Cytoflavin in the Treatment of Patients With Diabetic Polyneuropathy (CYLINDER)

Multicenter, Double-blind, Placebo-controlled Randomized Clinical Trial of Efficacy and Safety of the Drug Cytoflavin®, Administered Intravenously Followed by Oral Intake, in Patients With Diabetic Polyneuropathy

One of the most common complications of diabetes mellitus is diabetic polyneuropathy, which leads to disability and reduces quality of life. The toxic effects of high glucose concentrations contribute to the formation of ketoaldehyde free radicals, which, at an increased rate of their formation, leads to the development of oxidative stress in the nervous tissue. The planned study of the use of Cytoflavin® in diabetic polyneuropathy is substantiated by its antioxidant effect, which, by analogy with alpha-lipoic acid preparations, suggests its efficacy in the combined treatment of such patients. This clinical study is being conducted to assess the efficacy and safety of Cytoflavin® versus Placebo in diabetic polyneuropathy patients with type 2 diabetes. Study patients will receive study medication, 10 IV infusions followed by 75 days of oral intake. Clinical efficacy will be assessed by alleviation of symptoms (burning, numbness, pain and pricking), using the total symptoms score(TSS), after the completion of the treatment course.

Study Overview

• Status: Completed
• Conditions: Diabetic Neuropathies
• Intervention / Treatment: Drug: Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid); Drug: Placebo

• Study Type: Interventional
• Enrollment (Actual): 216
• Phase: Phase 3

Contacts and Locations

Study Locations

• Russian Federation
  • Moscow, Russian Federation
    • City Clinical Hospital n.a. V.P.Demikhov
  • Moscow, Russian Federation
    • City Clinical Hospital n.a.M.E.Zhadkevitch
  • Nizhny Novgorod, Russian Federation
    • City Clinical Hospital #13 Avtozavodsky district
  • Saint Petersburg, Russian Federation
    • I. P. Pavlov 1st St. Petersburg State Medical University
  • Saint Petersburg, Russian Federation
    • City General Hospital №2
  • Saint Petersburg, Russian Federation
    • North-West State Medical University named after I.I. Mechnikov
  • Saint Petersburg, Russian Federation, 196143
    • Research Center for Eco-safety, Ltd.
  • Saint Petersburg, Russian Federation
    • "Astarta" Ltd.
  • Saint Petersburg, Russian Federation
    • City Outpatient Clinic #51
  • Saint-Petersburg, Russian Federation
    • "Consultative and diagnostic center with a polyclinic" of the Administrative Department of the President of the Russian Federation
  • Saint-Petersburg, Russian Federation
    • Almazov National Medical Research Centre
  • Saint-Petersburg, Russian Federation
    • City Outpatient Clinic #117
  • Saint-Petersburg, Russian Federation
    • MEDICA Ltd.
  • Samara, Russian Federation
    • "Diabetes" medical center
  • Saratov, Russian Federation
    • Saratov State Medical University n.a. V.I.Razumovsky
  • Yaroslavl, Russian Federation
    • GBUZ YAO "Regional Clinical Hospital"

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 45 years to 74 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Signed informed consent form;
• Men and women aged 45 to 74 (inclusive);
• Confirmed diagnosis of type 2 diabetes lasting for 1 year or more;
• Permanent scheme of therapy (without changing doses and drugs) by oral hypoglycemic drugs and / or insulin, long-term or ultra-long (adjustment of insulin dose is possible within 10% from baseline dose) and / or agonists of glucagon-like peptide-1 receptors (GLP-1) for at least 12 weeks before screening;
• HbA1c from 7.0 and not higher than 10.0%;
• BMI 22-40 kg / m2;
• Symptomatic distal sensorimotor diabetic polyneuropathy;
• Baseline TSS (Total Syptom Score) ˃5 points;
• Score ≥2 by at least one of the TSS symptoms;
• The severity of pain by the corresponding TSS subscale ≤ 2;
• NISLL (Neuropathy Impairment Score Low Limbs) ≥ 2 points;
• Patient consent to use adequate contraceptive methods for the entire study;
• Consent to maintain a stable diet, exercise, therapy and diabetes control throughout the study;
• Ability to comply with all protocol requirements.

