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    Clinical Trial Results:
    A multicenter, randomized, double blind placebo controlled trial of Micronized purified Flavonoid-Fraction (MPFF) in the management of radiation proctitis

    Summary
    EudraCT number
    2019-001916-44
    Trial protocol
    AT  
    Global end of trial date
    13 Oct 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    12 Sep 2024
    First version publication date
    12 Sep 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    MiFlaPRO_2019
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04335617
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Medizinische Universität Innsbruck
    Sponsor organisation address
    Innrain 52, Innsbruck, Austria, 6020
    Public contact
    University Hospital for Visceral, Transplant and Thoracic Surgery, Medizinische Universität Innsbruck, 0043 51250422600, marijana.ninkovic@tirol-kliniken.at
    Scientific contact
    University Hospital for Visceral, Transplant and Thoracic Surgery, Medizinische Universität Innsbruck, 0043 51250422600, marijana.ninkovic@tirol-kliniken.at
    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
    27 Jun 2024
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    13 Oct 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    13 Oct 2023
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The goal of the study is to compare the number of necessary interventions required to stop radiation proctitis inducing rectal bleeding in patients receiving Daflon® in comparison to patients in the control group receiving Placebo within 12 months of medical treatment.
    Protection of trial subjects
    The MiFlaPRO study was conducted in strict accordance with the ethical principles originating from the Declaration of Helsinki, relevant regulatory requirements, and Good Clinical Practices (GCP). The study protocol was designed to ensure the protection of participant rights, safety, and well-being throughout the study.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    11 Feb 2020
    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
    Austria: 38
    Worldwide total number of subjects
    38
    EEA total number of subjects
    38
    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
    36
    85 years and over
    2

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    49 patients were screened for inclusion, of which n=38 were randomized. N=9 patients did not meet inclusion/exclusion criteria, and n=2 patients did not participate in the trial.

    Period 1
    Period 1 title
    Treatment period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Daflon
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Daflon
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    six tablets daily for the first four days, four tablets daily for the next three days, followed by two tablets daily for the remaining treatment period.

    Arm title
    Placebo
    Arm description
    -
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    six tablets daily for the first four days, four tablets daily for the next three days, followed by two tablets daily for the remaining treatment period.

    Number of subjects in period 1
    Daflon Placebo
    Started
    21
    17
    Completed
    13
    14
    Not completed
    8
    3
         Adverse event, serious fatal
    2
    -
         Consent withdrawn by subject
    4
    1
         Physician decision
    -
    1
         Adverse event, non-fatal
    2
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Daflon
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Reporting group values
    Daflon Placebo Total
    Number of subjects
    21 17 38
    Age categorical
    Units: Subjects
        From 65-84 years
    20 16 36
        85 years and over
    1 1 2
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    75.7 (72.5 to 79.3) 78.1 (74.8 to 80.6) -
    Gender categorical
    Units: Subjects
        Female
    3 0 3
        Male
    18 17 35
    Subject analysis sets

    Subject analysis set title
    Intention-to-treat
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    The efficacy analysis in the MiFlaPRO study was conducted using the ITT population, which included all randomized patients who received at least one dose of the investigational product, Daflon®, or placebo

    Subject analysis sets values
    Intention-to-treat
    Number of subjects
    38
    Age categorical
    Units: Subjects
        From 65-84 years
    36
        85 years and over
    2
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    Gender categorical
    Units: Subjects
        Female
    3
        Male
    35

    End points

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    End points reporting groups
    Reporting group title
    Daflon
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Subject analysis set title
    Intention-to-treat
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    The efficacy analysis in the MiFlaPRO study was conducted using the ITT population, which included all randomized patients who received at least one dose of the investigational product, Daflon®, or placebo

    Primary: Number of necessary interventions per patient required to manage macroscopic rectal bleeding

