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IVIg for Demyelination in Diabetes Mellitus

Information source: University of Toronto
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Peripheral Neuropathy; Diabetes Mellitus; Chronic Inflammatory Demyelinating Polyneuropathy

Intervention: 10% intravenous immunoglobulin (IVIg) (Drug); 0.9% sodium chloride (Drug)

Phase: Phase 4

Status: Recruiting

Sponsored by: University of Toronto

Official(s) and/or principal investigator(s):
Ari Breiner, MD, FRCPC, Principal Investigator, Affiliation: University of Toronto

Overall contact:
Eduardo Ng, MD, Phone: 416-340-4184, Email: eduardo.ng@uhn.ca

Summary

The purpose of this study is to determine whether intravenous immunoglobulin (IVIg) is an effective intervention for patients with diabetes, peripheral neuropathy, and demyelination on nerve conduction studies. All patients will receive both IVIg and placebo for 3 months each, with a 3 month washout period in between.

Clinical Details

Official title: Treatment With Gamunex 10% Intravenous Immunoglobulin (IVIg) for Patients With Demyelination and Diabetes Mellitus: A Blinded, Placebo-Controlled Crossover Pilot Study

Study design: Allocation: Randomized, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Primary outcome: Change in Overall Neuropathy Limitations Score (ONLS) after 3 months

Secondary outcome:

Change in Rasch-Built Overall Disability Scale (R-ODS) after 3 months

Change in Nerve Conduction Studies (NCS) after 3 months

Change in Medical Research Council (MRC) Sum Score after 3 months

Change in Grip Strength after 3 months

Change in Short Form 36 (SF-36) Quality of Life after 3 months

Adverse Events

Detailed description: There is a knowledge gap with regards to the appropriate method of detecting and treating chronic inflammatory demyelinating polyneuropathy (CIDP), in patients with co-existent diabetes. In this pilot study the investigators plan to examine the overlap between diabetic polyneuropathy and CIDP by treating patients with diabetes and demyelinating abnormalities using IVIg. The investigators will enroll diabetes patients with a broad spectrum of demyelinating abnormalities. The proposed trial will be an explanatory, blinded, single-centre, superiority, randomized controlled cross-over trial. Each patient will receive 3 months of 10% intravenous immunoglobulin and 3 months of placebo (0. 9% sodium chloride in water) with a 3-month washout period. The primary outcome measure is the mean change in ONLS (Overall Neuropathy Limitation Scale), a measure of disability in polyneuropathy; however secondary outcome measures will consider impairments and quality of life.

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria: 1. Age ≥18 years. 2. Diabetes, as per American Diabetes Association Criteria. 3. Clinical evidence of polyneuropathy and NCS shows 2 separate motor nerves (median, ulnar, tibial, or peroneal) which meet criteria for demyelination, defined as follows: 1. Conduction velocity <90% lower limit of normal (LLN), distal latency >110% upper limit of normal (ULN), or minimal F-wave latency >110% ULN 2. The changes are not exclusively due to median neuropathy at the wrist, ulnar neuropathy at the elbow, or peroneal neuropathy at the fibular head. 4. Clinical suspicion of possible demyelinating polyneuropathy (CIDP). Exclusion Criteria: 1. Pregnant patients, or those of childbearing potential not using contraception. 2. Patients <18 years of age. 3. Presence of an alternative etiology of peripheral neuropathy, such as: hereditary neuropathies (Charcot Marie-Tooth disease); B-vitamin deficiency- or excess-related neuropathy; uremic neuropathy; neuropathy secondary to monoclonal gammopathy; history of cancer- or chemotherapy-related neuropathy; other toxin exposures; and alcoholic neuropathy. 4. Contraindication to IVIg, including: history of recurrent thrombosis, immunoglobulin A deficiency, or severe hypersensitivity reaction to IVIg in past, renal failure, recurrent deep venous thrombosis, pulmonary embolus, stroke, or myocardial infarction. 5. Presence of serious or unstable medical condition, which may preclude study completion or lead to inability to tolerate IVIg. This may include active heart failure, uncontrolled hypertension, or severe anemia, among other conditions. 6. Presence of concomitant neurological illness, which may confound evaluation. 7. Fails or unable to provide informed consent.

Locations and Contacts

Eduardo Ng, MD, Phone: 416-340-4184, Email: eduardo.ng@uhn.ca

Toronto General Hospital / Toronto Western Hospital, Toronto, Ontario M5G 2C4, Canada; Recruiting
Eduardo Ng, MD, Phone: 416-340-4184, Email: eduardo.ng@uhn.ca
Additional Information

Starting date: February 2015
Last updated: February 19, 2015

Page last updated: August 23, 2015

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