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Subarachnoid HemorrhageNCT00283400

Treatment of Subarachnoid Hemorrhage With Human Albumin

A study testing 25% human albumin in people with Subarachnoid Hemorrhage, run by Baylor College of Medicine at 6 sites in 2 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The purpose of this study is to evaluate the tolerability and safety of 25 percent human albumin therapy in patients with subarachnoid hemorrhage. Read more about this study

Who is it for?
Ages 18 to 79 years
Conditions the study is for
Subarachnoid Hemorrhage
What is being tested?
25% human albumin
Could I receive a placebo?
No, everyone receives an active treatment
How many people
47 participants
Where
6 sitesin 2 countries
Study dates
Jan 2006to Apr 2011
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 79 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients (male or female) were at least 18 but younger than 80 years of age.
  • Onset of new neurological signs of subarachnoid hemorrhage within 72 hours at the time of evaluation and initiation of treatment with 25% human albumin.
  • Clinical signs consistent with the diagnosis of subarachnoid hemorrhage including severe thunderclap headache, cranial nerve abnormalities, decreased level of consciousness, meningismus and focal neurological deficits.
  • Computed tomography demonstrated subarachnoid hemorrhage.
  • Cerebral angiography revealed the presence of saccular aneurysm(s) in a location that explains the subarachnoid hemorrhage.
  • Treatment of cerebral aneurysm was carried out prior to initiation of HA infusion but within 72 hours of symptom onset. Accepted treatments of aneurysms include surgical clipping or endovascular embolization.

Who cannot join

  • Time of symptom onset could be reliably assessed.
  • No demonstrable aneurysm by cerebral angiography.
  • Evidence of traumatic, mycotic, or fusiform aneurysm by cerebral angiography.
  • World Federation of Neurological Surgeons scale of IV and V
  • Computed tomography scale of 0-1
  • History within the past 6 months, and/or physical findings on admission of decompensated congestive heart failure (NYHA Class IV or congestive heart failure requiring hospitalization).
Show all 18Show fewer
  • Patient received albumin prior to treatment assignment during the present admission.
  • Hospitalization for or diagnosis of acute myocardial infarction within the preceding 3 months.
  • Symptoms or electrocardiographic signs indicative of acute myocardial infarction on admission.
  • Electrocardiographic evidence and/or physical findings compatible with second- or third-degree heart block, or of cardiac arrhythmia associated with hemodynamic instability.
  • Echocardiogram performed before treatment revealing a left ventricular ejection fraction ≤ 40% (if available).
  • Serum creatinine > 2.0 mg/dl or creatinine clearance < 50 ml/min.
  • Pregnancy, lactation or parturition within previous 30 days.
  • Allergy to albumin.
  • Severe prior physical disability that precludes evaluation of clinical outcome measures.
  • History of chronic lung disease
  • Current participation in another drug treatment protocol.
  • Severe terminal disease with life expectancy less than 6 months.

Trial locations and contacts

6 sites in 2 countries.

6 sites in 2 countries

United States4 sites
  • The Johns Hopkins Hospital

    Baltimore, Maryland, 21287

  • Data Coordination Unit, Department of Biostatistics, Bioinformatics and Epidemiology, at the Medical University of South Carolina

    Charleston, South Carolina, 29425

  • Penn State University

    Hershey, Pennsylvania, 17033

  • Baylor College of Medicine

    Houston, Texas, 77030

Other trials in United States

Canada2 sites
  • University of Calgary

    Calgary, Alberta

  • University of Toronto

    Toronto, Ontario

Other trials in Canada

About this study

The purpose of this study is to evaluate the tolerability and safety of 25 percent human albumin therapy in patients with subarachnoid hemorrhage.