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    End point title
    Number of necessary interventions per patient required to manage macroscopic rectal bleeding
    End point description
    The primary efficacy endpoint was the number of necessary interventions per patient required to manage macroscopic rectal bleeding due to radiation proctitis over the 12-month treatment period.
    End point type
    Primary
    End point timeframe
    12-month period
    End point values
    Daflon Placebo Intention-to-treat
    Number of subjects analysed
    21
    17
    38
    Units: Patients
    5
    4
    9
    Statistical analysis title
    Number of necessary interventions to stop bleeding
    Statistical analysis description
    The primary efficacy endpoint was defined as the number of necessary treatment interventions per patient required to stop radiation proctitis induced rectal bleeding within 12 months after the randomization date. The number of these necessary interventions was compared between Daflon® and Placebo.
    Comparison groups
    Daflon v Placebo
    Number of subjects included in analysis
    38
    Analysis specification
    Pre-specified
    Analysis type
    superiority [1]
    P-value
    = 0.05
    Method
    two-sided Mann-Whitney U-Test
    Confidence interval
    Notes
    [1] - The statistical analysis showed no significant difference between the two groups regarding the number of interventions required (p=0.97). This indicates that there was no advantage of Daflon over placebo in reducing the need for surgical or interventional treatments for radiation proctitis.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    12.02.2020-13.10.2023 (12 month per patient)
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    5.0
    Reporting groups
    Reporting group title
    Daflon
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    Daflon Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    5 / 21 (23.81%)
    3 / 17 (17.65%)
         number of deaths (all causes)
    2
    0
         number of deaths resulting from adverse events
    2
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Prostate cancer
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Injury, poisoning and procedural complications
    Skull fracture
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Surgical and medical procedures
    Central venous catheter removal
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Benign prostatic hyperplasia
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Hematochezia
         subjects affected / exposed
    2 / 21 (9.52%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Constipation
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Functional gastrointestinal disorder
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pneumothorax spontaneous
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Acute respiratory distress syndrome
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Renal and urinary disorders
    Azotaemia
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (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: 0%
    Non-serious adverse events
    Daflon Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    12 / 21 (57.14%)
    14 / 17 (82.35%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Parathyroid tumour benign
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Pleural effusion
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Investigations
    Faecal calprotectin increased
         subjects affected / exposed
    0 / 21 (0.00%)
    2 / 17 (11.76%)
         occurrences all number
    0
    2
    Haemoglobin decreased
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Injury, poisoning and procedural complications
    Immunisation reaction
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Nervous system disorders
    Sciatica
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Blood and lymphatic system disorders
    Iron deficiency anaemia
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Anaemia
         subjects affected / exposed
    3 / 21 (14.29%)
    3 / 17 (17.65%)
         occurrences all number
    5
    3
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    2 / 21 (9.52%)
    1 / 17 (5.88%)
         occurrences all number
    2
    1
    Eye disorders
    Cataract
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Hematochezia
         subjects affected / exposed
    1 / 21 (4.76%)
    4 / 17 (23.53%)
         occurrences all number
    1
    5
    Mucous stools
         subjects affected / exposed
    2 / 21 (9.52%)
    4 / 17 (23.53%)
         occurrences all number
    2
    4
    Anal incontinence
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Anal pruritus
         subjects affected / exposed
    3 / 21 (14.29%)
    4 / 17 (23.53%)
         occurrences all number
    3
    4
    Dyschezia
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Flatulence
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Proctalgia
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Ascites
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Rectal ulcer
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Dyspepsia
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Skin and subcutaneous tissue disorders
    Dermal cyst
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Skin lesion
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Renal and urinary disorders
    Nephrolithiasis
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Musculoskeletal and connective tissue disorders
    Rheumatic disorder
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Infections and infestations
    COVID-19
         subjects affected / exposed
    1 / 21 (4.76%)
    1 / 17 (5.88%)
         occurrences all number
    1
    1
    Urinary tract infection
         subjects affected / exposed
    1 / 21 (4.76%)
    1 / 17 (5.88%)
         occurrences all number
    1
    1
    Pneumonia
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Escherichia urinary tract infection
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Staphylococcal skin infection
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Bronchitis
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Helicobacter gastritis
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         occurrences all number
    0
    1
    Metabolism and nutrition disorders
    Gout
         subjects affected / exposed
    1 / 21 (4.76%)
    0 / 17 (0.00%)
         occurrences all number
    1
    0
    Iron deficiency
         subjects affected / exposed
    0 / 21 (0.00%)
    1 / 17 (5.88%)
         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
    06 Mar 2020
    Monocentric to mulitcentric (addition of 7 sites)
    05 Jun 2020
    Addition of 4 sites (including update of CIP)
    01 Feb 2022
    Study extension (incl. update of CIP) and principal investigators changes

    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.
    None reported
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    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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