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A Phase IV Trial of Neuroprotection With ACTH in Acute Optic Neuritis (ACTHAR)

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified March 2014 by Elliot Frohman, University of Texas Southwestern Medical Center.
Recruitment status was:  Recruiting
Sponsor:
ClinicalTrials.gov Identifier:
NCT01838174
First Posted: April 23, 2013
Last Update Posted: March 28, 2014
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.
Collaborators:
University of Colorado, Denver
Mallinckrodt
Information provided by (Responsible Party):
Elliot Frohman, University of Texas Southwestern Medical Center
  Purpose

We hypothesize that the novel melanocortin-mediated anti-inflammatory effects of Adrenocorticotropic hormone (ACTH) will reduce axonal loss following ON by limiting inflammatory optic nerve injury. We will compare the effect of ACTH and intravenous methylprednisolone therapy on axonal injury following ON using ocular coherence tomography (OCT), a sensitive, reproducible and noninvasive tool to measure retinal nerve fiber layer (RNFL) thickness.

The primary outcome will be the average RNFL thickness at 6 months. Additional pre-specified statistical analyses will compare the difference in the mean RNFL thickness at 6 months in the affected eye between the IV methylprednisolone- and Acthar-treated groups, and the mean 6-month affected eye RNFL thicknesses adjusted for the baseline unaffected eye RNFL. The secondary outcome measure will examine the frequency of optic nerves with RNFL swelling between the IV methylprednisolone- and Acthar-treated groups at 1 and 3 months. The tertiary outcome will be changes in mfVEP amplitude and latency, ONHP detection, and pupillary diameter (UTSW only). A predefined exploratory outcome will compare the ganglion cell plus inner plexiform layer (GC+IPL) thickness at 6 months between treatment groups


Condition Intervention Phase
Multiple Sclerosis Drug: ACTHAR Gel (ACTH) Drug: IV steroids with oral taper Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase IV Trial of Neuroprotection With ACTH in Acute Optic Neuritis

Resource links provided by NLM:


Further study details as provided by Elliot Frohman, University of Texas Southwestern Medical Center:

Primary Outcome Measures:
  • Retinal Nerve Fiber Layer (RNFL) thickness [ Time Frame: 6 months ]
    The primary outcome will be the average RNFL thickness at 6 months.


Secondary Outcome Measures:
  • Frequency of RNFL swelling [ Time Frame: 1 and 3 months ]
    The secondary outcome measure will examine the frequency of optic nerves with RNFL swelling between the IV methylprednisolone- and Acthar-treated groups at 1 and 3 months.


Other Outcome Measures:
  • Multifocal Visual Evoked potentials (mfVEP) and Optic Nerve Head Component (ONHP) [ Time Frame: 6 months ]
    The tertiary outcome will be changes in mfVEP amplitude and latency, ONHP detection, and pupillary diameter (UTSW only). A predefined exploratory outcome will compare the ganglion cell plus inner plexiform layer (GC+IPL) thickness at 6 months between treatment groups.


Estimated Enrollment: 60
Study Start Date: May 2013
Estimated Study Completion Date: April 2015
Estimated Primary Completion Date: August 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Acthar Gel (ACTH)
15 days of intramuscular (IM) or sub-cutaneous corticotropin (SQ) Acthar (ACTH).
Drug: ACTHAR Gel (ACTH)
15 days of daily injections
Active Comparator: IV methylprednisolone (steroids) with oral taper
3 days of IV methylprednisolone followed by 11 days of oral prednisone
Drug: IV steroids with oral taper
3 days of intravenous methylprednisolone followed by 11 days of oral taper

  Show Detailed Description

  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 55 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Written informed consent must be obtained before any assessment is performed.
  2. Male and female patients aged between 18 and 55 years, inclusive.
  3. Diagnosis of clinically unilateral acute demyelinating optic neuritis (ADON)
  4. Clinical signs and symptoms of ADON starting within the 14 day prior to intended randomization (loss of vision, pain on movement, impairment of color vision).
  5. The qualifying episode of optic neuritis must be the first clinical episode of optic neuritis in the affected eye.
  6. Able to undergo treatment with intravenous methylprednisolone or Acthar gel.

Exclusion Criteria:

  1. Functionally or clinically relevant comorbidity of the affected eye (e.g., glaucoma, amblyopia, optic nerve hypoplasia, macular hole, macular edema, vitreomacular traction, uveitis, diabetes, optic neuritis, or other diseases of the optic nerve or a history thereof).
  2. Bilateral optic neuritis.
  3. Concurrent functionally or clinically relevant disturbances of the eye not affected by ADON.
  4. High clinical likelihood of a form of optic neuritis other than ADON (e.g., no pain on movement, no light perception, severe optic disk edema, atrophic optic disk, retinal exudates, or hemorrhages).
  5. Non-assessable OCT at screening.
  6. Refractive error greater than ±5 diopters or (pre-surgical value to be used for patients having undergone refractive surgery).
  7. Patients with an immune system disorder other than MS or ADON (e.g. rheumatoid arthritis, scleroderma, Sjogren's syndrome, Crohn's disease, ulcerative colitis, etc.) or with a known immunodeficiency syndrome (AIDS, hereditary immune deficiency, drug-induced immune deficiency). Diagnosis of neuromyelitis optica will not exclude a patient from the study but will be accounted for in the data analysis.
  8. Prior treatment with IV methylprednisolone (IVMP) or Acthar gel within the past 30 days.
  9. Treatment with rituximab, mitoxantrone, cyclophosphamide, mycophenolate, azathioprine, alemtuzumab, ocrelizumab, or other non-approved agents for the treatment of relapsing forms of MS.
  10. Concurrent use of 4-aminopyridine.
  Contacts and Locations
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): NCT01838174


Contacts
Contact: Gina Remington, RN, BSN 214-645-0560 gina.remington@utsouthwestern.edu

Locations
United States, Colorado
University of Colorado Denver Recruiting
Aurora, Colorado, United States, 80045
Contact: Jeffrey Bennett, MD, PhD    303-724-6450      
Principal Investigator: Jeffrey Bennett, MD, PhD         
United States, Texas
UT Southwestern Medical Center Recruiting
Dallas, Texas, United States, 75390
Contact: Gina Remington, RN, BSN    214-645-0560    gina.remington@utsouthwestern.edu   
Contact: Elliot Frohman, MD, PhD    214-645-0555    elliot.frohman@utsouthwestern.edu   
Principal Investigator: Elliot Frohman, MD, PhD         
Sponsors and Collaborators
Elliot Frohman
University of Colorado, Denver
Mallinckrodt
Investigators
Principal Investigator: Elliot Frohman, MD, PhD UT Southwestern Medical Center
Principal Investigator: Jeffrey Bennett, MD, PhD University of Colorado, Denver
  More Information

Responsible Party: Elliot Frohman, Professor, University of Texas Southwestern Medical Center
ClinicalTrials.gov Identifier: NCT01838174     History of Changes
Other Study ID Numbers: 06APR2012
First Submitted: April 18, 2013
First Posted: April 23, 2013
Last Update Posted: March 28, 2014
Last Verified: March 2014

Keywords provided by Elliot Frohman, University of Texas Southwestern Medical Center:
Optic Neuritis

Additional relevant MeSH terms:
Multiple Sclerosis
Neuritis
Optic Neuritis
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Demyelinating Diseases
Autoimmune Diseases
Immune System Diseases
Peripheral Nervous System Diseases
Neuromuscular Diseases
Optic Nerve Diseases
Cranial Nerve Diseases
Eye Diseases
Prednisolone acetate
Methylprednisolone acetate
Methylprednisolone
Methylprednisolone Hemisuccinate
Prednisolone
Prednisolone hemisuccinate
Prednisolone phosphate
Adrenocorticotropic Hormone
Anti-Inflammatory Agents
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Glucocorticoids
Hormones