Amlodipine for Myocardial Iron in Thalassemia (AMIT)
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| ClinicalTrials.gov Identifier: NCT02065492 |
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Recruitment Status :
Completed
First Posted : February 19, 2014
Last Update Posted : June 29, 2017
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| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Thalassemia | Drug: Standard Chelation Drug: Amlodipine | Phase 2 Phase 3 |
Null Hypothesis There is no difference between the efficacy of chelation plus amlodipine therapy and chelation therapy alone in retarding the rate of myocardial iron deposition in thalassemia patients with iron overload and a constant transfusion need.
Alternate Hypothesis Chelation plus amlodipine therapy is more efficacious than chelation therapy alone in retarding the rate of myocardial iron deposition in thalassemia patients with iron overload and a constant transfusion need.
The aim of the investigators study is to determine if amlodipine, an L-type specific calcium channel blocker, in addition to the standard aggressive chelation therapy, can retard the deposition of iron in the myocardium of thalassemia patients with significant myocardial iron load with or without cardiomyopathy.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 20 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | Single (Outcomes Assessor) |
| Primary Purpose: | Prevention |
| Official Title: | Effect of L-type Calcium Channel Blocker (Amlodipine) on Myocardial Iron Deposition in Thalassemic Patients With Moderate to Severe Myocardial Iron Deposition: A Randomized Pilot Study |
| Study Start Date : | February 2014 |
| Actual Primary Completion Date : | October 2015 |
| Actual Study Completion Date : | November 2015 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: Standard Chelation & Amlodipine
This arm will receive both chelation and amlodipine. Amlodipine will be administered as a single daily dose. It will be administered at a dose of 0.1 mg/kg/day or maximum of 2.5 mg/day. Standard Chelation therapy will be administered either by subcutaneous infusion of Deferoxamine (3-5 days a week) or oral Deferasirox (daily) or combination of Deferoxamine and Deferiprone. The dosage will depend on individual requirement, as determined by the treating hematologist. |
Drug: Standard Chelation
This will comprise of standard chelation drugs (Deferasirox or Deferoxamine or Combination of Deferoxamine and Deferiprone).The dosage and drug used will depend on ferritin levels and individual requirement, as determined by the treating hematologist and will be in accordance with the Iron chelation guidelines from Pakistan Thalassemia Society.
Other Name: Asunra or Kelfer or Desferal Drug: Amlodipine doses of 0.2 to 0.25 mg/kg/day PO would be given during this trial
Other Name: L-type calcium channel blocker |
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Active Comparator: Standard Chelation
Deferasirox or Deferoxamine or Deferiprone. Patients in this arm will be administered only standard chelation therapy,either by subcutaneous infusion of Chelation therapy of Deferoxamine (3-5 days a week) or oral Deferasirox (daily) or combination of Deferoxamine and Deferiprone. The dosage will depend on individual requirement, as determined by the treating hematologist. This will serve as the control arm of the study without any additional intervention. |
Drug: Standard Chelation
This will comprise of standard chelation drugs (Deferasirox or Deferoxamine or Combination of Deferoxamine and Deferiprone).The dosage and drug used will depend on ferritin levels and individual requirement, as determined by the treating hematologist and will be in accordance with the Iron chelation guidelines from Pakistan Thalassemia Society.
Other Name: Asunra or Kelfer or Desferal |
- Efficacy of amlodipine in retarding rate of myocardial iron deposition (Assessed by change in T2* times) [ Time Frame: At baseline, and then at 6 months and 12 months from the start of the study ]Each patient will be randomized into either of two study arms: amlodipine plus chelation or chelation alone. All patients will undergo MRI and T2* imaging at baseline and then at 6 and 12 month follow-up visits. Efficacy of Amlodipine will be assessed using change in T2* times.
- Effect of amlodipine therapy on left ventricular size, systolic and diastolic function [ Time Frame: At baseline and then at 6 months and 12 months from the start of the study ]
Cardiac MRI and echocardiogram will be utilized to assess both systolic and diastolic function. Basic parameters such as left ventricular end diastolic volume, left ventricular systolic volume and the ejection fraction will be measured.
Mitral Inflow Doppler as well as Tissue Doppler Imaging will be used to assess diastolic dysfunction.
