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Phase IV Trial to Evaluate Efficacy of Alpha-Lipoic Acid in Treating Symptomatic Diabetic Polyneuropathy in Egypt (MIRACLE-ALA)

Primary Purpose

Polyneuropathy, Diabetic

Status
Recruiting
Phase
Phase 4
Locations
Egypt
Study Type
Interventional
Intervention
Alpha-Lipoic Acid (ALA)
Placebo
Sponsored by
Eva Pharma
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Polyneuropathy, Diabetic focused on measuring Thiotacid, Double-blinded, Placebo-controlled, Multi-center

Eligibility Criteria

18 Years - 64 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Signed informed consent form. Male or female patients aged ≥ 18 and ≤ 64 years. Type 2 diabetes mellitus (T2DM) patients as defined according to the American Diabetes Association (ADA) criteria with diabetes duration ≥ 1 year. Hemoglobin A1c (HbA1c) ≤10%. Patients with symptomatic distal symmetrical polyneuropathy (DSPN) attributable to diabetes; after a thorough evaluation for other causes of neuropathy, with evidence of polyneuropathy based on abnormal peripheral nerve function according to clinical and electrophysiological examinations. Patients treated with oral antidiabetic drugs and/or insulin. Patients with the treatment regimen, weight, diet, and physical activity level relatively acceptable as judged by the investigator within 1 month prior to study entry. Patients with working telephone numbers. Exclusion Criteria: Female patients with child-bearing potential not using effective birth control methods including oral contraceptives with a stable regimen for at least 2 months, depo-medroxyprogesterone, a barrier method alone (diaphragm, condoms, or contraceptive sponge with spermicidals), or an intrauterine device that has been in place for at least 2 months. Patients with neuropathies other than DSPN; myopathy and other neurologic diseases that might interfere with the assessment of the severity of DSPN. Patients with a recent history of drug or alcohol abuse; within 1 year prior to study entry. Patients with a history of peripheral vascular disease and/or foot ulcers. Patients with a history of organ transplantation. Patients with a history of cardiovascular, pulmonary, gastrointestinal, hematologic, or endocrine disease, or malignancy that cause neuropathic pain. Hospitalization due to hypoglycemia or ketoacidosis within 3 months prior to study entry. Patients with significant hepatic or renal disease [Serum creatinine > 1.8 mg/dL for men and > 1.6 mg/dL for women, Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥ 3 times upper limit of normal (ULN)]. Use of medications indicated for neuropathic pain relief within 15 days (washout period) prior to study entry. For analgesia, standard doses of salicylates, ibuprofen, indoles, fenamates, oxicams, or pyrazoles are allowed. Use of antioxidants (including but not limited to vitamin E, vitamin C, and β-carotene) or pentoxifylline within 1 month prior to study entry. Use of medications or vitamins known to cause peripheral neuropathy including but not limited to the use of phenytoin or carbamazepine over 15 or more years, or use of pyridoxine > 100 mg/d within 12 months prior to study entry. Use of ≥ 50 mg ALA or use of alpha-linolenic acid-containing substances within 3 months prior to study entry. Use of an investigational drug within 6 months prior to study entry. Enrollment in any other clinical trial during the time of this trial.

Sites / Locations

  • Alexandria UniversityRecruiting
  • Beni Suef University HospitalRecruiting
  • Ain-Shams University HospitalRecruiting
  • Menoufia University HospitalRecruiting
  • Mansoura University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

IND Arm

Placebo Arm

Arm Description

200 patients will receive one tablet of 600 mg of alpha-lipoic acid twice a day orally for 24 weeks.

200 patients will receive one tablet of placebo twice a day orally for 24 weeks.

Outcomes

Primary Outcome Measures

To compare the relative change in NCS parameters between the study arms
The main objective of this study is to calculate the efficacy of alpha-lipoic acid in comparison with placebo in diabetic patients with symptomatic polyneuropathy assessed by the change in NCS parameters after 4 weeks of treatment using student t-test (Mann-Whitney test for non-parametric data) to compare relative change between treatment arm and control arm. This analysis will be comparative and will be done on eligible subjects without protocol violation and who have at least one treatment dose and an evaluable primary endpoint.

Secondary Outcome Measures

To compare the relative change in NCS parameters between the study arms.
The efficacy of alpha-lipoic acid in comparison with placebo in diabetic patients with symptomatic polyneuropathy assessed by the change in NCS after 24 weeks of treatment using student t-test (Mann-Whitney test for non-parametric data) to compare relative change between treatment arm and control arm.
To compare the relative change in NDS and Neuro-QoL between the study arms.
The efficacy of alpha-lipoic acid in comparison with placebo in diabetic patients with symptomatic polyneuropathy as assessed by the change in NDS* total score (out of 10 = the sum of the scores for right and left sides) using student t-test (Mann-Whitney test for non-parametric data) to compare relative change between treatment and control arms.
To compare the frequency of the need to rescue analgesic medications between the study arms
The efficacy alpha-lipoic acid in comparison with placebo in diabetic patients with symptomatic polyneuropathy assessed by number of patients receiving rescue analgesic medications using chi square test to compare between treatment arm and control arm. This analysis will be comparative and will be done on eligible subjects without protocol violation and who have at least one treatment dose and evaluable primary endpoint
To assess safety of Thiotacid® as per the nature and severity of the recorded adverse events.
The safety of alpha-lipoic acid in diabetic patients with symptomatic neuropathy assessed by the number of patients experiencing AE/SAE and number of patients who discontinued study drug due to AEs. These will be described using counts/percentages with 95% CI. This analysis will be descriptive and will be conducted on all patients enrolled to the study who signed an ICF.

Full Information

First Posted
April 3, 2023
Last Updated
April 3, 2023
Sponsor
Eva Pharma
Collaborators
MARC-CRO
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1. Study Identification

Unique Protocol Identification Number
NCT05813496
Brief Title
Phase IV Trial to Evaluate Efficacy of Alpha-Lipoic Acid in Treating Symptomatic Diabetic Polyneuropathy in Egypt
Acronym
MIRACLE-ALA
Official Title
A Multicenter, Interventional, Two-arm, Parallel-group, Randomized, Double-blinded, Placebo-controlled, Phase IV Trial to Evaluate the Efficacy of Alpha-Lipoic Acid in the Treatment of Symptomatic Diabetic Polyneuropathy in Egypt
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 26, 2022 (Actual)
Primary Completion Date
April 1, 2024 (Anticipated)
Study Completion Date
April 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Eva Pharma
Collaborators
MARC-CRO

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
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 the study is to find out whether ALA is effective and safe for treating Egyptian diabetic patients with symptomatic polyneuropathy. The ADA stated that despite the exploration of several pharmacological therapies for DPN management, substantial evidence on medicines that modify the natural history of DPN is still absent. This is a multicenter, interventional, two-arm, parallel-group, randomized, double-blinded, placebo-controlled, phase IV trial. Patients will be administered either one tablet of placebo or one tablet containing 600 mg of ALA twice a day for 24 weeks, depending on the randomization process.
Detailed Description
This is a multicenter, interventional, two-arm, parallel-group, randomized, double-blinded, placebo-controlled, phase IV trial to evaluate the efficacy and safety of ALA in the treatment of diabetic patients with symptomatic polyneuropathy in Egypt. Patients will be randomly assigned to receive either : One tablet of 600 mg ALA twice a day orally for 24 weeks. Total daily dose during the study duration (24 weeks) = 1200 mg. , or One tablet of placebo twice a day orally for 24 weeks. The standard of Care (SOC) treatments will be prescribed for both study arms (Experimental and control arm) as per the routine clinical practice and following the relevant clinical guidelines. The SOC treatments include those for glycemic control and other treatments for the management of painful diabetic polyneuropathy; when needed through the course of the clinical study. As per the ADA and NICE guidelines (ADA, 2022) ("Type 2 Diabetes Adults Manag.," 2022); Pregabalin, Duloxetine, or Gabapentin are recommended as initial pharmacologic treatments for neuropathic pain in diabetes. Estimated recruitment period: 24 weeks Estimated duration of participation: 24 weeks of treatment in addition to a screening period of approximately 1 week Visit 1: Screening/Baseline visit Visit 2: After 4 weeks ± 5 days of treatment Visit 3 (Phone call 1): After 12 weeks ± 15 days of treatment Visit 4 (Phone call 2): After 20 weeks ± 15 days of treatment Visit 5: After 24 weeks ± 15 days of treatment

