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Multi-Arm Multi-Stage Adaptive Platform Trial (APT) for the Acute Treatment of Traumatic Brain Injury (APT-TBI-01)

Primary Purpose

Traumatic Brain Injury

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Atorvastatin Calcium
Minocycline Hydrochloride
Candesartan Cilexetil
Placebo
Sponsored by
University of California, San Francisco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Traumatic Brain Injury

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Adults (18-65 years of age inclusive) Presents to an enrollment site within 12 hours of non-penetrating head injury warranting clinical evaluation with a non-contrast head CT based on American College of Emergency Physicians (ACEP) Centers for Disease Control and Prevention (CDC) clinical policy for TBI imaging. Post-resuscitation Glasgow Coma Scale (GCS) of between 9 to 15 Acute trauma-related neuroimaging abnormality (subarachnoid hemorrhage, contusion, subdural hematoma, petechial hemorrhage, intraventricular hemorrhage) on cranial CT (CT+) Initial Glial Fibrillary Acidic Protein (GFAP) blood level >100 pg/ml ≤ 15,000 pg/ml determined using a For Research Use Only (RUO) assay(s) or an Investigation Use Only (IUO) assay(s) Persons of childbearing potential (i.e., those not postmenopausal or surgically sterile) may participate provided that the participant is using adequate birth control methods for the duration of investigational product administration (see manual of procedures for adequate birth control methods) Participants able to undergo magnetic resonance imaging (MRI) scans, no contraindications or need for sedation Participants/legally authorized representative (LAR) willing and able to provide informed consent Participants or legally authorized representative able to read, speak, understand English or Spanish including the informed consent form (ICF) Willingness and ability to comply with all study procedures, treatment and follow-up Participants identified by site investigator as a good candidate for study participation Exclusion Criteria: Post-resuscitation GCS <9 Isolated epidural hematoma Pre-existing conditions including disabling developmental, neurologic, psychiatric, medical disorder that continues to produce functional disability up to the time of injury; or imminent death based on clinical judgement Current enrollment in another interventional study Currently pregnant or currently breastfeeding or planning on becoming pregnant in the next 6 months Current incarceration Currently prescribed one of the investigational products (or other drugs in the same class) prior to injury; or contra-indicated or as listed in the appendices Hypersensitivity or intolerance to investigational products or the investigational products respective classes Renal dysfunction (Creatinine Clearance (CrCl) or Estimate Glomerular Filtration Rate (eGFR) <60 mL/minute/1.73 m2) Hepatic dysfunction (Alanine Transaminase (ALT)/Aspartate Transaminase (AST)) >3 times upper limit of normal lab value) Persistent hypotension, more than 30 minutes (Systolic Blood Pressure (SBP) <90 mmHg and Diastolic Blood Pressure (DBP) <60 mmHg) Inability to swallow investigational product capsule Low likelihood of follow up or study compliance, or any other reason, in the opinion of the site investigator, the participants should not participate in the study

Sites / Locations

  • University of California, San Francisco

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Active Comparator

Placebo Comparator

Arm Label

Intervention 1: Atorvastatin calcium (ATOR)

Intervention 2: Minocycline hydrochloride (MINO)

Intervention 3: Candesartan cilexetil (CAND)

Matching Placebo

Arm Description

By Mouth (PO) Twice a day (BID) 80 mg/day, with no loading dose, for 28 days

By Mouth (PO) Twice a day (BID) 200 mg loading dose on Day 1, then 100 mg twice daily for 6 days, then placebo twice daily for 21 days

By Mouth (PO) Twice a day (BID) 8 mg once on Day 1, then 16 mg daily for 27 days

By Mouth (PO) Twice a day (BID) 2 capsules 2x/day

Outcomes

Primary Outcome Measures

Change in Glasgow Outcome Scale-Extended (GOSE-TBI only)
Functional impairment due only to the TBI will be measured using the GOSE Scale. The score ranges from 1-8, with higher scores indicating better recovery. Change will be measured from Week 2 to Month 3 postinjury and compared to placebo.

