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出境医 / 临床实验 / Efficacy of Nintedanib Per os as a Treatment for Epistaxis in HHT Disease. (EPICURE)

Efficacy of Nintedanib Per os as a Treatment for Epistaxis in HHT Disease. (EPICURE)

Study Description
Brief Summary:

The recognized manifestations of HHT are all due to abnormalities in vascular structure. Epistaxis are spontaneous, very variable, may occur as often as several times every day, and are recurrent in 90% of patients and associated with chronic and severe anemia in 2-10%. They also significantly reduce quality of life.

Blood transfusions are sometimes required in 10-30% of patients. Previous studies showed that antiangiogenic treatments such as anti-VEGF treatment (bevacizumab) administered intravenously was efficient on epistaxis and dramatically reduced nosebleeds.

Tyrosine kinase inhibitors are anti-angiogenic molecules which are available orally and could therefore overcome the difficulties encountered with bevacizumab. The investigator hypothesized that nintedanib, acting by indirect inhibition of the VEGF receptor should allow a reduction of epistaxis in HHT patient.

Nintedanib has been used in one HHT patient following the diagnosis of Insterstitial Pulmonary Fibrosis (published case report in 2017, Kovacs et al) with encouraging results.

The aim is to evaluate efficacy of nintedanib for the treatment of epistaxis in HHT patients


Condition or disease Intervention/treatment Phase
Hemorrhagic Hereditary Telangiectasia Drug: Nintedanib 150 mg and 100 mg soft capsules Drug: Oral treatment of placebo soft capsule Phase 2

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: Efficacy of Nintedanib Per os as a Treatment for Epistaxis in HHT Disease. A National, Randomized, Multicentre Phase II Study
Actual Study Start Date : June 22, 2020
Estimated Primary Completion Date : December 2022
Estimated Study Completion Date : December 2022
Arms and Interventions
Arm Intervention/treatment
Experimental: Nintedanib
Oral treatment of Nintedanib 150 mg soft capsule
Drug: Nintedanib 150 mg and 100 mg soft capsules
Nintedanib 150 mg soft capsules twice daily approximately 12 hours apart (i.e. 300 mg/day) for 12 weeks. In case of adverse reaction a dose reduction at 200 mg/day (100 mg twice daily) can be prescribe.

Placebo Comparator: Placebo
Oral treatment of placebo soft capsule
Drug: Oral treatment of placebo soft capsule
Placebo soft capsules (identical to 150 mg and 100 mg soft capsules)

Outcome Measures
Primary Outcome Measures :
  1. Epistaxis duration assessed on epistaxis grids completed by the patients. [ Time Frame: 12 weeks ]

Secondary Outcome Measures :
  1. number of adverse events [ Time Frame: 6 months ]
  2. number of adverse events [ Time Frame: 12 weeks ]
  3. number of adverse events [ Time Frame: 24 weeks ]
  4. Efficacy or nintedanib assessed by ESS (Epistaxis Severity Score) questionnaire [ Time Frame: 12 weeks ]
    This score assess the severity of epistaxis (minimum 0 corresponds to "none" and maximum 10 corresponds to"severe")

  5. Efficacy or nintedanib assessed by ESS questionnaire [ Time Frame: 24 weeks ]
    This score assess the severity of epistaxis (minimum 0 corresponds to "none" and maximum 10 corresponds to"severe")

  6. duration of epistaxis all over the study. Assessment on epistaxis grids completed by the patients. [ Time Frame: 12 weeks ]
  7. duration of epistaxis assessed on epistaxis grids completed by the patients. [ Time Frame: 24 weeks ]
  8. duration of epistaxis assessed on epistaxis grids completed by the patients. [ Time Frame: 12 weeks ]
  9. frequency of epistaxis assessed on epistaxis grids completed by the patients. [ Time Frame: 24 weeks ]
  10. Quality of life assessed by SF36 (Short Form 36) questionnaire [ Time Frame: 12 weeks ]
  11. Quality of life assessed by SF36 questionnaire [ Time Frame: 24 weeks ]
  12. number of red blood cell transfusions [ Time Frame: 12 weeks ]
  13. number of red blood cell transfusions [ Time Frame: 24 weeks ]
  14. number of iron infusions [ Time Frame: 12 weeks ]
  15. number of iron infusions [ Time Frame: 24 weeks ]
  16. hemoglobin level [ Time Frame: 12 weeks ]
  17. hemoglobin level [ Time Frame: 24 weeks ]
  18. ferritin level [ Time Frame: 12 weeks ]
  19. ferritin level [ Time Frame: 24 weeks ]

Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age > 18 years old
  • Patients who have given their free informed and signed consent
  • Patients affiliated to a social security scheme or similar
  • Patients monitored for clinically confirmed HHT and/or with molecular biology confirmation
  • Patient with an Epistaxis Severity Score (ESS) > 4

Exclusion Criteria:

  • Pregnant woman or woman of child bearing potential
  • Woman who are breast feeding.
  • Patient who is protected adults under the terms of the law (French Public Health Code).
  • Participation in another interventional clinical trial which may interfere with the proposed trial
  • Active infection.
  • (AST, ALT > 1,5 fold upper limit of normal (ULN) and/or Bilirubin > 1,5 fold upper limit of normal (ULN).
  • Severe renal impairment
  • Presence of non-treated pulmonary arteriovenous malformations accessible to a treatment on CT scan within 5 years.
  • Patients with hemoptysis or hematuria within 12 weeks prior to inclusion.
  • Patients with active gastro-intestinal (GI) bleeding or GI ulcers within 12 months prior to inclusion.
  • Presence of cerebral arteriovenous malformation.
  • Patients who require full-dose therapeutic anticoagulation (e.g. vitamin K antagonist or heparin, dabigatran) or high dose antiplatelet therapy, , patients under anticoagulation with rivaroxaban, apixaban and epixaban.
  • Patients with P-glycoprotein (P-gp) substrates/inducers/inhibitors (e.g.: ketoconazole, erythromycin, cyclosporine, rifampicin, carbamazepine, phenytoin, and St. John's Wort).
  • Patients with known coronary artery disease or recent history of myocardial infarction (within 1 year).
  • Known inherited predisposition to thrombosis or thrombotic events( including stroke and transient ischemic attack, excluded superficial venous thrombosis) within 12 months prior to inclusion.
  • Patients with QTc prolongation
  • Hypersensitivity to nintedanib, peanut or soya, or to any of the excipients.
  • Patient who incompletely filled in epistaxis grids within 8 weeks prior to inclusion.
  • Patient who have received intravenous bevacizumab within 6 months prior to inclusion.
  • Patient who had surgery (including ENT (Ear, Nose and Throat Specialist) surgery) within 12 weeks prior to inclusion.
  • Unhealed wound.
  • Planned major surgery within the next 3 months, including liver transplantation, major abdominal or intestinal surgery.
Contacts and Locations

Contacts
Layout table for location contacts
Contact: Sophie DUPUIS-GIROD, MD 4 27 85 65 25 ext +33 sophie.dupuis-girod@chu-lyon.fr

Locations
Layout table for location information
France
CHU d'Angers Not yet recruiting
Angers, France
Contact: C LAVIGNE       chlavigne@chu-angers.fr   
Principal Investigator: C LAVIGNE         
Hôpital Ambroise Paré Not yet recruiting
Boulogne Billancourt, France
Contact: Thierry CHINET       thierry.chinet@aphp.fr   
Principal Investigator: Thierry CHINET         
Hôpital Femme-Mère-Enfant-Centre de Référence pour la maladie de Rendu-Osler Recruiting
Bron, France
Contact: Sophie DUPUIS-GIROD       sophie.dupuis-girod@chu-lyon.fr   
CHU Clermont Ferrand Not yet recruiting
Clermont-Ferrand, France
Contact: Vincent GROBOST       vincent.grobost@gmail.com   
Principal Investigator: Vincent GROBOST         
Hôpital Jeanne de Flandre Not yet recruiting
Lille, France
Contact: Hélène MAILLARD       helene.maillard@chru-lille.fr   
Principal Investigator: Hélène MAILLARD         
CHU de Marseille-Hôpital la conception Recruiting
Marseille, France
Contact: Julie SEGUIER       julie.seguier@ap-hm.de   
Principal Investigator: Julie SEGUIER         
CHU de Montpellier-Hôpital St Eloi Not yet recruiting
Montpellier, France
Contact: Sophie RIVIERE       s-riviere@chu-montpellier.fr   
Principal Investigator: Sophie RIVIERE         
Hôpital Tenon Recruiting
Paris, France
Contact: Antoine PARROT       antoine-parrot@tnn.aphp.fr   
Principal Investigator: Antoine PARROT         
CHRU - Hôpital J.Bernard Not yet recruiting
Poitiers, France
Contact: Brigitte GILBERT-DUSSARDIER       brigitte.gilbert-dussardier@chu-poitiers.fr   
Principal Investigator: Brigitte GILBERT-DUSSARDIER         
CHU de Rennes-Hôpital Pontchaillou Recruiting
Rennes, France
Contact: Mallorie KERJOUAN       mallorie.kerjouan@chu-rennes.fr   
Principal Investigator: Mallorie KERJOUAN         
Sponsors and Collaborators
Hospices Civils de Lyon
Investigators
Layout table for investigator information
Principal Investigator: Sophie DUPUIS-GIROD Hospices Civils de Lyon
Tracking Information
First Submitted Date  ICMJE May 15, 2019
First Posted Date  ICMJE May 17, 2019
Last Update Posted Date January 7, 2021
Actual Study Start Date  ICMJE June 22, 2020
Estimated Primary Completion Date December 2022   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: May 15, 2019)
Epistaxis duration assessed on epistaxis grids completed by the patients. [ Time Frame: 12 weeks ]
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: May 17, 2019)
  • number of adverse events [ Time Frame: 6 months ]
  • number of adverse events [ Time Frame: 12 weeks ]
  • number of adverse events [ Time Frame: 24 weeks ]
  • Efficacy or nintedanib assessed by ESS (Epistaxis Severity Score) questionnaire [ Time Frame: 12 weeks ]
    This score assess the severity of epistaxis (minimum 0 corresponds to "none" and maximum 10 corresponds to"severe")
  • Efficacy or nintedanib assessed by ESS questionnaire [ Time Frame: 24 weeks ]
    This score assess the severity of epistaxis (minimum 0 corresponds to "none" and maximum 10 corresponds to"severe")
  • duration of epistaxis all over the study. Assessment on epistaxis grids completed by the patients. [ Time Frame: 12 weeks ]
  • duration of epistaxis assessed on epistaxis grids completed by the patients. [ Time Frame: 24 weeks ]
  • duration of epistaxis assessed on epistaxis grids completed by the patients. [ Time Frame: 12 weeks ]
  • frequency of epistaxis assessed on epistaxis grids completed by the patients. [ Time Frame: 24 weeks ]
  • Quality of life assessed by SF36 (Short Form 36) questionnaire [ Time Frame: 12 weeks ]
  • Quality of life assessed by SF36 questionnaire [ Time Frame: 24 weeks ]
  • number of red blood cell transfusions [ Time Frame: 12 weeks ]
  • number of red blood cell transfusions [ Time Frame: 24 weeks ]
  • number of iron infusions [ Time Frame: 12 weeks ]
  • number of iron infusions [ Time Frame: 24 weeks ]
  • hemoglobin level [ Time Frame: 12 weeks ]
  • hemoglobin level [ Time Frame: 24 weeks ]
  • ferritin level [ Time Frame: 12 weeks ]
  • ferritin level [ Time Frame: 24 weeks ]
Original Secondary Outcome Measures  ICMJE
 (submitted: May 15, 2019)
  • number of adverse events [ Time Frame: 6 months ]
  • number of adverse events [ Time Frame: 12 weeks ]
  • number of adverse events [ Time Frame: 24 weeks ]
  • Efficacy or nintedanib assessed by ESS (Epistaxis Severity Score) questionnaire [ Time Frame: 12 weeks ]
  • Efficacy or nintedanib assessed by ESS questionnaire [ Time Frame: 24 weeks ]
  • duration of epistaxis all over the study. Assessment on epistaxis grids completed by the patients. [ Time Frame: 12 weeks ]
  • duration of epistaxis assessed on epistaxis grids completed by the patients. [ Time Frame: 24 weeks ]
  • duration of epistaxis assessed on epistaxis grids completed by the patients. [ Time Frame: 12 weeks ]
  • frequency of epistaxis assessed on epistaxis grids completed by the patients. [ Time Frame: 24 weeks ]
  • Quality of life assessed by SF36 (Short Form 36) questionnaire [ Time Frame: 12 weeks ]
  • Quality of life assessed by SF36 questionnaire [ Time Frame: 24 weeks ]
  • number of red blood cell transfusions [ Time Frame: 12 weeks ]
  • number of red blood cell transfusions [ Time Frame: 24 weeks ]
  • number of iron infusions [ Time Frame: 12 weeks ]
  • number of iron infusions [ Time Frame: 24 weeks ]
  • hemoglobin level [ Time Frame: 12 weeks ]
  • hemoglobin level [ Time Frame: 24 weeks ]
  • ferritin level [ Time Frame: 12 weeks ]
  • ferritin level [ Time Frame: 24 weeks ]
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Efficacy of Nintedanib Per os as a Treatment for Epistaxis in HHT Disease.
Official Title  ICMJE Efficacy of Nintedanib Per os as a Treatment for Epistaxis in HHT Disease. A National, Randomized, Multicentre Phase II Study
Brief Summary

The recognized manifestations of HHT are all due to abnormalities in vascular structure. Epistaxis are spontaneous, very variable, may occur as often as several times every day, and are recurrent in 90% of patients and associated with chronic and severe anemia in 2-10%. They also significantly reduce quality of life.

