Treatment of Optic Neuritis With Erythropoietin: a Randomised, Double-blind, Placebo-controlled Trial

Overview

This clinical trial aims at preventing visual dysfunction and optic nerve degeneration associated with autoimmune optic neuritis by systemic i.v. administration of 33.000 IU erythropoietin over 3 days. The primary objective is to determine the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone as assessed by measurements of retinal nerve fibre layer thickness and low contrast visual acuity 6 months after acute optic neuritis.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: June 20, 2018

Interventions

  • Drug: Erythropoietin alfa
  • Drug: Placebo

Arms, Groups and Cohorts

  • Experimental: Erythropoietin alfa
    • Recombinant human EPO (Epoetin alfa HEXAL®) will be given as an i.v. bolus injection on days 1, 2 and 3. The dosage per day will be 33.000 IU in accordance with previous trials.
  • Placebo Comparator: Placebo
    • As matched placebo for this study, sterile normal saline (0.9% sodium chloride for i.v. administration) will be used. It will be given as a bolus injection in the same manner as EPO.

Clinical Trial Outcome Measures

Primary Measures

  • Global retinal nerve fibre layer thickness (RNFLT-G)
    • Time Frame: 6 months
    • Determination of the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone (standard of care) as assessed by measurement of global retinal nerve fibre layer thickness (RNFLT-G) in the affected eye 6 months after randomisation.
  • Low contrast visual acuity (LCVA)
    • Time Frame: 6 months
    • Determination of the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone (standard of care) as assessed by measurement of low contrast visual acuity (LCVA) in the affected eye 6 months after randomisation.

Secondary Measures

  • Absolute values of the global retinal nerve fibre layer thickness
    • Time Frame: 6 months
  • Retinal nerve fibre layer thickness in the papillomacular bundle
    • Time Frame: 6 months
  • Retinal nerve fibre layer thickness in the temporal quadrant
    • Time Frame: 6 months
  • Total macular volume
    • Time Frame: 6 months
  • Visual acuity
    • Time Frame: 6 months
  • Contrast sensitivity
    • Time Frame: 6 months
  • Mean visual field defect
    • Time Frame: 6 months
  • Latency [ms] and amplitude [µV] of visual evoked potentials (VEP)
    • Time Frame: 6 months
  • Expanded Disability Status Scale (EDSS) score
    • Time Frame: 6 months
  • Quality of life
    • Time Frame: 6 months
    • Determined by NEI-VFQ-25
  • Safety
    • Time Frame: Screening until end of study
    • Assessment of AEs / SAEs

Participating in This Clinical Trial

Patients eligible for inclusion in this trial must meet all of the following criteria: 1. Written informed consent obtained according to international guidelines and local laws 2. Male and female patients aged ≥ 18 to ≤ 50 years 3. Patients with ON 4. First symptoms of ON ≤ 10 days prior to the first administration of investigational product 5. High contrast visual acuity (HCVA) of ≤ 0.5 (decimal system) 6. Adequate OCT measurements available Patients eligible for this trial must not meet any of the following criteria: 1. Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial 2. Simultaneous participation in another interventional trial which could interfere with this trial and/or participation in a clinical trial within the last 3 months before enrolment in this trial 3. Refractive anomalies: Hyperopia > 5 dpt, myopia < -7 dpt, astigmatism > 3 dpt 4. Media opacity 5. Severe papillitis 6. Previous ON 7. Any other optic nerve and retinal disease 8. Pre-existing MS or any other neurological disease 9. Congenital diseases:

  • thrombophilia – phenylketonuria 10. Acquired diseases: – autoimmune diseases, – cardiovascular diseases, – diabetes mellitus, – uncontrolled hypertension (with blood pressure > 140 / 90 mm Hg (cf. chapter 7.7.5)), – any malignancy, – epilepsy, – known tuberculosis with ongoing or unknown activity, – acute gastrointestinal ulceration within the last 3 months prior to randomisation, – acute viral, bacterial or fungal infection, – known infection with Human Immunodeficiency Virus (HIV), Hepatitis B Virus, or Hepatitis C Virus, – history of colitis ulcerosa, diverticulitis, or acute enteroanastomosis, – known osteoporosis, – history of thromboembolic events, – elevated haemoglobin level (>17 g/dl in men or >15 g/dl in women) – polycythaemia – any other significant illness potentially interfering with any trial assessment or trial treatment 11. Performing semi-professional or professional sporting activities or physical training 12. Pre-treatment with corticosteroids in the last 30 days prior to the onset of optic neuritis 13. Pre-treatment with EPO 14. Known or persistent abuse of medication, drugs or alcohol 15. Active immunization within 2 weeks prior to randomisation 16. Significant surgery within 4 weeks prior to randomisation 17. Blood donation or bloodletting within 4 weeks prior to screening 18. Pre-treatment with immunosuppressive or immunomodulatory agents 19. Persons who are in a relationship of dependence/employment with the sponsor or the investigator This section concerns only female patients who are able to have a child: 20. Current or planned pregnancy; nursing period within 3 months from investigational product administration 21. Unwillingness to use one of the following safe combination methods of contraception within 3 months from investigational product administration to achieve a PEARL index of <1: female condom, diaphragm or coil, each used in combination with a spermicide; hormonal intra-uterine device or hormonal contraception in combination with a mechanical method of contraception

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 50 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University Eye Hospital, Freiburg
  • Collaborator
    • German Federal Ministry of Education and Research
  • Provider of Information About this Clinical Study
    • Principal Investigator: Prof. Dr. Wolf Lagrèze, Prof. Dr. med. – University Eye Hospital, Freiburg
  • Overall Official(s)
    • Wolf A. Lagrèze, Prof., Principal Investigator, Eye Hospital, Medical Center – University of Freiburg

References

Suhs KW, Hein K, Sattler MB, Gorlitz A, Ciupka C, Scholz K, Kasmann-Kellner B, Papanagiotou P, Schaffler N, Restemeyer C, Bittersohl D, Hassenstein A, Seitz B, Reith W, Fassbender K, Hilgers R, Heesen C, Bahr M, Diem R. A randomized, double-blind, phase 2 study of erythropoietin in optic neuritis. Ann Neurol. 2012 Aug;72(2):199-210. doi: 10.1002/ana.23573.

Diem R, Molnar F, Beisse F, Gross N, Druschler K, Heinrich SP, Joachimsen L, Rauer S, Pielen A, Suhs KW, Linker RA, Huchzermeyer C, Albrecht P, Hassenstein A, Aktas O, Guthoff T, Tonagel F, Kernstock C, Hartmann K, Kumpfel T, Hein K, van Oterendorp C, Grotejohann B, Ihorst G, Maurer J, Muller M, Volkmann M, Wildemann B, Platten M, Wick W, Heesen C, Schiefer U, Wolf S, Lagreze WA. Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial-study protocol. BMJ Open. 2016 Mar 1;6(3):e010956. doi: 10.1136/bmjopen-2015-010956.

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