Exclusion Criteria:

• Pregnant or lactating women, or women planning a pregnancy during a clinical trial;
• Type 1 diabetes and other specific types of diabetes;
• Acute metabolic complications of diabetes such as ketoacidosis or hyperosmolar state within 6 months prior to screening;
• Therapy with short and ultra-short insulin within 3 months before screening;
• Fasting plasma glucose at screening> 15 mmol / l;
• The presence of severe complications of diabetes;
• Epilepsy, epileptiform seizures, head trauma with loss of consciousness, tumor, inflammatory and demyelinating diseases of the central nervous system;
• Diseases requiring prior or current treatment by systemic corticosteroid drugs, cytostatics or penicillamine;malignant neoplasms within the last 5 years (excluding basal cell carcinoma);
• Cardiovascular diseases in the stage of decompensation at present or within 3 months before screening;
• Uncontrolled arterial hypertension with systolic arterial pressure> 180 mm Hg and diastolic blood pressure> 110 mm Hg at screening;
• Nephrotic syndrome, severe chronic renal failure or significant kidney disease with a level of glomerular filtration rate (GFR) <30 ml / min;
• Active viral (hepatitis B and C) or cirrhotic liver disease; increased aspartate aminotransferase (AST) or serum alanine aminotransferase (ALT) 3 times from upper normal limit; increased total bilirubin 2 times from upper normal limit;
• HIV; a severe infectious disease within 30 days before screening;
• Anemia (hemoglobin ≤ 105 g / l in women or ≤ 115 g / l in men); acute blood loss or donation of at least one unit of blood (500 ml) or blood transfusion within the previous 12 weeks;
• Drug or alcohol abuse;
• Intake of Cytoflavin® for 3 months before screening;
• Known allergies, hypersensitivity or contraindications to the drug Cytoflavin® or its components;
• Intake of alpha-lipoic acid, thiamine derivatives, pyridoxine, cyanocobalamin (excluding multivitamins), antidepressants and derivatives of gabapentin within 3 months before screening;
• Use of other investigational drugs within 3 months prior to screening;
• Inability to read or write; unwillingness to understand and follow protocol procedures; non-compliance with the protocol requirements.

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
Experimental: Group 1; Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid), 20 ml (two ampoules of 10 ml each) once a day intravenously in a dilution of 200 ml of 0.9% sodium chloride solution at a rate 3-4 ml/min, for 10 days + Cytoflavin ((Inosine + Nicotinamide + Riboflavin + Succinic Acid), 2 tablets 2 times a day, for 75 days	Drug: Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic Acid); The study drug will be administered in two phases: intravenous infusion of study drug for 10 days followed by oral administration of study drug for 75 days. Thus, the total duration of the study therapy is 12 weeks.
Placebo Comparator: Group 2; Placebo, 20 ml (two ampoules of 10 ml each) once a day intravenously in a dilution of 200 ml of 0.9% sodium chloride solution at a rate 3-4 ml / min, for 10 days + Placebo, 2 tablets 2 times a day, for 75 days	Drug: Placebo; The placebo comparator will be administered in two phases: intravenous infusion of placebo solution for 10 days followed by oral administration of placebo pills for 75 days. Thus, the total duration of the study therapy is 12 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
TSS (Total Symptom Score)	Change in total TSS score at Week 12 from baseline	12 weeks

Collaborators and Investigators

• Sponsor: POLYSAN Scientific & Technological Pharmaceutical Company
• Investigators: Study Chair: Igor A Strokov, Prof., "First Moscow State Medical University n.a. I.M.Sechenov of the Ministry of Health of Russia

Publications and helpful links

General Publications

• Kharitonova T, Shvarts YG, Verbovoy AF, Orlova NS, Puzyreva VP, Strokov IA. Efficacy and safety of the combined metabolic medication, containing inosine, nicotinamide, riboflavin and succinic acid, for the treatment of diabetic neuropathy: a multicenter randomized, double-blind, placebo-controlled parallel group clinical trial (CYLINDER). BMJ Open Diabetes Res Care. 2022 Jun;10(3):e002785. doi: 10.1136/bmjdrc-2022-002785.

Study record dates

Study Major Dates

• Study Start (Actual): November 25, 2020
• Primary Completion (Actual): March 29, 2021
• Study Completion (Actual): June 6, 2021

Study Registration Dates

• First Submitted: November 24, 2020
• First Submitted That Met QC Criteria: November 24, 2020
• First Posted (Actual): December 2, 2020

Study Record Updates

• Last Update Posted (Actual): January 27, 2023
• Last Update Submitted That Met QC Criteria: January 25, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Keywords: Antioxidants; Diabetes Mellitus; Peripheral Nervous System Diseases; Succinic acid
• Additional Relevant MeSH Terms: Nervous System Diseases; Endocrine System Diseases; Diabetes Complications; Diabetes Mellitus; Neuromuscular Diseases; Peripheral Nervous System Diseases; Polyneuropathies; Diabetic Neuropathies; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Vasodilator Agents; Antimetabolites; Photosensitizing Agents; Dermatologic Agents; Micronutrients; Hypolipidemic Agents; Lipid Regulating Agents; Vitamins; Vitamin B Complex; Nicotinic Acids; Riboflavin; Niacinamide; Niacin
• Other Study ID Numbers: CTF-III-DM-2019

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No