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Controlled Trial of Panhematin in Treatment of Acute Attacks of Porphyria

Primary Purpose

Acute Porphyrias

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Panhematin
Glucose
Sponsored by
The University of Texas Medical Branch, Galveston
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Porphyrias focused on measuring Acute porphyria, Hemin

Eligibility Criteria

18 Years - 100 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female aged 18 years
  • Willing to provide written informed consent
  • Acute symptoms (7 days duration or less to time of enrollment) such as abdominal, back and/or limb pain, diagnosed by the investigator as caused by porphyria after initial evaluation has excluded other causes.
  • Diagnosis of acute porphyria documented by a substantial increase in urinary or serum porphobilinogen (PBG).
  • Type of acute porphyria confirmed by additional testing (in addition to increased PBG), which may be completed before or after treatment begins using pretreatment samples:
  • For acute intermittent porphyria (AIP): Normal or only slight increases in plasma and fecal porphyrins. Most (~90 percent) will have deficient activity of erythrocyte porphobilinogen deaminase (PBGD), and almost all (>95 percent) will have a demonstrable disease-causing PBGD mutation.
  • For hereditary coproporphyria (HCP): Substantial increases in fecal porphyrins (almost entirely coproporphyrin III). In the absence of skin photosensitivity, most will have normal or only slight increases in plasma porphyrins. Almost all (>95 percent) will have a demonstrable disease-causing coproporphyrinogen oxidase (CPO) mutation.
  • For variegate porphyria (VP): Substantial increases in fecal porphyrins (mostly coproporphyrin III and protoporphyrin), increased plasma total porphyrins and a fluorescence emission maximum of diluted plasma at neutral pH near 626 nm. Almost all (~95 percent) will have a demonstrable disease-causing protoporphyrinogen oxidase (PPO) mutation.

Exclusion Criteria:

  • Symptoms such as abdominal, back or limb pain are explained by another condition, as judged by the investigator
  • Therapy with hemin within 7 days prior to enrollment in this study
  • Known or suspected allergy to Panhematin™ or related products
  • Preexisting coagulation defect or concurrent treatment with an anticoagulant
  • Previously documented renal impairment defined as a serum creatinine above 1.7 mg/dL or 150 mmol/L.
  • A diagnosis of diabetes mellitus, which might increase the risk of glucose infusion.
  • Heart failure, significant chronic anemia or any disease or condition that the investigator judges would lead to an unacceptable risk to the patient or interfere with the successful collection of date for the trial
  • Previous randomization in this trial

Sites / Locations

  • University of Texas Medical Branch

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Panhematin

Placebo

Arm Description

Panhematin plus glucose

Placebo (saline) plus glucose

Outcomes

Primary Outcome Measures

Pain scale
Numeric rating scale for pain (0-10; 0=no pain, 10=most severe pain)

Secondary Outcome Measures

Biochemical effects of Panhematin
Porphyrin precursors and porphyrins

Full Information

First Posted
June 25, 2014
Last Updated
March 29, 2023
Sponsor
The University of Texas Medical Branch, Galveston
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1. Study Identification

Unique Protocol Identification Number
NCT02180412
Brief Title
Controlled Trial of Panhematin in Treatment of Acute Attacks of Porphyria
Official Title
A Double-blind, Randomized, Placebo-controlled, Parallel Group Trial on the Efficacy and Safety of PanhematinTM in the Treatment of Acute Attacks of Porphyria
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
April 28, 2014 (Actual)
Primary Completion Date
February 3, 2022 (Actual)
Study Completion Date
February 3, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
The University of Texas Medical Branch, Galveston

