Oral Propranolol for the Prevention of High-Grade Retinopathy of Prematurity
Descrizione riassuntiva dello studio
In extremely preterm infants (<28 weeks of gestation [WG]), retinopathy of prematurity (ROP) can develop between 30 and 36 WG. ROP is associated with various visual impairments, blindness, and poorer long-term neuromotor development. The blood vessels of the retina are still poorly developed in extremely preterm infants and only reach their final size and functionality about 4-8 weeks before birth. In a few rare preterm infants, the vessel growth occurs excessively during this phase and can, in the worst case, lead to retinal detachment and even blindness. About one in a hundred of these extremely preterm infants is affected. Currently, ROP can be treated with laser beams or with antibodies injected into the eyeball against the vascular growth factor. Both treatments are expensive and show side effects (Laser: focal destruction of the retina with scarring and consequent visual field loss, antibody injection: recurrent growth of blood vessels, unclear impact on neuromotor development). Many, but not all cases of ROP-related blindness can be avoided with one of these two treatments. On the other hand, it is shown that ROP treatment is often associated with impaired neuromotor development at ages 2, 5, and 11 years. The search for evidence of a safe intervention to protect against severe ROP should continue with this study. The present study is an international multicenter study conducted double-blind (neither the doctor nor the parents know whether the child receives the medication or a placebo). Patients are randomly assigned to the treatment group (receives study medication) or the control group (receives placebo).
(BASEC)
Intervento studiato
Eligible preterm infants will receive oral propranolol or placebo 3-4 times daily for a maximum of 10 weeks (or until discharge). The starting dose is 0.4 mg/kg/day and will be increased to 1.6 mg/kg/day within 3 days. Before discharge, the medication will be reduced by 50% for one day and then discontinued the following day. Medication intake may be interrupted or stopped based on defined criteria. No medication will be administered to discharged children.
(BASEC)
Malattie studiate
Retinopathy of Prematurity (ROP) in extremely preterm infants (< 28 WG) with early ROP stage 1 or 2 at ages 31-37 WG.
(BASEC)
• Preterm infants born before 28 weeks of gestation with weight < 1250 g • at least 5 weeks old • postmenstrual gestational age at inclusion 31-37 weeks of gestation • diagnosed retinopathy of prematurity grade 1 or 2 (BASEC)
Criteri di esclusione
• diagnosed retinopathy of prematurity grade 3 • Congenital malformation that contraindicates the use of propranolol • Large hemangiomas (BASEC)
Luogo dello studio
Basilea, Berna, Losanna, San Gallo, Zurigo
(BASEC)
Sponsor
University of Zurich
(BASEC)
Contatto per ulteriori informazioni sullo studio
Persona di contatto in Svizzera
Dr. Christoph Rüegger
043 253 98 10
christoph.rueegger@clutterusz.chUniversity of Zurich / University hospital of Zurich
(BASEC)
Informazioni generali
University of Zurich,
+41 44 255 53 40
christoph.rueegger@clutterusz.ch(ICTRP)
Informazioni scientifiche
University of Zurich,
+41 44 255 53 40
christoph.rueegger@clutterusz.ch(ICTRP)
Nome del comitato etico approvante (per studi multicentrici solo il comitato principale)
Commissione etica Zurigo
(BASEC)
Data di approvazione del comitato etico
09.01.2019
(BASEC)
ID di studio ICTRP
NCT03083431 (ICTRP)
Titolo ufficiale (approvato dal comitato etico)
Oral propranolol for prevention of threshold retinopathy of prematurity (BASEC)
Titolo accademico
Oral Propranolol for Prevention of Threshold Retinopathy of Prematurity (ICTRP)
Titolo pubblico
Oral Propranolol for Prevention of Threshold Retinopathy of Prematurity (ICTRP)
Malattie studiate
Retinopathy of Prematurity (ICTRP)
Intervento studiato
Drug: Propranolol;Drug: Placebo (ICTRP)
Tipo di studio
Interventional (ICTRP)
Disegno dello studio
Allocation: Randomized. Intervention model: Parallel Assignment. Primary purpose: Prevention. Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor). (ICTRP)
Criteri di inclusione/esclusione
Gender: All
Maximum age: 15 Weeks
Minimum age: 5 Weeks
Inclusion criteria:
- Preterm infant born before 28 week's gestation
- Birth weight below 1250 g
- At least 5 weeks of age (at randomisation)
- PMA 310/7 - 36 6/7 weeks
- Ophthalmoscopic evidence of incipient ROP (stage 1 or 2, with or without plus
disease in any zone)
- Written informed consent by parents or legal guardian, according to national
requirements
Exclusion Criteria:
- ROP stage = 3, AP-ROP or suspected AP-ROP, or any other ROP requiring an
intervention (study endpoint already reached).
