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    Clinical Trial Results:
    Efficacy of Nintedanib per os as a treatment for epistaxis in HHT disease A national, randomized, multicenter phase II study EPICURE

    Summary
    EudraCT number
    2019-002593-31
    Trial protocol
    FR  
    Global end of trial date
    24 Feb 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    14 Dec 2024
    First version publication date
    14 Dec 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    69HCL19_0003
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03954782
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Hospices Civils de Lyon
    Sponsor organisation address
    3 Quais des Célestins, Lyon, France, 69003
    Public contact
    Regulatory Project Manager, Hospices Civils de Lyon, +33 472406829, drci_promo@chu-lyon.fr
    Scientific contact
    Principal investigator, Hospices Civils de Lyon, +33 427856522, sophie.dupuis-girod@chu-lyon.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
    10 Oct 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    24 Feb 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    24 Feb 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    evaluate efficacy, at the end of the treatment period, on epistaxis duration of nintedanib treatment per os (300 mg/day for 12 weeks) versus placebo in patients with HHT complicated by moderate to severe epistaxis.
    Protection of trial subjects
    The trial was in compliance with the ethical principles derived from the Declaration of Helsinki and the International Conference on Harmonization (ICH) Good Clinical Practice (GCP) guidelines. All the local regulatory requirements pertinent to safety of trial subjects were also followed during the conduct of the trial. Monitoring the safety of administration of the product, motivated by the iatrogenic risks, justifies the setting up of a specific independent monitoring and safety committee. The Data Safety Monitoring Board = DSMB) reviews the data and issues that may occur during the trial, especially the ones that are scientific, ethical and tolerance, which may change the benefit/risk ratio. Following this review, the DSMB shall provide recommendations to the sponsor, which may concern the continuation, modification or termination of the study.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Dec 2019
    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
    France: 60
    Worldwide total number of subjects
    60
    EEA total number of subjects
    60
    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)
    51
    From 65 to 84 years
    8
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    This study involved adult patients suffering from moderate to severe epistaxis related to HHT, which responsible for severe alterations in social functioning and quality of life. This parameter is evaluated with an Epistaxis Severity Score. It has been established that patients with epistaxis from moderate to severe, that is to say a score ESS> 4,

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

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    NINTEDANIB
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    OFEV®
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, soft
    Routes of administration
    Oral use
    Dosage and administration details
    the treatment tested is nintedanib commercialized as OFEV®, soft capsules containing 150 mg of nintedanib. The daily dose of 300 mg was administered per os by two capsules per day approximately 12 hours’ appart, for 12 weeks. In case of intolerance, the dose is reduced at 200 mg per day (2x100mg).

    Arm title
    Placebo
    Arm description
    -
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, soft
    Routes of administration
    Oral use
    Dosage and administration details
    the placebo are soft capsules containing a suspension of titanium dioxide as drug substance substitute. The final product is strictly identical as the study treatment.

    Number of subjects in period 1
    NINTEDANIB Placebo
    Started
    30
    30
    Completed
    30
    30

    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
    60 60
    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)
    51 51
        From 65-84 years
    8 8
        85 years and over
    1 1
    Gender categorical
    Units: Subjects
        Female
    31 31
        Male
    29 29
    Subject analysis sets

    Subject analysis set title
    Full Analysis Set
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    all patients included who started the treatment.

    Subject analysis sets values
    Full Analysis Set
    Number of subjects
    60
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    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)
    51
        From 65-84 years
    8
        85 years and over
    1
    Age continuous
    Units:
        
    ( )
    Gender categorical
    Units: Subjects
        Female
    31
        Male
    29

    End points

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

    Reporting group title
    Placebo
    Reporting group description
    -

    Subject analysis set title
    Full Analysis Set
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    all patients included who started the treatment.

    Primary: Proportion of patients reporting a response at the end of the treatment (based on nosebleeds, with a reduction of at least 50% on epistaxis monthly mean duration comparing the 8 weeks before treatment to the last 8 weeks of tre

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    End point title
    Proportion of patients reporting a response at the end of the treatment (based on nosebleeds, with a reduction of at least 50% on epistaxis monthly mean duration comparing the 8 weeks before treatment to the last 8 weeks of tre
    End point description
    End point type
    Primary
    End point timeframe
    12 weeks after beginning of the treatment
    End point values
    NINTEDANIB Placebo
    Number of subjects analysed
    30
    30
    Units: number
        number (not applicable)
    13
    8
    Statistical analysis title
    main analysis for primary outcome
    Comparison groups
    NINTEDANIB v Placebo
    Number of subjects included in analysis
    60
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.279
    Method
    Fisher exact
    Parameter type
    Risk difference (RD)
    Point estimate
    16.7
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    16.4
         upper limit
    16.9

