Intravenous Methylprednisolone Versus Oral Prednisolone for Infantile Spasms

Overview

Infantile Spasms (IS) are classically refractory to the usual antiepileptic drugs and often pose a therapeutic challenge. Since, there is associated significant morbidity, much effort has been directed over the past years to evaluate the role of various anticonvulsants in the management of IS. High dose oral prednisolone has been shown to cause early cessation of spasms and resolution of hypsarrythmia on Electroencephalogram. Recently, role of intravenous methylprednislone pulse therapy has been explored as one of the therapeutic modality in IS, in order to avoid the development of side-effects associated with prolonged oral steroid therapy and maintain long-term efficacy.However, there are no studies comparing iv methylprednisolone pulse therapy with high dose oral prednisolone..

Full Title of Study: “Intravenous Methylprednisolone Versus High Dose Oral Prednisolone for the Treatment of Infantile Spasms: a Randomized Open-labelled Trial”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: April 30, 2022

Detailed Description

Multiple studies have subsequently used higher dose of prednisolone in infantile spasms at the weight based dosing of 4-8 mg/kg/day with a maximum dose of 60mg/day. The results have shown high rates of clinical and elecroencephalographic remission with lower relapse rates.However, a major concern related to corticosteroids, especially in infants and children, is the possible development of side effects. The most frequent ones are excessive weight gain, hyperphagia, water retention with edema, cushingoid appearance, hypertension, behavioral disturbances, increased infection susceptibility, leukopenia, electrolyte disturbances, hyperglycemia, glycosuria, impaired glucose tolerance, frank diabetes and sleep disorders. Furthermore, long-term side effects such as hypothalamus-pituitary axis suppression, psychosis, osteoporosis, nephrocalcinosis, brain atrophy, cataracts and, in children, growth retardation, have also been reported. Recently, role of intravenous methylprednislone pulse therapy has been explored as one of the therapeutic modality in IS, in order to avoid the development of side-effects associated with prolonged oral steroid therapy and maintain long-term efficacy. There have been few studies on use of iv pulse methylprednisolone in IS with small sample size, showing to a rapid improvement in EEG & cessation of spasm in majority of the infants without significant adverse effects. Emerging evidence suggests that intravenous pulse methylprednisolone might have superior efficacy and better safety profile when compared to high dose oral prednisolone in treatment of IS. Hence, present study aims at comparing intravenous pulse methylprednisolone versus oral prednisolone in an open label, RCT for treatment of children with IS.

Interventions

  • Drug: Intravenous Methylprednisolone
    • Intravenous Methylprednisolone will be used in the intervention group
  • Drug: Oral Pednisolone
    • Oral Prednisolone will be used in the Control Group

Arms, Groups and Cohorts

  • Experimental: Intervention arm
    • Pulse intravenous methylprednisolone (30 mg / kg for 3 days) followed by 1-week taper of oral prednisolone Day 1-3 Intravenous Methylprednisolone in dose of 30 mg/kg/day Day 4-6 Oral Prednisolone in dose of 2mg/kg/day Day 7-10 Oral Prednisolone in dose of 1mg/kg/day
  • Active Comparator: Control
    • Oral prednisolone (4 mg/kg/day) for 2 weeks followed by tapering over 2 weeks Day 1-14 (2 weeks): dose 4mg/kg/day Day 15-21 (1 weeks): 2mg/kg/day Day 22-28 (1 weeks): 1mg/kg/day

Clinical Trial Outcome Measures

Primary Measures

  • Proportion of children who achieved spasm freedom as per parental reports in both the groups
    • Time Frame: 6 weeks
    • The proportion of children who achieve spasm freedom defined as no witnessed spasms on and between day 14 and day 42 as per parental reports will be evaluated in the both the groups

Secondary Measures

  • Number of days after initiation of trial treatment on which spasms were not seen and after which response was maintained until 6 weeks (day 42) of treatment in both the groups
    • Time Frame: 6 weeks
    • Number of days after initiation of trial treatment on which spasms were not seen and after which response was maintained until 6 weeks (day 42) of treatment in both the groups
  • Proportion of children who achieve resolution of hypsarrhythmia on electro encephalogram at 2 weeks (in all cases) and at 6 weeks (for cases with sustained clinical response) in both the groups.
    • Time Frame: 6 weeks
    • Proportion of children who achieve resolution of hypsarrhythmia on electro encephalogram at 2 weeks (in all cases) and at 6 weeks (for cases with sustained clinical response) in both the groups.
  • Description and proportion of the adverse effects of methylprednisolone in the experimental group
    • Time Frame: 6 weeks
    • Description and proportion of the adverse effects of methylprednisolone in the experimental group

Participating in This Clinical Trial

Inclusion Criteria

Newly diagnosed patients aged 4 – 30 months with epileptic spasms in clusters with electroencephalographic evidence of hypsarrhythmia or its variants with or without developmental delay - Exclusion Criteria:

1. Children with recognized progressive neurological illness will be excluded. 2. Children with chronic renal, pulmonary, cardiac or hepatic dysfunction 3. Severe malnutrition (weight for length and height for less than 3 SD for mean as per WHO growth charts) -

Gender Eligibility: All

Minimum Age: 4 Months

Maximum Age: 30 Months

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Suvasini Sharma
  • Provider of Information About this Clinical Study
    • Sponsor-Investigator: Suvasini Sharma, Associate Professor – Lady Hardinge Medical College
  • Overall Official(s)
    • Dipti Kapoor, MD, Principal Investigator, Lady Hardinge Medical College
  • Overall Contact(s)
    • Dipti Kapoor, MD, 91-9818426830, diptikumar81@yahoo.co.in

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.

At TrialBulletin.com, we keep tabs on over 200,000 clinical trials in the US and abroad, using medical data supplied directly by the US National Institutes of Health. Please see the About and Contact page for details.