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Safety and Efficacy Study of Erythropoietin as add-on Therapy of Methylprednisolone to Treat Acute Optic Neuritis

Primary Purpose

Optic Neuritis

Status
Completed
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Erythropoietin
Sponsored by
Institut fuer anwendungsorientierte Forschung und klinische Studien GmbH
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Optic Neuritis focused on measuring multiple sclerosis, add-on Therapy, erythropoietin, methylprednisolone, autoimmune optic neuritis

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: To be eligible to participate in this study, candidates must meet the following eligibility criteria at the time of randomization: Must give written informed consent and authorize the release and use of protected health information (PHI). Must be 18 to 50 years old, inclusive, at the time of informed consent. Must have acute unilateral optic neuritis with or without prior diagnosis of MS (according to McDonald criteria). Symptoms related to optic neuritis must exist for no longer than 10 days prior to inclusion. Must have had normal visual acuity on both eyes before and no history of optic neuritis. Must have a decreased visual acuity on the affected eye to 0.5 or less at screening. Exclusion Criteria: Candidates will be excluded from study if any of the following exclusion criteria exist at the time of randomization: Medical history: Abnormal laboratory results or clinical signs indicative of any significant cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary, gastrointestinal, dermatologic, psychiatric, renal, neurological (other than MS), and/or other major disease. History of prior optic neuritis on the affected or non-affected eye. History of squint or amblyopia on either side. Hyperopia > 3dptr on either side. Myopia < -5dptr on either side. Astigmatism > 2dptr on either side. Horizontal cup disc ratio > 0.5 on either side. Retinal nerve fiber layer thickness outside normal values (with respect to the OCT data base). Ocular diseases effecting visual acuity or visual fields (cataract, glaucoma, maculadegeneration, diabetic retinopathy, retinal heredodegeneration or others). History of elevated blood pressure. Systolic blood pressure of > 159 mmHg, diastolic blood pressure > 99 mmHg at screening examination. History of thromboembolic events. Frequent thromboembolic events in 1st grade family members. Significant surgery within the 4 weeks prior to randomization. History of severe allergic or anaphylactic reactions after administration of Epo. History of malignancy. History of seizures. Tuberculosis with ongoing or unknown activity. Acute gastrointestinal ulceration within the last three months. Acute virus, bacterial or fungus infection. Infection with HIV, HBV, or HCV. History of colitis ulcerosa, diverticulitis, or acute enteroanastomosis. Severe osteoporosis. Active immunization within 2 weeks prior to inclusion. Diagnosis of phenylketonuria. Implanted cardiac pacemaker or other non MRI-compatible metallic body implants. History of drug or alcohol abuse (as defined by the investigator) within 2 years prior to randomization. Any of the following abnormal blood tests at screening: alanine transaminase/serum glutamate-pyruvate transaminase (AST/SGPT), or aspartate transaminase/serum glutamicoxaloacetic transaminase (AST/SGOT), gamma-glutamyl-transferase (GGT), or serum creatinine > 2 times the upper limit of normal; hematocrit > the upper limit of normal. Treatment history Prior treatment with cyclosporine, mitoxantrone, methotrexate, cyclophosphamide or other immunosuppressive agents. Treatment with corticosteroids or Epo within 30 days prior to randomization. Miscellaneous Female subjects considering becoming pregnant while in the study. Female subjects who are currently pregnant or breast-feeding. Previous participation in this study or any other investigational drug study within the last four weeks. Current enrollment in any other investigational drug study. Unwillingness or inability to comply with the requirements of the protocol including the presence of any condition (physical, mental, or social) that is likely to affect the subject's ability to comply with the protocol. Any other reasons that, in the opinion of the investigator, the subject is determined to be unsuitable for enrollment in this study.

Sites / Locations

  • Department of Neurology University Hospital Goettingen
  • Department of Neurology University Homborg Hospital of the Saarland, Germany
  • University Hospital of Hamburg-Eppendorf (Institut of Neuroimmunology and Clinical MS Research (INIMS))

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

No Intervention

Arm Label

1

2

Arm Description

erythropoietin

Placebo

Outcomes

Primary Outcome Measures

nerve fiber loss in the optical nerve head determined by optical coherence tomography at weeks 4,8 and 16 compared to baseline. Measurements at baseline and week 16 are used to calculate estimates for changes and differences between the groups.

