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Treatment of Optic Neuritis With Erythropoietin: a Randomised, Double-blind, Placebo-controlled Trial (TONE)

Primary Purpose

Optic Neuritis

Status
Completed
Phase
Phase 3
Locations
Germany
Study Type
Interventional
Intervention
Erythropoietin alfa
Placebo
Sponsored by
University Eye Hospital, Freiburg
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Optic Neuritis focused on measuring Optic neuritis, Multiple Sclerosis, Clinically isolated syndrome, Erythropoietin

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Patients eligible for inclusion in this trial must meet all of the following criteria:

  1. Written informed consent obtained according to international guidelines and local laws
  2. Male and female patients aged ≥ 18 to ≤ 50 years
  3. Patients with ON
  4. First symptoms of ON ≤ 10 days prior to the first administration of investigational product
  5. High contrast visual acuity (HCVA) of ≤ 0.5 (decimal system)
  6. Adequate OCT measurements available

Patients eligible for this trial must not meet any of the following criteria:

  1. Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial
  2. Simultaneous participation in another interventional trial which could interfere with this trial and/or participation in a clinical trial within the last 3 months before enrolment in this trial
  3. Refractive anomalies: Hyperopia > 5 dpt, myopia < -7 dpt, astigmatism > 3 dpt
  4. Media opacity
  5. Severe papillitis
  6. Previous ON
  7. Any other optic nerve and retinal disease
  8. Pre-existing MS or any other neurological disease
  9. Congenital diseases:

    • thrombophilia
    • phenylketonuria
  10. Acquired diseases:

    • autoimmune diseases,
    • cardiovascular diseases,
    • diabetes mellitus,
    • uncontrolled hypertension (with blood pressure > 140 / 90 mm Hg (cf. chapter 7.7.5)),
    • any malignancy,
    • epilepsy,
    • known tuberculosis with ongoing or unknown activity,
    • acute gastrointestinal ulceration within the last 3 months prior to randomisation,
    • acute viral, bacterial or fungal infection,
    • known infection with Human Immunodeficiency Virus (HIV), Hepatitis B Virus, or Hepatitis C Virus,
    • history of colitis ulcerosa, diverticulitis, or acute enteroanastomosis,
    • known osteoporosis,
    • history of thromboembolic events,
    • elevated haemoglobin level (>17 g/dl in men or >15 g/dl in women)
    • polycythaemia
    • any other significant illness potentially interfering with any trial assessment or trial treatment
  11. Performing semi-professional or professional sporting activities or physical training
  12. Pre-treatment with corticosteroids in the last 30 days prior to the onset of optic neuritis
  13. Pre-treatment with EPO
  14. Known or persistent abuse of medication, drugs or alcohol
  15. Active immunization within 2 weeks prior to randomisation
  16. Significant surgery within 4 weeks prior to randomisation
  17. Blood donation or bloodletting within 4 weeks prior to screening
  18. Pre-treatment with immunosuppressive or immunomodulatory agents
  19. Persons who are in a relationship of dependence/employment with the sponsor or the investigator

    This section concerns only female patients who are able to have a child:

  20. Current or planned pregnancy; nursing period within 3 months from investigational product administration
  21. Unwillingness to use one of the following safe combination methods of contraception within 3 months from investigational product administration to achieve a PEARL index of <1: female condom, diaphragm or coil, each used in combination with a spermicide; hormonal intra-uterine device or hormonal contraception in combination with a mechanical method of contraception

Sites / Locations

  • Medical Center - University of Freiburg, Eye Hospital
  • Heidelberg University Hospital, Department of Neurooncology
  • Tuebingen University Hospital
  • University Hospital Erlangen
  • University Hospital of Munich
  • University Hospital Klinikum rechts der Isar, Munich
  • University Medical Center Göttingen
  • Hannover Medical School
  • Duesseldorf University Hospital
  • University Medical Center of the Johannes Gutenberg University Mainz
  • University Medical Center Hamburg-Eppendorf

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Erythropoietin alfa

Placebo

Arm Description

Recombinant human EPO (Epoetin alfa HEXAL®) will be given as an i.v. bolus injection on days 1, 2 and 3. The dosage per day will be 33.000 IU in accordance with previous trials.

