Efficacy of Nintedanib for Treatment of Epistaxis in Hereditary Hemorrhagic Telangiectasia (HHT) Patients

• Status: Not yet recruiting
• Trial end date: 2023-09-01
• Target enrollment: 0
• Participant gender: All

Summary

Patients affected by hereditary hemorrhagic telangiectasia (HHT) very often suffer from recurrent nosebleeds called epistaxis. There is no treatment currently available to reduce the frequency or severity of epistaxis.

This research project will examine the effect of nintedanib, a capsule to be taken twice a day, on the frequency and severity of epistaxis in HHT.

The study will take place at the Respiratory medicine department of the Lausanne University Hospital (Centre hospitalier universitaire vaudois, CHUV). The investigators will recruit about 48 participants with HHT, who will be divided in 2 groups. Each group will perform the same examinations and follow-up visits. The study will begin with 2 months of observation during which subjects will be asked to fill a diary to record the number and duration of epistaxis episodes. The diary will be filled daily for the entire duration of the study, i.e. 8 months. After 2 months of observation, the treatment phase will begin. Participants will take a capsule (nintedanib 150 mg or placebo) once a day for 2 weeks, then twice a day for 14 weeks. In case of intolerance at the dose of 2 capsules per day, the treatment may be reduced to 1 capsule per day. Subjects will also have to mention on the diary any blood transfusion, iron perfusion, and any symptoms they may be experiencing. Following the 16 weeks of treatment, an 8-week follow-up period will allow to observe the effects of nintedanib after the end of the treatment period, and to monitor any unexpected adverse events.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Dr. Romain Lazor
• Collaborator: Boehringer Ingelheim
• Treatments: Nintedanib

Criteria

Inclusion criteria:

1. signed informed consent

2. definite HHT disease (defined as the presence of a pathogenic mutation in one of the HHT genes, or the presence of 3 out of 4 Curaçao clinical criteria)

3. age ≥18 years at the time of informed consent

4. moderate to serious epistaxis defined as Epistaxis Severity Score (ESS) ≥3

5. absence of cerebral arteriovenous malformation demonstrated by brain imaging

Exclusion criteria:

1. Women who are pregnant or breastfeeding

2. For women of childbearing potential (WOCBP, see Annex VII for definition), non-agreement to follow instructions for method(s) of contraception for the heterosexual couple (see Annex VII for instructions) during the treatment period and follow-up, or at least 3 months after the last dose of IMP, or if there are concerns that they will not reliably comply with the contraception requirements.

3. Acute infection

4. aspartate aminotransferase (AST), or alanine aminotransferase (ALT), or total bilirubin >1.5x (or >2.5x in patients known for Gilbert's syndrome) the upper limit of normal

5. Renal clearance by Cockcroft-Gault formula <30 ml/min

6. Untreated pulmonary arteriovenous malformation

7. Hemoptysis or hematuria within the last 12 months

8. Ulcus or active gastric bleeding within the last 12 months

9. Anticoagulant or antiplatelets treatment

10. Coronary heart disease

11. Thrombotic event within the last 12 months

12. Long QT syndrome (on ECG performed at screening)

13. Known allergy to nintedanib, soya, peanuts

14. Bevacizumab, pazopanib or other anti-angiogenic treatments within the last 12 months

15. Concomitant treatment with ketoconazole, erythromycin, rifampicin, carbamazepine, phenytoin, St John's Wort

16. Surgery within the last 3 months or planned within the next 9 months

17. Recent unhealed wound

18. Any other serious underlying medical condition that could interfere with the study treatment and potential adverse events

19. Any mental or other impairment that may compromise compliance with the study requirements.