- Conditions that indicate open label propranolol such as: thyrotoxicosis, arterial
hypertension or certain heart diseases (such as tetralogy of Fallot, paroxysmal
supraventricular tachycardia, or long QT syndrome) etc.
- Major congenital malformations or known chromosomal anomalies
- Colobomas and other eye malformations
- PHACE syndrome (posterior fossa anomalies, large infantile hemangiomas of the face,
neck, and/or scalp, arterial lesions, cardiac abnormalities/coarctation of the
aorta, eye anomalies) (risk of cerebrovascular complications)
- Very large hemangioma (risk of hyperkalemia), as judged by the attending physician
- Medication of the infant with rifampicin or phenobarbitone (enhanced metabolic
clearance)
- Chronic kidney impairment (serum creatinine > 1.3 mg/dl [115 ?mol/L])
- Severe liver dysfunction (ALT (GPT) > 900 U/L)
- Known hypersensitivity to propranolol or any of the excipients (see 6.3.1.)
- Prinzmetal's angina, Raynaud's phenomenon (severe peripheral arterial circulatory
disturbance), or pheochromocytoma (contraindications for propranolol in adults, not
occurring in newborn infants)
- Any circumstances that make the investigator believe that participation in the study
leads to exceptional medical or organizational problems for the patient
- Conditions that prohibit propranolol therapy such as: Atrio-ventricular block grade
2 or 3 hypertrophic cardiomyopathy, sinoatrial block, uncontrolled heart failure or
cardiogenic shock, bronchial asthma
- Medication of the infant or the mother if breastfeeding with clonidine, reserpine,
angiotensin-converting enzyme inhibitors, angiotensin-receptor antagonists
(contraindicated in preterm infants) or antiarrhythmic drugs including amiodarone,
propafenone, lidocaine, digoxin/digitoxin, quinidine, verapamil, diltiazem, bepridil
(pharmacodynamic interaction) (ICTRP)
non disponibile
Endpoint primari e secondari
Survival without adverse ophthalmological outcome (stage = 3, AP-ROP, or any ROP treatment) (ICTRP)
Time to adverse ophthalmological outcome in days;Survival without adverse ophthalmological outcome;Survival with adverse ophthalmological outcome;Survival without local treatment for ROP;Death until discharge;Death until 48 weeks postmenstrual age;Recurrence of ROP in infants treated with anti-VEGF-antagonists;Need for repeated ROP therapy in infants treated with anti-VEGF-antagonists (ICTRP)
Data di registrazione
non disponibile
Inclusione del primo partecipante
non disponibile
Sponsor secondari
Ankara University;University Hospital Tuebingen (ICTRP)
Contatti aggiuntivi
Dirk Bassler, M.D.;Dirk Bassler, M.D., dirk.bassler@usz.ch, +41 44 255 53 40, University of Zurich, (ICTRP)
ID secondari
32ER30_173677, 2017-002124-24, RoProp (ICTRP)
Risultati-Dati individuali dei partecipanti
non disponibile
Ulteriori informazioni sullo studio
https://clinicaltrials.gov/ct2/show/NCT03083431 (ICTRP)
Risultati dello studio
Riepilogo dei risultati
non disponibile
Link ai risultati nel registro primario
non disponibile