Secondary Outcome Measures

Visual acuity and visual field perception determined at weeks 1, 4, 8, 16 compared to baseline (week 0). MRI measurements of optic nerve atrophy performed at weeks 4, 8 and 16 compared to baseline (week 0)

Full Information

First Posted
July 20, 2006
Last Updated
September 12, 2012
Sponsor
Institut fuer anwendungsorientierte Forschung und klinische Studien GmbH
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1. Study Identification

Unique Protocol Identification Number
NCT00355095
Brief Title
Safety and Efficacy Study of Erythropoietin as add-on Therapy of Methylprednisolone to Treat Acute Optic Neuritis
Official Title
Double Blind, Placebo-controlled Study to Determine the Safety and Efficacy of Erythropoietin as an add-on Therapy of Methylprednisolone in Subjects With Acute Optic Neuritis (VISION PROTECT)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2012
Overall Recruitment Status
Completed
Study Start Date
August 2006 (undefined)
Primary Completion Date
February 2011 (Actual)
Study Completion Date
July 2011 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Institut fuer anwendungsorientierte Forschung und klinische Studien GmbH

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine the safety and efficacy of erythropoietin as an add-on therapy to methylprednisolone in subjects with acute autoimmune optic neuritis.
Detailed Description
SUMMARY This study is a multicenter, double-blind, placebo-controlled, parallel-group study to determine the safety and efficacy of erythropoietin (Epo) as an add-on therapy to methylprednisolone (Mpred) in subjects with acute autoimmune optic neuritis. The primary study endpoint is nerve fiber loss in the optical nerve head determined by optical coherence tomography at weeks 4, 8, and 16 compared to baseline. Further study objectives include visual acuity, visual field perception, optic nerve atrophy determined by magnetic resonance imaging (MRI), and recovery of visual evoked potentials (VEPs). A number of 40 subjects will be randomized in equal numbers into one of the two treatment groups. Treatment groups: Epo or placebo will be administered i.v. at three consecutive days. Epo or placebo is to be given once daily following application of Mpred preferably between 8 and 10 a.m.. Subjects will be randomized to one of the following two treatment groups and dosed as follows: Mpred at a dose of 1000 mg per day on days 1 - 3 given as an i.v. infusion AND 3.3 x 10^4 IU recombinant human Epo per day on days 1- 3 given as an i.v. bolus injection. Mpred at a dose of 1000 mg per day on days 1 - 3 given as an i.v. infusion AND placebo (normal saline) on days 1 - 3 given as an i.v. bolus injection. Men and women between the ages of 18 and 50, inclusive, diagnosed with acute unilateral optic neuritis with or without prior diagnosis of multiple sclerosis (according to McDonald criteria; Polman et al., 2005) will be considered for inclusion into the study. Those subjects must have a decreased visual acuity on the affected eye to 0.5 or less and must have signed written informed consent. While safety will be monitored during the study, an efficacy evaluation will be done after all subjects have completed week 16. Each subject included in the study will be seen by a treating neurologist and an examining neurologist as well as by an examining ophthalmologist. The treating neurologist will function as the primary treating physician and conduct all subject safety assessments. The examining ophthalmologist and the examining neurologist will conduct all evaluations of vision/optical nerve head atrophy and neurological symptoms, respectively, but will not be involved in any other aspect of patient care. A neurophysiologist will perform measurements of VEPs. MRIs will be performed by a neuroradiologist.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Optic Neuritis
Keywords
multiple sclerosis, add-on Therapy, erythropoietin, methylprednisolone, autoimmune optic neuritis