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Polyneuropathy, Diabetic
Keywords
Thiotacid, Double-blinded, Placebo-controlled, Multi-center

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
After signing the ICF, eligible patients were randomized in a 1:1 allocation ratio, into one of the two treatment groups, to receive either ALA or placebo. Randomization will be done using an interactive web response system (IWRS). Randomization was stratified by baseline body mass index (BMI) (< 25 Kg/m2 or 25-40 Kg/m2) followed by age (<45 years or ≥ 45 years) and gender (male or female).
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double-blinded
Allocation
Randomized
Enrollment
400 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
IND Arm
Arm Type
Experimental
Arm Description
200 patients will receive one tablet of 600 mg of alpha-lipoic acid twice a day orally for 24 weeks.
Arm Title
Placebo Arm
Arm Type
Placebo Comparator
Arm Description
200 patients will receive one tablet of placebo twice a day orally for 24 weeks.
Intervention Type
Drug
Intervention Name(s)
Alpha-Lipoic Acid (ALA)
Other Intervention Name(s)
Thiotacid® 600 mg
Intervention Description
Oral tablet
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Oral tablet
Intervention Description
Microcrystalline cellulose (Ph 101) 427.5 mg, Magnesium stearate 71.25 mg, Sodium laurayl sulphate 6 mg, Croscarmellose sodium 11.25 mg, Silica, colloid anhydrous 11.25 mg, and Purified talc 30 mg.
Primary Outcome Measure Information:
Title
To compare the relative change in NCS parameters between the study arms
Description
The main objective of this study is to calculate the efficacy of alpha-lipoic acid in comparison with placebo in diabetic patients with symptomatic polyneuropathy assessed by the change in NCS parameters after 4 weeks of treatment using student t-test (Mann-Whitney test for non-parametric data) to compare relative change between treatment arm and control arm. This analysis will be comparative and will be done on eligible subjects without protocol violation and who have at least one treatment dose and an evaluable primary endpoint.
Time Frame
After four weeks of treatment
Secondary Outcome Measure Information:
Title
To compare the relative change in NCS parameters between the study arms.
Description
The efficacy of alpha-lipoic acid in comparison with placebo in diabetic patients with symptomatic polyneuropathy assessed by the change in NCS after 24 weeks of treatment using student t-test (Mann-Whitney test for non-parametric data) to compare relative change between treatment arm and control arm.
Time Frame
After 24 weeks of treatment
Title
To compare the relative change in NDS and Neuro-QoL between the study arms.
Description
The efficacy of alpha-lipoic acid in comparison with placebo in diabetic patients with symptomatic polyneuropathy as assessed by the change in NDS* total score (out of 10 = the sum of the scores for right and left sides) using student t-test (Mann-Whitney test for non-parametric data) to compare relative change between treatment and control arms.
Time Frame
After 24 weeks of treatment
Title
To compare the frequency of the need to rescue analgesic medications between the study arms
Description
The efficacy alpha-lipoic acid in comparison with placebo in diabetic patients with symptomatic polyneuropathy assessed by number of patients receiving rescue analgesic medications using chi square test to compare between treatment arm and control arm. This analysis will be comparative and will be done on eligible subjects without protocol violation and who have at least one treatment dose and evaluable primary endpoint
Time Frame
After 24 weeks of treatment
Title
To assess safety of Thiotacid® as per the nature and severity of the recorded adverse events.
Description
The safety of alpha-lipoic acid in diabetic patients with symptomatic neuropathy assessed by the number of patients experiencing AE/SAE and number of patients who discontinued study drug due to AEs. These will be described using counts/percentages with 95% CI. This analysis will be descriptive and will be conducted on all patients enrolled to the study who signed an ICF.
Time Frame
After 24 weeks of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
