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Inhibition of Complement Activation (Eculizumab) in Guillain-Barre Syndrome Study (ICA-GBS)

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ClinicalTrials.gov Identifier: NCT02029378
Recruitment Status : Unknown
Verified September 2014 by NHS Greater Glasgow and Clyde.
Recruitment status was:  Recruiting
First Posted : January 7, 2014
Last Update Posted : September 23, 2014
University of Glasgow
Information provided by (Responsible Party):
NHS Greater Glasgow and Clyde

Brief Summary:

Guillian-Barre Syndrome (GBS) is the most frequent cause of acute neuromuscular weakness in the Western World and can occur at any age. GBS is a rpadily progressive 'inflammatory' disorder of the perihperal nerves often leading to sever paresis of the limbs. Most GBS patients also have sensory disturbances (tingling or dull feeling) and pain. Some patients also have double vision or problems with swallowing. GBS mau also involve the respiratory muscles, leading to insufficient ventilation and admission to an intensive care unit. GBS pateints have a vairable prognosis; 20-30% require mechnical ventilation for a period ranging from weeks to months, 20% are unable to walk after 6 months nad 3-5% dies. Progression of weakness in GBS is usually rapid and reaches its peak within 4 weeks in the majority of patients, but many develop their maximum deficit within 2 weeks. Thereafter, the patients have a variable prognosis.

GBS is a treatable disorder. Intravenous immunoglobulin (IVIg) 2g/kg administered in 5 days was shown to be effective when administered within the first two weeks after onset of symptoms, and is considered the treatment of choice by most experts in the field. Although the standard treatment for GBS is a single course of IVIg (2g/kg administered in 5 days), many patients fails to recover abd remain with substantial disability. Patients with GBS and especially those with a poor prognosis potentially may benefit from more powerful abd when possible a more mechanistically rational therapy.

Recent experimental evidence suggests that complement activation palys a crucial role in the development of neuromuscular weakness in GBS making complement inhibitors and regulators attracive therapeutic targets. Our hypothesis is that Eculizumab, with its function as a complement inhibitor, will be very effective in preventing progression of weakness in patients with GBS.

Condition or disease Intervention/treatment Phase
Gullian Barre Syndrome Drug: Eculizumab Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Inhibition of Complement Activation (Eculizumab) in Guillain-Barre Syndrome Study
Study Start Date : September 2014
Estimated Primary Completion Date : October 2015
Estimated Study Completion Date : March 2016

Resource links provided by the National Library of Medicine

Drug Information available for: Eculizumab

Arm Intervention/treatment
Experimental: Eculizumab
Eculizumab, 900 mg intravenously once a week
Drug: Eculizumab
Placebo Comparator: Placebo
Matched placebo, intravenously once a week

Primary Outcome Measures :
  1. Determine the incidence of AE/SAEs after treatment with eculizumab and IVIg compared to placebo controls [ Time Frame: 6 months ]
    Primary safety endpoint

  2. Improvement of one or more grade in functional outcome (on the 6 point GBS disability scale) at 4 weeks [ Time Frame: 4 weeks ]
    Primary efficacy endpoint

Secondary Outcome Measures :
  1. Ability to walk unaided (GBS disability score 2) at 8 weeks [ Time Frame: 8 weeks ]
  2. Time taken to improve by at least one grade (on the GBS disability scale) [ Time Frame: 8 weeks ]
  3. Time taken to walk independently [ Time Frame: 1 year ]
  4. Difference in GBS disability score at maximum disability completed with 6 months [ Time Frame: 6 months ]
  5. Percentage of patients with a clinically relevant improvement in R-ODS score [ Time Frame: 6 months ]
    An increase from Baseline in R-ODS score by at least 6 points on the centile metric score at 4 weeks and 6 months

  6. Percentage of patients with a clinically relevant improvement in ONLS [ Time Frame: 6 months ]
    Defined as an increase from baseline in ONLS score by at least 1 point at 4 weeks and 6 months

  7. Requirement for ventilatory support (GBS disability score 5) [ Time Frame: 4 weeks ]
  8. Duration of ventilatory support [ Time Frame: 8 weeks ]
  9. Occurrence of relapse [ Time Frame: 2 years ]
  10. Dearth within the first 6 months [ Time Frame: 6 months ]

Information from the National Library of Medicine

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

Inclusion Criteria:

  • Patients aged >18 years diagnosed with GBS according to NINDS diagnostic criteria
  • Onset of weakness due to GBS is less than 2 weeks ago
  • Patients who are unable to walk unaided for >10 metres (grade >3 on GBS disability scale)
  • Patients who are being considered for or already on IVIg treatment
  • First dose of eculizumab must be started within 2 weeks from onset of weakness and any time during the IVIg treatment period
  • Signed informed consent

Exclusion Criteria:

  • Age <18 years
  • Patients who are being considered for, or already on, plasma exchange
  • Pregnancy or lactation
  • Patients show clear clinical evidence of a polyneuropahty caused by e.g. diabetes mellitus (except mild sensory), alcoholism, severe vitamin deficiency, and porphyria
  • Patients received immunosuppressive treatment (e.g. azathioprine, cyclosporine, mycofenolatemofetil, tacrolimus, sirolimus or > 20 mg prednisolone daily) during the last month
  • Patients known to have severe concurrent disease, like malignancy, severe cardiovascular disease, AIDS, severe COPD, TB
  • Inability to comply with study related procedures or appointments during 6 months
  • Any condition that in the opinion of the investigator could increase the patient's risk by participating in the study or confound the outcome of the study
  • Related to the administration of eculizumab:

Unresoled Neisseria meningitidisinfection of history of meningococcal infection Unsuitable for antibiotic prophylaxis (e.g due to allergy) Known hypersensitivity to eculizumab, murine proteins or to any of the excipients Known or suspected hereditary complement deficiencies Women of child-bearing potential who are unwilling to use effective contraception during treatment and for 5 months after treatment is completed.

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): NCT02029378

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Contact: Govindsinh Chavada govindsinh.chavada@glasgow.ac.uk
Contact: Ian Anderson 0141 201 2457 ian.anderson2@ggc.scot.nhs.uk

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United Kingdom
Southern General Hospital Recruiting
Glasgow, United Kingdom, G51 4TF
Contact: Govindsinh Chavada       govindsinh.chavada@glasgow.ac.uk   
Contact: Amy Davidson, MBChB, BSc, MRCP       amy.davidson2@nhs.net   
Sponsors and Collaborators
NHS Greater Glasgow and Clyde
University of Glasgow
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: NHS Greater Glasgow and Clyde
ClinicalTrials.gov Identifier: NCT02029378    
Other Study ID Numbers: GN12NE462
First Posted: January 7, 2014    Key Record Dates
Last Update Posted: September 23, 2014
Last Verified: September 2014
Additional relevant MeSH terms:
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Guillain-Barre Syndrome
Pathologic Processes
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Demyelinating Diseases
Peripheral Nervous System Diseases
Neuromuscular Diseases
Autoimmune Diseases
Immune System Diseases
Complement Inactivating Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs