The Therapeutic Effect of Thalidomide in Syringomyelia
The Effect of Thalidomide in Refractory Syringomyelia(RS): a Phase II Clinical Trial
Purpose: This phase II clinical trial aims to evaluate the indications, therapeutic effects and side effects of thalidomide in refractory syringomyelia.
Primary outcome measure: The primary endpoint is the change of ASIA at week 12. The clinical efficacy is defined as ASIA increase ≥ 1 at week 12, as compared with that before thalidomide usage.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
The pathogenesis of syringomyelia is poorly understood and duraplasty or shunting is not always effective. Although it is generally thought that syringomyelia is simply an accumulation of CSF from the subarachnoid space, the pathogenesis is likely to be more complex and may involve cellular and molecular processes.
The investigators supposed that blood spinal cord barrier(BSCB) might play a key role in the pathogenesis of syringomyelia, especially post-traumatic syringomyelia(PTS), and that thalidomide, as an BSCB protection-related drug, would reduce BSCB damage and protect BSCB in syringomyelia.
Primary objectives: This phase II clinical trial aims to evaluate the indications, therapeutic effects and safety of thalidomide in refractory syringomyelia.
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 2
Contacts and Locations
Study Contact
Study Contact
- Name: fengzeng jian
- Phone Number: +861083198899
- Email: jianfengzeng@xwh.ccmu.edu.cn
Study Contact Backup
- Name: chenghua yuan
- Phone Number: +861083198899
- Email: yuanchenghua@ccmu.edu.cn
Study Locations
-
-
Beijing City
-
Beijing, Beijing City, China, 100032
- Recruiting
- Fengzeng Jian
-
Contact:
- fengzeng jian, md
- Email: jianfengzeng@xwh.ccmu.edu.cn
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Contraindication to duraplasty and shunting treatment due to history or high risk of severe adverse effects,
- or non-effective response to duraplasty and shunting treatment in 12 months prior to study entry.
- Estimated life expectancy must be greater than 12 months.
- Routine laboratory studies: bilirubin </=1.0 * upper limits of normal (ULN); aspartate aminotransferase (AST or SGOT) or alanine aminotransferase (ALT)< 1.0 * ULN; creatinine <1.0 * ULN; white-cell count >/= 4,000 per cubic millimeter; neutrophils count >/=1500 per cubic millimeter platelets >/= 100,000 per cubic millimeter; Hb >/=110 gram per millilitres; PT, APTT, INR in a normal range.
- Ability to understand and willingness to sign a written informed consent document, or constant caregivers who well understand and willingness to sign a written informed consent document.
- Must be able to swallow tablets
Exclusion Criteria:
- Evidence of tumor metastasis, recurrence, or invasion;
- History of psychiatric diseases ;
- History of seizures;
- History of arteriosclerotic cardiovascular diseases (ASCVD), e.g. stroke, myocardial infaction, unstable angina, within 6 months;
- New York Heart Association Grade II or greater congestive heart failure;
- Serious and inadequately controlled cardiac arrhythmia;
- Significant vascular disease, e.g. moderate or severe carotid stenosis, aortic aneurysm, history of aortic dissection;
- Severe infection;
- History of allergy to relevant drugs;
- Pregnancy, lactation, or fertility program in the following 12 months;
- History or current diagnosis of peripheral nerve disease;
- Abnormal in liver and renal function;
- Active tuberculosis;
- Transplanted organs;
- Human immunodeficiency virus;
- Participation in other experimental studies.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Thalidomide
Oral Thalidomide
|
Thalidomide 50 - 200 mg once at nightime
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
ASIA Score
Time Frame: 1 day before and 3 days, 3 months after drug treatment
|
American Spinal Injury Association(ASIA) Score for evaluating the spinal cord function, degree of the spinal cord function, motor1-100, sensory 1-224, higher scores mean a better outcome
|
1 day before and 3 days, 3 months after drug treatment
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
syringomyelia remission
Time Frame: 1 day before and 3 days, 3 months after drug treatment
|
syringomyelia remission is defined as ≥ 25% reduction in syringomyelia volume on T2 images at week 12, as compared with that before thalidomide usage
