Albumin for Intracerebral Hemorrhage Intervention (ACHIEVE)

This study has been terminated.
(Enrollment was stopped due to low recruitment and the PI's move to a different institution.)
Sponsor:
Collaborator:
Baxter Healthcare Corporation
Information provided by (Responsible Party):
Chelsea Kidwell, M.D., Georgetown University
ClinicalTrials.gov Identifier:
NCT00990509
First received: October 1, 2009
Last updated: August 19, 2014
Last verified: August 2014
  Purpose

The purpose of this study is to find out what effects, good and bad, the medication Albumin has on subjects who have experienced a type of stroke known as an intracerebral hemorrhage (ICH). An ICH is when spontaneous bleeding into the brain occurs due to fragile blood vessels.

This research is being done because currently there is no effective treatment for ICH. However, study investigators believe that Albumin, the medication being tested in this study, is safe and may help improve patient recovery from ICH over time.

Subjects will be enrolled in the study for a total of 90 days. Following enrollment, subjects will be randomized to receive 3 daily injections of either Albumin or Placebo (liquid with no drug), and will receive 3 brain MRI scans (with and without contrast), as described below.

All subjects will be monitored continuously through 96 hours after enrollment (5 days) in the Georgetown ICU. Blood tests and clinical evaluations of neurological status, consisting of questions about subjects' functional abilities and medical history, will occur in the Georgetown ICU once every 24 hours through post-enrollment Day 5. Additionally, subjects will receive daily chest x-rays, and daily EKGs (exams that monitor how your heart is doing by placing electrodes, or small monitors, on your skin in specific locations).

Similar clinical evaluations will occur at Day 30 and Day 90. Should subjects be discharged at these time points, day 30 assessments will occur over the phone, and day 90 assessments will occur in-person at Georgetown University Medical Center.


Condition Intervention Phase
Intracerebral Hemorrhage
Drug: Albumin
Drug: Placebo
Procedure: Brain MRI with and without contrast
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Albumin for Intracerebral Hemorrhage Intervention

Resource links provided by NLM:


Further study details as provided by Georgetown University:

Primary Outcome Measures:
  • Mean Hyperintense Acute injuRy Marker (HARM) [ Time Frame: Day 5 MRI ] [ Designated as safety issue: No ]
    Hyperintense Acute injuRy Marker (HARM) characterizes the frequency and severity of blood brain barrier disruption. Mean HARM is assessed on the post-contrast study using a previously developed 5 point scale (0 to 5).). A score of 0 indicates no HARM, whereas a score of 5 indicates diffuse and generalized HARM. 11 of 14 participants received a Day 5 MRI. HARM reads could only be performed on 4 of the 7 placebo subjects due to insufficient sequences or presence of subarachnoid blood. Mean HARM score is presented.

  • Assessment of Safety of Albumin Administration in Primary ICH [ Time Frame: Through Day 90 following enrollment ] [ Designated as safety issue: Yes ]
    Serious adverse events. Specific safety outcomes assessed: frank pulmonary edema as visualized on chest X-Ray, congestive heart failure, neurological deterioration (4-point worsening on NIHSS), death

  • Mean Intracerebral Hemorrhage (ICH) Volume [ Time Frame: Day 5 MRI ] [ Designated as safety issue: No ]
    11 of 14 participants received a Day 5 MRI. Mean ICH volume based on 11 participants is presented.


Enrollment: 14
Study Start Date: September 2009
Study Completion Date: June 2013
Primary Completion Date: June 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Albumin Drug: Albumin
Three (3) daily IV infusions of 1.25 g/kg Albumin (25%) on Days 1-3 following enrollment.
Other Name: BUMINATE 25%, Albumin (Human)
Procedure: Brain MRI with and without contrast

All subjects will receive 3 brain MRI studies, regardless of if they are randomized into Albumin or Placebo condition.

MRIs will be with and without contrast will be performed at:

  • Baseline
  • 48 hours after enrollment(approximately Day 3)
  • 96 hours after drug treatment begins (approximately Day 5)
Other Names:
  • 1.5T Siemens Symphony MRI.
  • 3T Siemens Verio
Placebo Comparator: Placebo Drug: Placebo
Three (3) daily IV infusions of 1.25 g/kg Saline solution on Days 1-3 following enrollment
Procedure: Brain MRI with and without contrast

All subjects will receive 3 brain MRI studies, regardless of if they are randomized into Albumin or Placebo condition.

MRIs will be with and without contrast will be performed at:

  • Baseline
  • 48 hours after enrollment(approximately Day 3)
  • 96 hours after drug treatment begins (approximately Day 5)
Other Names:
  • 1.5T Siemens Symphony MRI.
  • 3T Siemens Verio

Detailed Description:

We aim to determine the safety and explore the efficacy of human albumin as a neuroprotective (or cytoprotective) agent for the treatment of acute primary supratentorial ICH. Albumin therapy has been shown to be cytoprotective in animal studies of both ischemic stroke and intracerebral hemorrhage, and in a phase II human study in ischemic stroke.

