection fraction when patients are taking the study medication (probenecid) versus when they are taking a placebo. | Posted | Median | Inter-Quartile Range | percent of blood | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
|
|
|
| Secondary | Impact of Study Medication on MRI Flow Rates of the Ventricles (Cardiac Output) in Single Ventricle Patients | Determine if there is a quantitative difference in cardiac output of single ventricle patients when taking the study medication (probenecid) versus taking a placebo. | Posted | Median | Inter-Quartile Range | L/min | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
|
|
|
| Secondary | Impact of Study Medication on MRI Strain Values in Single Ventricle Patients | Determine if there is a quantitative difference in longitudinal, circumferential, and radial strain MRI values when subjects take the study medication (probenecid) versus a placebo. | Posted | Median | Inter-Quartile Range | percent | Total time participation in the study will be twelve weeks. Four weeks on the placebo or study medication, four weeks of a washout period and another four weeks with the study medication or placebo. |
|
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|
| 0 |
| 8 |
| 0 |
| 8 |
| 1 |
| 8 |
| EG001 | Placebo | Participants in this arm were randomly assigned to receive placebo during the first phase, then went through a washout phase, and finally received the study medication, probenecid, during the last phase. | 0 | 8 | 1 | 8 | 4 | 8 |
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| Overdose of study medication | Gastrointestinal disorders | Non-systematic Assessment | One subject, upon medication reconciliation had potentially taken more study medication than indicated due to forgetting if it had already been taken in a given day. |
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| Hospital Admission | Cardiac disorders | Non-systematic Assessment | Patient admitted for atrial fibrillation. Previous diagnosis of congestive heart failure. Was not taking study medication at time of admission. |
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| Loss of appetite | General disorders | Non-systematic Assessment |
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| Abdominal Pain | Gastrointestinal disorders | Non-systematic Assessment |
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| Fatigue | General disorders | Non-systematic Assessment |
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| Nausea | Gastrointestinal disorders | Non-systematic Assessment |
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| Rhinovirus | Immune system disorders | Non-systematic Assessment |
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| Migraine | General disorders | Non-systematic Assessment |
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| Weight Gain | Metabolism and nutrition disorders | Non-systematic Assessment |
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| Elevated NT-proBNP | Blood and lymphatic system disorders | Non-systematic Assessment |
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| Sulfur Compounds |
| Radial Strain, systole |
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| Longitudinal strain, diastole |
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| Circumferential strain, diastole |
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| Radial strain, diastole |
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