|
1 day before and 3 days, 3 months after drug treatment
|
|
The evoked electromyographic signal (eEMG) potential
Time Frame: 1 day before and 3 days, 3 months after drug treatment
|
The evoked electromyographic signal (eEMG) potential is the standard index
|
1 day before and 3 days, 3 months after drug treatment
|
|
Visual Analog Scale (VAS)
Time Frame: 1 day before and 3 days, 3 months after drug treatment
|
degree of the pain, 1-10, higher scores mean a worse outcome
|
1 day before and 3 days, 3 months after drug treatment
|
|
Klekamp and Sammi syringomyelia scale
Time Frame: 1 day before and 3 days, 3 months after drug treatment
|
for evaluating the spinal cord function, higher scores mean a better outcome
|
1 day before and 3 days, 3 months after drug treatment
|
|
modified Japanese Orthopaedic Association Scores (mJOA)
Time Frame: 1 day before and 3 days, 3 months after drug treatment
|
Motor function, sensory, bladder function;for evaluating the spinal cord function;0-17, higher scores mean a better outcome
|
1 day before and 3 days, 3 months after drug treatment
|
|
xuanwu syringomyelia scale
Time Frame: 1 day before and 3 days, 3 months after drug treatment
|
for evaluating the spinal cord function, for evaluating the spinal cord function;0-18, higher scores mean a worse outcome
|
1 day before and 3 days, 3 months after drug treatment
|
|
Incidence of complications
Time Frame: 1 day before and 3 days, 3 months after drug treatment
|
Incidence of complications
|
1 day before and 3 days, 3 months after drug treatment
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Study Chair: fengzeng jian, Xuanwu Hospital, Beijing
Publications and helpful links
General Publications
- Chen H, Wu S, Tang M, Zhao R, Zhang Q, Dai Z, Gao Y, Yang S, Li Z, Du Y, Yang A, Zhong L, Lu L, Xu L, Shen X, Liu S, Zhong J, Li X, Lu H, Xiong H, Shen Y, Chen H, Gong S, Xue H, Ge Z. Thalidomide for Recurrent Bleeding Due to Small-Intestinal Angiodysplasia. N Engl J Med. 2023 Nov 2;389(18):1649-1659. doi: 10.1056/NEJMoa2303706.
- Guan J, Yuan C, Yao Q, Du Y, Fang Z, Zhang L, Jia S, Zhang C, Liu Z, Wang K, Duan W, Wang Z, Wang X, Wu H, Chen Z, Jian F. A novel scoring system for assessing adult syringomyelia associated with CM I treatment outcomes. Acta Neurol Belg. 2023 Jun;123(3):807-814. doi: 10.1007/s13760-023-02264-4. Epub 2023 Apr 12.
- Hemley SJ, Bilston LE, Cheng S, Stoodley MA. Aquaporin-4 expression and blood-spinal cord barrier permeability in canalicular syringomyelia. J Neurosurg Spine. 2012 Dec;17(6):602-12. doi: 10.3171/2012.9.SPINE1265. Epub 2012 Oct 19.
- Yuan C, Xia P, Duan W, Wang J, Guan J, Du Y, Zhang C, Liu Z, Wang K, Wang Z, Wang X, Wu H, Chen Z, Jian F. Long-term Impairment of the Blood Spinal Cord Barrier in Patients with Posttraumatic Syringomyelia and its Effect on Prognosis. Spine (Phila Pa 1976). 2023 Nov 28. doi: 10.1097/BRS.0000000000004884. Online ahead of print.
- Heiss JD. Cerebrospinal Fluid Hydrodynamics in Chiari I Malformation and Syringomyelia: Modeling Pathophysiology. Neurosurg Clin N Am. 2023 Jan;34(1):81-90. doi: 10.1016/j.nec.2022.08.007. Epub 2022 Nov 3.
- Guan J, Yuan C, Zhang C, Ma L, Yao Q, Cheng L, Liu Z, Wang K, Duan W, Wang X, Wu H, Chen Z, Jian F. Intradural Pathology Causing Cerebrospinal Fluid Obstruction in Syringomyelia and Effectiveness of Foramen Magnum and Foramen of Magendie Dredging Treatment. World Neurosurg. 2020 Dec;144:e178-e188. doi: 10.1016/j.wneu.2020.08.068. Epub 2020 Aug 15.
- Liu S, Ma L, Qi B, Li Q, Chen Z, Jian F. Suppression of TGFbetaR-Smad3 pathway alleviates the syrinx induced by syringomyelia. Cell Biosci. 2023 May 29;13(1):98. doi: 10.1186/s13578-023-01048-w.
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Central Nervous System Diseases
- Nervous System Diseases
- Spinal Cord Diseases
- Syringomyelia
- Physiological Effects of Drugs
- Anti-Infective Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Angiogenesis Inhibitors
- Angiogenesis Modulating Agents
- Growth Substances
- Growth Inhibitors
- Anti-Bacterial Agents
- Leprostatic Agents
- Thalidomide
Other Study ID Numbers
Other Study ID Numbers
- XWTETS
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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