As matched placebo for this study, sterile normal saline (0.9% sodium chloride for i.v. administration) will be used. It will be given as a bolus injection in the same manner as EPO.

Outcomes

Primary Outcome Measures

Global retinal nerve fibre layer thickness (RNFLT-G)
Determination of the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone (standard of care) as assessed by measurement of global retinal nerve fibre layer thickness (RNFLT-G) in the affected eye 6 months after randomisation.
Low contrast visual acuity (LCVA)
Determination of the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone (standard of care) as assessed by measurement of low contrast visual acuity (LCVA) in the affected eye 6 months after randomisation.

Secondary Outcome Measures

Absolute values of the global retinal nerve fibre layer thickness
Retinal nerve fibre layer thickness in the papillomacular bundle
Retinal nerve fibre layer thickness in the temporal quadrant
Total macular volume
Visual acuity
Contrast sensitivity
Mean visual field defect
Latency [ms] and amplitude [µV] of visual evoked potentials (VEP)
Expanded Disability Status Scale (EDSS) score
Quality of life
Determined by NEI-VFQ-25
Safety
Assessment of AEs / SAEs

Full Information

First Posted
September 30, 2013
Last Updated
November 29, 2019
Sponsor
University Eye Hospital, Freiburg
Collaborators
German Federal Ministry of Education and Research
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1. Study Identification

Unique Protocol Identification Number
NCT01962571
Brief Title
Treatment of Optic Neuritis With Erythropoietin: a Randomised, Double-blind, Placebo-controlled Trial
Acronym
TONE
Official Title
Treatment of Optic Neuritis With Erythropoietin: a Randomised, Double-blind, Placebo-controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
November 2019
Overall Recruitment Status
Completed
Study Start Date
November 25, 2014 (Actual)
Primary Completion Date
June 20, 2018 (Actual)
Study Completion Date
November 26, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Eye Hospital, Freiburg
Collaborators
German Federal Ministry of Education and Research

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This clinical trial aims at preventing visual dysfunction and optic nerve degeneration associated with autoimmune optic neuritis by systemic i.v. administration of 33.000 IU erythropoietin over 3 days. The primary objective is to determine the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone as assessed by measurements of retinal nerve fibre layer thickness and low contrast visual acuity 6 months after acute optic neuritis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Optic Neuritis
Keywords
Optic neuritis, Multiple Sclerosis, Clinically isolated syndrome, Erythropoietin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
108 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Erythropoietin alfa
Arm Type
Experimental
Arm Description
Recombinant human EPO (Epoetin alfa HEXAL®) will be given as an i.v. bolus injection on days 1, 2 and 3. The dosage per day will be 33.000 IU in accordance with previous trials.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
As matched placebo for this study, sterile normal saline (0.9% sodium chloride for i.v. administration) will be used. It will be given as a bolus injection in the same manner as EPO.
Intervention Type
Drug
Intervention Name(s)
Erythropoietin alfa
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Saline
Primary Outcome Measure Information:
Title
Global retinal nerve fibre layer thickness (RNFLT-G)
Description
Determination of the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone (standard of care) as assessed by measurement of global retinal nerve fibre layer thickness (RNFLT-G) in the affected eye 6 months after randomisation.
Time Frame
6 months
Title
Low contrast visual acuity (LCVA)
Description
Determination of the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone (standard of care) as assessed by measurement of low contrast visual acuity (LCVA) in the affected eye 6 months after randomisation.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Absolute values of the global retinal nerve fibre layer thickness
Time Frame
6 months
Title
Retinal nerve fibre layer thickness in the papillomacular bundle
Time Frame
6 months
Title
Retinal nerve fibre layer thickness in the temporal quadrant
Time Frame
6 months
Title
Total macular volume
Time Frame
6 months
Title
Visual acuity
Time Frame
6 months
Title
Contrast sensitivity
Time Frame
6 months
Title
Mean visual field defect
Time Frame
6 months
Title
Latency [ms] and amplitude [µV] of visual evoked potentials (VEP)
Time Frame
6 months
Title
Expanded Disability Status Scale (EDSS) score
Time Frame
6 months
Title
Quality of life
Description
Determined by NEI-VFQ-25
Time Frame
6 months
Title
Safety
Description
Assessment of AEs / SAEs
Time Frame
Screening until end of study

