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    Clinical Trial Results:
    Parallel-Group, Placebo-Controlled Randomized Study Investigating the Effect of Intravenous Iso-osmolar Iodinated Contrast Material Iodixanol (Visipaque™ Injection 320 mgI/mL) on Renal Function in Adults with Chronic Kidney Disease (CKD) Stage III or Stage IV Who Have Undergone Endovascular Aneurysm Repair (EVAR)

    Summary
    EudraCT number
    2016-001668-13
    Trial protocol
    ES   GB   BE   HU   PL   NL  
    Global end of trial date
    19 Oct 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    02 Nov 2019
    First version publication date
    02 Nov 2019
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    GE-012-106
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03119662
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    GE Healthcare Ltd.
    Sponsor organisation address
    The Grove Centre, White Lion Road, Amersham, Buckinghamshire, United Kingdom, HP7 9LL
    Public contact
    Medical Director - Nuclear Medicine, GE Healthcare Ltd., info@ge.com
    Scientific contact
    Medical Director - Nuclear Medicine, GE Healthcare Ltd., info@ge.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    07 Dec 2018
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    19 Oct 2018
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    To demonstrate the safety of intravenous (i.v.) iodinated iso-osmolar iodixanol (Visipaque™ Injection 320 mgI/mL) usage in contrast-enhanced computed tomography (CECT) for CKD stage III/IV patients by evaluating the incidence of acute kidney injury (AKI) stage >=1, per acute kidney injury network (AKIN) serum creatinine (SCr) criteria [AKIN 2015] [Mehta et al. 2007], in patients undergoing CECT with iodixanol vs subjects receiving placebo and undergoing nonenhanced computed tomography (NECT) and an additional non–contrast-enhanced ultrasound imaging modality.
    Protection of trial subjects
    A Steering Committee oversaw the study from conceptual protocol development, throughout study conduct and termination. In addition to the Steering Committee, a Critical Event Adjudication Committee (CEAC) was established to review all morbidity and mortality events (i.e., critical events, including Endovascular Aneurysm Repair (EVAR)-related post-baseline events). A Data Safety Monitoring Board (DSMB) was established to periodically review acute kidney injury (AKI) rates and make recommendations on the continuation of the study or potential requirement to amend the protocol. The Steering Committee and CEAC were not provided access to any treatment allocation information during the conduct of the study.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    08 Feb 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Spain: 2
    Country: Number of subjects enrolled
    United States: 2
    Worldwide total number of subjects
    4
    EEA total number of subjects
    2
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    4
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The Study was conducted at 29 sites in United States of America & Europe from 8 February 2018 to 19 October 2018. A total of 8 subjects with Chronic Kidney Disease (CKD) stage III/IV were enrolled at 4 sites. Of which, 4 of these subjects failed screening due to not meeting one or more inclusion/exclusion criteria.

    Pre-assignment
    Screening details
    A total of 4 subjects were randomized in 1:1 ratio to undergo either contrast-enhanced computed tomography (CECT) or non-enhanced computed tomography (NECT), of which 1 subject withdrew from study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT)
    Arm description
    Subjects received 1 intravenous injection of Visipaque™ 320 mg I/ml injection (100 mL iodixanol) and underwent computed tomography (CT) examination.
    Arm type
    Experimental

    Investigational medicinal product name
    Visipaque
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    100 mL iodixanol (Visipaque Injection 320 mg I/mL), followed by a 10 mL saline flush to ensure delivery of the full dose of Visipaque.

    Arm title
    Saline: Non-Enhanced Computed Tomography (NECT)
    Arm description
    Subjects received 1 intravenous injection of saline placebo (matched to Visipaque™ 320 mg I/ml injection) and underwent computed tomography (CT) examination and supplemental non-contrast duplex ultrasonography imaging examination.
    Arm type
    Placebo

    Investigational medicinal product name
    Saline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    100 mL saline, followed by a 10 mL saline flush.

    Number of subjects in period 1
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT) Saline: Non-Enhanced Computed Tomography (NECT)
    Started
    2
    2
    Completed
    2
    1
    Not completed
    0
    1
         Consent withdrawn by subject
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT)
    Reporting group description
    Subjects received 1 intravenous injection of Visipaque™ 320 mg I/ml injection (100 mL iodixanol) and underwent computed tomography (CT) examination.

    Reporting group title
    Saline: Non-Enhanced Computed Tomography (NECT)
    Reporting group description
    Subjects received 1 intravenous injection of saline placebo (matched to Visipaque™ 320 mg I/ml injection) and underwent computed tomography (CT) examination and supplemental non-contrast duplex ultrasonography imaging examination.

    Reporting group values
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT) Saline: Non-Enhanced Computed Tomography (NECT) Total
    Number of subjects
    2 2 4
    Age categorical
    Units: Subjects
        <=18 years
    0 0 0
        Between 18 and 65 years
    0 0 0
        >=65 years
    2 2 4
    Gender categorical
    Units: Subjects
        Female
    0 0 0
        Male
    2 2 4
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    1 0 1
        Not Hispanic or Latino
    1 2 3
        Unknown or Not Reported
    0 0 0
    Race
    Units: Subjects
        American Indian or Alaska Native
    0 0 0
        Asian
    0 0 0
        Native Hawaiian or Other Pacific Islander
    0 0 0
        Black or African American
    0 0 0
        White
    2 2 4
        More than one race
    0 0 0
        Unknown or Not Reported
    0 0 0

    End points

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    End points reporting groups
    Reporting group title
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT)
    Reporting group description
    Subjects received 1 intravenous injection of Visipaque™ 320 mg I/ml injection (100 mL iodixanol) and underwent computed tomography (CT) examination.

    Reporting group title
    Saline: Non-Enhanced Computed Tomography (NECT)
    Reporting group description
    Subjects received 1 intravenous injection of saline placebo (matched to Visipaque™ 320 mg I/ml injection) and underwent computed tomography (CT) examination and supplemental non-contrast duplex ultrasonography imaging examination.

    Primary: Assessment of the Incidence of Acute Kidney Injury (AKI) Stage >=1 Per Acute Kidney Injury Network (AKIN) Serum Creatinine (SCr) Criteria

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    End point title
    Assessment of the Incidence of Acute Kidney Injury (AKI) Stage >=1 Per Acute Kidney Injury Network (AKIN) Serum Creatinine (SCr) Criteria [1]
    End point description
    AKIN Serum Creatinine Criteria for AKI- Stage 1: a SCr increase of >=0.3 mg/dL (>=26.4 μmol/L) or increase to >=150% to 200% (>=1.5- to 2.0-fold) from baseline within 48 hours. Stage 2: a SCr increase to >200% to 300% (>2.0- to 3-fold) from baseline within 48 hours. Stage 3: a SCr increase to >300% (>3.0-fold) from baseline or SCr >=4.0 mg/dL (>=354 μmol/L) with an acute increase of >=0.5 mg/dL (>=44 μmol/L) within 48 hours. The study was early terminated as limited number of subjects enrolled (N=4 randomized subjects) hence, no statistical analyses were performed, and no tables and listings were produced.
    End point type
    Primary
    End point timeframe
    48 hours post-baseline (Follow-up 1)
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Due to early termination of study, no statistical analyses were performed, and no tables and listings were produced.
    End point values
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT) Saline: Non-Enhanced Computed Tomography (NECT)
    Number of subjects analysed
    0 [2]
    0 [3]
    Units: mg/dL
        number (not applicable)
    Notes
    [2] - Due to early termination of study, no tables & listings were produced to perform planned analysis.
    [3] - Due to early termination of study, no tables & listings were produced to perform planned analysis.
    No statistical analyses for this end point

    Secondary: Assessment of the Incidence of Acute Kidney Injury (AKI) Stage >=2 Per Acute Kidney Injury Network (AKIN) Serum Creatinine (SCr) Criteria

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    End point title
    Assessment of the Incidence of Acute Kidney Injury (AKI) Stage >=2 Per Acute Kidney Injury Network (AKIN) Serum Creatinine (SCr) Criteria
    End point description
    AKIN Serum Creatinine Criteria for AKI- Stage 1: a SCr increase of >=0.3 mg/dL (>=26.4 μmol/L) or increase to >=150% to 200% (>=1.5- to 2.0-fold) from baseline within 48 hours. Stage 2: a SCr increase to >200% to 300% (>2.0- to 3-fold) from baseline within 48 hours. Stage 3: a SCr increase to >300% (>3.0-fold) from baseline or SCr >=4.0 mg/dL (>=354 μmol/L) with an acute increase of >=0.5 mg/dL (>=44 μmol/L) within 48 hours. The study was early terminated as limited number of subjects enrolled (N=4 randomized subjects) hence, no statistical analyses were performed, and no tables and listings were produced.
    End point type
    Secondary
    End point timeframe
    48 hours post-baseline (Follow-up 1)
    End point values
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT) Saline: Non-Enhanced Computed Tomography (NECT)
    Number of subjects analysed
    0 [4]
    0 [5]
    Units: mg/dL
        number (not applicable)
    Notes
    [4] - Due to early termination of study, no tables and listings were produced to perform planned analysis.
    [5] - Due to early termination of study, no tables and listings were produced to perform planned analysis.
    No statistical analyses for this end point

