Interest of Oral Corticosteroids in the Treatment of Chronic Subdural Hematomas (hemacort)

Interest of Oral Corticosteroids in the Treatment of Chronic Subdural Hematomas. Prospective Randomized Multicenter Trial

The chronic subdural hematoma is a common disease in the population over 60 years. For example, in patients over 70 years, it occurs every year 7 new cases per 100,000 people. A chronic subdural hematoma is an accumulation of blood in the intracranial space between brain membrane (dura mater) and the brain. The origin of blood in this area follows a minor brain injury, which causes the rupture of small vessels in the area. During its evolution, the volume of the hematoma increases. After a few weeks, the amount of fluid build-up can compress the brain. That's when clinical symptoms occur: persistent headaches, neurological deficits, seizures, impaired consciousness, cognitive functions (memory loss, impaired intellectual function, or hallucinations, etc.). The compression of the brain may cause impairment of consciousness resulting in more severe cases coma and death. At this stage, a neurosurgical intervention is necessary. Recurrences are numerous (15 to 25% recurrence over six months after neurosurgery). That is why in France, about 20% of medical teams administer a postoperative treatment with corticosteroids to reduce the risk of recurrence. Until now, the potential benefit of this treatment has not yet been confirmed by a clinical study. So the purpose of this research.

Study Overview

• Status: Terminated
• Conditions: Chronic Intracranial Subdural Hematoma
• Intervention / Treatment: Drug: placebo; Drug: oral corticosteroids

Detailed Description

The chronic subdural hematoma (HSDC) is a common disease in the population over 60 years. The incidence is 7 / 100000 in patients over 70 years. This condition occurs readily after a minor head injury. Bleeding secondary to cerebral concussion and vascular fragility from a cortico-dural vein. It is favored in most cases by taking anti-platelet or other blood thinners. The hematoma formed and causes a local inflammatory reaction. This reaction tends to partition the collection by the formation of a membrane whose pathological vessels weakened by inflammation, causing bleeding iterative low abundance. A vicious circle is established by a combination of these phenomena and causes a progressive worsening clinical and radiological.Because of the importance of recurrence (15 to 25% at 6 months) and the high rate of mortality at one year (10 to 15%), but also supposed pathophysiological mechanisms (inflammation, formation of membrane self-sustaining blood collection ), a postoperative treatment with corticosteroids was introduced in secondary prevention by some teams (about 20% in France). However, this practice has never been a prospective study on clinical and radiological interest.The aim of this prospective multicenter randomized, double blind, is to evaluate in patients with chronic subdural hematoma, compared with placebo, the efficacy of postoperative corticosteroid treatment orally for approximately 2 months on the rate of clinical recurrence and / or radiological subdural hematoma 6 months after surgery (primary endpoint).The secondary endpoints are the rate of mortality at one year, and the 6 month follow-up of clinical and radiological evolution, neurological status (Markwalder scale), quality of life (health scale perceptual Nottingham), autonomy (Karnofsky scale), the state of consciousness (Glasgow scale), and size of the hematoma on CT scan without injection.340 adult patients of the 2 sexes who received surgical treatment for a chronic subdural hematoma unilateral or bilateral primary diagnosis (hematoma hypodense or isodense with a blade of at least 3 mm thick axial CT scan on brain) will be included in the study on 5 centers (services of Neurosurgery Hospital of Montpellier, Marseille, Nice, Perpignan and Lyon).Patients enrolled will be assigned to one of two treatment groups (active treatment or placebo) by lot. Active treatment is prednisone establishment within 72 hours after the end of surgery at the dose of 1 mg / kg (rounded to the nearest 10 mg) once daily orally for one week . The daily dose then decreases in increments of 10 mg weekly, by the second week. Once the level of 10 mg / day reached the daily dose by one level lower than 5 mg weekly. Treatment is stopped after this week to 5 mg / day .. The placebo was similar in all respects to active treatment and is administered in the same way that the active treatment. Additional treatment will be administered to all patients throughout the duration of the experimental treatment. It is a vitamin and calcium supplementation in preventing the risk of osteoporosis.Medical monitoring of patients will be over a period of six months with visits scheduled in the various departments of Neurosurgery at 1 month, 3 months and 6 months after surgery. Each visit is a consultation with a neurosurgical team physician including a review of clinical research with the recurrence of subdural hematoma and the collection of adverse events. This physician, independent of the investigative team, will also collect scores Markwalder, Nottingham, Karnofsky and Glasgow. Analysis of the CT scan will be centralized. A blood sample will be performed at the visit at 1 month, to establish a biological monitoring in relation to the potential electrolyte disturbances related to steroids.The mortality survey will take place 1 year after surgery by telephone interview between an investigator and the patient or his entourage.The overall duration of the study is about 6 years including 4 years of clinical phase.Given the extensive use of corticosteroids in the treatment of chronic subdural hematomas and absence of solid data on the subject, our research should clarify the role of corticosteroids in secondary prevention and improve the overall management of patients.

