- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04432662
Darbepoetin in Neonatal Encephalopathy Trial (EDEN)
Darbepoetin in Neonatal Encephalopathy (EDEN) Trial
Hypoxic Ischemic Encephalopathy is also known as 'birth asphyxia related brain injury' and happens when the brain does not receive enough oxygen or blood flow around the time of birth. Birth asphyxia related brain injury is the most common cause of death and neurodisability in term babies.
Cooling therapy has substantially improved the outcomes of babies with HIE. However, unacceptably high rate of adverse outcomes are still seen in cooled babies with HIE.
The EDEN trial is a 2 arm randomised control trial and aims to examine the physiological effects of Darbepoetin alfa (Darbe) therapy on proton magnetic resonance spectroscopy thalamic N-acetylaspartate (NAA) level in babies with neonatal encephalopathy undergoing cooling therapy.
A total of 150 babies with neonatal encephalopathy will be recruited from the participating sites in UK over a 24 month period. The babies will be randomly allocated to darbepoetin or usual care. MR imaging and spectroscopy will be performed at 1 to 2 weeks of age to examine the brain injury. Neurodevelopmental outcomes will be assessed at 18 months of age.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Birth asphyxia related brain injury occurs in 2.6 (95% CI 2.5 to 2.8) per 1000 live births in the UK and is the most common cause of death and neurodisability in term babies. The economic burden to the treasury on support costs of neurodisability from neonatal encephalopathy is massive (£4 billion per year). In addition, birth asphyxia related (obstetric) claims accounted for almost half of the NHS litigation expenses in 2016/17 (approx. £2 billion), increasing by 15% from the previous year. It has been reported that the NHS cost to meet the complex life-long care needs of babies born with brain damage could be soon over £20m per child, and this situation is unsustainable to the NHS.The UK Government has recently (October 2016) announced that reducing birth asphyxia related costs is a priority area for the Government.
The only effective treatment for neonatal encephalopathy is whole-body cooling, with an estimated saving of £100 million per annum to the UK economy, since its introduction as standard therapy in the NHS in 2007. Cooling therapy has substantially improved the outcomes of babies with neonatal encephalopathy in the past decade. However, unacceptably high rate of adverse outcomes are still seen in cooled babies with moderate or severe neonatal encephalopathy : death 28% (range 24-38); cognitive impairment 24% (range 21-25); cerebral palsy 22% (range 13-28); epilepsy 19% (range 15-24); cortical visual impairment 6% (range 1-10), with combined death or moderate/severe disability 48% (range 44- 53), and hence better treatments and further optimisation of cooling therapy is required. Additionally, cooling provides a window of opportunity for therapeutic interventions that may arrest or reduce secondary brain injury and it is unclear whether it provides protection from a sub-acute chronic injury that may have occurred during the antenatal period.
A key roadblock in clinical translation of over fifteen highly effective neuroprotective treatments in animal models is the long delay between the intervention and outcome assessments in neonatal encephalopathy . i.e., the earliest age at which neurodevelopmental outcome can be accurately assessed is 18 months. Hence, despite having several highly effective treatments in animal models, no further neuroprotective drugs in neonatal encephalopathy have been introduced into the NHS in the past ten years.
Erythropoietin (Epo) is a widely used drug for treating anaemia in various age groups, including newborn infants. Several recent reviews have highlighted Epo as one of the most promising therapies to augment hypothermic neuroprotection. Epo has both acute effects (anti-inflammatory, anti-excitotoxic, anti-oxidant, and anti-apoptotic) and regenerative effects (neurogenesis, angiogenesis, and oligodendrogenesis) essential for the repair of injury and normal neurodevelopment in animal models. Of the long list of highly effective drugs in animal models of neonatal encephalopathy and early clinical studies, Epo is the most promising. It is the only drug with a long therapeutic window, is widely available, inexpensive, and can be easily administered on a once-a-day dosing schedule. It has been extensively evaluated in large randomised controlled trials for anaemia of prematurity and has a proven safety profile in newborn infants. Due to the regenerative effects and the longer therapeutic window provided by Epo, there is potential to impact the chronic injury caused to an antenatally compromised foetus.
Although earlier studies have shown benefit with Epo, the time of initiation and duration of treatment remains uncertain. Moreover, recently published High-Dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial which administered high dose Epo (1000u/kg/day) within 24 hours of birth and continued until 7 days of age failed to demonstrate the neuroprotective effect of erythropoietin in moderate and severe encephalopathy as an adjuvant to therapeutic hypothermia. This result suggest the exposure of the drug during the therapeutic hypothermia may not be beneficial due to an overlap in the neuroprotective mechanism. Perhaps a prolonged exposure of Epo following therapeutic hypothermia might be beneficial.
Another erythropoiesis stimulating agent is Darbepoetin (Darbe) with dual erythropoietic and potential neuroprotective effects. Darbe is an ideal candidate to augment hypothermic neuroprotection as it is a long-acting erythropoiesis stimulating agent, allowing prolonged exposure with less dosing. In preclinical study in rats, darbepoetin alfa crossed the blood brain barrier and remained stable up to 24 hours. Neuroprotective effects of darbepoetin were demonstrated following the contusion injury and hemorrhage in rats. The DANCE study (Darbepoetin Administered to Neonates undergoing Cooling for Encephalopathy) randomised 30 term infants with moderate to severe neonatal encephalopathy to placebo (n=10), 2 μg/kg Darbe (n=10) or 10 μg/kg Darbe (n=10). At 2 and 10 μg/kg Darbe, t1/2 was 24 and 32 hours. A dose of 10 μg/kg dose achieved an AUC in the neuroprotective range and a terminal t1/2 of 53.4 hours when compared to the 2 μg/kg dose. No side effects attributable to Darbe were reported. In another feasibility and safety trial, infants with mild encephalopathy were randomised to receive Darbepoetin 10 μg/kg single dose within 24 hours and found the drug to be safe with no reported adverse events.
