Evaluation of long-term treatment of children with congenital lactic acidosis with dichloroacetate.
OBJECTIVE
The purpose of this research was to report results on long-term administration of dichloroacetate in 36 children with congenital lactic acidosis who participated previously in a controlled trial of this drug.


METHODS
We conducted a randomized control trial, followed by an open-label study. Data were analyzed for each patient from the time they began treatment through May 2005.


RESULTS
Subject exposure to dichloroacetate totaled 110.42 years. Median height and weight increased over time, but the standardized values declined slightly and remained below the first percentile. There were no significant changes in biochemical metabolic indices, except for a 2% rise in total protein and a 22% increase in 24-hour urinary oxalate. Both the basal and carbohydrate meal-induced rises in lactate were blunted by dichloroacetate. The median cerebrospinal fluid lactate also decreased over time. Conduction velocity decreased and distal latency increased in peroneal nerves. Mean 3-year survival for all of the subjects was 79%.


CONCLUSIONS
Oral dichloroacetate is generally well tolerated in young children with congenital lactic acidosis. Although continued dichloroacetate exposure is associated with evidence of peripheral neuropathy, it cannot be determined whether this is attributable mainly to the drug or to progression of underlying disease.
Stacpoole
Peter W
PW
Department of Medicine, General Clinical Research Center, JHMHC, Gainesville, FL 32610-0226, USA. peter.stacpoole@medicine.ufl.edu
Gilbert
Lesa R
LR
Neiberger
Richard E
RE
Carney
Paul R
PR
Valenstein
Edward
E
Theriaque
Douglas W
DW
Shuster
Jonathan J
JJ
D000140:Acidosis, Lactic / Q000150:complications / Q000151:congenital* / Q000188:drug therapy* / Q000378:metabolism; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003999:Dichloroacetic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D019344:Lactic Acid / Q000097:blood; D008297:Male; D017237:Mitochondrial Encephalomyopathies / Q000150:complications; D009431:Neural Conduction; D015325:Pyruvate Dehydrogenase Complex Deficiency Disease / Q000150:complications
D019344:Lactic Acid; D003999:Dichloroacetic Acid