• Study Type: Interventional
• Enrollment (Actual): 162
• Phase: Phase 3

Contacts and Locations

Study Locations

• France
  • Montpellier, France, 34090
    • Gui de Chauliac Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients of both sexes operated for chronic subdural hematoma one-sided or bilateral of firstly diagnosis, after consultation in neurosurgery for a symptomatology in touch with this hematic collection.
• At the End of the surgical operation < 72 hours
• Hematoma must be hypodense or isodense. He has to present a value < 50 on the scale of Hounsfield measured in the center of the collection on the initial intellectual scanning, this measure not in front of not to be made on a zone of new bleeding treble or on a membrane (in case of compartmentalized hematoma).

The blade of the hematoma has to measure at least 3 mm in thickness on an axial cutting.

Exclusion Criteria:

• Age < 18 years
• Weight > 104 kg
• Histories of hematoma chronic subdural for which a medical and\or surgical treatment were before realized
• Patient Presenting:

uncontrolled arterial hypertension, current Infection, Diabetes treated by drugs, Ulcer evolutionary gastroduodenal in the course of treatment and dating < 6 months, turned out Osteoporosis symptomatic of cortisone origin, uncontrolled psychotic State by a treatment, except the sultopride, ulcerous Colitis, recent intestinal Anastomose, Renal insufficiency, hepatic Incapacity, Hypercalcemia,Hypercalciuria,calcic Lithiasis, high sensibility at drug'study, Intolerance: galactose, fructose, deficit in lactase, syndrome of malabsorption of glucose or galactose

• Clinical or radiological Characteristics of hematoma suspecting an intra-cranial infection (abscess,..)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: placebo; The aim of this prospective multicenter randomized, double blind, is to evaluate in patients with chronic subdural hematoma, compared with placebo, the efficacy of postoperative corticosteroid treatment orally for approximately 2 months on the rate of clinical recurrence	Drug: placebo; placebo
Active Comparator: oral corticosteroids; The aim of this prospective multicenter randomized, double blind, is to evaluate in patients with chronic subdural hematoma, compared with placebo, the efficacy of postoperative corticosteroid treatment orally for approximately 2 months on the rate of clinical recurrence	Drug: oral corticosteroids; Active treatment is prednisone establishment within 72 hours after the end of surgery at the dose of 1 mg / kg (rounded to the nearest 10 mg) once daily orally for one week . The daily dose then decreases in increments of 10 mg weekly, by the second week. Once the level of 10 mg / day reached the daily dose by one level lower than 5 mg weekly. Treatment is stopped after this week to 5 mg / day (average 2 months of treatment); Other Names: Cortancyl

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the evaluation of efficacy of postoperative corticosteroid treatment in patients group compared with placebo	The objective of this study is to evaluate in patients with chronic subdural hematoma, compared with placebo, the efficacy of postoperative corticosteroid treatment orally for about two months on the rate of clinical recurrence and / radiological or subdural hematoma 6 months after surgery (primary endpoint).	6 months after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluation of mortality rate at one year	Secondary objective is the evaluation of the effectiveness of corticosteroid treatment on the postoperative mortality rate at one year	one year
Evaluation of quality of life at one year	Secondary objective is the evaluation of the effectiveness of corticosteroid treatment on the quality of life of patients	one year
evaluation of tolerance at one year	Secondary objective is the evaluation of the tolerance of corticosteroid treatment at one year.	one year

Collaborators and Investigators

• Sponsor: University Hospital, Montpellier
• Collaborators: Hospices Civils de Lyon; Centre Hospitalier Universitaire de Nice; University Hospital, Marseille; Centre hospitalier de Perpignan
• Investigators: Principal Investigator: Lonjon Nicolas, MD,PhD, CHU de Montpellier

Study record dates

Study Major Dates

• Study Start (Actual): July 22, 2011
• Primary Completion (Actual): September 12, 2014
• Study Completion (Actual): September 12, 2014

Study Registration Dates

• First Submitted: June 16, 2011
• First Submitted That Met QC Criteria: June 21, 2011
• First Posted (Estimate): June 27, 2011

Study Record Updates

• Last Update Posted (Actual): December 28, 2021
• Last Update Submitted That Met QC Criteria: December 27, 2021
• Last Verified: December 1, 2021

More Information

Terms related to this study

• Keywords: treatment; corticosteroid; neurosurgery; chronic subdural hematomas; recurrence, adjuvant
• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Hemorrhage; Craniocerebral Trauma; Trauma, Nervous System; Intracranial Hemorrhages; Intracranial Hemorrhage, Traumatic; Hematoma; Hematoma, Subdural; Hematoma, Subdural, Chronic; Hematoma, Subdural, Intracranial; Physiological Effects of Drugs; Anti-Inflammatory Agents; Antineoplastic Agents; Glucocorticoids; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Antineoplastic Agents, Hormonal; Prednisone
• Other Study ID Numbers: 8545; 2009-015524-28 (EudraCT Number)