    Secondary: relative change of Hemoglobin level between inclusion and enf of treatment

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    End point title
    relative change of Hemoglobin level between inclusion and enf of treatment
    End point description
    End point type
    Secondary
    End point timeframe
    12 weeks after beginning of the treatment vs at the beginning of the treatment
    End point values
    NINTEDANIB Placebo
    Number of subjects analysed
    30
    30
    Units: g/L
        arithmetic mean (standard deviation)
    0.11 ( 0.20 )
    0 ( 0.16 )
    Statistical analysis title
    Secondary outcome measure
    Comparison groups
    NINTEDANIB v Placebo
    Number of subjects included in analysis
    60
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.019
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    All adverse events and severe adverse events observed during the 24 weeks (6 months) of the study were collected (at D14, D28, D56, D84 D168)
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    21
    Reporting groups
    Reporting group title
    Nintedanib
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    Nintedanib Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    2 / 30 (6.67%)
    4 / 30 (13.33%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac failure
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pulmonary embolism
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hypoalbuminaemia
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         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
    Nintedanib Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    26 / 30 (86.67%)
    19 / 30 (63.33%)
    Investigations
    Transaminases increased
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences all number
    0
    1
    Weight decreased
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences all number
    0
    1
    Vascular disorders
    Haemorrhage
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Hypertension
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 30 (3.33%)
         occurrences all number
    2
    1
    Peripheral arterial occlusive disease
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences all number
    0
    1
    Nervous system disorders
    Headache
         subjects affected / exposed
    7 / 30 (23.33%)
    3 / 30 (10.00%)
         occurrences all number
    9
    6
    migraine
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences all number
    0
    1
    Insomnia
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 30 (0.00%)
         occurrences all number
    2
    0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    General disorders and administration site conditions
    general disorders
         subjects affected / exposed
    5 / 30 (16.67%)
    2 / 30 (6.67%)
         occurrences all number
    5
    2
    Toothache
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 30 (0.00%)
         occurrences all number
    2
    0
    Thyroid cyst
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 30 (0.00%)
         occurrences all number
    2
    0
    Gastrointestinal disorders
    Abdominal distension
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    2
    0
    Gastroenteritis
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Abdominal pain
         subjects affected / exposed
    8 / 30 (26.67%)
    2 / 30 (6.67%)
         occurrences all number
    9
    3
    Abdominal pain upper
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences all number
    0
    1
    Constipation
         subjects affected / exposed
    2 / 30 (6.67%)
    1 / 30 (3.33%)
         occurrences all number
    2
    1
    Diarrhoea
         subjects affected / exposed
    11 / 30 (36.67%)
    1 / 30 (3.33%)
         occurrences all number
    20
    1
    Epigastric discomfort
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Faeces soft
         subjects affected / exposed
    2 / 30 (6.67%)
    1 / 30 (3.33%)
         occurrences all number
    2
    1
    Flatulence
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Functional gastrointestinal disorder
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences all number
    0
    1
    Gastrointestinal pain
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 30 (0.00%)
         occurrences all number
    2
    0
    Gingival pain
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Haemorrhoids
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Melaena
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences all number
    0
    1
    Nausea
         subjects affected / exposed
    9 / 30 (30.00%)
    3 / 30 (10.00%)
         occurrences all number
    9
    4
    Oral discomfort
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Proctalgia
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Vomiting
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 30 (0.00%)
         occurrences all number
    2
    0
    Reproductive system and breast disorders
    Intermenstrual bleeding
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 30 (0.00%)
         occurrences all number
    2
    0
    sinusitis
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    3 / 30 (10.00%)
    0 / 30 (0.00%)
         occurrences all number
    3
    0
    Rash
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    2
    0
    Renal and urinary disorders
    Renal failure
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 30 (3.33%)
         occurrences all number
    0
    1
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 30 (3.33%)
         occurrences all number
    1
    1
    Back pain
         subjects affected / exposed
    2 / 30 (6.67%)
    1 / 30 (3.33%)
         occurrences all number
    2
    1
    Muscle spasms
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 30 (3.33%)
         occurrences all number
    4
    1
    Myalgia
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 30 (0.00%)
         occurrences all number
    3
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    02 Oct 2020
    - Addition of clarifications of 2 non-inclusion criteria concerning the history of gastrointestinal ulcers and thrombosis - Collection of medication intake in epistaxis grids - Modification of the SAE reporting circuit to the sponsor (via eCRF) - Modification of the definition of the per protocol population - New version of the OFEV® BI - Addition of a user notice
    02 Jun 2022
    - Extension of the recruitment period by 6 months. - New version of the OFEV® BI

    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
    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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