Clinical Trial Results:
International Collaborative Infantile Spasms Study (ICISS)
Summary
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EudraCT number |
2006-000788-27 |
Trial protocol |
GB DE |
Global end of trial date |
31 Dec 2017
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Results information
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Results version number |
v1 |
This version publication date |
16 Jul 2018
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First version publication date |
16 Jul 2018
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Other versions |
v2 |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
RD01273
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Additional study identifiers
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ISRCTN number |
ISRCTN54363174 | ||
US NCT number |
- | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Royal United Hospitals Bath NHS Foundation Trust
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Sponsor organisation address |
Combe Park, Bath, United Kingdom, BA1 3NG
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Public contact |
The ICISS Trial Office, The Childrens Centre, Royal United Hospital, Combe Park, Bath, BA1 3NG, United Kingdom, iciss@ruh-bath.swest.nhs.uk
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Scientific contact |
The ICISS Trial Office, The Childrens Centre, Royal United Hospital, Combe Park, Bath, BA1 3NG, United Kingdom, iciss@ruh-bath.swest.nhs.uk
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
21 Jun 2018
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
31 Dec 2017
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
The aim of this study is to examine if combining hormonal treatment and vigabatrin is better at early control of infantile spasms (day 14-42 of treatment) and at helping development at 18 months of age than taking a hormonal treatment alone.
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Protection of trial subjects |
The trial was conducted in compliance with the approved protocol and adhered to the principles of good clinical practice as stated in European Commission Directive 2005/28/EC and data protection regulations. A clinical trial risk assessment was undertaken by the Sponsor prior to commencement of recruitment and a Data Monitoring and Ethics Committee (DMEC) was appointed who met once a year to review study recruitment, serious adverse reactions (SARs) and approve the annual safety reports. A Trial Steering Committee (TSC) met approximately every 3 months to oversee the progress of the trial. The TSC and the Sponsor could both request the DMEC to assess the progress of the trial, including safety and drop out. The DMEC could recommend to the TSC and/or Sponsor whether to continue, modify or stop the trial. Any SAR or Suspected Unexpected Serious Adverse Reaction (SUSAR) was reported to the relevant authorities within the required time-frames. Informed signed consent was obtained for each child and the parents or guardians were informed they were free to withdraw their child from the trial at any time without giving a reason and without affecting the care they receive. Central monitoring of data was undertaken by the Trial Centre.
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Background therapy |
- | ||
Evidence for comparator |
Vigabatrin and hormonal therapies are the two most commonly used and investigated treatments for the treatment of infantile spasms (see Hancock EC, Osborne JP, Edwards SW. Treatment of Infantile Spasms. Cochrane Database Syst Rev. 2013 Jun 5;6:CD001770. DOI: 10.1002/14651858.CD001770.pub3. PubMed ID: 23740534). Our previous study demonstrated that hormonal therapy was superior to vigabatrin at stopping spasms (see Lux AL et al., Lancet 2004; 364: 1773–1778. PubMed ID: 15541450). However, it was also evident from the UKISS study that some patients who failed on their initially randomised therapy (either hormonal therapy or vigabatrin) responded to the other therapy when they were crossed over. Consequently we formed the hypothesis that combining hormonal therapy with vigabatrin may be more effective than hormonal therapy alone at stopping spasms and may therefore also be associated with better developmental outcomes. | ||
Actual start date of recruitment |
07 Mar 2007
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Long term follow-up planned |
Yes
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Long term follow-up rationale |
Scientific research | ||
Long term follow-up duration |
42 Months | ||
Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
United Kingdom: 285
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Country: Number of subjects enrolled |
Germany: 31
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Country: Number of subjects enrolled |
Australia: 25
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Country: Number of subjects enrolled |
New Zealand: 16
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Country: Number of subjects enrolled |
Switzerland: 20
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Worldwide total number of subjects |
377
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EEA total number of subjects |
316
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
377
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
0
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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Recruitment details |
Between March 7 2007 and May 22 2014, 766 infants were assessed for eligibility, of whom 377 met the inclusion criteria and were randomly assigned. Recruitment took place in Australia, Germany, New Zealand, Switzerland and the United Kingdom. | |||||||||
Pre-assignment
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Screening details |
Incl:Clinical features of Infantile Spasms confirmed by clinician, EEG hypsarrhythmic or similar compatible with diagnosis.Signed informed consent Excl:Age<2mths or >14mths, >7 days since diagnosis, TS, prev treatment for IS,prev hormonal or vgb treatment,potentially lethal condition, can't follow-up @18mths,language difficulty,in concurrent trial | |||||||||
