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Treat_CCM: Propranolol in Cerebral Cavernous Malformation (Treat_CCM)

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ClinicalTrials.gov Identifier: NCT03589014
Recruitment Status : Recruiting
First Posted : July 17, 2018
Last Update Posted : January 10, 2019
Sponsor:
Collaborator:
IFOM, The FIRC Institute of Molecular Oncology
Information provided by (Responsible Party):
Mario Negri Institute for Pharmacological Research

Brief Summary:

Cerebral Cavernous Malformation (CCM) is a cerebrovascular disease which can be either congenital in origin or sporadic and is characterized by the presence of isolated or multiple CCM lesions, causing recurrent headache, seizures, focal neurological deficits and hemorrhages. Inasmuch, to date, the only curative treatment available is limited to surgical lesion eradication or stereotactic radiosurgery. It is therefore necessary to find an effective medical treatment that may limit disease progression and decrease the burden of adverse clinical events. The non-selective betablocker propranolol has been found to be effective in the treatment of infantile cutaneous hemangioma, and anecdotal reports have been published on its efficacy in CCM. The safety profile of propranolol has been documented in millions of patients of all ages.

The primary objective of this exploratory trial is to test whether a chronic treatment with propranolol will reduce the burden of cerebrovascular lesions, of clinical events and symptoms in patients with familial CCM.


Condition or disease Intervention/treatment Phase
Cerebral Cavernous Malformation Drug: Propranolol Phase 2

Detailed Description:

The project will consist of a multicenter, open-label, randomized study (PROBE design) in patients with CCM to be randomized in a 2:1 ratio (propranolol:control) and will allow comparison of 2 groups: one receiving propranolol (recommended initial dose is 40 mg bid, to be uptitrated to 80 mg bid) on the top of recommended standard care, the other receiving recommended standard care. This investigator-driven study will be open-label with a PROBE design will be applied so that each MRI exam will be centrally read and all adverse clinical events will be centrally adjudicated. It should be pointed out that by no means surgery, whenever indicated, will be delayed and/or avoided because of study treatment allocation.

The purpose of this exploratory trial is to test whether a chronic treatment with propranolol will reduce the burden of cerebrovascular lesions, of clinical events and symptoms in patients with familial CCM. Inherited CCM is a rare disease with a prevalence of less than 5/10.000. Thus, since the number of patients to be included in this exploratory trial will be insufficient to prove or disprove a statistically significant beneficial effect of propranolol on clinical events, the extension to more centers and patients is formally included in the present protocol. Special care will be paid to the biologic consistency of the different endpoints, even if none of them will yield statistically significant differences. The assessment of the tolerability of propranolol in normotensive otherwise healthy patients is another clinically relevant endpoint


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Masking Description:

Treat_CCM is a Prospective Randomized Open Trial with Blinded Evaluation of outcomes (PROBE).

Clinical events CCM-related (i.e. intra-cerebral hemorrhage and focal neurological deficits including seizures) will be blindly adjudicated by an independent Event Committee.All MRI exams will be read in a Central Laboratory by experienced neuroradiologists, unaware of patient identification and study treatment.

Primary Purpose: Treatment
Official Title: Treat_CCM Clinical Trial A Multicenter Randomized Clinical Trial on Propranolol in Cerebral Cavernous Malformation
Actual Study Start Date : March 1, 2018
Estimated Primary Completion Date : July 31, 2020
Estimated Study Completion Date : October 31, 2020


Arm Intervention/treatment
No Intervention: Control
Standard Treatments recommended for CCM
Experimental: Propranolol
Initial oral dose 40 mg bid, uptitrated to 80mg bid
Drug: Propranolol
Patients randomized to the experimental arm will receive propranolol on top of standard recommended treatment for CCM. Initial oral dose of 40 mg bid will be uptitrated to 80 mg bid in the absence of excessive bradycardia or hypotension.
Other Name: Inderal




Primary Outcome Measures :
  1. Adverse clinical events CCM-related. [ Time Frame: up to 24 months ]
    New occurrence of clinical events CCM-related, that is intra-cerebral hemorrhage (ICH) and focal neurological deficits (FND) including seizures.


Secondary Outcome Measures :
  1. De novo CCM lesions depiction on MRI. [ Time Frame: up to 24 months ]
    De novo CCM lesions depiction will be obtained on MRI QSM and Susceptibility Weighted Images (SWI) that is very sensitive to hemoglobin and iron deposition.

  2. Adverse clinical outcomes, other than ICH and FND. [ Time Frame: up to 24 months ]
    Global disability and health related quality of life as assessed by Beck Depression Inventory -BDI- questionnaire. BDI is made of 21 questions scored on a scale from 0 to 3, 0 representing the best condition. Final score will be the sum of all scores and will range from 0 to 63, were 0 is the best condition.

  3. Adverse clinical outcomes, other than ICH and FND. [ Time Frame: up to 24 months ]
    Global disability and health related quality of life as assessed by SF-36 questionnaire. SF-36 is made of 36 questions scored on a scale from 0 to 100 representing the highest level of functioning possible. Questions are aggregated in 8 dimensions of health (eg pain, phsical functioning etc.).