64 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed informed consent form. Male or female patients aged ≥ 18 and ≤ 64 years. Type 2 diabetes mellitus (T2DM) patients as defined according to the American Diabetes Association (ADA) criteria with diabetes duration ≥ 1 year. Hemoglobin A1c (HbA1c) ≤10%. Patients with symptomatic distal symmetrical polyneuropathy (DSPN) attributable to diabetes; after a thorough evaluation for other causes of neuropathy, with evidence of polyneuropathy based on abnormal peripheral nerve function according to clinical and electrophysiological examinations. Patients treated with oral antidiabetic drugs and/or insulin. Patients with the treatment regimen, weight, diet, and physical activity level relatively acceptable as judged by the investigator within 1 month prior to study entry. Patients with working telephone numbers. Exclusion Criteria: Female patients with child-bearing potential not using effective birth control methods including oral contraceptives with a stable regimen for at least 2 months, depo-medroxyprogesterone, a barrier method alone (diaphragm, condoms, or contraceptive sponge with spermicidals), or an intrauterine device that has been in place for at least 2 months. Patients with neuropathies other than DSPN; myopathy and other neurologic diseases that might interfere with the assessment of the severity of DSPN. Patients with a recent history of drug or alcohol abuse; within 1 year prior to study entry. Patients with a history of peripheral vascular disease and/or foot ulcers. Patients with a history of organ transplantation. Patients with a history of cardiovascular, pulmonary, gastrointestinal, hematologic, or endocrine disease, or malignancy that cause neuropathic pain. Hospitalization due to hypoglycemia or ketoacidosis within 3 months prior to study entry. Patients with significant hepatic or renal disease [Serum creatinine > 1.8 mg/dL for men and > 1.6 mg/dL for women, Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥ 3 times upper limit of normal (ULN)]. Use of medications indicated for neuropathic pain relief within 15 days (washout period) prior to study entry. For analgesia, standard doses of salicylates, ibuprofen, indoles, fenamates, oxicams, or pyrazoles are allowed. Use of antioxidants (including but not limited to vitamin E, vitamin C, and β-carotene) or pentoxifylline within 1 month prior to study entry. Use of medications or vitamins known to cause peripheral neuropathy including but not limited to the use of phenytoin or carbamazepine over 15 or more years, or use of pyridoxine > 100 mg/d within 12 months prior to study entry. Use of ≥ 50 mg ALA or use of alpha-linolenic acid-containing substances within 3 months prior to study entry. Use of an investigational drug within 6 months prior to study entry. Enrollment in any other clinical trial during the time of this trial.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Laila Gad El Rub, Msc
Phone
(+2) 01061664999
Email
laila.gadelrub@marc-eg.org
First Name & Middle Initial & Last Name or Official Title & Degree
Maryam Awadh, Bsc
Phone
(+2) 01210667443
Email
maryam.yasser@marc-eg.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Samir H Assaad Khali, PhD
Organizational Affiliation
Alexandria University Hospital / Internal Medicine
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Mohamed R Halawa, PhD
Organizational Affiliation
Ain-Shams University Hospital / Internal Medicine
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Nabil AF El Kafrawy, PhD
Organizational Affiliation
Menoufia University Hospital / Internal Medicine
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Hanan M El Sotouhy Gawish, PhD
Organizational Affiliation
Mansoura University Hospital / Internal Medicine
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Khaled ES El Hadidy, PhD
Organizational Affiliation
Beni Suef University Hospital / Internal Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Alexandria University
City
Alexandria
State/Province
Bab Sharqi
ZIP/Postal Code
21544
Country
Egypt
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Samir H Assaad Khalil, PhD
Phone
01222197789
Email
assaadkhalils@gmail.com
First Name & Middle Initial & Last Name & Degree
Dr. Samir H Assaad Khalil, PhD
Facility Name
Beni Suef University Hospital
City
Banī Suwayf
State/Province
Beni-Suef
ZIP/Postal Code
2711860
Country
Egypt
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Khaled ES El Hadidy, PhD
Phone
01005440212
Email
kshadidy@hotmail.com
First Name & Middle Initial & Last Name & Degree
Khaled ES El Hadidy, PhD
Facility Name
Ain-Shams University Hospital
City
Cairo
State/Province
Heliopolis
ZIP/Postal Code
11588
Country
Egypt
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mohamed R Halawa, PhD
Phone
01119178283
Email
drhalawa@gmail.com
First Name & Middle Initial & Last Name & Degree
Mohamed R Halawa, PhD
Facility Name
Menoufia University Hospital
City
Shibīn al-Kawm
State/Province
Shebin El Kom
Country
Egypt
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nabil El Kafrawy, PhD
Phone
01001566211
Email
alkafrawy_nabil@hotmail.com
First Name & Middle Initial & Last Name & Degree
Nabil El Kafrawy, PhD
Facility Name
Mansoura University Hospital
City
Mansoura
Country
Egypt
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hanan Gawish
Phone
01002598161
Email
drhanang@hotmail.com
First Name & Middle Initial & Last Name & Degree
Hanan M El Sotouhy Gawish, PhD

