- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06020495
Systematic Use of DDAVP to Prevent Serum Sodium Overcorrection in Severe Hyponatremia: a Multicenter Open-label Randomized Controlled Trial (DASSOH)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Multicentre, prospective, open-label randomized controlled superiority trial with stratification on the presence of neurological symptoms at inclusion and on the presence/absence of risk factors for central pontine myelinolysis (chronic alcohol abuse, malnutrition, serum potassium < 3.0 mmol/L).
Patients in ICU with severe hyponatremia defined by SNa < 115 mmol/L or SNa < 120 mmol/L in the presence of neurological symptoms (convulsions, stupor defined by a Glasgow score <12 or signs of brain herniation) and a normal or decreased extracellular fluid volume will be included.
After written informed consent, they will be randomized (1:1), using a computer-generated randomization scheme of various-sized blocks, stratified by the presence of neurological symptoms at inclusion (seizures, stupor defined as Glasgow score <12 or signs of brain herniation) and on the presence/absence of risk factors for central pontine myelinolysis (chronic alcohol abuse [defined according to World Health Organization definition], malnutrition [BMI<20.5 or weight loss >5% in 3 months], serum potassium < 3.0 mmol/L), through a centralized 24-hour Internet service (CleanWEB™), to receive standard hyponatremic treatment alone or standard hyponatremic treatment and DDAVP 4 μg/ml IV, after randomisation and for a total duration of 48 hours. Since administration of DDAVP leads to an important decrease in urine output and increase in urine osmolarity which are clinically obvious very rapidly, a single or double blind trial is not appropriate. However, all investigators will be unaware of aggregate outcomes during the study and brain MRI imaging will be performed and analyzed blinded to the randomization group
Study Type
Enrollment (Estimated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: GAUDRY Stéphane
- Phone Number: 01.48.95.55.55
- Email: stephane.gaudry@aphp.fr
Study Contact Backup
- Name: DECHANET Aline
- Phone Number: 01 40 25 78 30
- Email: aline.dechanet@aphp.fr
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adults ( ≥18 years)
- Current admission in ICU
- Severe hyponatremia defined by SNa <120 mmol/L in the presence of neurological symptoms (seizures, stupor defined as Glasgow score < 12, or signs of brain herniation) or by SNa <115 mmol/L
- Normal or decreased extracellular fluid volume
Exclusion Criteria:
- Obvious increase of extracellular fluid volume (cirrhosis with ascites, congestive heart failure, nephrotic syndrome);
- Previous DDAVP or hypertonic fluid administration for the current episode of severe hyponatremia
- SNa increased by 5 mmol or more between admission at hospital and randomisation (H0)
Known contraindication to DDAVP
- Allergy
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- History of unstable angina and/or known or suspected heart failure.
- Willebrand disease type 2b (due to risk of thrombocytopenia)
- Severe previous neurologic disability (Glasgow Outcome Scale < 3)
- Diabetes insipidus receiving DDAVP treatment
- Moribund state (patient likely to die within 24h)
- Need for invasive mechanic ventilation
- Limitation of life support (comfort care applied only) at the time of screening
- Enrolment to another interventional study on hyponatremia care/management
- Pregnancy or breastfeeding
- Subject deprived of freedom, subject under a legal protective measure
- No affiliation to any health insurance system
- Refusal to participate to the study (patient or legal representative or family member or close relative if present)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: DDAVP
DDAVP 4µg/ml IV Additional doses may be administrated every 6h for a maximum of 48h - Standard hyponatremia treatment : Presence of neurological symptoms : sodium chloride 3% 150ml for 20 min Absence of neurological symptoms : Hyper or isotonic fluid but never hypotonic |
Posology: 4µg in 2ml IV solution Route of administration: Intravenous Duration of treatment: 48h maximum (additional doses every 6h)
|
Active Comparator: Standard hyponatremia treatment
Standard hyponatremia treatment alone : Presence of neurological symptoms : sodium chloride 3% 150ml for 20 min Absence of neurological symptoms : Hyper or isotonic fluid but never hypotonic |
Standard hyponatremia treatment alone : Presence of neurological symptoms : sodium chloride 3% 150ml for 20 min Absence of neurological symptoms : Hyper or isotonic fluid but never hypotonic |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
reduced occurrence of overcorrection of serum sodium concentration (SNa) in the first 48 hours after randomization
Time Frame: 48 hours after the randomization
|
proportion of patients with SNa level overcorrection : any risk factor: SNa increase > 6 mmol/L in less than H24, or >12 mmol/L in less than H48.
