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Trial registered on ANZCTR
Registration number
ACTRN12617000973314
Ethics application status
Approved
Date submitted
23/06/2017
Date registered
6/07/2017
Date last updated
13/07/2021
Date data sharing statement initially provided
14/02/2019
Type of registration
Retrospectively registered
Titles & IDs
Public title
Efficacy of a two bag N-acetylcysteine(NAC) regimen to treat paracetamol overdose (2NAC study).
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Scientific title
Efficacy of a two bag N-acetylcysteine(NAC) regimen to treat paracetamol overdose (2NAC study)
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Secondary ID [1]
292268
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None
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Universal Trial Number (UTN)
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Trial acronym
2 NAC study
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
paracetamol overdose
303790
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Condition category
Condition code
Mental Health
303159
303159
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0
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Suicide
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Oral and Gastrointestinal
303160
303160
0
0
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Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
Acetylcysteine intravenously (200mg/kg over 4 hours followed immediately by 100mg/kg over 16 h0urs)
For patients requiring treatment with antidote post paracetamol overdose.
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Intervention code [1]
298446
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Not applicable
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Comparator / control treatment
Acetylcysteine intravenously (150 mg/kg over 0.25 to 1 hour, 50 mg/kg over 4 hours, 100mg/kg over 16 hours)
For patients requiring treatment with antidote post paracetamol overdose.
Historical control: Between 1980 and 2005 - Canadian Acetaminophen Overdose Study
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Control group
Historical
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Outcomes
Primary outcome [1]
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The primary outcome will be the rate of acute liver injury (defined as peak Alanine transaminase (ALT)>150 IU/L and double baseline) stratified by time to first presentation bloods (<8 hrs or >8hrs). This will be assessed using serum samples.
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Assessment method [1]
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Timepoint [1]
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During hospital admission.
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Secondary outcome [1]
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Development of hepatotoxicity (alanine transaminase:ALT > 1000 IU/L). This will be assessed using serum samples.
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Assessment method [1]
336314
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Timepoint [1]
336314
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During hospital admission
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Eligibility
Key inclusion criteria
All paracetamol overdose treated with acetylcysteine
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Minimum age
No limit
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
No treatment with acetylcysteine or overdose of paracetamol.
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Study design
Purpose
Natural history
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Duration
Longitudinal
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Selection
Defined population
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Timing
Both
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Statistical methods / analysis
Descriptive data and proportions will be used in the study. Means (95%CI) or median (IQR) will be reported and the student t-test or the Mann Whitney U test will be used to analyze unpaired continuous data as indicated. The Chi square will be used to analyse unpaired categorical data.
Statistical significance will be recognized at <0.05.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
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Actual
1/02/2014
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Date of last participant enrolment
Anticipated
1/06/2022
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Actual
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Date of last data collection
Anticipated
1/06/2022
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Actual
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Sample size
Target
3000
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Accrual to date
2600
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Final
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,VIC
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Recruitment hospital [1]
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Austin Health - Austin Hospital - Heidelberg
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Recruitment hospital [2]
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Monash Medical Centre - Clayton campus - Clayton
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Recruitment hospital [3]
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Casey Hospital - Berwick
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Recruitment hospital [4]
8436
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Dandenong Hospital - Dandenong
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Recruitment hospital [5]
8437
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Prince of Wales Hospital - Randwick
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Recruitment hospital [6]
8438
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Princess Alexandra Hospital - Woolloongabba
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Recruitment hospital [7]
8439
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Calvary Mater Newcastle - Waratah
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Recruitment hospital [8]
8440
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Royal Prince Alfred Hospital - Camperdown
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Recruitment hospital [9]
8441
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Westmead Hospital - Westmead
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Recruitment hospital [10]
8442
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Blacktown Hospital - Blacktown
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Recruitment postcode(s) [1]
16505
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3084 - Heidelberg
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Recruitment postcode(s) [2]
16506
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3168 - Clayton
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Recruitment postcode(s) [3]
16507
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3806 - Berwick
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Recruitment postcode(s) [4]
16508
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3175 - Dandenong
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Recruitment postcode(s) [5]
16509
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2031 - Randwick
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Recruitment postcode(s) [6]
16510
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4102 - Woolloongabba
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Recruitment postcode(s) [7]
16511
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2298 - Waratah
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Recruitment postcode(s) [8]
16512
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2050 - Camperdown
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Recruitment postcode(s) [9]
16513
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2145 - Westmead
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Recruitment postcode(s) [10]
16514
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2148 - Blacktown
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Funding & Sponsors
Funding source category [1]
296815
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Hospital
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Name [1]
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Monash Health
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Address [1]
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Clayton Road, Clayton, Victoria 3168
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Country [1]
296815
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Australia
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Primary sponsor type
Hospital
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Name
Monash Health
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Address
Clayton Road, Clayton, Victoria 3168
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Country
Australia
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Secondary sponsor category [1]
295805
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None
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Name [1]
295805
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Address [1]
295805
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Country [1]
295805
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
298051
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Monash Health HREC
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Ethics committee address [1]
298051
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Clayton Road, Clayton, Victoria 3168
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Ethics committee country [1]
298051
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Australia
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Date submitted for ethics approval [1]
298051
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Approval date [1]
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24/04/2017
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Ethics approval number [1]
298051
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Summary
Brief summary
Paracetamol overdose is the most common pharmaceutical poisoning in developed countries and its incidence is increasing in the developing world. Overdose can lead to liver failure, and in the worst circumstances, death. In overdose, the increased production of N-acetyl para-benzoquinoneimine (NAPQI) depletes hepatic glutathione stores and eventually causes hepatocyte injury. Acetylcysteine is administered as the antidote to prevent hepatotoxicity in overdose. The typical three-bag infusion-dosing regimen in Australia is 150 mg/kg over 1 hour, 50 mg/kg over 4 hours and 100 mg/kg over 16 hours. Despite the safety of this regimen, there remains a significant amount of adverse reactions to acetylcysteine and delays between infusions. To this effect, a recent study of over 200 patients who received a two-bag acetylcysteine regimen was recently undertaken. A 200mg/kg loading dose of NAC was infused over four hours with a further 100 mg/kg infused over 16-hours. The incidence and severity of adverse reactions was significantly reduced, compared to the three-bag regimen, from 10% to 4.3%. A similar two-bag regimen has been adopted by various hospitals around Australia. The efficacy of this new two-bag regimen has not been determined. We aim to compare the rate of acute liver injury using a two-bag acetylcysteine regimen and compare this to the three-bag regimen in the setting of paracetamol overdose.
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Trial website
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Trial related presentations / publications
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Public notes
Ethics obtained from Feb 2014 from Monash Health to 24/4/17. Multicentre study approved thereafter.
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Contacts
Principal investigator
Name
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Dr Anselm Wong
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Address
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c/o Emergency Department
Austin Health
Heidelberg 3084
Victoria
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Country
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Australia
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Phone
75822
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+61 394965000
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Fax
75822
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Email
75822
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[email protected]
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Contact person for public queries
Name
75823
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Anselm Wong
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Address
75823
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c/o Emergency Department
Austin Health
Heidelberg 3084
Victoria
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Country
75823
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Australia
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Phone
75823
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+61 394965000
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Fax
75823
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Email
75823
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[email protected]
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Contact person for scientific queries
Name
75824
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Anselm Wong
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Address
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c/o Emergency Department
Austin Health
Heidelberg 3084
Victoria
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Country
75824
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Australia
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Phone
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+61 394965000
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Fax
75824
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Email
75824
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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