Primary Hyperparathyroidism (PHPT): Early Effect of Vitamin D

NCT ID: NCT01329666

Last Updated: 2015-03-05

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: PHASE2/PHASE3
• Study Classification: INTERVENTIONAL
• Study Start Date: 2010-05-31
• Study Completion Date: 2015-01-31

Brief Summary

Primary hyperparathyroidism (PHPT) is a common disease that occurs in 1 in 10,000 people every year. In the presence of this condition, the parathyroid glands produce excessive amounts of parathyroid hormone (PTH), which regulates calcium levels. The high levels of parathyroid hormone remove too much calcium from bones, and then deposit the excess calcium in the blood, which is then filtered into the urine by the kidneys. Bone health is threatened by excess calcium loss which weakens bone structure. Other affected organs include the skeleton (calcium loss leads to a "weakening" of the skeleton), and the kidneys (high blood calcium can lead to kidney stones).

It is now evident that the majority of patients with even mild Primary Hyperparathyroidism are vitamin D deficient. In 2009, new international guidelines for the management of asymptomatic PHPT direct physicians to measure 25-hydroxyvitamin D (D3 or 25-OHD) in all patients, and to replete the reserve of vitamin D when the level is low (< 20 ng/ml). However, no recommendations for vitamin D repletion are given, because of limited data regarding the effects of vitamin D repletion, appropriate dosing and safety. Therefore, there is an urgent need for data upon which to base such recommendations, as well as are data on the effects of such treatment upon bones.

Subjects with low vitamin D3 levels will be selected for this trial. They will be given enough vitamin D3 to raise their low blood levels from a low to a normal range. The assessments in this study, including the quadruple label bone biopsy, will allow us to document the short term effects of administering vitamin D3 on changes in bone.

All participants enrolled in this trial will be vitamin D3 deficient. Participants will take an antibiotic (tetracycline) 4 times a day to mark the starting point from which bone changes will be assessed. After 3 days of tetracycline, a 12 week course of vitamin D3 or placebo will be initiated. Six of 7 participants will receive the study drug (active vitamin D3), while 1 in 7 will receive a placebo (sugar pill). Ten weeks later, another 3-day course of tetracycline will be given. At the end of 12 weeks, a bone biopsy will be done. A small piece of bone (about the size of a pencil eraser) will be removed from the hip (iliac crest). The bone will be analyzed to determine the effect of vitamin D3 on primary hyperparathyroidism.

There will be 4 study visits: Screening, Baseline, Week 8, and Week 12 when the bone biopsy will be performed.

Study Procedures:

Medical and Social History

Blood tests (drawn at the study center and local Quest Lab)

24-Hour urine collection for calcium and creatinine excretion

Abdominal X-ray (to assess for kidney stones)

Transiliac crest Bone Biopsy

Conditions

Primary Hyperparathyroidism; Hypercalcemia; Vitamin D Deficiency; Osteoporosis; Osteopenia

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Blinding Strategy: QUADRUPLE

Study Groups

50,000 IU Vitamin D3

Group Type: EXPERIMENTAL

Vitamin D3

Intervention Type: DIETARY_SUPPLEMENT

Baseline:

50,000 IU/week for 8 weeks

Week 8:

Subjects with D3 less than 30 ng/ml: 50,000 IU/week for 4 weeks.

Subjects with D3 25-OHD at or above 30 ng/ml: 50,000 IU/every 2 weeks for 4 weeks.

Placebo (inactive Vitamin D3)

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: DIETARY_SUPPLEMENT

Subjects will receive placebo vitamin D3, 1 pill weekly for 12 weeks.

Interventions

Placebo

Subjects will receive placebo vitamin D3, 1 pill weekly for 12 weeks.

Intervention Type: DIETARY_SUPPLEMENT

Vitamin D3

Baseline:

50,000 IU/week for 8 weeks

Week 8:

Subjects with D3 less than 30 ng/ml: 50,000 IU/week for 4 weeks.

Subjects with D3 25-OHD at or above 30 ng/ml: 50,000 IU/every 2 weeks for 4 weeks.

Intervention Type: DIETARY_SUPPLEMENT

Eligibility Criteria

Inclusion Criteria

1. Females and males >= 45 years of age

2. PHPT, defined as elevated PTH with elevated serum calcium

3. Screening 25-OHD <= 20 ng/ml

Exclusion Criteria

1. Pre-menopausal

2. Serum calcium is >11.5mg/dl.

3. Urinary calcium is >350 mg/dl.

4. Active nephrolithiasis

5. Nephocalcinosis

6. Known sensitivity to tetracycline (Sumycin)

7. Familial history of hyperparathyroid syndromes

8. Bisphosphonate use within past 2 years.

9. Current use of Prolia.

10. Current use of Cinacalcet.

11. Currently using Cimetidine.

12. Currently use Colestipol.

13. Currently using Orlistat.

14. Current or past malignancy, except cured basal or squamous cell skin carcinoma or other cancers that have not recurred for at least five years.

15. Current tuberculosis, or history of Sarcoidosis, HIV/AIDS, chronic kidney disease (serum creatinine >= 1.5), liver disease, Crohn's Disease, Celiac Disease, or gastric bypass

• Minimum Eligible Age: 45 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role: collaborator

Columbia University

OTHER

Sponsor Role: lead

Responsible Party

Shonni J. Silverberg

Professor of Medicine, Endocrinology

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Shonni J. Silverberg, MD

Role: PRINCIPAL_INVESTIGATOR

Columbia University

Locations

Columbia University Medical Center

New York, New York, United States

Countries

United States

Other Identifiers

R01DK084986

Identifier Type: NIH

Identifier Source: secondary_id

View Link

AAAF1846

Identifier Type: -

Identifier Source: org_study_id