Pre-assignment period milestones
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Number of subjects started |
377 | |||||||||
Number of subjects completed |
377 | |||||||||
Period 1
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Period 1 title |
Overall trial (overall period)
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Is this the baseline period? |
Yes | |||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Not blinded | |||||||||
Blinding implementation details |
Blinding of outcome measures: The pre-treatment and post-treatment EEGs were assessed by investigators masked to treatment and to clinical outcome: a majority view of three of four assessors was accepted for determination of the resolution of EEG features supporting the diagnosis. Aetiology was determined masked to treatment through clinical history, examination, and investigation. A study radiologist masked to treatment reviewed MRI scans done after the primary clinical outcome was determined
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Hormonal therapy and Vigabatrin (Combination therapy) | |||||||||
Arm description |
Combination therapy is hormonal therapy (prednisolone OR tetracosactide depot) with vigabatrin | |||||||||
Arm type |
Experimental | |||||||||
Investigational medicinal product name |
Vigabatrin
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Investigational medicinal product code |
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Other name |
Sabril Sachets
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Pharmaceutical forms |
Powder for oral solution
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Routes of administration |
Oral use
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Dosage and administration details |
Vigabatrin was given orally in two doses per day: 50 mg/kg per day for the first two doses; increasing to 100 mg/kg per day after 24 h and, if spasms continued after a further 72 h, to 150 mg/kg per day. Vigabatrin was given at the same dose on a bodyweight basis until 3 months from the start of treatment, and then the dose was reduced over 4 weeks.
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Investigational medicinal product name |
Tetracosactide Depot
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Investigational medicinal product code |
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Other name |
Synacthen Depot
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Pharmaceutical forms |
Injection
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Routes of administration |
Intramuscular use
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Dosage and administration details |
Tetracosactide depot was given intramuscularly (0·5 mg [40 IU] on alternate days) for 2 weeks. If spasms continued on day 7 or reappeared between day 8 and day 14 inclusive, the dose was increased to 0·75 mg on alternate days. After 2 weeks of treatment, hormonal therapy was tapered: all children received a reduced dose of prednisolone, with reductions of 10 mg every 5 days or, if on the higher dose of treatment, 40 mg daily, then 20 mg, then 10 mg. Hormonal therapy ceased after day 29.
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Investigational medicinal product name |
Prednisolone (Soluble tablets)
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Investigational medicinal product code |
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Other name |
Soluble Prednisolone Tablets
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Prednisolone was given orally (10 mg four times a day) for 2 weeks. If spasms continued on day 7 or reappeared between day 8 and day 14 inclusive, the dose was increased to 20 mg three times a day. After 2 weeks of treatment, hormonal therapy was tapered: all children received a reduced dose of prednisolone, with reductions of 10 mg every 5 days or, if on the higher dose of treatment, 40 mg daily, then 20 mg, then 10 mg. Hormonal therapy ceased after day 29.
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Arm title
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Hormonal therapy alone | |||||||||
Arm description |
Hormonal therapy alone is either prednisolone OR tetracosactide depot | |||||||||
Arm type |
Active comparator | |||||||||
Investigational medicinal product name |
Tetracosactide Depot
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Investigational medicinal product code |
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Other name |
Synacthen Depot
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Pharmaceutical forms |
Injection
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Routes of administration |
Intramuscular use
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Dosage and administration details |
Tetracosactide depot was given intramuscularly (0·5 mg [40 IU] on alternate days) for 2 weeks. If spasms continued on day 7 or reappeared between day 8 and day 14 inclusive, the dose was increased to 0·75 mg on alternate days. After 2 weeks of treatment, hormonal therapy was tapered: all children received a reduced dose of prednisolone, with reductions of 10 mg every 5 days or, if on the higher dose of treatment, 40 mg daily, then 20 mg, then 10 mg. Hormonal therapy ceased after day 29.
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Investigational medicinal product name |
Prednisolone (Soluble tablets)
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Investigational medicinal product code |
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Other name |
Soluble Prednisolone Tablets
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Prednisolone was given orally (10 mg four times a day) for 2 weeks. If spasms continued on day 7 or reappeared between day 8 and day 14 inclusive, the dose was increased to 20 mg three times a day. After 2 weeks of treatment, hormonal therapy was tapered: all children received a reduced dose of prednisolone, with reductions of 10 mg every 5 days or, if on the higher dose of treatment, 40 mg daily, then 20 mg, then 10 mg. Hormonal therapy ceased after day 29.
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Baseline characteristics reporting groups
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Reporting group title |
Hormonal therapy and Vigabatrin (Combination therapy)
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Reporting group description |
Combination therapy is hormonal therapy (prednisolone OR tetracosactide depot) with vigabatrin | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Hormonal therapy alone
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Reporting group description |
Hormonal therapy alone is either prednisolone OR tetracosactide depot | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Hormonal therapy and Vigabatrin (Combination therapy)
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Reporting group description |
Combination therapy is hormonal therapy (prednisolone OR tetracosactide depot) with vigabatrin | ||
Reporting group title |
Hormonal therapy alone
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Reporting group description |
Hormonal therapy alone is either prednisolone OR tetracosactide depot |
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End point title |
Cessation of spasms | |||||||||||||||
End point description |
The primary early outcome was cessation of spasms which was defined as no witnessed spasms on and between Days 14 and Day 42 from trial entry.
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End point type |
Primary
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End point timeframe |
Between Day 14 and Day 42 after enrolment
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Statistical analysis title |
Early primary outcome - Chi-squared | |||||||||||||||
Comparison groups |
Hormonal therapy and Vigabatrin (Combination therapy) v Hormonal therapy alone
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Number of subjects included in analysis |
377
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||||||||
P-value |
= 0.002 | |||||||||||||||
Method |
Chi-squared | |||||||||||||||
Parameter type |
Percentage difference in response | |||||||||||||||
Point estimate |
15
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Confidence interval |
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level |
95% | |||||||||||||||
sides |
2-sided
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lower limit |
5.1 | |||||||||||||||
upper limit |
24.9 | |||||||||||||||
Statistical analysis title |
Early primary outcome - logistic regression | |||||||||||||||
Statistical analysis description |
Sensitivity analysis using logistic regression to control for stratification variables and potential confounders
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Comparison groups |
Hormonal therapy and Vigabatrin (Combination therapy) v Hormonal therapy alone
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Number of subjects included in analysis |
377
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||||||||
P-value |
= 0.001 | |||||||||||||||
Method |
Regression, Logistic | |||||||||||||||
Parameter type |
Odds ratio (OR) | |||||||||||||||
Point estimate |
2.1
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Confidence interval |
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level |
95% | |||||||||||||||
sides |
2-sided
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lower limit |
1.3 | |||||||||||||||
upper limit |
3.2 |
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End point title |
Time to response | ||||||||||||
End point description |
Defined as the first day after initiation of trial treatment on which spasms were not seen and after which response was maintained until Day 42 of treatment.
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End point type |
Secondary
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End point timeframe |
Day 0 to Day 42
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Statistical analysis title |
Secondary outcome - time to response analysis | ||||||||||||
Comparison groups |
Hormonal therapy and Vigabatrin (Combination therapy) v Hormonal therapy alone
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Number of subjects included in analysis |
377
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
< 0.001 | ||||||||||||
Method |
t-test, 2-sided | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
1.9
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
1.1 | ||||||||||||
upper limit |
2.6 |
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End point title |
Electro-clinical response | |||||||||||||||
End point description |
Defined as cessation of spasms and resolution of the EEG features supporting the diagnosis (i.e. hysarrythmia or similar, compatible with the diagnosis of infantile spasms).
