Topics

Dexamethasone Compared to Conventional Therapy in the Treatment of Acute Pericarditis

2020-04-01 04:26:53 | BioPortfolio

Summary

The treatment of acute pericarditis is empiric and is based on treatment with medications with anti-inflammatory properties such as non-steroidal anti-inflammatory drugs (NSAID) and corticosteroids. However, this therapy is given as a relatively long course of therapy (≥ 3 weeks) and can be associated with substantial side effects.

Dexamethasone is a potent corticosteroid that has not been investigated an alternative to conventional therapy in patients with acute pericarditis.

Dexamethasone is an inexpensive drug and can be given in an oral tablet form. It has a quick onset of action, relatively long duration of action and is therefore often given in high doses for short periods.

Dexamethasone has been shown to be a safe therapeutic option in ITP (Immune Thrombocytopenia), another disease in which steroids are an accepted treatment option. The abundant data on using dexamethasone in comparison to longer prednisone-based regimens has been evaluated in this disease and has shown to be effective and without the longer exposure time to steroids and potential side effects. This data shows that dexamethasone can be a safe therapeutic option.The investigators hypothesize that therapy with short term, high dose dexamethasone will offer better clinical responses to conventional therapy in the treatment of acute pericarditis with less potential side effects compared to conventional therapy.

The Investigators aim to conduct a randomised, non-blinded trial assessing the use of dexamethasone as an alternative to conventional therapy for use in patients with acute pericarditis.

Description

Dexamethasone compared to conventional therapy in the treatment of acute pericarditis: a superiority randomized controlled trial (Dexa-P)

Objectives:

The investigators hypothesize that therapy with short term, high dose dexamethasone will offer better clinical responses to conventional therapy with less potential side effects compared to conventional therapy

Trial design:

A randomised, non-blinded trial assessing the use of dexamethasone as an alternative to conventional therapy for use in patients with acute pericarditis.

Quality Assurance:

After the first 3 participants have been enrolled and completed a month of follow up, the preliminary findings will be forwarded to the quality control committee of the Helsinki Ethics Committee of Rabin Medical Center

Withdrawal of participants:

Participants are free to discontinue their participation in the study at any time and without prejudice to further treatment.

A participant may withdraw or be withdrawn from the study for the following reasons:

- Subject withdrew consent.

- Severe Adverse Event (As described below) Reasons for withdrawal will be documented. In cases of more than one reason for early withdrawal from the study, the most significant reason will be stated.

Replacement of withdrawn participants:

Withdrawn randomized participants will not be replaced.

Discontinuing or modifying allocated interventions:

If a participant has incessant pericarditis within one month of therapy:

- Participants in the dexamethasone arm will be given another cycle of dexamethasone therapy of 20mg for 4 days can be given. If there is a further persistence, prednisone therapy will then be initiated.

- Participants in the conventional therapy arm will be changes to prednisone therapy

Definition of incessant pericarditis:

Recurrence of pleuritic chest pain and one or more of the following signs:

1. Pericardial friction rub

2. Electrocardiographic changes specific to pericarditis (concave ST elevation, PR depression)

3. Echocardiographic evidence of pericardial effusion

3) An elevation in inflammatory markers (white-cell count, or C-reactive protein level) without a symptom-free interval of 6 weeks or longer after the first acute event.

If participant is hospitalized with a possible side effect, the treating physician will be notified to assess for modifying the participant allocation.

Concomitant care:

There are no prohibited concomitant medications. Participants should continue to take drugs for other co-morbidities as usual.

Participant Timeline:

The enrollment will be done within 72 hours of initial assessment. Each participant will undergo eligibility screen and suitable participants will receive informed consent. The allocation will be determined immediately after the participant will be found to be eligible and will be made randomly.

Once participants are identified with an initial episode of acute pericarditis and informed consent is given, an initial assessment will be done.

This will include baseline blood tests - including baseline liver and renal function tests, full blood count and C-reactive protein.

All participants will undergo echocardiographic imaging at baseline. There are two possible interventions: dexamethasone therapy or "conventional" therapy.

Participants will be followed up at 1 weeks, 1 month, 6 months and 12 months after treatment initiation.

The follow up will be telephonically at 1 week, 6 months and 12 months. At the 1 month follow up, clinical assessment, inflammatory marker and a repeat echocardiogram will be performed. This follow up will be at the pericardial disease clinic at Rabin Medical Center .

Sample size:

Assuming a recurrence rate of 26.6% in the control group at 12 months, 269 participants in each arm will allow for a 80% power to detect a 10% absolute reduction in the recurrence rate in in the Dexamethasone arm at a significance level of 5%.

Recruitment:

Investigators will include physicians in the emergency room and admission setting to help identify and recruit participants.

Methods: Data Collection, management and analysis

Enrollment:

First assessment including baseline variables and suitability of the participant to the study will be made during the enrollment, by the study coordinators.

In addition demographic and clinical characteristics will be recorded. The data will be collected during an interview of the participant or with assistance of the computerized medical records.

Furthermore, laboratory tests such as blood count, liver and kidneys functions and C reactive protein will be made and be recorded for each participant.

Interventions:

The type of intervention will be recorded by the study coordinators for each participant according to the allocation group.

Assessments of outcomes:

The primary outcome at each follow up, both telephonically and on clinical follow up The secondary outcomes will be assessed telephonically and using the medical computerized systems.

Data management:

All data regarding the participant's hospitalization: Baselines variables, interventions and glucose levels will be stored in secured excel documents for each study group.