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
Citation
ADA. (2022). Standards of Medical Care in Diabetes-2022 Th E Jou R Nal of C Li N Ical an D Appli Ed R Esearc H an D Education. Diabetes Care, 45(Suppliment 1), S1-S264. https://doi.org/10.2337/dc22-SREV
Results Reference
background
PubMed Identifier
15793206
Citation
Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, Malik RA, Maser RE, Sosenko JM, Ziegler D; American Diabetes Association. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005 Apr;28(4):956-62. doi: 10.2337/diacare.28.4.956. No abstract available.
Results Reference
background
PubMed Identifier
27999003
Citation
Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, Sosenko JM, Ziegler D. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017 Jan;40(1):136-154. doi: 10.2337/dc16-2042. No abstract available.
Results Reference
background
PubMed Identifier
28058263
Citation
Roman-Pintos LM, Villegas-Rivera G, Rodriguez-Carrizalez AD, Miranda-Diaz AG, Cardona-Munoz EG. Diabetic Polyneuropathy in Type 2 Diabetes Mellitus: Inflammation, Oxidative Stress, and Mitochondrial Function. J Diabetes Res. 2016;2016:3425617. doi: 10.1155/2016/3425617. Epub 2016 Dec 12.
Results Reference
background
Citation
Type 2 diabetes in adults: management. (2022). Type 2 Diabetes in Adults: Management, March. https://www.ncbi.nlm.nih.gov/books/NBK553486/
Results Reference
background
PubMed Identifier
8458529
Citation
Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993 Feb;36(2):150-4. doi: 10.1007/BF00400697.
Results Reference
background
PubMed Identifier
9285502
Citation
Ziegler D, Gries FA. Alpha-lipoic acid in the treatment of diabetic peripheral and cardiac autonomic neuropathy. Diabetes. 1997 Sep;46 Suppl 2:S62-6. doi: 10.2337/diab.46.2.s62.
Results Reference
background

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Phase IV Trial to Evaluate Efficacy of Alpha-Lipoic Acid in Treating Symptomatic Diabetic Polyneuropathy in Egypt

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