PAEAN - Erythropoietin for Hypoxic Ischaemic Encephalopathy in Newborns

NCT ID: NCT03079167

Last Updated: 2024-06-05

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 313 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-05-14
• Study Completion Date: 2024-04-30

Brief Summary

Double-blind, placebo controlled Phase III trial of erythropoietin for hypoxic ischaemic encephalopathy in infants receiving hypothermia. The study aim is to determine whether Epo in conjunction with hypothermia in infants with moderate/severe hypoxic ischaemic encephalopathy (HIE) will improve neurodevelopmental outcomes at 2 years of age, without significant adverse effects, when compared to hypothermia alone.

Detailed Description

A lack of oxygen (hypoxia) or low blood supply (ischaemia) before or during birth can destroy cells in a newborn baby's brain. The damage caused by the lack of oxygen continues for some time afterwards. One way to try to reduce this damage is to induce hypothermia cooling the baby or just the baby's head for hours to days. Erythropoietin (Epo) given in the first week after birth shows promise as a treatment that may also help. This study is to find out whether Epo plus induced hypothermia (cooling) of near-term newborn babies who have suffered from low blood or oxygen supply to the brain at birth reduces death and disability in survivors at two years of age.

The target population is 300 newborn term or near term infants (greater than or equal to 35+0 weeks gestation) with hypoxic ischaemic encephalopathy who are receiving, or planned to receive hypothermia and who are able to be recruited in time to allow study treatment to commence before 24 hours of age.

This is a double blind, placebo controlled, parallel, 2 arm randomised, phase III multicentre trial, stratified by study site and by severity of encephalopathy at study entry.

The treatment group of 150 infants will receive human recombinant Epo, 1000 IU/kg IV on days 1, 2, 3, 5 & 7 of life. The control group will receive 0.9% sodium chloride as a placebo on days 1, 2, 3, 5 & 7 of life.

Families will be followed up every 6 months until the primary assessment of death and disability at 2 years of age.

Conditions

Hypoxic-Ischemic Encephalopathy

Study Design

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

Study Groups

Erythropoietin

Erythropoietin (epoetin alfa) 1000 IU/kg birth weight (capped at 4000IU daily) IV infusion, on Days 1, 2, 3, 5 and 7 of age

Group Type: EXPERIMENTAL

Epoetin Alfa

Intervention Type: DRUG

Placebo

IV normal saline (equiv. volume), on Days 1, 2, 3, 5 and 7 of age

Group Type: PLACEBO_COMPARATOR

Normal saline

Intervention Type: DRUG

Interventions

Epoetin Alfa

Intervention Type: DRUG

Normal saline

Intervention Type: DRUG

Other Intervention Names

Epogen; Procrit; 0.9% NaCl

Eligibility Criteria

Inclusion Criteria

• Male or female infants born greater than or equal to 35+0 weeks gestation and able to be randomised less than 23 hours after birth
• One or more of the following indicators of perinatal depression:

1. Apgar less than or equal to 5 at 10 minutes after birth, OR

2. Receiving ongoing resuscitation e.g. assisted ventilation (positive pressure ventilation or CPAP) or chest compressions at 10 minutes after birth, OR

3. on cord blood or arterial or venous blood obtained at less than 60 minutes after birth, either pH less than 7.00 OR base deficit greater than or equal to 12.0 mmol/L

• Moderate to severe encephalopathy, defined between one and six hours after birth by one or both of the following:

1. 3 out of 6 modified Sarnat criteria indicating moderate/severe encephalopathy, OR

2. 2 out of 6 modified Sarnat criteria plus seizure(s) requiring anticonvulsant treatment (diagnosed either clinically or using EEG monitoring) at any time prior to randomisation

• Hypothermia treatment initiated by 6 hours ofa ge; i.e. controlled whole-body cooling planned to continue for 72 hours to a target temperature (adjusted manually or with a device) and subsequent controlled re-warming
• Study treatment planned to start within 24 hours after birth (as soon as feasible after randomisation)
• At least one parent greater than or equal to 18 years of age
• Anticipated ability to collect primary endpoint at 2 years of age
• Signed, written informed parental consent

Exclusion Criteria

• Contraindications to investigational product
• Indication prior to randomisation for erythropoietin or any other erythropoietic stimulating agent to be given during the first two weeks of life
• Severe intrauterine growth restriction (birth weight less than 1800g)
• Suspected major chromosomal or congenital anomalies
• Head circumference less than 3rd centile below the mean for gestation and gender
• Infant for whom imminent withdrawal of care is being planned

• Maximum Eligible Age: 23 Hours
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Health and Medical Research Council, Australia

OTHER

Sponsor Role: collaborator

University of Sydney

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Helen Liley, BHB, MBChB

Role: STUDY_CHAIR

University of Sydney

Locations

Canberra Hospital

Garran, Australian Capital Territory, Australia

Royal Prince Alfred Hospital

Camperdown, New South Wales, Australia

Nepean Hospital

Kingswood, New South Wales, Australia

John Hunter Hospital

New Lambton, New South Wales, Australia

Royal Hospital for Women

Randwick, New South Wales, Australia

Royal North Shore Hospital

St Leonards, New South Wales, Australia

Westmead Hospital

Westmead, New South Wales, Australia

Royal Women's & Brisbane Hospital

Herston, Queensland, Australia

Mater Mothers' Hospital

South Brisbane, Queensland, Australia

Flinders Medical Centre

Bedford Park, South Australia, Australia

Women's and Children's Hospital

North Adelaide, South Australia, Australia

Royal Hobart Hospital

Hobart, Tasmania, Australia

Monash Medical Centre

Clayton, Victoria, Australia

Mercy Hospital for Women

Heidelberg, Victoria, Australia

The Royal Children's Hospital

Parkville, Victoria, Australia

The Royal Women's Hospital

Parkville, Victoria, Australia

King Edward Memorial Hospital

Subiaco, Western Australia, Australia

Princess Margaret Hospital

Subiaco, Western Australia, Australia

Auckland City Hospital

Auckland, , New Zealand

Middlemore Hospital

Auckland, , New Zealand

Christchurch Hospital

Christchurch, , New Zealand

Waikato Hospital

Hamilton, , New Zealand

Wellington Hospital

Wellington, , New Zealand

KK Women's and Children's Hospital

Singapore, , Singapore

Countries

Australia; New Zealand; Singapore

Other Identifiers

12614000669695

Identifier Type: REGISTRY

Identifier Source: secondary_id

CTC0119

Identifier Type: -

Identifier Source: org_study_id