    Secondary: Assessment of the Incidence of Acute Kidney Injury (AKI) by Contrast Induced Nephropathy (CIN)

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    End point title
    Assessment of the Incidence of Acute Kidney Injury (AKI) by Contrast Induced Nephropathy (CIN)
    End point description
    Standard definition of CIN: Increase in SCr of 0.5 mg/dL or more in the 24 to 72 hours after the CT scan. The study was early terminated as limited number of subjects enrolled (N=4 randomized subjects) hence, no statistical analyses were performed, and no tables and listings were produced.
    End point type
    Secondary
    End point timeframe
    48 hours post-baseline (Follow-up 1)
    End point values
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT) Saline: Non-Enhanced Computed Tomography (NECT)
    Number of subjects analysed
    0 [6]
    0 [7]
    Units: mg/dL
        number (not applicable)
    Notes
    [6] - Due to early termination of study, no tables and listings were produced to perform planned analyses.
    [7] - Due to early termination of study, no tables and listings were produced to perform planned analyses.
    No statistical analyses for this end point

    Secondary: Assessment of the Incidence of Acute Kidney Injury (AKI) Stage >=2 By Waikar Criteria

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    End point title
    Assessment of the Incidence of Acute Kidney Injury (AKI) Stage >=2 By Waikar Criteria
    End point description
    Waikar’s definitions of AKI: Stage 1: 0.3 mg/dL increase in SCr over 24 hours or a 0.5 mg/dL increase in SCr over 48 hours. Stage 2: 0.5 mg/dL increase in SCr over 24 hours or a 1.0 mg/dL increase in SCr over 48 hours. Stage 3: 1.0 mg/dL increase in SCr over 24 hours or a 1.5 mg/dL increase in SCr over 48 hours. The study was early terminated as limited number of subjects enrolled (N=4 randomized subjects) hence, no statistical analyses were performed, and no tables and listings were produced.
    End point type
    Secondary
    End point timeframe
    48 hours post-baseline (Follow-up 1)
    End point values
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT) Saline: Non-Enhanced Computed Tomography (NECT)
    Number of subjects analysed
    0 [8]
    0 [9]
    Units: mg/dL
        number (not applicable)
    Notes
    [8] - Due to early termination of study, no tables and listings were produced to perform planned analyses.
    [9] - Due to early termination of study, no tables and listings were produced to perform planned analyses.
    No statistical analyses for this end point

    Secondary: All Cause Mortality and Morbidity

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    End point title
    All Cause Mortality and Morbidity
    End point description
    Mortality (all cause death) and morbidity i.e. critical events. The study was early terminated as limited number of subjects enrolled (N=4 randomized subjects) hence, no statistical analyses were performed, and no tables and listings were produced.
    End point type
    Secondary
    End point timeframe
    From Baseline to Month 6
    End point values
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT) Saline: Non-Enhanced Computed Tomography (NECT)
    Number of subjects analysed
    0 [10]
    0 [11]
    Units: subjects
    Notes
    [10] - Due to early termination of study, no tables and listings were produced to perform planned analyses.
    [11] - Due to early termination of study, no tables and listings were produced to perform planned analyses.
    No statistical analyses for this end point

    Secondary: Blinded Independent Assessment of Image Quality/Diagnostic Confidence Using a 5-Point Scale

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    End point title
    Blinded Independent Assessment of Image Quality/Diagnostic Confidence Using a 5-Point Scale
    End point description
    Blinded independent assessment of image quality/diagnostic confidence using a 5-point scale. Image quality/diagnostic confidence for all imaging studies was rated on a 5-point scale from 1 (poor) to 5 (excellent).
    End point type
    Secondary
    End point timeframe
    Month 6
    End point values
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT) Saline: Non-Enhanced Computed Tomography (NECT)
    Number of subjects analysed
    0 [12]
    0 [13]
    Units: subjects
    Notes
    [12] - Due to early termination of study, no tables and listings were produced to perform planned analyses.
    [13] - Due to early termination of study, no tables and listings were produced to perform planned analyses.
    No statistical analyses for this end point