Secondary Outcome Measures

Change in Blood-based biomarkers (Neurofilament light chain)
Neurofilament light chain (NfL) levels postinjury in participants with TBI will be measured and compared to placebo
Blood-based biomarker (GFAP)
GFAP levels postinjury in participants with TBI as compared to placebo
Imaging biomarkers
Comparison of MRI diffusion tensor imaging (DTI) Axial Diffusivity (AD) measure using the average of 4 long association/projections tracts: (i) Anterior Limb of Internal Capsule (ALIC); (ii) External Capsule (EC); (iii) Superior Corona Radiata (SCR); and (iv) Superior Longitudinal Fasciculus (SLF). Change will be measured from 2 Weeks to 3 Months postinjury.
Post-TBI cognitive outcome (BTACT)
Neurocognitive impairment due to TBI will be measured using the Brief Test of Adult Cognition by Telephone (BTACT). Change will be measured by composite z-score from Day 3 to Week 4 postinjury
Post-TBI symptom outcome (Rivermead)
Post-concussive symptoms due to TBI as measured by the change in Rivermead Post Concussion Symptoms Questionnaire (RPQ) Total score (0-64) from Day 3 to Week 4. Higher scores indicate more severe symptoms

Full Information

First Posted
April 12, 2023
Last Updated
June 2, 2023
Sponsor
University of California, San Francisco
Collaborators
United States Department of Defense
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1. Study Identification

Unique Protocol Identification Number
NCT05826912
Brief Title
Multi-Arm Multi-Stage Adaptive Platform Trial (APT) for the Acute Treatment of Traumatic Brain Injury
Acronym
APT-TBI-01
Official Title
Multi-Arm Multi-Stage Adaptive Platform Trial (APT) for the Acute Treatment of Traumatic Brain Injury
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
August 30, 2023 (Anticipated)
Primary Completion Date
May 30, 2027 (Anticipated)
Study Completion Date
May 30, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, San Francisco
Collaborators
United States Department of Defense

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 if experimental drug treatment improves recovery after TBI as compared to a control (placebo) group. Changes in recovery will be measured throughout the study. The study drugs listed below are approved by the U.S. Food and Drug Administration (FDA) but are being used "off-label" in this study. This means that the drugs are not currently approved to treat TBI.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Traumatic Brain Injury

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Intervention 1: Atorvastatin calcium (ATOR)
Arm Type
Active Comparator
Arm Description
By Mouth (PO) Twice a day (BID) 80 mg/day, with no loading dose, for 28 days
Arm Title
Intervention 2: Minocycline hydrochloride (MINO)
Arm Type
Active Comparator
Arm Description
By Mouth (PO) Twice a day (BID) 200 mg loading dose on Day 1, then 100 mg twice daily for 6 days, then placebo twice daily for 21 days
Arm Title
Intervention 3: Candesartan cilexetil (CAND)
Arm Type
Active Comparator
Arm Description
By Mouth (PO) Twice a day (BID) 8 mg once on Day 1, then 16 mg daily for 27 days
Arm Title
Matching Placebo
Arm Type
Placebo Comparator
Arm Description
By Mouth (PO) Twice a day (BID) 2 capsules 2x/day
Intervention Type
Drug
Intervention Name(s)
Atorvastatin Calcium
Other Intervention Name(s)
ATOR
Intervention Description
Capsule, 80 mg/day, with no loading dose, for 28 days
Intervention Type
Drug
Intervention Name(s)
Minocycline Hydrochloride
Other Intervention Name(s)
MINO
Intervention Description
Capsule, 200 mg loading dose on Day 1, then 100 mg twice daily for 6 days, then placebo twice daily for 21 days
Intervention Type
Drug
Intervention Name(s)
Candesartan Cilexetil
Other Intervention Name(s)
CAND
Intervention Description
Capsule, 8 mg once on Day 1, then 16 mg daily for 27 days
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Capsule, 2x/day for 28 days
Primary Outcome Measure Information:
Title
Change in Glasgow Outcome Scale-Extended (GOSE-TBI only)
Description
Functional impairment due only to the TBI will be measured using the GOSE Scale. The score ranges from 1-8, with higher scores indicating better recovery. Change will be measured from Week 2 to Month 3 postinjury and compared to placebo.
Time Frame
2 weeks to 3 months postinjury
Secondary Outcome Measure Information:
Title
Change in Blood-based biomarkers (Neurofilament light chain)
Description
Neurofilament light chain (NfL) levels postinjury in participants with TBI will be measured and compared to placebo
Time Frame
Week 2
Title
Blood-based biomarker (GFAP)
Description
GFAP levels postinjury in participants with TBI as compared to placebo
Time Frame
Week 2
Title
Imaging biomarkers
Description
Comparison of MRI diffusion tensor imaging (DTI) Axial Diffusivity (AD) measure using the average of 4 long association/projections tracts: (i) Anterior Limb of Internal Capsule (ALIC); (ii) External Capsule (EC); (iii) Superior Corona Radiata (SCR); and (iv) Superior Longitudinal Fasciculus (SLF). Change will be measured from 2 Weeks to 3 Months postinjury.
Time Frame
2 weeks to 3 months postinjury
Title
Post-TBI cognitive outcome (BTACT)
Description
Neurocognitive impairment due to TBI will be measured using the Brief Test of Adult Cognition by Telephone (BTACT). Change will be measured by composite z-score from Day 3 to Week 4 postinjury
Time Frame
Day 3 to Week 4 postinjury
Title
Post-TBI symptom outcome (Rivermead)
Description
Post-concussive symptoms due to TBI as measured by the change in Rivermead Post Concussion Symptoms Questionnaire (RPQ) Total score (0-64) from Day 3 to Week 4. Higher scores indicate more severe symptoms
Time Frame
Day 3 to Week 4