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Patients eligible for inclusion in this trial must meet all of the following criteria: Written informed consent obtained according to international guidelines and local laws Male and female patients aged ≥ 18 to ≤ 50 years Patients with ON First symptoms of ON ≤ 10 days prior to the first administration of investigational product High contrast visual acuity (HCVA) of ≤ 0.5 (decimal system) Adequate OCT measurements available Patients eligible for this trial must not meet any of the following criteria: Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial Simultaneous participation in another interventional trial which could interfere with this trial and/or participation in a clinical trial within the last 3 months before enrolment in this trial Refractive anomalies: Hyperopia > 5 dpt, myopia < -7 dpt, astigmatism > 3 dpt Media opacity Severe papillitis Previous ON Any other optic nerve and retinal disease Pre-existing MS or any other neurological disease Congenital diseases: thrombophilia phenylketonuria Acquired diseases: autoimmune diseases, cardiovascular diseases, diabetes mellitus, uncontrolled hypertension (with blood pressure > 140 / 90 mm Hg (cf. chapter 7.7.5)), any malignancy, epilepsy, known tuberculosis with ongoing or unknown activity, acute gastrointestinal ulceration within the last 3 months prior to randomisation, acute viral, bacterial or fungal infection, known infection with Human Immunodeficiency Virus (HIV), Hepatitis B Virus, or Hepatitis C Virus, history of colitis ulcerosa, diverticulitis, or acute enteroanastomosis, known osteoporosis, history of thromboembolic events, elevated haemoglobin level (>17 g/dl in men or >15 g/dl in women) polycythaemia any other significant illness potentially interfering with any trial assessment or trial treatment Performing semi-professional or professional sporting activities or physical training Pre-treatment with corticosteroids in the last 30 days prior to the onset of optic neuritis Pre-treatment with EPO Known or persistent abuse of medication, drugs or alcohol Active immunization within 2 weeks prior to randomisation Significant surgery within 4 weeks prior to randomisation Blood donation or bloodletting within 4 weeks prior to screening Pre-treatment with immunosuppressive or immunomodulatory agents Persons who are in a relationship of dependence/employment with the sponsor or the investigator This section concerns only female patients who are able to have a child: Current or planned pregnancy; nursing period within 3 months from investigational product administration Unwillingness to use one of the following safe combination methods of contraception within 3 months from investigational product administration to achieve a PEARL index of <1: female condom, diaphragm or coil, each used in combination with a spermicide; hormonal intra-uterine device or hormonal contraception in combination with a mechanical method of contraception
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wolf A. Lagrèze, Prof.
Organizational Affiliation
Eye Hospital, Medical Center - University of Freiburg
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medical Center - University of Freiburg, Eye Hospital
City
Freiburg
State/Province
Baden-Wuerttemberg
ZIP/Postal Code
79106
Country
Germany
Facility Name
Heidelberg University Hospital, Department of Neurooncology
City
Heidelberg
State/Province
Baden-Wuerttemberg
ZIP/Postal Code
69120
Country
Germany
Facility Name
Tuebingen University Hospital
City
Tuebingen
State/Province
Baden-Wuerttemberg
ZIP/Postal Code
72076
Country
Germany
Facility Name
University Hospital Erlangen
City
Erlangen
State/Province
Bayern
ZIP/Postal Code
91054
Country
Germany
Facility Name
University Hospital of Munich
City
Munich
State/Province
Bayern
ZIP/Postal Code
81377
Country
Germany
Facility Name
University Hospital Klinikum rechts der Isar, Munich
City
Munich
State/Province
Bayern
ZIP/Postal Code
81675
Country
Germany
Facility Name
University Medical Center Göttingen
City
Göttingen
State/Province
Niedersachsen
ZIP/Postal Code
37075
Country
Germany
Facility Name
Hannover Medical School
City
Hannover
State/Province
Niedersachsen
ZIP/Postal Code
30625
Country
Germany
Facility Name
Duesseldorf University Hospital
City
Duesseldorf
State/Province
Nordrhein-Westfalen
ZIP/Postal Code
40225
Country
Germany
Facility Name
University Medical Center of the Johannes Gutenberg University Mainz
City
Mainz
State/Province
Rheinland-Pfalz
ZIP/Postal Code
55131
Country
Germany
Facility Name
University Medical Center Hamburg-Eppendorf
City
Hamburg
ZIP/Postal Code
20246
Country
Germany

