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Cytoflavin in the Treatment of Patients With Diabetic Polyneuropathy (CYLINDER)

Primary Purpose

Diabetic Neuropathies

Status
Completed
Phase
Phase 3
Locations
Russian Federation
Study Type
Interventional
Intervention
Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid)
Placebo
Sponsored by
POLYSAN Scientific & Technological Pharmaceutical Company
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetic Neuropathies focused on measuring Diabetes Mellitus, Peripheral Nervous System Diseases, Antioxidants, Succinic acid

Eligibility Criteria

45 Years - 74 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Signed informed consent form;
  • Men and women aged 45 to 74 (inclusive);
  • Confirmed diagnosis of type 2 diabetes lasting for 1 year or more;
  • Permanent scheme of therapy (without changing doses and drugs) by oral hypoglycemic drugs and / or insulin, long-term or ultra-long (adjustment of insulin dose is possible within 10% from baseline dose) and / or agonists of glucagon-like peptide-1 receptors (GLP-1) for at least 12 weeks before screening;
  • HbA1c from 7.0 and not higher than 10.0%;
  • BMI 22-40 kg / m2;
  • Symptomatic distal sensorimotor diabetic polyneuropathy;
  • Baseline TSS (Total Syptom Score) ˃5 points;
  • Score ≥2 by at least one of the TSS symptoms;
  • The severity of pain by the corresponding TSS subscale ≤ 2;
  • NISLL (Neuropathy Impairment Score Low Limbs) ≥ 2 points;
  • Patient consent to use adequate contraceptive methods for the entire study;
  • Consent to maintain a stable diet, exercise, therapy and diabetes control throughout the study;
  • Ability to comply with all protocol requirements.

Exclusion Criteria:

  • Pregnant or lactating women, or women planning a pregnancy during a clinical trial;
  • Type 1 diabetes and other specific types of diabetes;
  • Acute metabolic complications of diabetes such as ketoacidosis or hyperosmolar state within 6 months prior to screening;
  • Therapy with short and ultra-short insulin within 3 months before screening;
  • Fasting plasma glucose at screening> 15 mmol / l;
  • The presence of severe complications of diabetes;
  • Epilepsy, epileptiform seizures, head trauma with loss of consciousness, tumor, inflammatory and demyelinating diseases of the central nervous system;
  • Diseases requiring prior or current treatment by systemic corticosteroid drugs, cytostatics or penicillamine;malignant neoplasms within the last 5 years (excluding basal cell carcinoma);
  • Cardiovascular diseases in the stage of decompensation at present or within 3 months before screening;
  • Uncontrolled arterial hypertension with systolic arterial pressure> 180 mm Hg and diastolic blood pressure> 110 mm Hg at screening;
  • Nephrotic syndrome, severe chronic renal failure or significant kidney disease with a level of glomerular filtration rate (GFR) <30 ml / min;
  • Active viral (hepatitis B and C) or cirrhotic liver disease; increased aspartate aminotransferase (AST) or serum alanine aminotransferase (ALT) 3 times from upper normal limit; increased total bilirubin 2 times from upper normal limit;
  • HIV; a severe infectious disease within 30 days before screening;
  • Anemia (hemoglobin ≤ 105 g / l in women or ≤ 115 g / l in men); acute blood loss or donation of at least one unit of blood (500 ml) or blood transfusion within the previous 12 weeks;
  • Drug or alcohol abuse;
  • Intake of Cytoflavin® for 3 months before screening;
  • Known allergies, hypersensitivity or contraindications to the drug Cytoflavin® or its components;
  • Intake of alpha-lipoic acid, thiamine derivatives, pyridoxine, cyanocobalamin (excluding multivitamins), antidepressants and derivatives of gabapentin within 3 months before screening;
  • Use of other investigational drugs within 3 months prior to screening;
  • Inability to read or write; unwillingness to understand and follow protocol procedures; non-compliance with the protocol requirements.

Sites / Locations

  • City Clinical Hospital n.a. V.P.Demikhov
  • City Clinical Hospital n.a.M.E.Zhadkevitch
  • City Clinical Hospital #13 Avtozavodsky district
  • Research Center for Eco-safety, Ltd.
  • "Astarta" Ltd.
  • City General Hospital №2
  • City Outpatient Clinic #51
  • I. P. Pavlov 1st St. Petersburg State Medical University
  • North-West State Medical University named after I.I. Mechnikov
  • "Consultative and diagnostic center with a polyclinic" of the Administrative Department of the President of the Russian Federation
  • Almazov National Medical Research Centre
  • City Outpatient Clinic #117
  • MEDICA Ltd.
  • "Diabetes" medical center
  • Saratov State Medical University n.a. V.I.Razumovsky
  • GBUZ YAO "Regional Clinical Hospital"

