Phase 2 Study of PEG-Intron in Hereditary Hemorrhagic Telangiectasia

This study has been terminated.
(Schering-Plough discontinued supplying study drug.)
Sponsor:
Collaborators:
Georgia Regents University
St. Michael's Hospital, Toronto
Schering-Plough
Information provided by:
Mayo Clinic
ClinicalTrials.gov Identifier:
NCT00588146
First received: December 26, 2007
Last updated: February 19, 2013
Last verified: February 2013
  Purpose

The purpose of the study is to evaluate the safety and tolerability of pegylated interferon alpha-2b (PEG-Intron) in patients with severe complications related to Hereditary hemorrhagic telangiectasia (HHT).

Funding Source - FDA Office of Orphan Products Development (OOPD)


Condition Intervention Phase
Anemia
Liver Disease
Hypoxemia
Drug: Pegylated Interferon Alpha2b
Other: Standard care
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Crossover Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase 2 Study of PEG-Intron in Hereditary Hemorrhagic Telangiectasia

Resource links provided by NLM:


Further study details as provided by Mayo Clinic:

Primary Outcome Measures:
  • Change in Hemoglobin [ Time Frame: baseline, one year ] [ Designated as safety issue: Yes ]
    The hemoglobin level is expressed as the amount of hemoglobin in grams (gm) per deciliter (dL) of whole blood.


Enrollment: 10
Study Start Date: January 2007
Study Completion Date: September 2011
Primary Completion Date: September 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Pegylated Interferon Alpha2b, then Standard Care
Weekly subcutaneous injection of pegylated interferon alpha2b 1 microgram/kg/week for 6 months, then standard care for 6 months.
Drug: Pegylated Interferon Alpha2b
Weekly subcutaneous injection of 1 microgram/kg/week
Other Name: PEG-Intron
Other: Standard care
Standard care
Experimental: Standard Care, then Pegylated Interferon Alpha2b
Standard care for 6 months, then weekly subcutaneous injection of pegylated interferon alpha2b 1 microgram/kg/week for 6 months.
Drug: Pegylated Interferon Alpha2b
Weekly subcutaneous injection of 1 microgram/kg/week
Other Name: PEG-Intron
Other: Standard care
Standard care

Detailed Description:

The objective of this study is to evaluate the safety and tolerability of pegylated interferon alpha-2b (PEG-Intron) in patients with severe complications related to Hereditary Hemorrhagic Telangiectasia (HHT). Participants will be randomized to the treatment arm or control arm and then crossed over to the alternate arm at 6 months for the remainder of the 12-month study. Study treatment will consist of weekly subcutaneous injections of pegylated interferon alpha-2b (PEG-Intron), 1 microgram/kilogram/week. Adverse events as well as monitoring and treatment of toxicities will be followed as stated in the protocol. Adverse events will be graded according to the Modified NCI Common Toxicity Criteria. After every five participants have completed one month of treatment, an independent data safety monitoring board will review any adverse events.

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Definite diagnosis of HHT by clinical criteria or genetic diagnosis. For the clinical diagnosis, 3 of the 4 following criteria1 must be present:

    1. Epistaxis: spontaneous, recurrent
    2. Telangiectases: multiple at characteristic sites
    3. Visceral lesions including telangiectases and/or arteriovenous malformations (AVM) (pulmonary, hepatic, gastrointestinal, cerebral, spinal)
    4. Family history of a first degree relative with HHT
  2. Transfusion-dependent anemia from HHT-related bleeding (epistaxis from nasal mucosal telangiectases or gastrointestinal bleeding from gastrointestinal telangiectases) defined as a hemoglobin (Hb) < 9g/dL with transfusion of at least one unit of packed red blood cells within the past 6 months or Hb < 11g/dL in females or < 13g/dL in males with transfusion of at least 5 units of blood within the past 6 months. Patients must be on a stable dose of iron or intolerant of iron. Patients must have failed traditional treatment options.
  3. Clinically stable outpatient
  4. Able and willing to return for outpatient visits
  5. Ability to perform subcutaneous injections
  6. Adult (Age 18 - 70 years)
  7. Presence of the following laboratory results at entry:

    1. White blood cell count ≥ 2000/mm^3
    2. Neutrophil count ≥ 1000/mm^3
    3. Platelet count ≥ 80,000/mm^3
    4. Thyroid stimulating hormone within normal limits (Minimal abnormalities of the sensitive thyroid stimulating hormone may be allowed provided that the free thyroxin is normal and the patient is clinically euthyroid)
  8. Negative pregnancy test at enrollment, if applicable
  9. If the participant is a sexually active woman of childbearing potential, evidence that she is practicing adequate contraception during the treatment period. Adequate contraception includes use of an intrauterine device, oral contraceptives, progesterone implanted rods, medroxyprogesterone acetate, surgical sterilization, barrier method (diaphragm + spermicide), a monogamous relationship with a male partner who has had a vasectomy or is using a condom + spermicide or a birth control method acceptable to the study physicians. Participants and/or their partners must agree to continue the use of adequate contraception for at least 6 months following completion of treatment.
  10. Written informed consent specific for this protocol obtained prior to entry
  11. Patients agree to take study medication as directed and follow all study related procedures until the conclusion of their protocol participation
  12. Hepatic involvement by HHT characterized by high output heart failure due to hepatic vascular malformations (symptoms of heart failure including edema, ascites, S3 gallop, orthopnea, or jugular venous pressure > 10 cm H_2O) plus cardiac index (CI) measured at right heart catheterization > 4.4 L/min/m^2. Patients must have failed traditional treatment options.
  13. Computed tomography scanning (CT) of the liver documenting vascular abnormalities consistent with HHT
  14. Child-Pugh category A
  15. Diffuse pulmonary telangiectases or AVMs documented by pulmonary angiography not amenable to treatment with embolization techniques. Patients must have failed traditional treatment options.
  16. Positive contrast echocardiography documenting right to left intrapulmonary shunt
  17. Resting or exercise-induced hypoxemia defined as a partial pressure of oxygen (PaO_2) < 70 mmHg at rest or an oxygen saturation (SpO_2) < 85% with exercise.

Exclusion Criteria:

  1. Anemia from any other cause than that due to HHT-related bleeding
  2. Hypersensitivity to PEG-Intron or any other component of the product
  3. Decompensated liver disease

    1. Chronic active Hepatitis B infection
    2. Child-Pugh category B or C
  4. History of severe psychiatric disease

    1. Prior suicide attempt
    2. Hospitalization for psychiatric disease
    3. Period of disability due to a psychiatric disease
    4. Current episode of moderate to severe depression not responsive to treatment
  5. History of immunologically mediated disease

    1. Inflammatory bowel disease
    2. Idiopathic thrombocytopenic purpura
    3. Systemic lupus erythematosus
    4. Autoimmune hemolytic anemia
    5. Scleroderma
    6. Sarcoidosis
    7. Multiple sclerosis
    8. Severe psoriasis
    9. Clinical evidence of rheumatoid arthritis
    10. Autoimmune hepatitis
  6. History of clinically significant cardiovascular disease

    1. Positive stress test
    2. Clinically significant arrhythmia
    3. Congestive heart failure
    4. Uncontrolled hypertension
    5. Coronary artery bypass surgery within 24 weeks prior to entry
    6. Angina pectoris or myocardial infarction within 1 year prior to entry
  7. Seizure disorder uncontrolled by anticonvulsants (within the last 12 months)
  8. History of thyroid disease poorly controlled on prescribed medications
  9. History or evidence of retinopathy
  10. Patients on chronic anticoagulation
  11. History of chronic renal insufficiency (creatinine > 2.5 mg/dL)
  12. Patients who have received an investigational drug within 24 weeks of treatment assignment
  13. History or other evidence of severe illness or other comorbid condition which would make the patient unsuitable for participation in a research protocol
  14. Liver dysfunction from any other cause than that due to HHT (chronic active hepatitis B infection, hepatitis C infection, alcoholic cirrhosis, etc.)
  15. Cardiac index < 4.4 L/min/m^2
  16. Pulmonary AVMs with feeding arteries > 3 mm in diameter amenable to embolization techniques
  17. Other pulmonary diseases causing hypoxemia.
  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: NCT00588146

Locations
United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905
Sponsors and Collaborators
Mayo Clinic
Georgia Regents University
St. Michael's Hospital, Toronto
Schering-Plough
Investigators
Principal Investigator: Karen L Swanson, DO Mayo Clinic
  More Information

Additional Information:
No publications provided

Responsible Party: Karen Swanson, Mayo Clinic
ClinicalTrials.gov Identifier: NCT00588146     History of Changes
Other Study ID Numbers: 2400-05, R01FD003076-01
Study First Received: December 26, 2007
Results First Received: December 20, 2012
Last Updated: February 19, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by Mayo Clinic:
anemia
HHT
Liver disease
Hypoxemia
Iron deficiency anemia
Liver disease with high cardiac output
Diffuse pulmonary AVMs with hypoxemia

Additional relevant MeSH terms:
Anemia
Liver Diseases
Telangiectasis
Telangiectasia, Hereditary Hemorrhagic
Hematologic Diseases
Digestive System Diseases
Vascular Diseases
Cardiovascular Diseases
Hemostatic Disorders
Hemorrhagic Disorders
Vascular Malformations
Cardiovascular Abnormalities
Congenital Abnormalities
Interferon-alpha
Interferons
Peginterferon alfa-2b
Antiviral Agents
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Immunologic Factors
Physiological Effects of Drugs
Antineoplastic Agents

ClinicalTrials.gov processed this record on September 30, 2014