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Active Comparator
Arm Description
erythropoietin
Arm Title
2
Arm Type
No Intervention
Arm Description
Placebo
Intervention Type
Drug
Intervention Name(s)
Erythropoietin
Other Intervention Name(s)
Erypo®
Intervention Description
intravenous daily 3.3 *10^4 Units, duration 3 days
Primary Outcome Measure Information:
Title
nerve fiber loss in the optical nerve head determined by optical coherence tomography at weeks 4,8 and 16 compared to baseline. Measurements at baseline and week 16 are used to calculate estimates for changes and differences between the groups.
Time Frame
4 months
Secondary Outcome Measure Information:
Title
Visual acuity and visual field perception determined at weeks 1, 4, 8, 16 compared to baseline (week 0). MRI measurements of optic nerve atrophy performed at weeks 4, 8 and 16 compared to baseline (week 0)
Time Frame
4 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: To be eligible to participate in this study, candidates must meet the following eligibility criteria at the time of randomization: Must give written informed consent and authorize the release and use of protected health information (PHI). Must be 18 to 50 years old, inclusive, at the time of informed consent. Must have acute unilateral optic neuritis with or without prior diagnosis of MS (according to McDonald criteria). Symptoms related to optic neuritis must exist for no longer than 10 days prior to inclusion. Must have had normal visual acuity on both eyes before and no history of optic neuritis. Must have a decreased visual acuity on the affected eye to 0.5 or less at screening. Exclusion Criteria: Candidates will be excluded from study if any of the following exclusion criteria exist at the time of randomization: Medical history: Abnormal laboratory results or clinical signs indicative of any significant cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary, gastrointestinal, dermatologic, psychiatric, renal, neurological (other than MS), and/or other major disease. History of prior optic neuritis on the affected or non-affected eye. History of squint or amblyopia on either side. Hyperopia > 3dptr on either side. Myopia < -5dptr on either side. Astigmatism > 2dptr on either side. Horizontal cup disc ratio > 0.5 on either side. Retinal nerve fiber layer thickness outside normal values (with respect to the OCT data base). Ocular diseases effecting visual acuity or visual fields (cataract, glaucoma, maculadegeneration, diabetic retinopathy, retinal heredodegeneration or others). History of elevated blood pressure. Systolic blood pressure of > 159 mmHg, diastolic blood pressure > 99 mmHg at screening examination. History of thromboembolic events. Frequent thromboembolic events in 1st grade family members. Significant surgery within the 4 weeks prior to randomization. History of severe allergic or anaphylactic reactions after administration of Epo. History of malignancy. History of seizures. Tuberculosis with ongoing or unknown activity. Acute gastrointestinal ulceration within the last three months. Acute virus, bacterial or fungus infection. Infection with HIV, HBV, or HCV. History of colitis ulcerosa, diverticulitis, or acute enteroanastomosis. Severe osteoporosis. Active immunization within 2 weeks prior to inclusion. Diagnosis of phenylketonuria. Implanted cardiac pacemaker or other non MRI-compatible metallic body implants. History of drug or alcohol abuse (as defined by the investigator) within 2 years prior to randomization. Any of the following abnormal blood tests at screening: alanine transaminase/serum glutamate-pyruvate transaminase (AST/SGPT), or aspartate transaminase/serum glutamicoxaloacetic transaminase (AST/SGOT), gamma-glutamyl-transferase (GGT), or serum creatinine > 2 times the upper limit of normal; hematocrit > the upper limit of normal. Treatment history Prior treatment with cyclosporine, mitoxantrone, methotrexate, cyclophosphamide or other immunosuppressive agents. Treatment with corticosteroids or Epo within 30 days prior to randomization. Miscellaneous Female subjects considering becoming pregnant while in the study. Female subjects who are currently pregnant or breast-feeding. Previous participation in this study or any other investigational drug study within the last four weeks. Current enrollment in any other investigational drug study. Unwillingness or inability to comply with the requirements of the protocol including the presence of any condition (physical, mental, or social) that is likely to affect the subject's ability to comply with the protocol. Any other reasons that, in the opinion of the investigator, the subject is determined to be unsuitable for enrollment in this study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ricarda Diem, MD Prof.
Organizational Affiliation
Department of Neurology University Homborg Hospital of the Saarland, Germany
Official's Role
Study Director
Facility Information:
Facility Name
Department of Neurology University Hospital Goettingen
City
Goettingen
State/Province
Niedersachsen
ZIP/Postal Code
37075
Country
Germany
Facility Name
Department of Neurology University Homborg Hospital of the Saarland, Germany
City
Homburg
State/Province
Saarland
ZIP/Postal Code
66421
Country
Germany
Facility Name
University Hospital of Hamburg-Eppendorf (Institut of Neuroimmunology and Clinical MS Research (INIMS))
City
Hamburg
ZIP/Postal Code
20246
Country
Germany

12. IPD Sharing Statement

Citations:
PubMed Identifier
15605985
Citation
Maier K, Rau CR, Storch MK, Sattler MB, Demmer I, Weissert R, Taheri N, Kuhnert AV, Bahr M, Diem R. Ciliary neurotrophic factor protects retinal ganglion cells from secondary cell death during acute autoimmune optic neuritis in rats. Brain Pathol. 2004 Oct;14(4):378-87. doi: 10.1111/j.1750-3639.2004.tb00081.x.
Results Reference
background
PubMed Identifier
27706045
Citation
Suhs KW, Papanagiotou P, Hein K, Pul R, Scholz K, Heesen C, Diem R. Disease Activity and Conversion into Multiple Sclerosis after Optic Neuritis Is Treated with Erythropoietin. Int J Mol Sci. 2016 Sep 30;17(10):1666. doi: 10.3390/ijms17101666.
Results Reference
derived
PubMed Identifier
22926853
Citation
Suhs KW, Hein K, Sattler MB, Gorlitz A, Ciupka C, Scholz K, Kasmann-Kellner B, Papanagiotou P, Schaffler N, Restemeyer C, Bittersohl D, Hassenstein A, Seitz B, Reith W, Fassbender K, Hilgers R, Heesen C, Bahr M, Diem R. A randomized, double-blind, phase 2 study of erythropoietin in optic neuritis. Ann Neurol. 2012 Aug;72(2):199-210. doi: 10.1002/ana.23573.
Results Reference
derived

Learn more about this trial

Safety and Efficacy Study of Erythropoietin as add-on Therapy of Methylprednisolone to Treat Acute Optic Neuritis

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