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Group 1

Group 2

Arm Description

Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid), 20 ml (two ampoules of 10 ml each) once a day intravenously in a dilution of 200 ml of 0.9% sodium chloride solution at a rate 3-4 ml/min, for 10 days + Cytoflavin ((Inosine + Nicotinamide + Riboflavin + Succinic Acid), 2 tablets 2 times a day, for 75 days

Placebo, 20 ml (two ampoules of 10 ml each) once a day intravenously in a dilution of 200 ml of 0.9% sodium chloride solution at a rate 3-4 ml / min, for 10 days + Placebo, 2 tablets 2 times a day, for 75 days

Outcomes

Primary Outcome Measures

TSS (Total Symptom Score)
Change in total TSS score at Week 12 from baseline

Secondary Outcome Measures

Full Information

First Posted
November 24, 2020
Last Updated
January 25, 2023
Sponsor
POLYSAN Scientific & Technological Pharmaceutical Company
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1. Study Identification

Unique Protocol Identification Number
NCT04649203
Brief Title
Cytoflavin in the Treatment of Patients With Diabetic Polyneuropathy
Acronym
CYLINDER
Official Title
Multicenter, Double-blind, Placebo-controlled Randomized Clinical Trial of Efficacy and Safety of the Drug Cytoflavin®, Administered Intravenously Followed by Oral Intake, in Patients With Diabetic Polyneuropathy
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Completed
Study Start Date
November 25, 2020 (Actual)
Primary Completion Date
March 29, 2021 (Actual)
Study Completion Date
June 6, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
POLYSAN Scientific & Technological Pharmaceutical Company

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
One of the most common complications of diabetes mellitus is diabetic polyneuropathy, which leads to disability and reduces quality of life. The toxic effects of high glucose concentrations contribute to the formation of ketoaldehyde free radicals, which, at an increased rate of their formation, leads to the development of oxidative stress in the nervous tissue. The planned study of the use of Cytoflavin® in diabetic polyneuropathy is substantiated by its antioxidant effect, which, by analogy with alpha-lipoic acid preparations, suggests its efficacy in the combined treatment of such patients. This clinical study is being conducted to assess the efficacy and safety of Cytoflavin® versus Placebo in diabetic polyneuropathy patients with type 2 diabetes. Study patients will receive study medication, 10 IV infusions followed by 75 days of oral intake. Clinical efficacy will be assessed by alleviation of symptoms (burning, numbness, pain and pricking), using the total symptoms score(TSS), after the completion of the treatment course.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Neuropathies
Keywords
Diabetes Mellitus, Peripheral Nervous System Diseases, Antioxidants, Succinic acid

