IRB-approved amendments were also made in the PEDS- C protocol to increase recruitment. The exclusion criteria were modified from “abnormal ceruloplasmin and alpha-1- antitrypsin” to “abnormally low ceruloplasmin or alpha-l- antitrypsin”, and the allowable interval between liver biopsy and screening was changed from 24 to 36 months. Sites were also given permission to recruit more than 15 patients per site.
In addition, an exemption committee was established for the rapid consideration of requested protocol exemptions for recruitment. The committee consisted of four steering committee site principal investigators and a member of the National Institute of Diabetes and Digestive and Kidney Diseases. The exemption request was submitted on a generic form and each voted upon by the committee within 1—-2 days of submission. The exemptions were also submitted to the IRBS of all the participating sites and were approved. A total of 12 exemptions were requested and 10 were granted. Most were related to minor laboratory abnormalities, or biopsy and screening dates out of range by a few days. The protocol reflected any changes made on the basis of the exemptions which were also approved by the IRB of all participating sites in a timely fashion. The final strategies employed by the PEDS-C group were: allowing the option of using local laboratories for repeat laboratory testing, screening foster