A Phase 3 Clinical Trial of Intravenous Sodium Thiosulfate in Acute Calciphylaxis Patients (CALISTA)
Primary Purpose
Calciphylaxis
Status
Terminated
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Sodium Thiosulfate
Placebo-Normal Saline
Sponsored by
About this trial
This is an interventional treatment trial for Calciphylaxis focused on measuring calciphylaxis, calcific uremic arteriolopathy, calcinosis, calcium metabolism disorders, metabolic diseases, sodium thiosulfate
Eligibility Criteria
Inclusion Criteria:
- Informed of the investigational nature of the study and sign written informed consent
- Willing and able to adhere to all study-related procedures, including adherence to study medication regimen
- Male or female ≥18 years old
- End-stage renal disease on chronic hemodialysis
- Calciphylaxis with active skin lesion(s) of any morphological appearance (including but not limited to livedo, induration, ulceration, etc.) and tissue histology review consistent with calciphylaxis diagnosis. Histological features consistent with calciphylaxis will include soft tissue calcification, microthrombosis, and/or fibrointimal hyperplasia of dermal arterioles
- Acute pain associated with calciphylaxis lesions pain intensity score of ≥ 5 at initial screening on the modified BPI/SF scale
- Women of childbearing potential must have a pregnancy test (urine or serum [if anuric]) at screening and not be pregnant and willing to use an acceptable method of contraception for the entire duration of the study (3 weeks)
Exclusion Criteria:
- Peritoneal dialysis patients
- Current congestive heart failure exacerbation
- Baseline abnormalities related to QT prolongation (corrected QT interval > 470 ms), hypocalcemia (serum albumin-corrected calcium < 8 mg/dL ), metabolic acidosis (serum bicarbonate < 18 mmol/L, hypotension (resting systolic blood pressure while seated < 80), or interdialytic weight gain ≥ 4.0 kg
- History of ventricular arrhythmias including ventricular fibrillation or ventricular tachycardia associated with shortness of breath, dizziness, hypotension, or syncope
- Any prior (within the past 30 days) or current intravenous Sodium Thiosulfate Injection treatment
- Other investigational agent (drug, biologic, or device) study within the past 30 days and/or for the duration of the trial
- Pregnant or lactating women
- History of allergy to sulfites, thiosulfate, or any component in Sodium Thiosulfate Injection (sulfa allergy is not an exclusion criterion)
- Significant other acute or chronic concomitant diseases (including but not limited to hepatic, cardiovascular, pulmonary, or oncologic disease, sepsis, pulmonary edema, pulmonary embolism) that would be inconsistent with survival for at least 3 months
- Other serious concurrent or recent medical or psychiatric condition which, in the opinion of the Investigator, makes the patient unsuitable for participation in this study
- Ongoing application of dialysate admixed with iron salt e.g. ferric pyrophosphate during the entire trial period (patients who are on dialysate admixed with iron salt at screening are eligible if dialysate admixed with iron salt can be substituted with non-iron based dialysate and patients can be maintained on non-iron based dialysate therapy for the entire duration of trial period)
- Recent (within 1 week) history of surgical parathyroidectomy or scheduled for surgical parathyroidectomy during the course of the study
- History of opioid addiction
Sites / Locations
- Mayo Clinic
- Northwestern University Hospital
- Loyola University Medical Center
- University of Iowa Hospitals and Clinics
- Massachusetts General Hospital
- Veterans Administration Medical Center
- The Icahn School of Medicine at Mount Sinai Hospital
- Sanford Health
- Cleveland Clinic
- Rhode Island Hospital
- University of Virginia Health System
- Veterans Administration Medical Center
- University of Calgary Foothills Medical Center
- University of Alberta Hospital
- Health Sciences Centre Winnipeg
- Kingston Health Sciences Centre
- Centre Hospitalier de l'Universite de Montreal
- Salford Royal Hospital NHS Foundation Trust
- Hammersmith Hospital
- Churchill Hospital
- Lister Hospital
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
Sodium Thiosulfate
Placebo-Normal Saline
Arm Description
Sodium Thiosulfate Injection (25 grams sodium thiosulfate)
0.9% sodium chloride injection, USP (normal saline)
Outcomes
Primary Outcome Measures
Number of patients with 30% improvement in pain severity
To compare the effects of treatment with intravenous Sodium Thiosulfate Injection vs. placebo for the proportion of patients (responders) who achieve a ≥ 30% reduction based upon pain intensity score (modified BPI/SF).
Secondary Outcome Measures
Secondary Endpoint-a: Number of patients with stabilization or improvement in calciphylaxis skin lesions.
Proportion of patients who achieve improvement or stabilization (i.e., not worsening) of skin lesions.