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare Provider
Allocation
Randomized
Enrollment
216 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Experimental
Arm Description
Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid), 20 ml (two ampoules of 10 ml each) once a day intravenously in a dilution of 200 ml of 0.9% sodium chloride solution at a rate 3-4 ml/min, for 10 days + Cytoflavin ((Inosine + Nicotinamide + Riboflavin + Succinic Acid), 2 tablets 2 times a day, for 75 days
Arm Title
Group 2
Arm Type
Placebo Comparator
Arm Description
Placebo, 20 ml (two ampoules of 10 ml each) once a day intravenously in a dilution of 200 ml of 0.9% sodium chloride solution at a rate 3-4 ml / min, for 10 days + Placebo, 2 tablets 2 times a day, for 75 days
Intervention Type
Drug
Intervention Name(s)
Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid)
Intervention Description
The study drug will be administered in two phases: intravenous infusion of study drug for 10 days followed by oral administration of study drug for 75 days. Thus, the total duration of the study therapy is 12 weeks.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
The placebo comparator will be administered in two phases: intravenous infusion of placebo solution for 10 days followed by oral administration of placebo pills for 75 days. Thus, the total duration of the study therapy is 12 weeks.
Primary Outcome Measure Information:
Title
TSS (Total Symptom Score)
Description
Change in total TSS score at Week 12 from baseline
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
45 Years
Maximum Age & Unit of Time
74 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed informed consent form; Men and women aged 45 to 74 (inclusive); Confirmed diagnosis of type 2 diabetes lasting for 1 year or more; Permanent scheme of therapy (without changing doses and drugs) by oral hypoglycemic drugs and / or insulin, long-term or ultra-long (adjustment of insulin dose is possible within 10% from baseline dose) and / or agonists of glucagon-like peptide-1 receptors (GLP-1) for at least 12 weeks before screening; HbA1c from 7.0 and not higher than 10.0%; BMI 22-40 kg / m2; Symptomatic distal sensorimotor diabetic polyneuropathy; Baseline TSS (Total Syptom Score) ˃5 points; Score ≥2 by at least one of the TSS symptoms; The severity of pain by the corresponding TSS subscale ≤ 2; NISLL (Neuropathy Impairment Score Low Limbs) ≥ 2 points; Patient consent to use adequate contraceptive methods for the entire study; Consent to maintain a stable diet, exercise, therapy and diabetes control throughout the study; Ability to comply with all protocol requirements. Exclusion Criteria: Pregnant or lactating women, or women planning a pregnancy during a clinical trial; Type 1 diabetes and other specific types of diabetes; Acute metabolic complications of diabetes such as ketoacidosis or hyperosmolar state within 6 months prior to screening; Therapy with short and ultra-short insulin within 3 months before screening; Fasting plasma glucose at screening> 15 mmol / l; The presence of severe complications of diabetes; Epilepsy, epileptiform seizures, head trauma with loss of consciousness, tumor, inflammatory and demyelinating diseases of the central nervous system; Diseases requiring prior or current treatment by systemic corticosteroid drugs, cytostatics or penicillamine;malignant neoplasms within the last 5 years (excluding basal cell carcinoma); Cardiovascular diseases in the stage of decompensation at present or within 3 months before screening; Uncontrolled arterial hypertension with systolic arterial pressure> 180 mm Hg and diastolic blood pressure> 110 mm Hg at screening; Nephrotic syndrome, severe chronic renal failure or significant kidney disease with a level of glomerular filtration rate (GFR) <30 ml / min; Active viral (hepatitis B and C) or cirrhotic liver disease; increased aspartate aminotransferase (AST) or serum alanine aminotransferase (ALT) 3 times from upper normal limit; increased total bilirubin 2 times from upper normal limit; HIV; a severe infectious disease within 30 days before screening; Anemia (hemoglobin ≤ 105 g / l in women or ≤ 115 g / l in men); acute blood loss or donation of at least one unit of blood (500 ml) or blood transfusion within the previous 12 weeks; Drug or alcohol abuse; Intake of Cytoflavin® for 3 months before screening; Known allergies, hypersensitivity or contraindications to the drug Cytoflavin® or its components; Intake of alpha-lipoic acid, thiamine derivatives, pyridoxine, cyanocobalamin (excluding multivitamins), antidepressants and derivatives of gabapentin within 3 months before screening; Use of other investigational drugs within 3 months prior to screening; Inability to read or write; unwillingness to understand and follow protocol procedures; non-compliance with the protocol requirements.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Igor A Strokov, Prof.
Organizational Affiliation
"First Moscow State Medical University n.a. I.M.Sechenov of the Ministry of Health of Russia
Official's Role
Study Chair
Facility Information:
Facility Name
City Clinical Hospital n.a. V.P.Demikhov
City
Moscow
Country
Russian Federation
Facility Name
City Clinical Hospital n.a.M.E.Zhadkevitch
City
Moscow
Country
Russian Federation
Facility Name
City Clinical Hospital #13 Avtozavodsky district
City
Nizhny Novgorod
Country
Russian Federation
Facility Name
Research Center for Eco-safety, Ltd.
City
Saint Petersburg
ZIP/Postal Code
196143
Country
Russian Federation
Facility Name
"Astarta" Ltd.
City
Saint Petersburg
Country
Russian Federation
Facility Name
City General Hospital №2
City
Saint Petersburg
Country
Russian Federation
Facility Name
City Outpatient Clinic #51
City
Saint Petersburg
Country
Russian Federation
Facility Name
I. P. Pavlov 1st St. Petersburg State Medical University
City
Saint Petersburg
Country
Russian Federation
Facility Name
North-West State Medical University named after I.I. Mechnikov
City
Saint Petersburg
Country
Russian Federation
Facility Name
"Consultative and diagnostic center with a polyclinic" of the Administrative Department of the President of the Russian Federation
City
Saint-Petersburg
Country
Russian Federation
Facility Name
Almazov National Medical Research Centre
City
Saint-Petersburg
Country
Russian Federation
Facility Name
City Outpatient Clinic #117
City
Saint-Petersburg
Country
Russian Federation
Facility Name
MEDICA Ltd.
City
Saint-Petersburg
Country
Russian Federation
Facility Name
"Diabetes" medical center
City
Samara
Country
Russian Federation
Facility Name
Saratov State Medical University n.a. V.I.Razumovsky
City
Saratov
Country
Russian Federation
Facility Name
GBUZ YAO "Regional Clinical Hospital"
City
Yaroslavl
Country
Russian Federation

12. IPD Sharing Statement

Citations:
PubMed Identifier
35680173
Citation
Kharitonova T, Shvarts YG, Verbovoy AF, Orlova NS, Puzyreva VP, Strokov IA. Efficacy and safety of the combined metabolic medication, containing inosine, nicotinamide, riboflavin and succinic acid, for the treatment of diabetic neuropathy: a multicenter randomized, double-blind, placebo-controlled parallel group clinical trial (CYLINDER). BMJ Open Diabetes Res Care. 2022 Jun;10(3):e002785. doi: 10.1136/bmjdrc-2022-002785.
Results Reference
result

Learn more about this trial

Cytoflavin in the Treatment of Patients With Diabetic Polyneuropathy

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