Read the detailed description

An estimated 37,500 people in the United States have subarachnoid hemorrhage (SAH) every year. SAH is usually secondary to a brain aneurysm that has burst. In SAH the bleeding accumulates around the lining of the brain. SAH is associated with a 51percent mortality rate, and one third of survivors are left functionally dependent. Cerebral vasospasm, which is a delayed narrowing of the cerebral arteries following SAH, has been identified as the most important reason for neurological deterioration and bad outcome in cases of SAH. Cerebral vasospasm may be caused by multiple mechanisms.

Treatment with a neuroprotective agent, such as human albumin (HA), may be beneficial for prevention of cerebral vasospasm and improved clinical outcome in patients with SAH. HA is a major protein found in blood and is responsible for maintaining fluid balance in the vascular system (blood vessels). The purpose of this study was to determine the safety and tolerability of 25 percent HA therapy in patients with SAH. This open-label, dose-escalation study will provide necessary information for a future definitive phase III clinical trial on the efficacy of treatment with HA in patients with SAH.

The study was designed to enroll 80 patients at 5 centers in the US. Patients with eligible SAH first underwent surgical or endovascular repair, which was considered standard care. Endovascular repair was a repair of the aneurysm from the inside of the blood vessel.

Following neurosurgical or endovascular treatment, participants were given a daily infusion of HA for 7 days. The HA dose was allocated as follows: the first tier (20 patients) would receive 0.625 grams (g) of HA per kilogram (kg) of body weight; patients in the second tier would receive 1.25g of HA per kg; patients in the third tier would receive 1.875g of HA per kg; and patients in the fourth tier would receive 2.5g of HA per kg. Safety and tolerability was evaluated by the Data and Safety Monitoring Board (DSMB) after each tier was completed and before the study advanced to the next dose tier. A specific safety threshold for congestive heart failure and other adverse events was defined based on data from previous studies.

In the follow-up phase, patients participated in study-related evaluations of their health at 15 days and three months. Duration of the study for participants was 90 days.

Being tested
25% human albumin
Keywords
subarachnoid hemorrhage, SAH, human albumin, HA, cerebral vasospasm, aneurysm, neuroprotective
Medical subject headings
Subarachnoid Hemorrhage, Vasospasm, Intracranial, Aneurysm

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • 25% human albuminDrug

    25% human albumin: after approval by the Data and Safety Monitoring Board dosage tier would be escalated to the subsequent higher level sequentially.

Study groups in NCT00283400
Study groupRoleWhat they receive
dosage tier 1Active comparator0.625 g/kg 25% human albumin
Receives: Drug: 25% human albumin
dosage tier 2Active comparator1.25 g/kg 25% human albumin
Receives: Drug: 25% human albumin
dosage tier 3Active comparator1.875 g/kg 25% human albumin
Receives: Drug: 25% human albumin
dosage tier 4Active comparator2.5 g/kg 25% human albumin
Receives: Drug: 25% human albumin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Safety and Tolerability of the 25% Human Albumin Dosages and the Functional Outcome.

    Tolerability outcome: Subject's ability to receive the full allocated human albumin dose without incurring frank congestive heart failure or experiencing anaphylactic reactions that required discontinuation of the treatment. Study would be terminated if 2 or more subjects developed severe or life-threatening heart failure considered to be related (probably, possibly, and definitely) to albumin treatment.

    Measured: 9 days after enrollment

Secondary outcomes (2)
  1. Serious Adverse Events

    Serious adverse events included neurological and medical complications and neurological deterioration.

    Neurological deterioration was defined as a decline by more than 2 points in the Glasgow Coma Scale.

    Measured: within 3 months after enrollment

  2. Good Clinical Outcome Was Defined as a Glasgow Outcome Scale Score of 0-1

    Number of subjects with good clinical outcome defined as a Glasgw Outcome Scale score of 0-1

    Measured: 3 months after enrollment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Jan 2006 (estimated)
  2. Study startJan 2006
  3. Primary completionJan 2011
  4. Study completionApr 2011

Why it stopped: Study met safety endpoints

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
47 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00283400
Sponsor's protocol ID
R01NS049135
Other IDs
R01NS049135
Status last verified
Mar 2015
First submitted
26 Jan 2006
Last updated
1 Apr 2015
Data monitoring committee
Yes

Publications

  • Suarez JI, Shannon L, Zaidat OO, Suri MF, Singh G, Lynch G, Selman WR. Effect of human albumin administration on clinical outcome and hospital cost in patients with subarachnoid hemorrhage. J Neurosurg. 2004 Apr;100(4):585-90. doi: 10.3171/jns.2004.100.4.0585.