12. IPD Sharing Statement

Citations:
PubMed Identifier
22926853
Citation
Suhs KW, Hein K, Sattler MB, Gorlitz A, Ciupka C, Scholz K, Kasmann-Kellner B, Papanagiotou P, Schaffler N, Restemeyer C, Bittersohl D, Hassenstein A, Seitz B, Reith W, Fassbender K, Hilgers R, Heesen C, Bahr M, Diem R. A randomized, double-blind, phase 2 study of erythropoietin in optic neuritis. Ann Neurol. 2012 Aug;72(2):199-210. doi: 10.1002/ana.23573.
Results Reference
background
PubMed Identifier
26932144
Citation
Diem R, Molnar F, Beisse F, Gross N, Druschler K, Heinrich SP, Joachimsen L, Rauer S, Pielen A, Suhs KW, Linker RA, Huchzermeyer C, Albrecht P, Hassenstein A, Aktas O, Guthoff T, Tonagel F, Kernstock C, Hartmann K, Kumpfel T, Hein K, van Oterendorp C, Grotejohann B, Ihorst G, Maurer J, Muller M, Volkmann M, Wildemann B, Platten M, Wick W, Heesen C, Schiefer U, Wolf S, Lagreze WA. Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial-study protocol. BMJ Open. 2016 Mar 1;6(3):e010956. doi: 10.1136/bmjopen-2015-010956.
Results Reference
background
PubMed Identifier
34800417
Citation
Lagreze WA, Kuchlin S, Ihorst G, Grotejohann B, Beisse F, Volkmann M, Heinrich SP, Albrecht P, Ungewiss J, Worner M, Hug MJ, Wolf S, Diem R; TONE study group. Safety and efficacy of erythropoietin for the treatment of patients with optic neuritis (TONE): a randomised, double-blind, multicentre, placebo-controlled study. Lancet Neurol. 2021 Dec;20(12):991-1000. doi: 10.1016/S1474-4422(21)00322-7.
Results Reference
derived
PubMed Identifier
26396053
Citation
Wilhelm H, Schabet M. The Diagnosis and Treatment of Optic Neuritis. Dtsch Arztebl Int. 2015 Sep 11;112(37):616-25; quiz 626. doi: 10.3238/arztebl.2015.0616.
Results Reference
derived
PubMed Identifier
25063544
Citation
Lagreze W, Diem R. [New aspects in the therapy of multiple sclerosis and optic neuritis]. Ophthalmologe. 2014 Aug;111(8):709-14. doi: 10.1007/s00347-013-2987-7. German.
Results Reference
derived

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Treatment of Optic Neuritis With Erythropoietin: a Randomised, Double-blind, Placebo-controlled Trial

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