- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05582707
Safety and Suitability of Supplementing Early MIP Surgery (MIPS) of ICH With Pioglitazone (ENRICHPLUS)
A Non-Randomized Controlled Trial to Examine the Safety and Suitability of Supplementing Early Minimally Invasive Parafascicular Surgery (MIPS) for Clot Evacuation of Basal Ganglia Intracerebral Hemorrhage (ICH) With Pioglitazone
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Arms:
Group 1: 20 Subjects will undergo MIPS for evacuation of ICH using the BrainPath access device plus perioperative pioglitazone for 3 weeks
Group 2: Subjects will undergo MIPS for evacuation of ICH using the BrainPath access device as part of the ENRICH trial (NCT02880878). These subjects will be enrolled at an ENRICH trial site independent of our Institution. Deidentified patient information from 20 subjects in this group, who will be matched to those in the ENRICH-PLUS group, will be provided to the principal investigator for comparison of outcomes.
Consent for study participation will be obtained from the patient or the LAR only after fulfilling all inclusion and exclusion criteria either before or after MIPS, which will be scheduled as a standard institutional procedure outside the realm of the study.
Study participants will be administered pioglitazone (15 mg tablet) either p.o. or enteral (via nasogastric tube). The first dose may be administered prior to surgery or within 3 hours of the end of surgery but must be administered within 24 hours of the index event or time last known normal (TLKN). Pioglitazone (15 mg tablet) administration will continue 3 times daily for 3 weeks, including after hospital discharge, if applicable.
Following completion of pioglitazone, subjects will be followed at days 30, 90, 120 and 180 post MIPS. In addition to AE monitoring during these follow up's, a utility-weighted mRS (uw-mRS) at 180 days will serve as the primary end point.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: J Marc Simard, MD, PhD
- Phone Number: (410)328-0850
- Email: msimard@som.umaryland.edu
Study Contact Backup
- Name: Kaitlyn Henry
- Phone Number: (410)328-0939
- Email: Khenry@som.umaryland.edu
Study Locations
-
-
Maryland
-
Baltimore, Maryland, United States, 21201
- Recruiting
- University of Maryland, Baltimore
-
Contact:
- J Marc Simard, MD, PhD
- Email: msimard@som.umaryland.edu
-
Contact:
- Kaitlyn Henry, Coordinator
- Phone Number: 814-404-9809
- Email: khenry@som.umaryland.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 18-80 years
- CT scan demonstrating an acute, spontaneous, primary basal ganglia ICH
- ICH volume between 30 - 80 mL as calculated by the ABC/2 method
- Study intervention can reasonably be initiated within 24 hours after the onset of stroke symptoms. In situations with unclear time of onset, then the onset will be considered the time that the subject was last known to be well
- Glasgow Coma Score (GCS) 5 - 14
- Historical Modified Rankin Score 0 or 1
- Consent by patient or LAR to MIS evacuation of the ICH based on best medical practice1
- Time to pioglitazone treatment ≤ 24 hours from symptom onset or TLKN1
Exclusion Criteria:
- Ruptured aneurysm, arteriovenous malformation (AVM), vascular anomaly, moyamoya disease, hemorrhagic conversion of an ischemic infarct, or bleeding into a known neoplastic lesion
- NIHSS< 5, bilateral fixed dilated pupils, extensor motor posturing, unstable mass or evolving intracranial compartment syndrome
- Intraventricular extension of the hemorrhage estimated to involve >50% of either of the lateral ventricles (External ventricular drain (EVD) to treat intracranial pressure (ICP) or hydrocephalus is allowed)
- Primary thalamic ICH or infratentorial intraparenchymal hemorrhage including midbrain, pons or cerebellum
- Evidence of active bleeding involving a retroperitoneal, gastrointestinal, genitourinary, or respiratory tract site
- Severe kidney or liver disease (serum ALT > 2.5 x ULN) with active coagulopathy
- Patients requiring long-term anticoagulation that needs to be initiated < 5 days from index ICH; patient must not require Coumadin (anticoagulation) during the first 30 days (reversal of anticoagulation is permitted for medically stable patients who can safely tolerate the short-term risk of reversal)
- Use of anticoagulants that cannot be rapidly reversed, uncorrected coagulopathy or known clotting disorder
- Platelet count < 75,000