Secondary Endpoint-b: Occurence of surgical debridement of skin lesions and/or amputation.
Occurence of surgical debridement of skin lesions and/or amputation.
Secondary Endpoint-c: Occurrence of surgical debridement of skin lesions and/or amputation.
Occurrence of surgical debridement of skin lesions and/or amputation.
Secondary Endpoint-d: Time to achieve ≥ 30% improvement in pain severity
Time in days when a patient achieves a ≥ 30% improvement based upon pain intensity score (modified BPI/SF).
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT03150420
Brief Title
A Phase 3 Clinical Trial of Intravenous Sodium Thiosulfate in Acute Calciphylaxis Patients
Acronym
CALISTA
Official Title
A Phase 3, Intravenous Sodium Thiosulfate for Acute Calciphylaxis Treatment: A Multicenter, Randomized, Double-blind, Placebo-controlled, Clinical Trial
Study Type
Interventional
2. Study Status
Record Verification Date
May 2020
Overall Recruitment Status
Terminated
Why Stopped
Inability to accrue subjects that met the exclusion criterion "Any prior (within the past 30 days) or current Sodium Thiosulfate treatment".
Study Start Date
May 24, 2017 (Actual)
Primary Completion Date
April 15, 2020 (Actual)
Study Completion Date
April 15, 2020 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hope Pharmaceuticals
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This multicenter, randomized, double-blind, placebo-controlled clinical trial will evaluate the efficacy and safety of intravenous Sodium Thiosulfate Injection for treatment of acute calciphylaxis-associated pain in chronic hemodialysis patients.
Detailed Description
This Phase 3, multicenter, randomized, double-blind, placebo-controlled clinical trial will evaluate the efficacy and safety of intravenous Sodium Thiosulfate Injection for treatment of acute calciphylaxis-associated pain in chronic hemodialysis patients. Acute calciphylaxis- associated pain intensity will be the primary outcome measure.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Calciphylaxis
Keywords
calciphylaxis, calcific uremic arteriolopathy, calcinosis, calcium metabolism disorders, metabolic diseases, sodium thiosulfate
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
29 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Sodium Thiosulfate
Arm Type
Experimental
Arm Description
Sodium Thiosulfate Injection (25 grams sodium thiosulfate)
Arm Title
Placebo-Normal Saline
Arm Type
Placebo Comparator
Arm Description
0.9% sodium chloride injection, USP (normal saline)
Intervention Type
Drug
Intervention Name(s)
Sodium Thiosulfate
Other Intervention Name(s)
Intravenous Sodium Thiosulfate Injection
Intervention Description
Intravenous Sodium Thiosulfate Injection (25 grams sodium thiosulfate) to be administered each hemodialysis session (3 times weekly) for 3 weeks
Intervention Type
Drug
Intervention Name(s)
Placebo-Normal Saline
Other Intervention Name(s)
0.9% sodium chloride solution
Intervention Description
Placebo: to be administered each hemodialysis session (3 times weekly) for 3 weeks
Primary Outcome Measure Information:
Title
Number of patients with 30% improvement in pain severity
Description
To compare the effects of treatment with intravenous Sodium Thiosulfate Injection vs. placebo for the proportion of patients (responders) who achieve a ≥ 30% reduction based upon pain intensity score (modified BPI/SF).
Time Frame
randomization to 3 weeks
Secondary Outcome Measure Information:
Title
Secondary Endpoint-a: Number of patients with stabilization or improvement in calciphylaxis skin lesions.
Description
Proportion of patients who achieve improvement or stabilization (i.e., not worsening) of skin lesions.
Time Frame
randomization to 3 weeks
Title
Secondary Endpoint-b: Occurence of surgical debridement of skin lesions and/or amputation.
Description
Occurence of surgical debridement of skin lesions and/or amputation.
Time Frame
during week 3
Title
Secondary Endpoint-c: Occurrence of surgical debridement of skin lesions and/or amputation.
Description
Occurrence of surgical debridement of skin lesions and/or amputation.
Time Frame
randomization to 3 weeks
Title
Secondary Endpoint-d: Time to achieve ≥ 30% improvement in pain severity
Description
Time in days when a patient achieves a ≥ 30% improvement based upon pain intensity score (modified BPI/SF).