Conventional Pulsed Doppler Echocardiography will be utilized to derive the myocardial performance index (Tei Index) of each patient which will serve as a surrogate for systolic function.
Peak global and segmental longitudinal left and right ventricular strain and strain rate will be calculated using speckle tracking by tracing images obtained from the apical 4-chamber view. Peak global and segmental right and left ventricular circumferential strain and strain rate will also be calculated from a parasternal, mid-cavity short axis view using speckle tracking also.
- Efficacy of amlodipine in retarding liver iron content (mg/g) [ Time Frame: At baseline and then at 6 months and 12 months from the start of the study ]Liver iron content will be measured using T2* imaging of the liver
- Adverse effects of amlodipine therapy [ Time Frame: At baseline and at 6 months and 12 months from the start of the study; at all visits to the Clinical Trial Unit pharmacy at the Aga Khan Hosptal for dispensing amlodipine and at all routine visits to the outpatient hematology clinic ]Data on adverse effects will be be collected using the adverse event form. The adverse effects anticipated include fatigue, nausea, edema, palpitations, flushing, headache, dizziness, blurred vision, somnolence, cough, hypertension and sinus bradycardia. Any other adverse event will also be reported. Adverse events that require only symptomatic management will be treated by the participant's primary hematologist. Adverse events that require hospitalization will also be managed by the participant's primary hematologist and the costs incurred will be covered by the research fund. Cardiovascular adverse events that require outpatient or inpatient management will be treated by the Principal Investigator and his cardiology team and all costs incurred will be covered by the research fund.
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| Ages Eligible for Study: | 6 Years to 20 Years (Child, Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Pediatric patients aged ≥ 6 and ≤ 20 years managed at AKUH for at least 1 year
- ≥ 10 blood transfusion in life time
- Transfusion need ≥ 180 ml/kg/year
- Serum ferritin ≥ 1000 ug/dl
- Patient deemed capable of receiving chelation therapy (by treating hematologist) either subcutaneous infusion of Deferoxamine (Desferal) (3-5 days a week) or oral deferasirox (daily) or Defeperione (oral) or a combination of Desferal and Defeperione.
- Patients who have been on a stable chelation regimen ≥ 6 months
- Completed and signed Informed consent/assent.
Exclusion Criteria:
- Patients with known hypersensitivity to amlodipine.
- Patients with known sinoatrial nodal disease or aortic stenosis.
- Patients with known severe myocardial dysfunction, defined as A LV ejection fraction of ≤ 4 SD for age even without symptoms.
- Patients with known signs and symptoms of heart failure.
- Patients with a T2* value of < 4 ms on cardiac MRI.
- Patients with systolic blood pressures ≤ 2 SD for age (systemic hypotension) at the time of enrolment.
- Patients with previously diagnosed significant congenital heart diseases or acquired heart diseases other than thalassemia (as defined earlier).
- Patients with known contraindications to MRI (pacemakers, cerebral aneurysm metal clips, etc.)
- Patient with a known history of developing tetany after use of a calcium channel blocker
- Known pregnancy.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02065492
| Pakistan | |
| Aga Khan University Hospital | |
| Karachi, Sindh, Pakistan, 74800 | |
| Principal Investigator: | Babar Hasan | Aga Khan University |
| Responsible Party: | Dr Babar S Hasan, Assistant Professor, Aga Khan University |
| ClinicalTrials.gov Identifier: | NCT02065492 |
| Other Study ID Numbers: |
AMIT |
| First Posted: | February 19, 2014 Key Record Dates |
| Last Update Posted: | June 29, 2017 |
| Last Verified: | June 2017 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | Undecided |
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Thalassemia Amlodipine Chelation |
T2* MRI Myocardial Iron |
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Thalassemia Anemia, Hemolytic, Congenital Anemia, Hemolytic Anemia Hematologic Diseases Hemoglobinopathies Genetic Diseases, Inborn Amlodipine |
Calcium Channel Blockers Calcium-Regulating Hormones and Agents Physiological Effects of Drugs Antihypertensive Agents Membrane Transport Modulators Molecular Mechanisms of Pharmacological Action Vasodilator Agents |