Spinal Cord Injury Neuroprotection With Glyburide (SCING)
Primary Purpose
Acute Spinal Cord Injury
Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Glyburide
Sponsored by
About this trial
This is an interventional treatment trial for Acute Spinal Cord Injury
Eligibility Criteria
Inclusion Criteria:
- Age: ≥ 18 years and ≤ 80 years
- Written informed consent by patient or legal authorized representative
- No other life-threatening injury
- No evidence of sepsis
- Acute cervical SCI with ASIA Impairment Scale grade A, B or C on admission
- Non-penetrating SCI at neurologic level from C2 to C8
- Initiation of study drug within 8 hours of injury
Exclusion Criteria
- Unconsciousness or other mental impairment that prevents neurological assessment within the first 8 hours
- Acute SCI with ASIA Impairment Scale grade D or E
- Currently involved in another non-observational SCI research study or receiving another investigational drug
- History of hypersensitivity to sulfonylureas, in particular glyburide, or any of its components
- Other illness (including mental disorder) that could preclude accurate medical and neurological evaluation (at discretion of the site investigator)
- Unable to commit to the follow-up schedule
- A recent history of regular substance abuse (illicit drugs, alcohol), which in the opinion of the investigator would interfere with the subject's participation in the study
- Any condition likely to result in the patient's death within the next 12 months
- Prisoner
- Severe renal disorder from the patient's history (e.g. dialysis) or baseline eGFR of < 30 mL/min/1.73 m2
- Known severe liver disease, or ALT > 3 times upper limit of normal or bilirubin > 2 times upper limit normal. Subjects may be randomized if liver function tests have been drawn but are not yet available and the subject has no known history of liver disease; however, treatment with DiaBeta will be discontinued prior to the second dose if liver function tests indicate ALT > 3 times upper limit of normal or bilirubin > 2 times upper limit of normal
- Blood glucose <55 mg/dL at enrollment or immediately prior to administration of DiaBeta, or a clinically significant history of hypoglycemia
- Acute ST elevation myocardial infarction, and/or acute decompensated heart failure, and/or QTc > 520 ms, and/or known history of cardiac arrest (PEA, VT, VF, asystole), and/or admission for an acute coronary syndrome, myocardial infarction, or coronary intervention (percutaneous coronary intervention or coronary artery surgery) within the past 3 months
- Known treatment with Bosentan within past 7 days
- Known G6PD enzyme deficiency
- Pregnancy: Women must be either post-menopausal, permanently sterilized or, if ≤ 50 years old, must have a negative test for pregnancy obtained before enrollment
- Breast-feeding women who do not agree to stop breast-feeding during and for 7 days following the end of oral glyburide administration
- Subjects who in the opinion of the investigator are not suitable for inclusion in the study (reason to be documented).
Sites / Locations
- The Ohio State University
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Glyburide Treatment Arm
Arm Description
Enrolled patients will receive 12 doses of Glyburide starting within 8 hours of SCI. The dosing regimen involves an initial dose of 1.25 mg followed by eleven consecutive doses of 0.625 mg every 6 hours. The total daily dose of Glyburide on Day 1, Day 2 and Day 3 will be 3.125 mg, 2.5 mg, and 2.5 mg respectively.
Outcomes
Primary Outcome Measures
Number of Participants With tSCI Recruited Within the Specified Time Window
A measure of feasibility of undertaking a larger phase II study among this population of patients where treatment must begin within a short injury-to-drug time window.
Number of Drug Related Adverse Events
A measure of safety of treating patients with traumatic spinal cord injury with Glyburide administered orally within a short injury-to-drug time window.
Secondary Outcome Measures
Number of Participants With Neurologic Recovery Following tSCI
The neurologic status of patients will be assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) as assessed by International Standards for Neurological Classification of SCI (ISNCSCI) criteria.
Serum Pharmacokinetic and Biomarker Analysis
Plasma concentrations will be serially quantified through day 3 following tSCI to evaluate the pharmacokinetics of Glyburide in the acute tSCI population. Comparisons will be made to reported levels achieved in healthy patient cohorts. Standard enzyme-linked immunosorbent assay (ELISA) techniques will be used to measure blood levels of neurofilament light chain, neuron- specific enolase, tau, S100b, and glial fibrillary acidic protein levels on admission, at 24 hours and on days 3 and 7 following tSCI to evaluate serum biomarker levels. Comparisons will be made to previously published values observed in non-treated control patients
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02524379
Brief Title
Spinal Cord Injury Neuroprotection With Glyburide
Acronym
SCING
Official Title
Spinal Cord Injury Neuroprotection With Glyburide; Pilot Study: An Open-Label Prospective Evaluation of the Feasibility, Safety, Pharmacokinetics, and Preliminary Efficacy of Oral Glyburide (DiaBeta) in Patients With Acute Traumatic Spinal Cord Injury
Study Type
Interventional
2. Study Status
Record Verification Date
June 2022
Overall Recruitment Status
Terminated
Why Stopped
Principal investigator has left the university; there were not enough participants to analyze the data.
Study Start Date
February 14, 2017 (Actual)
Primary Completion Date
February 8, 2021 (Actual)
Study Completion Date
February 8, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ohio State University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this study is to determine the safety of using oral Glyburide in patients with acute traumatic cervical spinal cord injuries (SCI).
Detailed Description
This study will include patients between 18 and 80 years who have experienced acute traumatic cervical spinal cord injury (specifically ASIA A, B or C). Patients will then begin an oral drug regimen of Glyburide, which must be started within 8 hours of injury and continued for 72 hours at a daily dose of 3.125 mg on Day 1, 2.5 mg on Day 2 and 2.5 mg on Day 3. If indicated, the patient will also have surgical intervention for spinal cord decompression and spinal stabilization. Each patient who takes part in this study will have labs drawn regularly and adverse events assessed daily through Day 14 or discharge (whichever is earlier). Study participation will last for 365 days (+/- 30 days), with post-hospitalization follow-up occurring on Days 28, 42, 84, 182 and 365.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Spinal Cord Injury
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
3 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Glyburide Treatment Arm
Arm Type
Experimental
Arm Description
Enrolled patients will receive 12 doses of Glyburide starting within 8 hours of SCI. The dosing regimen involves an initial dose of 1.25 mg followed by eleven consecutive doses of 0.625 mg every 6 hours. The total daily dose of Glyburide on Day 1, Day 2 and Day 3 will be 3.125 mg, 2.5 mg, and 2.5 mg respectively.
Intervention Type
Drug
Intervention Name(s)
Glyburide
Intervention Description
3 day drug regimen beginning 8 hours after acute traumatic spinal cord injury.
Primary Outcome Measure Information:
Title
Number of Participants With tSCI Recruited Within the Specified Time Window
Description
A measure of feasibility of undertaking a larger phase II study among this population of patients where treatment must begin within a short injury-to-drug time window.
Time Frame
Enrollment Period (within 8 hours of tSCI)
Title
Number of Drug Related Adverse Events
Description
A measure of safety of treating patients with traumatic spinal cord injury with Glyburide administered orally within a short injury-to-drug time window.
Time Frame
One year post enrollment
Secondary Outcome Measure Information:
Title
Number of Participants With Neurologic Recovery Following tSCI
Description
The neurologic status of patients will be assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) as assessed by International Standards for Neurological Classification of SCI (ISNCSCI) criteria.
Time Frame
One year post enrollment
Title
Serum Pharmacokinetic and Biomarker Analysis
Description
Plasma concentrations will be serially quantified through day 3 following tSCI to evaluate the pharmacokinetics of Glyburide in the acute tSCI population. Comparisons will be made to reported levels achieved in healthy patient cohorts. Standard enzyme-linked immunosorbent assay (ELISA) techniques will be used to measure blood levels of neurofilament light chain, neuron- specific enolase, tau, S100b, and glial fibrillary acidic protein levels on admission, at 24 hours and on days 3 and 7 following tSCI to evaluate serum biomarker levels. Comparisons will be made to previously published values observed in non-treated control patients
Time Frame
Enrollment through post-treatment day 7
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age: ≥ 18 years and ≤ 80 years
Written informed consent by patient or legal authorized representative
No other life-threatening injury
No evidence of sepsis
Acute cervical SCI with ASIA Impairment Scale grade A, B or C on admission
Non-penetrating SCI at neurologic level from C2 to C8
Initiation of study drug within 8 hours of injury
Exclusion Criteria
Unconsciousness or other mental impairment that prevents neurological assessment within the first 8 hours
Acute SCI with ASIA Impairment Scale grade D or E
Currently involved in another non-observational SCI research study or receiving another investigational drug
History of hypersensitivity to sulfonylureas, in particular glyburide, or any of its components
Other illness (including mental disorder) that could preclude accurate medical and neurological evaluation (at discretion of the site investigator)
Unable to commit to the follow-up schedule
A recent history of regular substance abuse (illicit drugs, alcohol), which in the opinion of the investigator would interfere with the subject's participation in the study
Any condition likely to result in the patient's death within the next 12 months
Prisoner
Severe renal disorder from the patient's history (e.g. dialysis) or baseline eGFR of < 30 mL/min/1.73 m2
Known severe liver disease, or ALT > 3 times upper limit of normal or bilirubin > 2 times upper limit normal. Subjects may be randomized if liver function tests have been drawn but are not yet available and the subject has no known history of liver disease; however, treatment with DiaBeta will be discontinued prior to the second dose if liver function tests indicate ALT > 3 times upper limit of normal or bilirubin > 2 times upper limit of normal
Blood glucose <55 mg/dL at enrollment or immediately prior to administration of DiaBeta, or a clinically significant history of hypoglycemia
Acute ST elevation myocardial infarction, and/or acute decompensated heart failure, and/or QTc > 520 ms, and/or known history of cardiac arrest (PEA, VT, VF, asystole), and/or admission for an acute coronary syndrome, myocardial infarction, or coronary intervention (percutaneous coronary intervention or coronary artery surgery) within the past 3 months
Known treatment with Bosentan within past 7 days
Known G6PD enzyme deficiency
Pregnancy: Women must be either post-menopausal, permanently sterilized or, if ≤ 50 years old, must have a negative test for pregnancy obtained before enrollment
Breast-feeding women who do not agree to stop breast-feeding during and for 7 days following the end of oral glyburide administration
Subjects who in the opinion of the investigator are not suitable for inclusion in the study (reason to be documented).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
H. Francis Farhadi, MD, PhD
Organizational Affiliation
Ohio State University
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
Undecided
Citations:
PubMed Identifier
31601596
Citation
Minnema AJ, Mehta A, Boling WW, Schwab J, Simard JM, Farhadi HF. SCING-Spinal Cord Injury Neuroprotection with Glyburide: a pilot, open-label, multicentre, prospective evaluation of oral glyburide in patients with acute traumatic spinal cord injury in the USA. BMJ Open. 2019 Oct 10;9(10):e031329. doi: 10.1136/bmjopen-2019-031329.
Results Reference
derived
Learn more about this trial
Spinal Cord Injury Neuroprotection With Glyburide
We'll reach out to this number within 24 hrs