Data regarding the participant's outcomes will be stored in a different secured excel documents for each study group.

The coding of the documents and the separation between the hospitalization and follow up period data is designated to ensure the investigator blinding.

Statistical analysis:

The primary outcome is the occurrence of Recurrent Pericarditis within 12 months. This will be calculated by bivariate analysis as relative risk. The secondary outcome of time to recurrence will be plotted using Kaplan-Meier curves and compared using the Log-rank test (unadjusted analysis), Hazard ratio for the risk of the primary analysis between the control and Dexamethasone arm will be calculated using a univariate cox proportional hazards ratio model (unadjusted analysis). Further secondary outcomes will be analysed by bivariate analysis.

Methods: monitoring Harms: Side effects will be monitoring during therapy as defined

Study Design

Conditions

Pericarditis Acute

Intervention

Dexamethasone therapy, Conventional Therapy

Status

Not yet recruiting

Source

Rabin Medical Center

Results (where available)

View Results

Links

Published on BioPortfolio: 2020-04-01T04:26:53-0400

Clinical Trials [4997 Associated Clinical Trials listed on BioPortfolio]

Prognostic Biomarkers in Patients With Acute Pericarditis

The study will aim at investigating novel plasma or imaging biomarkers in patients with acute pericarditis. All participants will be treated according to established clinical recommendatio...

Study of Colchicine to Treat Acute Pericarditis and Prevent Recurrences

The purpose of the study is to determine whether colchicine is safe and effective in the treatment of acute pericarditis and the prevention of subsequent recurrences.

Benign Acute Pericarditis: Brief Versus Longer Treatment Using Aspirin

Treatment of pericarditis largely remains empirical due to the relative lack of randomized controlled trials. Nevertheless, some recommendations have been formulated to guide management an...

A Pilot Study of KPL-914 in Recurrent Pericarditis

The purpose of this study is to assess the preliminary efficacy and safety of KPL-914 treatment in subjects with recurrent pericarditis.

Thalidomide/Dexamethasone vs MP for Induction Therapy and Thalidomide/Intron A vs Intron A for Maintenance Therapy

This is an international multi-center prospective, double randomized, open, controlled phase III study with a phase II entrance phase to compare the therapeutic efficacy of thalidomide plu...

PubMed Articles [20747 Associated PubMed Articles listed on BioPortfolio]

Management of Acute Idiopathic (Viral) Pericarditis in the Emergency Department: A Review for the Nursing Professional.

Acute pericarditis is an inflammatory disorder that contributes to chest pain admissions in the emergency department (ED). Nursing professionals can play a vital role in the differential, triage and m...

Impact of dose and duration of therapy on dexamethasone pharmacokinetics in childhood acute lymphoblastic leukaemia-a report from the UKALL 2011 trial.

The use of dexamethasone in acute lymphoblastic leukaemia therapy contributes to short- and long-term toxicities. The UKALL 2011 randomised trial investigated whether a more intense dexamethasone dose...

Diagnosis and Management of Tuberculous Pericarditis: What Is New?

This review provides an update on the immunopathogenesis of tuberculous pericarditis (TBP), investigations to confirm tuberculous etiology, the limitations of anti-tuberculous therapy (ATT), and recen...

Upper Limb Robotic Rehabilitation After Stroke: A Multicenter, Randomized Clinical Trial.

After stroke, only 12% of survivors obtain complete upper limb (UL) functional recovery, while in 30% to 60% UL deficits persist. Despite the complexity of the UL, prior robot-mediated therapy researc...

Benefits and risks of low molecular weight heparin in patients with acute exacerbation of chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials.

Low molecular weight heparin (LMWH) is an anticoagulant that has recently been found benefit in the acute exacerbation stage of chronic obstructive pulmonary disease (COPD). But its efficacy is contro...

Medical and Biotech [MESH] Definitions

Therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice. They may lack biomedical explanations but as they become better researched some (PHYSICAL THERAPY MODALITIES; DIET; ACUPUNCTURE) become widely accepted whereas others (humors, radium therapy) quietly fade away, yet are important historical footnotes. Therapies are termed as Complementary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment.

Preliminary cancer therapy (chemotherapy, radiation therapy, hormone/endocrine therapy, immunotherapy, hyperthermia, etc.) that precedes a necessary second modality of treatment.

Inflammation of the PERICARDIUM from various origins, such as infection, neoplasm, autoimmune process, injuries, or drugs-induced. Pericarditis usually leads to PERICARDIAL EFFUSION, or CONSTRICTIVE PERICARDITIS.

A therapeutic approach, involving chemotherapy, radiation therapy, or surgery, after initial regimens have failed to lead to improvement in a patient's condition. Salvage therapy is most often used for neoplastic diseases.

Drug therapy given to augment or stimulate some other form of treatment such as surgery or radiation therapy. Adjuvant chemotherapy is commonly used in the therapy of cancer and can be administered before or after the primary treatment.

More From BioPortfolio on "Dexamethasone Compared to Conventional Therapy in the Treatment of Acute Pericarditis"

Quick Search

Relevant Topics

Drug Discovery
Clinical Approvals Clinical Trials Drug Approvals Drug Delivery Drug Discovery Generics Drugs Prescription Drugs In the fields of medicine, biotechnology and pharmacology, drug discovery is the process by which drugs are dis...

Bioethics
Bioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philo...


Searches Linking to this Trial