Phase 2 a Study to Assess Safety and Pharmacokinetics of VAS203 in Patients With Traumatic Brain Injury

NCT ID: NCT02012582

Last Updated: 2016-03-07

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 32 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2009-11-30
• Study Completion Date: 2012-09-30

Brief Summary

In the exploratory multi-center Phase 2 a study safety, tolerability, pharmacodynamics and pharmacokinetics of the Nitric Oxide Synthase inhibitor VAS203 is assessed in patients with moderate and severe traumatic brain injury. Traumatic brain injury patients (32 males) receive 15, 20 and 30 mg/kg VAS203, respectively, by continuous infusion in three cohorts (Cohort 1 open; Cohorts 2 and 3 double blind, randomised placebo-controlled). End of Study for all patients will be Day 14; adverse events and concomitant medications will be documented throughout the study.

Objectives are to assess safety and tolerability of VAS203, to evaluate concentrations of metabolites of VAS203 in plasma and microdialysate and to assess pharmacodynamic effects of VAS203 on surrogate parameters. Safety parameter will include vital signs (blood pressure heart rate, respiration rate, oxygen saturation and blood gases), fluid balance, ECG, laboratory examinations (clinical chemistry, liver function, haematology/coagulation, urinalysis, renal parameters) and adverse events. Concentration of VAS203 will be determined in plasma and microdialysate. Pharmacodynamic parameters will include intracranial pressure (ICP), biochemical parameters in microdialysate (nitrite/nitrate, arginine, citrulline, pyruvate, lactate, glucose), Partial Oxygen Pressure in brain parenchyma and Therapy Intensity Level (TIL).

Detailed Description

Intravenous administration of study medication for each patient will start as soon as possible but not later than 12 hours after trauma. Patients in Group 1 will receive open label study drug (VAS203). Patients in Group 2 and 3 will be randomised to treatment with VAS203 or placebo.

In addition to study treatment, each patient will receive the best "standard of care" for the study centre; no treatment will be withheld.

Conditions

Traumatic Brain Injury

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

VAS203 15 mg/kg

Three 5 mg/kg/12-hours infusion with 12 hours break after each infusion. Total dose: 15 mg/kg

Group Type: EXPERIMENTAL

VAS203

Intervention Type: DRUG

i.v. infusion

VAS203 20 mg/kg

10 mg/kg/24 hours, 48 hour continuous infusion. Total dose: 20 mg/kg

Group Type: EXPERIMENTAL

VAS203

Intervention Type: DRUG

i.v. infusion

VAS203 30 mg/kg

10 mg/kg/24 hours, 72 hour continuous infusion. Total dose: 30 mg/kg

Group Type: EXPERIMENTAL

VAS203

Intervention Type: DRUG

i.v. infusion

Saline

0.9 % Sodium chloride infusion

Group Type: PLACEBO_COMPARATOR

Saline

Intervention Type: DRUG

i.v. infusion

Interventions

VAS203

i.v. infusion

Intervention Type: DRUG

Saline

i.v. infusion

Intervention Type: DRUG

Other Intervention Names

Ronopterin; 0.9 % NaCl

Eligibility Criteria

Inclusion Criteria

• Written informed consent from patient's legal guardian or legal representative
• 18 - 65 years of age, inclusive
• Head trauma within the last 12 hours
• Traumatic brain injury with Glasgow Coma Score (GCS) ≥ 5 and that requires ICP monitoring
• Catheter placement for monitoring and management of increased ICP
• Microdialysis probe placement in penumbra zone or ipsilateral to contusion if focal
• Systolic blood pressure ≥ 100 mmHg
• Females of child-bearing potential must have a negative pregnancy test

Exclusion Criteria

• Penetrating head injury (e.g. missile, stab wound)
• Not expected to survive more than 24 hours after admission
• Concurrent, but not pre-existing, spinal cord injury
• Unilateral and bilateral fixed and dilated pupil (> 4 mm)
• Cardiopulmonary resuscitation performed post injury
• continuing bleeding likely to require multiple transfusions (> 4 units red blood cells)
• Coma due to a "pure" epidural hematoma (lucid interval and absence of structural brain damage on CT scan)
• Coma suspected to be primarily due to other causes than head injury (e.g. drug overdose)
• Known or CT scan evidence of pre-existing major cerebral damage
• Decompressive craniectomy, planned prior to randomization
• Polytraumatic patients with Injury Severity Score > 25, or rhabdomyolysis
• Injuries to ascending aorta and/or carotid arteries
• serum creatinine values > 1.5 mg/dL
• estimated Glomerular Filtration Rate < 60 ml/min (MDRD-formula)
• body mass index (BMI) > 35, Body weight > 120 kg
• Any severe concomitant condition (cancer; hematologic, renal, hepatic, coronary disease; major psychiatric disorder; alcohol or drug abuse), that can be ascertained at admission
• Known to have received an experimental drug within 4 weeks prior to current injury
• Administration of > 100 ml of contrast media containing iodine

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

veriNOS operations GmbH

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Frank Tegtmeier, Dr.

Role: STUDY_DIRECTOR

veriNOS operations GmbH

Locations

Medical University Innsbruck Department of Neurology

Innsbruck, , Austria

HIA Sainte-Anne Boulevard Sainte-Anne

Toulon, , France

Vall d'Hebron University Hospital Department of Neurosurgery

Barcelona, , Spain

Hospital Clinic University of Barcelona Surgical Intensive Care Unit

Barcelona, , Spain

University Hospital Zuerich Surgical Intensive Care

Zurich, , Switzerland

Southampton University Hospital Division of Clinical Neurosciences

Southampton, , United Kingdom

Countries

Austria; France; Spain; Switzerland; United Kingdom

References

Stover JF, Belli A, Boret H, Bulters D, Sahuquillo J, Schmutzhard E, Zavala E, Ungerstedt U, Schinzel R, Tegtmeier F; NOSTRA Investigators. Nitric oxide synthase inhibition with the antipterin VAS203 improves outcome in moderate and severe traumatic brain injury: a placebo-controlled randomized Phase IIa trial (NOSTRA). J Neurotrauma. 2014 Oct 1;31(19):1599-606. doi: 10.1089/neu.2014.3344. Epub 2014 Jul 28.

Reference Type: RESULT

PMID: 24831445 (View on PubMed)

Other Identifiers

VAS203/II/1/03

Identifier Type: -

Identifier Source: org_study_id