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    Clinical Trial Results:
    Pilot study, single-blind, candesartan versus usual care of peripheral neuropathy development induced by vincristine (PNIV) in patients treated for lymphoma B.

    Summary
    EudraCT number
    2017-000585-30
    Trial protocol
    FR  
    Global end of trial date
    23 Sep 2021

    Results information
    Results version number
    v1(current)
    This version publication date
    09 Nov 2023
    First version publication date
    09 Nov 2023
    Other versions
    Summary report(s)
    NEUPERSART/Statistical analysis

    Trial information

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    Trial identification
    Sponsor protocol code
    I16016
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03688633
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    CHU de Limoges
    Sponsor organisation address
    2 avenue Martin Luther King, Limoges, France, 87042
    Public contact
    Principal Investigator, CHU de Limoges, 33 555051572, laurent.magy@unilim.fr
    Scientific contact
    Principal Investigator, CHU de Limoges, 33 555051572, laurent.magy@unilim.fr
    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
    13 Oct 2022
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    23 Sep 2021
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The main objective of the clinical study is: Describing the impact of Candesartan on the occurrence of neuropathy as measured by variation in Total Clinical Neuropathy Score (TNSc) in patients treated for non-Hodgkin's lymphoma type B with multidrugine-containing chemotherapy, evaluating clinical signs Of neuropathy) between baseline (V1) and end of chemotherapy (V4).
    Protection of trial subjects
    The trial was carried out in accordance with the regulation, the ICH and the Helsinki declaration. All patients have been informed and have given their consent.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    02 Oct 2017
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    France: 9
    Worldwide total number of subjects
    9
    EEA total number of subjects
    9
    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)
    6
    From 65 to 84 years
    3
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The first inclusion took place on 29/05/2019 and the last on 27/05/2021. The recruitment took place at the University Hospital of Limoges.

    Pre-assignment
    Screening details
    Patients with a diagnosis of lymphoma, are recruited in consultation or in hospitalization in the hematologic department During this interview, the patient will be given information about the study and an information about the benefics and the side effects.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Single blind
    Roles blinded
    Assessor [1]
    Blinding implementation details
    The patient is open-label and the primary endpoint is assessed by an investigator blinded to the randomization group.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    CANDESARTAN
    Arm description
    Candesartan (8mg) will then be prescribed and dispensed for a first intake the next day, in addition to the usual treatment (Neurological assessment and neurophysiological exploration). A prescription is given to the patient for creatinine and kalemia measurement at home after 7 days of treatment.
    Arm type
    Experimental

    Investigational medicinal product name
    CANDESARTAN
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    8 to 16 mg/d daily for 15 weeks Oral use

    Arm title
    Usual care
    Arm description
    Neurological assessment (EVA, TNSc,EQ-5D) and neurophysiological exploration (ENMG, Sudoscan)
    Arm type
    No intervention

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Notes
    [1] - The roles blinded appear inconsistent with a simple blinded trial.
    Justification: The patient is open-label and the primary endpoint is assessed by an investigator blinded to the randomization group
    Number of subjects in period 1
    CANDESARTAN Usual care
    Started
    4
    5
    Completed
    4
    5

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    9 9
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    9 9
        From 65-84 years
    0 0
        85 years and over
    0 0
    Age continuous
    Units: years
        least squares mean (standard deviation)
    59 ± 9.1 -
    Gender categorical
    Units: Subjects
        Female
    5 5
        Male
    4 4

    End points

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    End points reporting groups
    Reporting group title
    CANDESARTAN
    Reporting group description
    Candesartan (8mg) will then be prescribed and dispensed for a first intake the next day, in addition to the usual treatment (Neurological assessment and neurophysiological exploration). A prescription is given to the patient for creatinine and kalemia measurement at home after 7 days of treatment.

    Reporting group title
    Usual care
    Reporting group description
    Neurological assessment (EVA, TNSc,EQ-5D) and neurophysiological exploration (ENMG, Sudoscan)

    Primary: TNSc score variation

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    End point title
    TNSc score variation [1]
    End point description
    End point type
    Primary
    End point timeframe
    19 weeks after the start of treatment
    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: Because of the small number of patients included, no results can be derived from the analysis . Therefore, the statistical analysis performed on this small number of included subjects is purely descriptive.
    End point values
    CANDESARTAN Usual care
    Number of subjects analysed
    3
    3
    Units: Score variation
        arithmetic mean (standard error)
    3 ± 1
    5.7 ± 2.1
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From the signing of the consent up to 1 month after the end of the treatment
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    25.0
    Reporting groups
    Reporting group title
    CANDESARTAN
    Reporting group description
    -

    Reporting group title
    Usual care
    Reporting group description
    -

    Serious adverse events
    CANDESARTAN Usual care
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 4 (25.00%)
    2 / 5 (40.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Investigations
    Troponin increased
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Malignant melanoma
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pertussis
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory syncytial virus infection
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    CANDESARTAN Usual care
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    4 / 4 (100.00%)
    5 / 5 (100.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Malignant melanoma
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    2
    Hypotension
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    0 / 4 (0.00%)
    3 / 5 (60.00%)
         occurrences all number
    0
    3
    Chest pain
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    14
    0
    Hyperthermia
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Immune system disorders
    Drug hypersensitivity
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Reproductive system and breast disorders
    Heavy menstrual bleeding
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Psychiatric disorders
    Bulimia nervosa
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Investigations
    Blood bilirubin decreased
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Blood creatinine decreased
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    3
    0
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Platelet count decreased
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Troponin increased
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Weight decreased
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Paraesthesia
         subjects affected / exposed
    1 / 4 (25.00%)
    2 / 5 (40.00%)
         occurrences all number
    1
    2
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Leukopenia
         subjects affected / exposed
    3 / 4 (75.00%)
    3 / 5 (60.00%)
         occurrences all number
    14
    16
    Lymphopenia
         subjects affected / exposed
    4 / 4 (100.00%)
    5 / 5 (100.00%)
         occurrences all number
    16
    25
    Neutropenia
         subjects affected / exposed
    3 / 4 (75.00%)
    2 / 5 (40.00%)
         occurrences all number
    14
    8
    Thrombocytopenia
         subjects affected / exposed
    1 / 4 (25.00%)
    1 / 5 (20.00%)
         occurrences all number
    3
    5
    Eye disorders
    Dry eye
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    1 / 4 (25.00%)
    2 / 5 (40.00%)
         occurrences all number
    1
    3
    Dyspepsia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Nausea
         subjects affected / exposed
    0 / 4 (0.00%)
    4 / 5 (80.00%)
         occurrences all number
    0
    4
    Vomiting
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    2 / 4 (50.00%)
    0 / 5 (0.00%)
         occurrences all number
    2
    0
    Infections and infestations
    Cystitis
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    2
    Pertussis
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Respiratory syncytial virus infection
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    11 Feb 2020
    1- Change in non-inclusion criteria: - Delete "diabetes" - Delete "known previous vitamin deficiency - Delete "patient on anticoagulant or with known blood clotting disorder". 2- Extension of candesartan duration treatment beyond V4 to cover toxicity from last chemotherapy

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    23 Sep 2021
    Reasons for Permanent Discontinuation: -Low accrual rate: 28 months after the enrollment of the first patient, only 9 patients were recruited out of the 40 planned , despite an extension of the inclusion period and modification of the inclusion and non-inclusion criteria. -Overestimation of the inclusion potential Given the very small number of patients, no benefit / risk analysis can be performed. However a full safety analysis is performed as well as a descriptive analysis.
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Early termination leading to a small number of subjects analysed; The few data collected does not allow anay analysis.
    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
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