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End point type |
Secondary
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End point timeframe |
Between Day 14 and Day 42 after enrolment
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Notes [1] - 1 missing value from total of 186 [2] - 2 missing values from total of 191 |
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Statistical analysis title |
Electro-clinical response analysis | |||||||||||||||
Comparison groups |
Hormonal therapy and Vigabatrin (Combination therapy) v Hormonal therapy alone
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Number of subjects included in analysis |
374
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||||||||
P-value |
= 0.023 | |||||||||||||||
Method |
Chi-squared | |||||||||||||||
Parameter type |
Percentage difference in response | |||||||||||||||
Point estimate |
11.5
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Confidence interval |
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level |
95% | |||||||||||||||
sides |
2-sided
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lower limit |
1.4 | |||||||||||||||
upper limit |
21.6 | |||||||||||||||
Statistical analysis title |
Electro-clinical response logistic regression | |||||||||||||||
Statistical analysis description |
Sensitivity analysis controlling for stratification variables and potential confounders
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Comparison groups |
Hormonal therapy and Vigabatrin (Combination therapy) v Hormonal therapy alone
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Number of subjects included in analysis |
374
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||||||||
P-value |
= 0.015 | |||||||||||||||
Method |
Regression, Logistic | |||||||||||||||
Parameter type |
Odds ratio (OR) | |||||||||||||||
Point estimate |
1.7
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Confidence interval |
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level |
95% | |||||||||||||||
sides |
2-sided
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lower limit |
1.1 | |||||||||||||||
upper limit |
2.8 |
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End point title |
Absence of spasms on Days 13 and 14 | |||||||||||||||
End point description |
Absence of spasms on Days 13 and 14
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End point type |
Secondary
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End point timeframe |
Day 13 to Day 14 inclusive
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Statistical analysis title |
Cessation at Days 13 and 14 analysis | |||||||||||||||
Comparison groups |
Hormonal therapy and Vigabatrin (Combination therapy) v Hormonal therapy alone
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Number of subjects included in analysis |
377
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||||||||
P-value |
< 0.001 | |||||||||||||||
Method |
Chi-squared | |||||||||||||||
Parameter type |
Percentage difference in response | |||||||||||||||
Point estimate |
20.2
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Confidence interval |
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level |
95% | |||||||||||||||
sides |
2-sided
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lower limit |
11.8 | |||||||||||||||
upper limit |
28.6 |
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End point title |
Number of responders if single spasms are allowed in responders from Day 14 to Day 42 inclusive | |||||||||||||||
End point description |
Number of responders if single spasms are allowed in responders from Day 14 to Day 42 inclusive
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End point type |
Secondary
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End point timeframe |
Day 0 to Day 42
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Statistical analysis title |
Responders if single spasms allowed analysis | |||||||||||||||
Comparison groups |
Hormonal therapy and Vigabatrin (Combination therapy) v Hormonal therapy alone
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Number of subjects included in analysis |
377
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||||||||
P-value |
= 0.009 | |||||||||||||||
Method |
Chi-squared | |||||||||||||||
Parameter type |
Percentage difference in response | |||||||||||||||
Point estimate |
12.4
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Confidence interval |
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level |
95% | |||||||||||||||
sides |
2-sided
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lower limit |
2.9 | |||||||||||||||
upper limit |
21.9 |
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Adverse events information
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Timeframe for reporting adverse events |
From Day 0 to Day 42 inclusive from trial entry
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Adverse event reporting additional description |
**PLEASE NOTE: All adverse events were assessed by the local investigator to determine whether in their view they were adverse reactions. Only adverse reactions were reported to the trial centre using the classification stated in the ICISS protocol. Therefore ADVERSE REACTIONS ONLY are presented in this report.
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
ICISS Protocol | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
1.3
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Reporting groups
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Reporting group title |
Hormonal therapy and Vigabatrin (Combination therapy)
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Reporting group description |
Combination therapy is hormonal therapy (prednisolone OR tetracosactide depot) with vigabatrin | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Hormonal therapy alone
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Reporting group description |
Hormonal therapy alone is either prednisolone OR tetracosactide depot | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 0% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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05 Apr 2005 |
Protocol updated from version 1.0 to version 1.1. This occurred between the original ethics submission in the UK and obtaining final approval. Please see Appendix 1 Section A1 of Protocol Version 1.3 for a description and explanation of all the amendments made to the protocol as part of this amendment. ICISS Protocol Version 1.3 can be downloaded from the trial website at www.iciss.org.uk
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20 Dec 2006 |
Protocol updated from version 1.1 to version 1.2. This occurred before the start date of recruitment. Please see Appendix 1 Section A2 of Protocol Version 1.3 for a description and explanation of all the amendments made to the protocol as part of this amendment. ICISS Protocol Version 1.3 can be downloaded from the trial website at www.iciss.org.uk |
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05 Jan 2011 |
Protocol updated from version 1.2 to version 1.3. Please see Appendix 1 Section A3 of Protocol Version 1.3 for a description and explanation of all the amendments made to the protocol as part of this amendment. ICISS Protocol Version 1.3 can be downloaded from the trial website at www.iciss.org.uk |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
Results Version 1 presents the early outcome measures. Version 2 will include the late outcome measures at 18 months of age (currently in press). Version 3 will include the late outcome measures at 42 months of age. | |||
Online references |
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http://www.ncbi.nlm.nih.gov/pubmed/27838190 |