- International Normalized Ratio (INR) > 1.4 after correction or inability to sustain INR ≤ 1.4 using short- and long-active procoagulants (such as, but not limited to, NovoSeven, fresh frozen plasma, vitamin K, Kcentra or Feiba)
- Untreatable elevated activated partial thromboplastin time (aPTT)
- Patients with a mechanical heart valve (presence of bioprosthetic valve(s) is permitted)
- Positive urine or serum pregnancy test in female subjects without documented history of surgical sterilization or is post-menopausal
- Participation in a concurrent interventional medical investigation or clinical trial
- Known life-expectancy of less than 6 months, no reasonable expectation of recovery, Do-Not-Resuscitate (DNR), or comfort measures only prior to randomization
- Inability or unwillingness of subject or legal guardian/representative to give written informed consent
- Homelessness or history of drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements
- intolerance or allergy to any TZD1
- T2DM treated with insulin or an oral medication including Glyburide, unless the NICU physician deems it safe to replace the T2DM medication with pioglitazone1
- heart failure (symptomatic or NYHA Class I-IV or newly diagnosed on admission TTE screening)
- patients with abnormal (>1x upper limit of normal) of alanine aminotransferase (ALT), aspartate aminotransferase (AST), or total bilirubin
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: MIPS + Pioglitazone
20 Subjects will undergo MIPS for evacuation of ICH using the BrainPath access device plus perioperative pioglitazone for 3 weeks
|
Study participants will be administered pioglitazone (15 mg tablet) either p.o. or enteral (via nasogastric tube).
The first dose may be administered prior to surgery or within 3 hours of the end of surgery but must be administered within 24 hours of the index event or time last known normal (TLKN).
Pioglitazone (15 mg tablet) administration will continue 3 times daily for 3 weeks, including after hospital discharge, if applicable.
|
No Intervention: MIPS Alone
This trial will compare it's subjects to subjects who have previously undergone MIPS for evacuation of ICH using the BrainPath access device as part of the ENRICH trial (NCT02880878).
These subjects will be enrolled at an ENRICH trial site independent of our Institution.
Deidentified patient information from 20 subjects in this group, who will be matched to those in the ENRICH-PLUS group, will be provided to the principal investigator for comparison of outcomes.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Functional Improvement - modified Rankin Scale (mRS)
Time Frame: 180 Days
|
Functional Improvement as determined by utility-weighted modified Rankin Scale (mRS) at 180 days.
This is a scale from 0 to 6, where 0 is the best score (no symptoms) and 6 is the worst score.
|
180 Days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Efficacy as demonstrated by hematoma clearance
Time Frame: 7 Days
|
Determination whether there is non-inferiority or a trend toward more rapid hematoma clearance and perihematomal edema in Group 1 compared to the control arm (Group 2) as measured by serial CT scans during hospitalization residual clot on CT, perihematomal edema on CT
|
7 Days
|
Safety: Number of Participants with 30-day mortality
Time Frame: 30 days
|
30-day mortality (30 days from intervention)
|
30 days
|
Safety: hemorrhage volume
Time Frame: 24 Hours
|
increase in hemorrhage volume between index CT and 24-hour follow-up CT
|
24 Hours
|
Safety: Number of Participants with bacterial brain infection
Time Frame: 30 Days
|
30-day bacterial brain infection (30 days from intervention)
|
30 Days
|
Safety: Number of Participants with hypoglycemia
Time Frame: 30, 90, 120, and 180 days
|
occurrences of Moderate hypoglycemia (<70 mg/dL) or Severe hypoglycemia (<50 mg/dL) requiring rescue therapy
|
30, 90, 120, and 180 days
|
Safety: Number of Participants with Drug Toxicity
Time Frame: 30, 90, 120, and 180 days
|
30, 90, 120, and 180 days
|
|
Economic
Time Frame: 30, 90, 120, and 180 days
|
Economic differential as determined by quantification of the cost per quality-adjusted life-years (QALY).
QALY uses a scale of 0.00 (dead) to 1.00 (perfect health) for each health status.
It is the product of duration of life and a measurement of quality of life.
|
30, 90, 120, and 180 days
|
Collaborators and Investigators
Collaborators
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 (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- HP-00102344
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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