Blood transfusions are sometimes required in 10-30% of patients. Previous studies showed that antiangiogenic treatments such as anti-VEGF treatment (bevacizumab) administered intravenously was efficient on epistaxis and dramatically reduced nosebleeds.

Tyrosine kinase inhibitors are anti-angiogenic molecules which are available orally and could therefore overcome the difficulties encountered with bevacizumab. The investigator hypothesized that nintedanib, acting by indirect inhibition of the VEGF receptor should allow a reduction of epistaxis in HHT patient.

Nintedanib has been used in one HHT patient following the diagnosis of Insterstitial Pulmonary Fibrosis (published case report in 2017, Kovacs et al) with encouraging results.

The aim is to evaluate efficacy of nintedanib for the treatment of epistaxis in HHT patients

Detailed Description Not Provided
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 2
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Condition  ICMJE Hemorrhagic Hereditary Telangiectasia
Intervention  ICMJE
  • Drug: Nintedanib 150 mg and 100 mg soft capsules
    Nintedanib 150 mg soft capsules twice daily approximately 12 hours apart (i.e. 300 mg/day) for 12 weeks. In case of adverse reaction a dose reduction at 200 mg/day (100 mg twice daily) can be prescribe.
  • Drug: Oral treatment of placebo soft capsule
    Placebo soft capsules (identical to 150 mg and 100 mg soft capsules)
Study Arms  ICMJE
  • Experimental: Nintedanib
    Oral treatment of Nintedanib 150 mg soft capsule
    Intervention: Drug: Nintedanib 150 mg and 100 mg soft capsules
  • Placebo Comparator: Placebo
    Oral treatment of placebo soft capsule
    Intervention: Drug: Oral treatment of placebo soft capsule
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Recruiting
Estimated Enrollment  ICMJE
 (submitted: May 15, 2019)
60
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE December 2022
Estimated Primary Completion Date December 2022   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Age > 18 years old
  • Patients who have given their free informed and signed consent
  • Patients affiliated to a social security scheme or similar
  • Patients monitored for clinically confirmed HHT and/or with molecular biology confirmation
  • Patient with an Epistaxis Severity Score (ESS) > 4

Exclusion Criteria:

  • Pregnant woman or woman of child bearing potential
  • Woman who are breast feeding.
  • Patient who is protected adults under the terms of the law (French Public Health Code).
  • Participation in another interventional clinical trial which may interfere with the proposed trial
  • Active infection.
  • (AST, ALT > 1,5 fold upper limit of normal (ULN) and/or Bilirubin > 1,5 fold upper limit of normal (ULN).
  • Severe renal impairment
  • Presence of non-treated pulmonary arteriovenous malformations accessible to a treatment on CT scan within 5 years.
  • Patients with hemoptysis or hematuria within 12 weeks prior to inclusion.
  • Patients with active gastro-intestinal (GI) bleeding or GI ulcers within 12 months prior to inclusion.
  • Presence of cerebral arteriovenous malformation.
  • Patients who require full-dose therapeutic anticoagulation (e.g. vitamin K antagonist or heparin, dabigatran) or high dose antiplatelet therapy, , patients under anticoagulation with rivaroxaban, apixaban and epixaban.
  • Patients with P-glycoprotein (P-gp) substrates/inducers/inhibitors (e.g.: ketoconazole, erythromycin, cyclosporine, rifampicin, carbamazepine, phenytoin, and St. John's Wort).
  • Patients with known coronary artery disease or recent history of myocardial infarction (within 1 year).
  • Known inherited predisposition to thrombosis or thrombotic events( including stroke and transient ischemic attack, excluded superficial venous thrombosis) within 12 months prior to inclusion.
  • Patients with QTc prolongation
  • Hypersensitivity to nintedanib, peanut or soya, or to any of the excipients.
  • Patient who incompletely filled in epistaxis grids within 8 weeks prior to inclusion.
  • Patient who have received intravenous bevacizumab within 6 months prior to inclusion.
  • Patient who had surgery (including ENT (Ear, Nose and Throat Specialist) surgery) within 12 weeks prior to inclusion.
  • Unhealed wound.
  • Planned major surgery within the next 3 months, including liver transplantation, major abdominal or intestinal surgery.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Sophie DUPUIS-GIROD, MD 4 27 85 65 25 ext +33 sophie.dupuis-girod@chu-lyon.fr
Listed Location Countries  ICMJE France
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03954782
Other Study ID Numbers  ICMJE 69HCL19_0003
2019-002593-31 ( EudraCT Number )
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Hospices Civils de Lyon
Study Sponsor  ICMJE Hospices Civils de Lyon
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Sophie DUPUIS-GIROD Hospices Civils de Lyon
PRS Account Hospices Civils de Lyon
Verification Date January 2021

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP