Evaluation of Tolerability and Efficacy of Erythropoietin (EPO) Treatment in Spinal Shock: Comparative Study Versus Methylprednisolone (MP)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00561067
Recruitment Status : Suspended (Italian Medicines Agency decision)
First Posted : November 20, 2007
Last Update Posted : February 22, 2012
Information provided by (Responsible Party):
Niguarda Hospital

Brief Summary:
The purpose of this study is to evaluate the tolerability and efficacy of erythropoietin (EPO) treatment in spinal shock in comparison with the methylprednisolone treatment (MP).

Condition or disease Intervention/treatment Phase
Spinal Cord Injury Drug: Erythropoietin Drug: Methylprednisolone Phase 3

Detailed Description:
Traumatic spinal cord injury (TSCI) is devastating for the patient and costly to society. Currently, methylprednisolone (MP) administered according NASCIS (III) protocol is the only therapy which has minor benefits and is accompanied by dangerous side effects. Any new treatment of TSCI that allows major recovery of function would be a significant advance in clinical care. Much of the motor and sensory paralysis following TSCI occurs because of a delayed and widespread oligodendrocyte apoptosis and demyelination of long spinal tracts. We have recently reported that erythropoietin (EPO) administration significantly attenuates such delayed secondary degeneration and promotes functional recovery in TSCI animal models. The research proposed is a multicenter trial involving the Italian Spinal Units that have developed a multidisciplinary experience on the management of TSCI. Primary objective of the study is to assess the superiority of EPO compared to MP in improving the clinical outcome of SCI (ASIA Impairment Scale); secondary objectives are: to assess the safety of EPO compared to MP, the effects on the motor and sensory functions and on improving functional autonomy, the influence on spasticity and neurogenic pain, and, the impact on surrogate end-points (Somatosensory Evoked Potentials and Magnetic Resonance Imaging).The study population is characterized by all patients with TSCI (ASIA Impairment Scale A or B) admitted to Italian Spinal Units: we estimate an enrolment of 100 subjects , 50 in each therapeutic arm. The study proposed is a single-blind randomized phase III parallel group trial in which eligible patients are randomized to one of the following treatment modalities: MP according to NASCIS III protocol or EPO iv (500 UI/kg within 8 hours after the SCI, dosage repeated at 24 and 48 hours). The duration of the study will be 24 months, with a 21-month maximum time to engage all the patients required by the power calculation.The primary end-point will be assessed using the Cochrane-Mantel-Haenzel test; the changes in the SEP (latency) and size of the MRI lesions using the Repeated Measures Analysis of Variance (ANOVA), the Ashworth, VAS, PENN, and SCIM scores with the parametric Wilcoxon's signed-ranks test. The effect of treatment on the primary end-point will be evaluated using a multivariate analysis model (binary logistic regression). The non-parametric alternative will be conducted if the assumption of normality will be not verified.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 100 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Evaluation of the Tolerability and Efficacy of Erythropoietin (EPO) Treatment in Spinal Shock: Comparative Study VS Methylprednisolone (MP)
Study Start Date : April 2008
Actual Primary Completion Date : July 2008

Arm Intervention/treatment
Active Comparator: 1
Drug: Methylprednisolone
MP 30 mg/kg intravenous (iv) in the first hour, followed by 5.4 mg/kg/h for 23 hours if treatment is started within three hours after the spinal injury,or for 48 hours if treatment is started between three and eight hours (protocol NASCIS III, National Acute Spinal Cord Injury Study)
Experimental: 2
Drug: Erythropoietin
EPO 500 IU/kg diluted in 50 ml saline and infused in 30 minutes; treatment is started within eight hours after the spinal injury; the same drug dosage will be infused at 24 and 48 hours

Primary Outcome Measures :
  1. Improvement of ASIA Impairment Scale of at least 1 grade. Score on ASIA Scale and a ASIA Impairment Scale are an inclusion criteria, then at 3rd, 7th, 14th, 30th, 60th, 90th days [ Time Frame: 3 months ]

Secondary Outcome Measures :
  1. Increase of ASIA motor/sensory scores at 3rd, 7th, 14th, 30th, 60th, 90th days [ Time Frame: 3 months ]
  2. Functional autonomy with SCIM scores at 7th, 30th, 60th, 90th days [ Time Frame: 3 months ]
  3. Spasticity with the Ashworth Scale, spasms with the PENN Scale and neurogenic pain with the VAS Scale at 7th, 14th days [ Time Frame: 3 months ]

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Ages Eligible for Study:   18 Years to 65 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Traumatic SCI occurred within 8 hours
  • Hemodynamic stability at the time of treatment start (systolic blood pressure > 90 mmHg for at least 1 hour without massive infusion or vasopressor support for ongoing bleeding)
  • Neurological level between C5 and T12 (ASIA scale)
  • ASIA Impairment Scale: A or B
  • Informed consent

Exclusion Criteria:

  • SCI other than traumatic
  • SCI caused by edged weapons or fire arms
  • Traumatic SCI after 8 hours
  • Neurological level above C5 or below T12
  • ASIA Impairment Scale C, D, E
  • Uncontrolled arterial hypertension
  • Past or current cerebrovascular disease
  • Past or current acute myocardial infarction
  • History of thrombotic events
  • Other chronic cardiovascular disorders (cardiac arrhythmias, congestive heart failure)
  • History of peripheral arterial disease, polycythemia, porphyria, active malignancy
  • Previous or current neurological diseases with abnormal neurological examination
  • Suspected or definite pregnancy or lactation (requiring ßHCG confirmation)
  • Clinically relevant psychiatric disease
  • Known allergy to EPO
  • Hypersensitivity to human albumin
  • Acute or chronic renal failure

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00561067

A.O. Ospedale Ca' Granda
Milan, Italy, 20162
Sponsors and Collaborators
Niguarda Hospital
Principal Investigator: Tiziana Redaelli, MD Azienda Ospedaliera Ospedale Niguarda Ca' Granda Milano

Responsible Party: Niguarda Hospital Identifier: NCT00561067     History of Changes
Other Study ID Numbers: FARM6Y35XM
First Posted: November 20, 2007    Key Record Dates
Last Update Posted: February 22, 2012
Last Verified: February 2012

Keywords provided by Niguarda Hospital:
Spinal cord injury
spinal shock

Additional relevant MeSH terms:
Spinal Cord Injuries
Spinal Cord Diseases
Central Nervous System Diseases
Nervous System Diseases
Trauma, Nervous System
Wounds and Injuries
Prednisolone acetate
Methylprednisolone acetate
Methylprednisolone Hemisuccinate
Prednisolone hemisuccinate
Prednisolone phosphate
Epoetin Alfa
Anti-Inflammatory Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Hormones, Hormone Substitutes, and Hormone Antagonists
Neuroprotective Agents
Protective Agents
Antineoplastic Agents, Hormonal
Antineoplastic Agents