Time Frame
randomization to 3 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Informed of the investigational nature of the study and sign written informed consent
Willing and able to adhere to all study-related procedures, including adherence to study medication regimen
Male or female ≥18 years old
End-stage renal disease on chronic hemodialysis
Calciphylaxis with active skin lesion(s) of any morphological appearance (including but not limited to livedo, induration, ulceration, etc.) and tissue histology review consistent with calciphylaxis diagnosis. Histological features consistent with calciphylaxis will include soft tissue calcification, microthrombosis, and/or fibrointimal hyperplasia of dermal arterioles
Acute pain associated with calciphylaxis lesions pain intensity score of ≥ 5 at initial screening on the modified BPI/SF scale
Women of childbearing potential must have a pregnancy test (urine or serum [if anuric]) at screening and not be pregnant and willing to use an acceptable method of contraception for the entire duration of the study (3 weeks)
Exclusion Criteria:
Peritoneal dialysis patients
Current congestive heart failure exacerbation
Baseline abnormalities related to QT prolongation (corrected QT interval > 470 ms), hypocalcemia (serum albumin-corrected calcium < 8 mg/dL ), metabolic acidosis (serum bicarbonate < 18 mmol/L, hypotension (resting systolic blood pressure while seated < 80), or interdialytic weight gain ≥ 4.0 kg
History of ventricular arrhythmias including ventricular fibrillation or ventricular tachycardia associated with shortness of breath, dizziness, hypotension, or syncope
Any prior (within the past 30 days) or current intravenous Sodium Thiosulfate Injection treatment
Other investigational agent (drug, biologic, or device) study within the past 30 days and/or for the duration of the trial
Pregnant or lactating women
History of allergy to sulfites, thiosulfate, or any component in Sodium Thiosulfate Injection (sulfa allergy is not an exclusion criterion)
Significant other acute or chronic concomitant diseases (including but not limited to hepatic, cardiovascular, pulmonary, or oncologic disease, sepsis, pulmonary edema, pulmonary embolism) that would be inconsistent with survival for at least 3 months
Other serious concurrent or recent medical or psychiatric condition which, in the opinion of the Investigator, makes the patient unsuitable for participation in this study
Ongoing application of dialysate admixed with iron salt e.g. ferric pyrophosphate during the entire trial period (patients who are on dialysate admixed with iron salt at screening are eligible if dialysate admixed with iron salt can be substituted with non-iron based dialysate and patients can be maintained on non-iron based dialysate therapy for the entire duration of trial period)
Recent (within 1 week) history of surgical parathyroidectomy or scheduled for surgical parathyroidectomy during the course of the study
History of opioid addiction
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Craig Sherman, MD
Organizational Affiliation
Hope Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Mayo Clinic
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32224
Country
United States
Facility Name
Northwestern University Hospital
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Loyola University Medical Center
City
Maywood
State/Province
Illinois
ZIP/Postal Code
60153
Country
United States
Facility Name
University of Iowa Hospitals and Clinics
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Veterans Administration Medical Center
City
Albany
State/Province
New York
ZIP/Postal Code
12208
Country
United States
Facility Name
The Icahn School of Medicine at Mount Sinai Hospital
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Facility Name
Sanford Health
City
Fargo
State/Province
North Dakota
ZIP/Postal Code
58122
Country
United States
Facility Name
Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
Rhode Island Hospital
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02914
Country
United States
Facility Name
University of Virginia Health System
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States
Facility Name
Veterans Administration Medical Center
City
Salem
State/Province
Virginia
ZIP/Postal Code
24153
Country
United States
Facility Name
University of Calgary Foothills Medical Center
City
Calgary
State/Province
Alberta
ZIP/Postal Code
T2W 1S7
Country
Canada
Facility Name
University of Alberta Hospital
City
Edmonton
State/Province
Alberta
ZIP/Postal Code
T6G 1Z1
Country
Canada
Facility Name
Health Sciences Centre Winnipeg
City
Winnipeg
State/Province
Manitoba
ZIP/Postal Code
R2V 3M3
Country
Canada
Facility Name
Kingston Health Sciences Centre
City
Kingston
State/Province
Ontario
ZIP/Postal Code
K7L 2V7
Country
Canada
Facility Name
Centre Hospitalier de l'Universite de Montreal
City
Montréal
State/Province
Quebec
ZIP/Postal Code
H2X 0A9
Country
Canada
Facility Name
Salford Royal Hospital NHS Foundation Trust
City
Salford
State/Province
Manchester
ZIP/Postal Code
M6 8HD
Country
United Kingdom
Facility Name
Hammersmith Hospital
City
London
ZIP/Postal Code
W12 0HS
Country
United Kingdom
Facility Name
Churchill Hospital
City
Oxford
ZIP/Postal Code
OX3 7LE
Country
United Kingdom
Facility Name
Lister Hospital
City
Stevenage
ZIP/Postal Code
SG1 4AB
Country
United Kingdom
12. IPD Sharing Statement
Plan to Share IPD
Undecided
Learn more about this trial
A Phase 3 Clinical Trial of Intravenous Sodium Thiosulfate in Acute Calciphylaxis Patients
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