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adults (18-65 years of age inclusive) Presents to an enrollment site within 12 hours of non-penetrating head injury warranting clinical evaluation with a non-contrast head CT based on American College of Emergency Physicians (ACEP) Centers for Disease Control and Prevention (CDC) clinical policy for TBI imaging. Post-resuscitation Glasgow Coma Scale (GCS) of between 9 to 15 Acute trauma-related neuroimaging abnormality (subarachnoid hemorrhage, contusion, subdural hematoma, petechial hemorrhage, intraventricular hemorrhage) on cranial CT (CT+) Initial Glial Fibrillary Acidic Protein (GFAP) blood level >100 pg/ml ≤ 15,000 pg/ml determined using a For Research Use Only (RUO) assay(s) or an Investigation Use Only (IUO) assay(s) Persons of childbearing potential (i.e., those not postmenopausal or surgically sterile) may participate provided that the participant is using adequate birth control methods for the duration of investigational product administration (see manual of procedures for adequate birth control methods) Participants able to undergo magnetic resonance imaging (MRI) scans, no contraindications or need for sedation Participants/legally authorized representative (LAR) willing and able to provide informed consent Participants or legally authorized representative able to read, speak, understand English or Spanish including the informed consent form (ICF) Willingness and ability to comply with all study procedures, treatment and follow-up Participants identified by site investigator as a good candidate for study participation Exclusion Criteria: Post-resuscitation GCS <9 Isolated epidural hematoma Pre-existing conditions including disabling developmental, neurologic, psychiatric, medical disorder that continues to produce functional disability up to the time of injury; or imminent death based on clinical judgement Current enrollment in another interventional study Currently pregnant or currently breastfeeding or planning on becoming pregnant in the next 6 months Current incarceration Currently prescribed one of the investigational products (or other drugs in the same class) prior to injury; or contra-indicated or as listed in the appendices Hypersensitivity or intolerance to investigational products or the investigational products respective classes Renal dysfunction (Creatinine Clearance (CrCl) or Estimate Glomerular Filtration Rate (eGFR) <60 mL/minute/1.73 m2) Hepatic dysfunction (Alanine Transaminase (ALT)/Aspartate Transaminase (AST)) >3 times upper limit of normal lab value) Persistent hypotension, more than 30 minutes (Systolic Blood Pressure (SBP) <90 mmHg and Diastolic Blood Pressure (DBP) <60 mmHg) Inability to swallow investigational product capsule Low likelihood of follow up or study compliance, or any other reason, in the opinion of the site investigator, the participants should not participate in the study
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Gigi Sugar, MSc, MSN
Phone
628-206-4457
Email
gigi.sugar@ucsf.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Jasmin Hutyra
Email
jasmin.to@ucsf.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Geoffrey Manley, MD PhD
Organizational Affiliation
University of California, San Francisco
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California, San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94110
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gigi Sugar, MSc, MSN
Email
gigi.sugar@ucsf.edu
First Name & Middle Initial & Last Name & Degree
Michael Huang, MD

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Data will be made available through the Federal Interagency TBI Research (FITBIR) Database.
IPD Sharing Time Frame
Shared scientific data will be made accessible as soon as possible, and no later than the time of an associated publication, or the end of performance period, whichever comes first.
IPD Sharing Access Criteria
FITBIR qualified investigators will be provided access
IPD Sharing URL
https://fitbir.nih.gov/
Links:
URL
https://tracktbi.ucsf.edu/
Description
Related Info
URL
https://tracktbi.ucsf.edu/publications
Description
Related Info
URL
https://tracktbinet.ucsf.edu/
Description
Related Info

Learn more about this trial

Multi-Arm Multi-Stage Adaptive Platform Trial (APT) for the Acute Treatment of Traumatic Brain Injury

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