Without risk factor: SNa increase > 10 mmol/L in less than H24, or > 18 mmol/L in less than H48
|
48 hours after the randomization
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
the reversal of acute neurological symptoms in patients with neurological symptoms at inclusion
Time Frame: 6 hours after the randomization
|
proportion of patients with neurological symptoms at inclusion and who subsequently have a normal Glasgow Coma Scale at H6
|
6 hours after the randomization
|
ICU and hospital length of stay
Time Frame: ICU or hospital discharge
|
length of ICU and hospital stay
|
ICU or hospital discharge
|
survival
Time Frame: death after randomization
|
time to death after inclusion
|
death after randomization
|
the occurrence of central pontine myelinolysis diagnosed on clinical and MRI criteria
Time Frame: 15 days after randomization
|
proportion of patients with the occurrence of central pontine myelinolysis diagnosed on clinical and MRI criteria at day 15 (or earlier if clinically justified)
|
15 days after randomization
|
the occurrence of any (pontine or extrapontine) osmotic demyelination as assessed by brain MRI
Time Frame: 15 days after randomization
|
proportion of patients with any (pontine or extrapontine), symptomatic or not, osmotic demyelination as assessed by brain MRI at day 15 (or earlier if clinically justified)
|
15 days after randomization
|
on the percentage of patients with neurological symptoms at inclusion and reaching the initial goal of rapid partial pre-defined correction of SNa level
Time Frame: 6 hours after the randomization
|
proportion of patients with neurological symptoms with an increase of 5.0 mmol/L or more of SNa from inclusion to H6
|
6 hours after the randomization
|
the urine output between H0 and H6
Time Frame: 6 hours after the randomization
|
urine output between H0 and H6
|
6 hours after the randomization
|
the urine output between H6 and H12
Time Frame: 12 hours after the randomization
|
urine output between H6 and H12
|
12 hours after the randomization
|
the urine output between H12 and H24
Time Frame: 24 hours after the randomization
|
urine output between H12 and H24
|
24 hours after the randomization
|
the urine output between H24 and H48
Time Frame: 48 hours after the randomization
|
urine output between H24 and H48
|
48 hours after the randomization
|
the urine osmolality between H0 and H6
Time Frame: 6 hours after the randomization
|
urine osmolality between H0 and H6
|
6 hours after the randomization
|
the urine osmolality between H6 and H12
Time Frame: 12 hours after the randomization
|
urine osmolality between H6 and H12
|
12 hours after the randomization
|
the urine osmolality between H12 and H24
Time Frame: 24 hours after the randomization
|
urine osmolality between H12 and H24
|
24 hours after the randomization
|
the urine osmolality between H24 and H48
Time Frame: 48 hours after the randomization
|
urine osmolality between H24 and H48
|
48 hours after the randomization
|
SNa level correction rate between H0 and H24
Time Frame: 24 hours after the randomization
|
slope of the SNa increase between H0 and H24
|
24 hours after the randomization
|
SNa level correction rate between H0 and H48
Time Frame: 48 hours after the randomization
|
slope of the SNa increase between H0 and H48
|
48 hours after the randomization
|
the maximal change of SNa level between H0 and H24
Time Frame: 24 hours after the randomization
|
maximum change of SNa from baseline between H0 and H24
|
24 hours after the randomization
|
the maximal change of SNa level between H0 and H48
Time Frame: 48 hours after the randomization
|
maximum change of SNa from baseline between H0 and H48
|
48 hours after the randomization
|
amount of hypotonic fluids administration
Time Frame: 24 hours after the randomization
|
total amount of intravenous hypotonic fluids administered between H0 and H24
|
24 hours after the randomization
|
amount of hypotonic fluids administration
Time Frame: 48 hours after the randomization
|
total amount of intravenous hypotonic fluids administered between H0 and H48
|
48 hours after the randomization
|
amount of sodium and potassium administered between H0 and H24
Time Frame: 24 hours after the randomization
|
total amount of sodium and potassium administered between H0 and H24
|
24 hours after the randomization
|
amount of sodium and potassium administered between H0 and H48
Time Frame: 48 hours after the randomization
|
total amount of sodium and potassium administered between H0 and H48
|
48 hours after the randomization
|
the occurrence of any new neurological sign in relation with hyponatremia in patients with a normal neurological exam at inclusion or on the reappearance of any neurological sign in relation with hyponatremia after inclusion
Time Frame: 28 days after randomization
|
proportion of patients with seizures, stupor or sign of brain herniation appearing or reappearing after inclusion
|
28 days after randomization
|
the occurrence of excessive re-lowering of sodium
Time Frame: 48 hours after the randomization
|
Occurrence of a reduction of SNa of 5.0 mmol/L or more from inclusion between H0 and H48
|
48 hours after the randomization
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Estimated)
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
- APHP220676
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
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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