The EDEN trial is a 2 arm randomised control trial and aims to examine the physiological effects of Darbepoetin alfa (Darbe) therapy on proton magnetic resonance spectroscopy thalamic N-acetylaspartate (NAA) level in babies with neonatal encephalopathy undergoing cooling therapy.
After informed parental consent, a total of 150 babies with HIE (aged <24 hours) undergoing therapeutic hypothermia will be randomised to one of the following groups
- Arm 1:Darbepoetin Alpha (10 mcg/kg) IV x2 doses following cooling therapy.
- Arm 2: Cooling only (usual care)
Babies recruited will have electroencephalography (EEG), MR imaging and spectroscopy will be performed at 1 to 2 weeks of age to examine the brain injury. The neurological outcomes will be assessed between 18 to 22 months of age. The trial duration will be 4 years, consisting of a 4 week start up period, 24 month recruitment period, a 18 month follow-up period, and 5 months for data analysis and write up.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Sudhin Thayyil, PhD
- Phone Number: 02033132488
- Email: s.thayyil@imperial.ac.uk
Study Contact Backup
- Name: Ismita Chhetri, PhD
- Phone Number: 02033132488
- Email: i.chhetri@imperial.ac.uk
Study Locations
-
-
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Birmingham, United Kingdom
- Not yet recruiting
- Birmingham Womens Hospital
-
Contact:
- Manobi Boorah, FRCPCH
-
Bradford, United Kingdom
- Not yet recruiting
- Bradford Teaching Hospitals NHS Foundation Trust
-
Contact:
- Sam Oddie
- Email: sam.oddie@bthft.nhs.uk
-
Cambridge, United Kingdom
- Not yet recruiting
- Cambridge University Hospitals NHS Foundation Trust
-
Contact:
- Topun Austin, MD
-
Gillingham, United Kingdom
- Recruiting
- Medway Nhs Foundation Trust
-
Contact:
- Dr Aung Soe, FRCPCH
- Email: aung.soe@medway.nhs.uk
-
Contact:
- Russel Pryce, PhD
-
Liverpool, United Kingdom
- Not yet recruiting
- Liverpool Womens NHS Foundation Trust
-
Contact:
- Balamurugan Palanisami, MBBS
- Email: Balamurugan.Palanisami@lwh.nhs.uk
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London, United Kingdom
- Recruiting
- Imperial College Healthcare Trust
-
Contact:
- Gaurav Atreja, MD
- Phone Number: 02033131134
- Email: gatreja@nhs.net
-
Contact:
- Maria Moreno Morales, BsC
- Phone Number: 02033132473
- Email: m.moreno-morales@imperial.ac.uk
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London, United Kingdom
- Recruiting
- Homerton University Hospital
-
Contact:
- Narendra Aldangady
-
Luton, United Kingdom
- Recruiting
- Bedfordshire Hospitals Nhs Foundation Trust
-
Contact:
- Bharat Vakharia, MD
-
Newcastle, United Kingdom
- Recruiting
- The Newcastle Upon Tyne NHS Foundation Trust
-
Contact:
- Dr Sundeep Harigopal
- Email: sundeep.harigopal@nuth.nhs.uk
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
All the following criteria should be met
- Babies aged < 24 hours, gestation age >36 weeks with a birthweight >1.8kg.
- Acute perinatal asphyxia (metabolic acidosis in cord and/or blood gas (pH<7.0; base deficit > 16 mmol/L) within first 1 hour of birth). If pH between 7.01 and 7.15, a base deficit between 10 and 15.9 mmol/L, additionally acute obstetric event and either need for continued resuscitation or ventilation at 10 minutes after birth and/or 10 minutes Apgar score <5 is required.
- Evidence of mild, moderate, or severe encephalopathy on an NICHD neurological examination performed between 1 and 6 hours of birth. The worst recorded encephalopathy stage between 1 and 6 hours of birth should be used.
- Cooling therapy initiated for neonatal encephalopathy within 6 hours of age as a part of standard clinical care, with an intention of continuing for 72 hours.
Exclusion Criteria:
- Major life-threatening congenital malformation.
- Concomitant participation in other research projects
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Darbepoetin Alpha
Administration of Darbepoetin Alpha (10 mcg/kg) IV x2 doses following cooling therapy.
|
Administration of Darbepoetin Alpha (10 mcg/kg) IV x2 doses following cooling therapy.
|
No Intervention: Standard of care
Standard of care: Cooling only
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Primary outcome measure (Mean (SD) of thalamic NAA level)
Time Frame: Expected average 1 to 2 weeks after birth
|
Mean (SD) of thalamic NAA level in babies treated with Darbe when compared with untreated infants.
|
Expected average 1 to 2 weeks after birth
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Secondary outcome measure (accurate quantification of NAA level)
Time Frame: 24 months
|
Number of babies in whom thalamic NAA level could be accurately quantified in 3Telsa and 1.5Tesla MR scanners.
|
24 months
|
Collaborators and Investigators
Sponsor
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 277361
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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