  4. Location and MRI signal characteristics of CCM lesions at MRI. [ Time Frame: up to 24 months ]
    Location and MRI signal characteristics of CCM lesions will be assessed by 3 T brain MRI. The encephalic regions evaluated will be: cerebellum, brainstem, right/left hemisphere, right/left basal ganglia. Lesions with previous surgical treatment will be excluded from imaging analysis

  5. Diameter of CCM lesions at MRI. [ Time Frame: up to 24 months ]
    Diameter will be assessed in millimeters.

  6. Length of CCM lesions at MRI [ Time Frame: up to 24 months ]
    Length will be assessed in millimeters.

  7. Micro-hemorrhages at MRI. [ Time Frame: up to 24 months ]
    Micro-hemorrhages will be assessed by magnetic susceptibility of the brain tissue, a biophysical property proportional to local iron content (quantitative susceptibility mapping, QSM). Unit of Measure of QSM is parts per million (ppm). Changes from baseline will be calculated.



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

Inclusion Criteria:

  1. Patients with Familial cerebral cavernous malformations (FCCM);
  2. history of clinical symptoms or events: intracerebral hemorrhage, stroke, permanent or transient focal deficits, seizures, disability or any other neurological symptom supposedly related to CCM;
  3. age of at least 18 years.
  4. Written informed consent to participate in the study prior to any study procedures.

Exclusion Criteria:

  1. Implanted pacemaker or any other condition preventing the magnetic resonance imaging (MRI);
  2. bradycardia or 2nd or 3rd degree AV block, hypotension (symptomatic);
  3. unstable diabetes;
  4. severe asthma;
  5. renal and/or liver failure;
  6. current use of verapamil and diltiazem for risk of excessive bradycardia;
  7. previous brain surgery (within 6 months);
  8. known hypersensitivity to study drug (propranolol or any of the ingredients)
  9. pregnant or lactating women or women of childbearing potential who are not protected from pregnancy by an accepted method of contraception
  10. participation to another clinical trial;
  11. inability to cooperate with the trial procedures.

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 ClinicalTrials.gov identifier (NCT number): NCT03589014


Contacts
Contact: Roberto Latini, MD +390239014454 roberto.latini@marionegri.it
Contact: Silvia Lanfranconi, MD +390255033870 silvia.lanfranconi@policlinico.mi.it

Locations
Italy
IRCCS Casa Sollievo della Sofferenza Not yet recruiting
San Giovanni Rotondo, FG, Italy, 71013
Contact: Marco Castori    0882416288    m.castori@operapadrepio.it   
IRCCS Centro Neurolesi "Bonino Pulejo" Recruiting
Messina, ME, Italy, 98124
Contact: Emanuela Mazzon    +3909060128172    emanuela.mazzon@irccsme.it   
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Recruiting
Milano, Mi, Italy, 20122
Contact: Silvia Lanfranconi    +390255033870    silvia.lanfranconi@policlinico.mi.it   
Fond. IRCCS Ist. Naz. Neurologico Carlo Besta Recruiting
Milano, MI, Italy, 20133
Contact: Maria Rita Carriero    +390223943310    mariarita.carriero@istituto-besta.it   
ASST Grande Ospedale Metropolitano Niguarda Recruiting
Milano, MI, Italy, 20162
Contact: Laura Tassi    +390264442874    laura.tassi@ospedaleniguarda.it   
Fondazione Policlinico Universitario "A. Gemelli" Recruiting
Roma, RM, Italy, 00168
Contact: Roberto Pallini    +39063015343    Roberto.Pallini@unicatt.it   
Sponsors and Collaborators
Mario Negri Institute for Pharmacological Research
IFOM, The FIRC Institute of Molecular Oncology
Investigators
Study Chair: Elisabetta Dejana, Professor IFOM, The FIRC Institute of Molecular Oncology
Study Director: Roberto Latini Istituto Di Ricerche Farmacologiche Mario Negri

Publications:

Responsible Party: Mario Negri Institute for Pharmacological Research
ClinicalTrials.gov Identifier: NCT03589014     History of Changes
Other Study ID Numbers: IRFMN-7358
2017-003595-30 ( EudraCT Number )
First Posted: July 17, 2018    Key Record Dates
Last Update Posted: January 10, 2019
Last Verified: May 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Mario Negri Institute for Pharmacological Research:
Cerebral Cavernous Malformation
Propranolol
Magnetic Resonance Imaging

Additional relevant MeSH terms:
Congenital Abnormalities
Hemangioma, Cavernous, Central Nervous System
Hemangioma, Cavernous
Hemangioma
Neoplasms, Vascular Tissue
Neoplasms by Histologic Type
Neoplasms
Central Nervous System Vascular Malformations
Nervous System Malformations
Nervous System Diseases
Vascular Malformations
Cardiovascular Abnormalities
Cardiovascular Diseases
Hemostatic Disorders
Vascular Diseases
Hemorrhagic Disorders
Hematologic Diseases
Propranolol
Adrenergic beta-Antagonists
Adrenergic Antagonists
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Anti-Arrhythmia Agents
Antihypertensive Agents
Vasodilator Agents