    Adverse events

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    Adverse events information [1]
    Timeframe for reporting adverse events
    All Adverse Events (AEs) were collected from randomization until the end of the follow-up period (Month 6) regardless of seriousness or relationship to investigational product.
    Adverse event reporting additional description
    Reported AEs are study-emergent AEs that is AEs that developed/worsened during any time after randomization until end of the follow-up period (Month 6). Analysis was performed on safety population which included all participants who were randomized to receive Visipaque™ or saline placebo and had post-randomization observations.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0
    Reporting groups
    Reporting group title
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT)
    Reporting group description
    Subjects received 1 intravenous injection of Visipaque™ 320 mg I/ml injection (100 mL iodixanol) and underwent CT examination.

    Reporting group title
    Saline: Non-Enhanced Computed Tomography (NECT)
    Reporting group description
    Subjects received 1 intravenous injection of saline placebo (matched to Visipaque™ 320 mg I/ml injection) and underwent CT examination and supplemental non-contrast duplex ultrasonography imaging examination.

    Notes
    [1] - There are no non-serious adverse events recorded for these results. It is expected that there will be at least one non-serious adverse event reported.
    Justification: There were no non- serious adverse events reported in this study.
    Serious adverse events
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT) Saline: Non-Enhanced Computed Tomography (NECT)
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 2 (50.00%)
    0 / 2 (0.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    Injury, poisoning and procedural complications
    Humerus Fracture
         subjects affected / exposed
    1 / 2 (50.00%)
    0 / 2 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Visipaque™: Contrast-Enhanced Computed Tomography (CECT) Saline: Non-Enhanced Computed Tomography (NECT)
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    0 / 2 (0.00%)
    0 / 2 (0.00%)

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    12 Apr 2017
    Following amendments were made: Information on the recent European Society of Cardiology (ESC) 2014 guidelines was added. •Clarification that the subset of subjects who might receive MB-102 and monitored by ORFM would be from selected sites in the USA. •Clarification on use of NSAIDs and excluded medication. •Clarification of SAE reporting, laboratory AE evaluation, and blood sampling at Follow-up 1. •Critical study events were more fully defined. •Clarification of hydration requirements and the use of intravenous (i.v.) hydration. •Clarification of procedures at screening and baseline, including timing of visits and signing of informed consent. •Definition of the per-protocol set was updated. •Minor typographical errors were corrected.
    25 Jan 2018
    •Acceptable methods of contraception were further clarified to include acceptable, but not highly effective, birth control methods in line with guidelines and informed consent. •Period of metformin discontinuation prior to the Baseline Visit was increased from 24 hours to 48 hours in line with core safety information. •Thyroid-stimulating hormone (TSH) was added to the Screening laboratory evaluation.
    28 Mar 2018
    •Potentially eligible subjects could enter this study any time during their post-Endovascular Aneurysm Repair (EVAR) follow-up, once they had passed the first imaging examination (commonly scheduled 1 month after the index EVAR), and if no complications, such as endoleaks, had been detected. Consequently, assessment for eligibility could happen years after the index EVAR, when documentation of the first imaging exam might not be available, despite subsequent follow-up examination(s) providing sufficient assurance on the stable post- EVAR status of such subjects. The changes in inclusion criteria and exclusion criterion aim to allow enrolment of otherwise eligible post-EVAR subjects in cases where documentation and evidence on the first month imaging examination were not available. The requirement for stable post-EVAR conditions (no endoleak, no clinically meaningful EVAR-related complication) was unchanged, so the characteristics of the subject population remained unchanged. •The screening period was increased from 7 days to 14 days for logistical reasons. •Recent literature reference was added. •A definition of the end of the study was added. •Clarification that randomization was in a 1:1 ratio. •Text added to clarify that the use of N-acetylcysteine was discouraged for the purpose of preventing AKI. •The period of time after which the Sponsor reserves the right to discontinue participation of a study center at which no subjects had been enrolled wasincreased from within 3 months to within 6 months of initiation. •Clarification that ‘personnel who were trained in the acute management of anaphylaxis and other emergencies and who have access to appropriate clinical supplies must be immediately available for 30 minutes after dosing’ was added.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Study was early terminated after enrollment of 4 subjects due to very slow recruitment rates. Sample size was 4 participants instead of planned 1164 participants, hence no statistical analyses were performed, no tables and listings were produced.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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