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study aims to provide high quality evidence for the effectiveness and safety of hemin (PanhematinTM , Recordati) for treatment of acute attacks of porphyria. These types of studies have not been done before with either PanhematinTM or the hemin preparation available in Europe (NormosangTM, Orphan Europe). There are two treatment groups in this study. One group will be treated with PanhematinTM plus glucose, and the other group will be treated with glucose plus an inactive salt solution (called a "placebo"). To avoid prejudice, the treatment given to each participant will be blinded (meaning the participants and most of the hospital staff will not know which treatment the participant will receive) and randomized (meaning participants will have an equal chance of receiving either treatment, like the flip of a coin). A placebo-controlled, randomized study is the standard method used to prove treatments are effective and safe. PanhematinTM and glucose will be given in the same manner as is usual for treating an attack of porphyria. For participants who are chosen to receive the placebo, their treatment will be switched to real PanhematinTM at any time if their symptoms do not improve. This is called "rescue" treatment, and assures that they study is safe and patients who need hemin will receive it. Treatment with hemin will be for 4 days, or longer if needed. Since the study treatment is started as soon as possible after symptoms appear, there will be very little delay in providing hemin to those who need it. Funding Source - Office of Orphan Products Development (FDA OOPD)

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Porphyrias
Keywords
Acute porphyria, Hemin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
25 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Panhematin
Arm Type
Experimental
Arm Description
Panhematin plus glucose
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo (saline) plus glucose
Intervention Type
Biological
Intervention Name(s)
Panhematin
Other Intervention Name(s)
Glucose
Intervention Description
Glucose loading
Intervention Type
Other
Intervention Name(s)
Glucose
Intervention Description
Glucose is administered to both groups as routine care.
Primary Outcome Measure Information:
Title
Pain scale
Description
Numeric rating scale for pain (0-10; 0=no pain, 10=most severe pain)
Time Frame
4 days
Secondary Outcome Measure Information:
Title
Biochemical effects of Panhematin
Description
Porphyrin precursors and porphyrins
Time Frame
4 days
Other Pre-specified Outcome Measures:
Title
Effects of clinical features on response to Panhematin
Description
Age, sex, exacerbating factors
Time Frame
4 days
Title
Effects of genetic features on response to Panhematin
Description
Types of mutations
Time Frame
4 days
Title
Use of reconstitution of Panhematin with albumin
Description
Frequency of side effects or adverse events
Time Frame
4 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
100 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female aged 18 years Willing to provide written informed consent Acute symptoms (7 days duration or less to time of enrollment) such as abdominal, back and/or limb pain, diagnosed by the investigator as caused by porphyria after initial evaluation has excluded other causes. Diagnosis of acute porphyria documented by a substantial increase in urinary or serum porphobilinogen (PBG). Type of acute porphyria confirmed by additional testing (in addition to increased PBG), which may be completed before or after treatment begins using pretreatment samples: For acute intermittent porphyria (AIP): Normal or only slight increases in plasma and fecal porphyrins. Most (~90 percent) will have deficient activity of erythrocyte porphobilinogen deaminase (PBGD), and almost all (>95 percent) will have a demonstrable disease-causing PBGD mutation. For hereditary coproporphyria (HCP): Substantial increases in fecal porphyrins (almost entirely coproporphyrin III). In the absence of skin photosensitivity, most will have normal or only slight increases in plasma porphyrins. Almost all (>95 percent) will have a demonstrable disease-causing coproporphyrinogen oxidase (CPO) mutation. For variegate porphyria (VP): Substantial increases in fecal porphyrins (mostly coproporphyrin III and protoporphyrin), increased plasma total porphyrins and a fluorescence emission maximum of diluted plasma at neutral pH near 626 nm. Almost all (~95 percent) will have a demonstrable disease-causing protoporphyrinogen oxidase (PPO) mutation. Exclusion Criteria: Symptoms such as abdominal, back or limb pain are explained by another condition, as judged by the investigator Therapy with hemin within 7 days prior to enrollment in this study Known or suspected allergy to Panhematin™ or related products Preexisting coagulation defect or concurrent treatment with an anticoagulant Previously documented renal impairment defined as a serum creatinine above 1.7 mg/dL or 150 mmol/L. A diagnosis of diabetes mellitus, which might increase the risk of glucose infusion. Heart failure, significant chronic anemia or any disease or condition that the investigator judges would lead to an unacceptable risk to the patient or interfere with the successful collection of date for the trial Previous randomization in this trial
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Karl E Anderson, MD
Organizational Affiliation
UT, Galveston
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Texas Medical Branch
City
Galveston
State/Province
Texas
ZIP/Postal Code
77555
Country
United States

12. IPD Sharing Statement

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Controlled Trial of Panhematin in Treatment of Acute Attacks of Porphyria

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