Treat_CCM: Propranolol in Cerebral Cavernous Malformation (Treat_CCM)
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|ClinicalTrials.gov Identifier: NCT03589014|
Recruitment Status : Active, not recruiting
First Posted : July 17, 2018
Last Update Posted : December 4, 2019
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|
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, however, doses as low as 10 mg bid and up to 160 mg bid are acceptable according to tolerability) 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.
If the overall evaluation of the safety (no difference in AEs and SAEs between propranolol and control arms), and of the efficacy profile (assessed as consistency between incidence of adverse clinical events and magnetic resonance brain imaging results between propranolol and control arms) at the conclusion of the present study, will be reassuring for propranolol, a protocol for a definitive Phase 2 trial will be submitted for approval to Regulatory Authorities. This second trial may be designed as single-arm as far as adequate data on incidence of endpoint events will be available from Treat_CCM.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||70 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Single (Outcomes Assessor)|
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 excluding 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.
|Official Title:||Treat_CCM Clinical Trial A Multicenter Randomized Clinical Trial on Propranolol in Cerebral Cavernous Malformation|
|Actual Study Start Date :||April 11, 2018|
|Estimated Primary Completion Date :||October 31, 2020|
|Estimated Study Completion Date :||December 31, 2020|
No Intervention: Control
Standard Treatments recommended for CCM
Initial oral dose 40 mg bid, uptitrated to 80mg bid doses as low as 10 mg bid and up to 160 mg bid, 20 to 320mg daily, are acceptable according to tolerability.
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. Doses as low as 10 mg bid and up to 160 mg bid, 20 to 320mg daily, are acceptable according to tolerability.
Other Name: Inderal
- 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) excluding seizures.
- 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.
- 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. 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.).
- 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
- Diameter of CCM lesions at MRI. [ Time Frame: up to 24 months ]Diameter will be assessed in millimeters.
- Length of CCM lesions at MRI [ Time Frame: up to 24 months ]Length will be assessed in millimeters.
- 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.
- Dynamic contrast enhanced permeability (DCEP) at MRI. [ Time Frame: up to 24 months ]Cerebral vascular permeability will be assessed after injection of gadolinium at MRI by dynamic contrast enhanced permeability (DCEP) method. Changes from baseline will be calculated.
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
|IRCCS Casa Sollievo della Sofferenza|
|San Giovanni Rotondo, FG, Italy, 71013|
|IRCCS Centro Neurolesi "Bonino Pulejo"|
|Messina, ME, Italy, 98124|
|Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico|
|Milano, Mi, Italy, 20122|
|Fond. IRCCS Ist. Naz. Neurologico Carlo Besta|
|Milano, MI, Italy, 20133|
|ASST Grande Ospedale Metropolitano Niguarda|
|Milano, MI, Italy, 20162|
|Fondazione Policlinico Universitario "A. Gemelli"|
|Roma, RM, Italy, 00168|
|Study Chair:||Elisabetta Dejana, Professor||IFOM, The FIRC Institute of Molecular Oncology|
|Study Director:||Roberto Latini||Istituto Di Ricerche Farmacologiche Mario Negri|