    PubMed 15070109
  • Suarez JI, Qureshi AI, Yahia AB, Parekh PD, Tamargo RJ, Williams MA, Ulatowski JA, Hanley DF, Razumovsky AY. Symptomatic vasospasm diagnosis after subarachnoid hemorrhage: evaluation of transcranial Doppler ultrasound and cerebral angiography as related to compromised vascular distribution. Crit Care Med. 2002 Jun;30(6):1348-55. doi: 10.1097/00003246-200206000-00035.

    PubMed 12072693
  • Lennihan L, Mayer SA, Fink ME, Beckford A, Paik MC, Zhang H, Wu YC, Klebanoff LM, Raps EC, Solomon RA. Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage : a randomized controlled trial. Stroke. 2000 Feb;31(2):383-91. doi: 10.1161/01.str.31.2.383.

    PubMed 10657410
  • Haley EC Jr, Kassell NF, Torner JC. A randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. J Neurosurg. 1993 Apr;78(4):537-47. doi: 10.3171/jns.1993.78.4.0537.

    PubMed 8450326
  • Wilkes MM, Navickis RJ. Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials. Ann Intern Med. 2001 Aug 7;135(3):149-64. doi: 10.7326/0003-4819-135-3-200108070-00007.

    PubMed 11487482
  • Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R; SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004 May 27;350(22):2247-56. doi: 10.1056/NEJMoa040232.

    PubMed 15163774
  • Belayev L, Liu Y, Zhao W, Busto R, Ginsberg MD. Human albumin therapy of acute ischemic stroke: marked neuroprotective efficacy at moderate doses and with a broad therapeutic window. Stroke. 2001 Feb;32(2):553-60. doi: 10.1161/01.str.32.2.553.

    PubMed 11157196
  • Osterloh K, Ewert U, Pries AR. Interaction of albumin with the endothelial cell surface. Am J Physiol Heart Circ Physiol. 2002 Jul;283(1):H398-405. doi: 10.1152/ajpheart.00558.2001.

    PubMed 12063314
  • Zhang WJ, Frei B. Albumin selectively inhibits TNF alpha-induced expression of vascular cell adhesion molecule-1 in human aortic endothelial cells. Cardiovasc Res. 2002 Sep;55(4):820-9. doi: 10.1016/s0008-6363(02)00492-3.

    PubMed 12176131
  • Suarez JI, Martin RH, Calvillo E, Dillon C, Bershad EM, Macdonald RL, Wong J, Harbaugh R; ALISAH Investigators. The Albumin in Subarachnoid Hemorrhage (ALISAH) multicenter pilot clinical trial: safety and neurologic outcomes. Stroke. 2012 Mar;43(3):683-90. doi: 10.1161/STROKEAHA.111.633958. Epub 2012 Jan 19.

    PubMed 22267829
  • Suarez JI, Martin RH, Calvillo E, Bershad EM, Venkatasubba Rao CP. Effect of human albumin on TCD vasospasm, DCI, and cerebral infarction in subarachnoid hemorrhage: the ALISAH study. Acta Neurochir Suppl. 2015;120:287-90. doi: 10.1007/978-3-319-04981-6_48.

    PubMed 25366638

Questions about this trial

What is this clinical trial studying?

A study testing 25% human albumin in people with Subarachnoid Hemorrhage, run by Baylor College of Medicine at 6 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 1 Apr 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 1 Apr 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Safety and Tolerability of the 25% Human Albumin Dosages and the Functional Outcome. (time frame: 9 days after enrollment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00283400, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Apr 2015.

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