To date no acute intervention (beyond supportive medical care) has been identified to improve outcomes in patients with primary ICH. Neuronal injury from a primary ICH is due not only to the space occupying effects of the hemorrhage but also due to the development of edema and toxicity from blood breakdown products in the subacute phase. Cytoprotective strategies targeted to limit blood brain barrier (BBB) breakdown and edema formation hold promise as treatment strategies to limit this injury.

A number of MR imaging outcome markers demonstrating a potential neuroprotective effect include measures of hematoma volume, perihematomal edema, and blood brain barrier disruption. The term "hyperintense acute injury marker" (HARM) has been proposed to describe the radiologic finding of hyperintense signal within the cerebrospinal fluid spaces visualized on post-contrast fluid attenuated inversion recovery (FLAIR) MRI in patients with acute ischemic stroke. HARM has the potential to serve as a marker of blood brain barrier disruption in patients with primary ICH. The current study will involve serial MR imaging in ICH patients randomized to placebo vs. albumin to assess whether there are differences in the frequency of HARM and perihematomal edema in the albumin treated patients.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Primary supratentorial ICH
  • < 48 hours from symptom onset
  • Age >18
  • Signed informed consent obtained from the patient or patient's legally authorized representative

Exclusion Criteria:

  • ICH volume < 5 cc
  • Glasgow Coma Scale < 6
  • Surgical evacuation anticipated
  • Pre-existing medical, neurological or psychiatric disease that would confound the neurological, functional, or imaging evaluations
  • Pregnancy or breastfeeding
  • Hemodynamic instability (SBP < 100 mmHg, > 200 mmHg)
  • Current participation in another experimental treatment protocol
  • Renal impairment with GFR < 30 or Creatinine > 2.0
  • History of or known allergy to albumin
  • History of or known severe allergy to rubber latex
  • Episode/exacerbation of congestive heart failure (CHF) from any cause in the last 6 months. (An episode of congestive heart failure is any heart failure that required a change in medication, diet or hospitalization)
  • Acute myocardial infarction in the last 6 months
  • Elevated serum troponin level on admission > 0.1 mcg/L
  • Known valvular heart disease with CHF in the last 6 months
  • Known (or in the investigator's judgment) existence of severe aortic stenosis or mitral stenosis
  • Cardiac surgery involving thoracotomy (e.g., coronary artery bypass graft (CABG), valve replacement surgery) in the last 6 months
  • Suspicion of aortic dissection on admission
  • Acute arrhythmia (including any tachy- or bradycardia) with hemodynamic instability on admission (systolic blood pressure < 100 mmHg).
  • Findings on physical examination of any of the following: (1) jugular venous distention (JVP > 4 cm above the sternal angle); (2) 3rd heart sound; (3) resting tachycardia (heart rate > 100/min) attributable to congestive heart failure; (4) abnormal hepatojugular reflux; (5) lower extremity pitting edema attributable to congestive heart failure or without apparent cause; (6) bilateral rales; and/or (7) if a chest x-ray is performed, definite evidence of pulmonary edema, bilateral pleural effusion, or pulmonary vascular redistribution.
  • Current acute or chronic lung disease requiring supplemental chronic or intermittent oxygen therapy.
  • Prosthetic heart valves
  • Contraindication to MRI (metal implant, etc.)
  • Documented left ventricular ejection fraction < 35%
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00990509

Locations
United States, District of Columbia
Georgetown University Hospital
Washington, District of Columbia, United States, 20007
Sponsors and Collaborators
Georgetown University
Baxter Healthcare Corporation
Investigators
Principal Investigator: Chelsea Kidwell, MD Georgetown University
  More Information

No publications provided

Responsible Party: Chelsea Kidwell, M.D., Professor of Neurology; Medical Director, Georgetown University Stroke Center, Georgetown University
ClinicalTrials.gov Identifier: NCT00990509     History of Changes
Other Study ID Numbers: 2009-173
Study First Received: October 1, 2009
Results First Received: July 22, 2014
Last Updated: August 19, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by Georgetown University:
Primary ICH
Albumin
MRI
Neuroimaging outcome
Placebo-controlled
Phase II
Blinded
Safety
Acute ICH
ICH
Primary acute (< 48 hours) supratentorial ICH

Additional relevant MeSH terms:
Hemorrhage
Cerebral Hemorrhage
Pathologic Processes
Intracranial Hemorrhages
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases

ClinicalTrials.gov processed this record on September 22, 2014