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Primary Raynaud PhenomenonNCT03815162

Cocoa Flavanol Supplementation in Raynaud's Phenomenon

A study testing High Flavanol Cocoa extract and Alkalised cocoa in people with Primary Raynaud Phenomenon, run by University of Nottingham at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The study aims to investigate the effect that supplementing the diet with cocoa flavanols has on vasospasm symptoms and temperature regulation in women with primary Raynaud's phenomenon (PRP). Read more about this study

Who is it for?
Ages 18 to 60 yearsHealthy volunteers can take part
Conditions the study is for
Primary Raynaud Phenomenon
What is being tested?
High Flavanol Cocoa extract and Alkalised cocoa
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
27 participants
Where
1 siteUnited Kingdom
Study dates
16 Oct 2018to 31 Jul 2021
Phase
Interventional
Are there results?
None posted in the registry

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 60 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Experience symptoms of Primary Raynaud's Phenomenon, with >1 attack / week through the winter months
  • Daily consumption of caffeine containing foods/drinks.
  • BMI <27kg/m2

Who cannot join

  • pregnant or breast feeding (women only),
  • clinically significant metabolic or endocrine abnormalities
  • fasting glucose >6.5mmol/l,
  • taking Bosentan, aspirin, dipyridamole, heparin or transdermal nitrates,
  • herbal supplement use,
  • food allergies related to the investigational product (cocoa, peanuts, milk),
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  • sensitivity to methylxanthines (e.g. caffeine, theobromine).
  • Presence or history of digital ulceration,
  • blood parameters suggesting secondary Raynaud's,
  • history of migraines

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • David Greenfield Human Physiology Laboratories

    Nottingham, Notts, NG72UH

Other trials in United Kingdom

About this study

Official title: Pilot Study to Investigate the Effect of Cocoa Flavanols on Symptoms in Primary Raynaud's Phenomenon

The study aims to investigate the effect that supplementing the diet with cocoa flavanols has on vasospasm symptoms and temperature regulation in women with primary Raynaud's phenomenon (PRP). Participants will be randomised to consume either high flavanol cocoa extract or low flavanol cocoa (placebo) daily for 3 months.

Read the detailed description

Primary Raynaud's phenomenon (PRP) is characterised by periodic vasospasm of the fingers and toes precipitated by exposure to cold or emotional stimuli and stress. Previous studies have demonstrated that underlying this condition there can be vascular endothelium dysfunction. Pharmacological interventions used to relieve symptoms and complications in PRP include drugs targeted at increasing nitric oxide (NO; transdermal nitrates) levels. Cocoa derived products, rich in the phytonutrients 'flavanols', have been shown to increase the bioavailability of NO at the vascular endothelium and promote vasodilation, which may address an underlying cause of PRP and mitigate symptoms. Previous work carried out in the research group has indicated that the acute consumption of cocoa does not compromise the counter-regulatory responses to localised cold exposure in those with PRP.

30 individuals with PRP will be recruited. Those interested in taking part will attend a medical screening and consent visit. If recruited, a participant number will be assigned to them sequentially and they will be randomised to either experimental or control group, with neither the participants nor the research team knowing which group they have been allocated to. Participants will be asked to complete a diet diary before attending 4 further visits over a period of 3 months.

Visit 1 (pre-intervention) and 4 (end of intervention); immediately on arrival, participants will be asked to lie semi-supine on a hospital bed. Skin temperature (surface thermocouples) and 'core' temperature (infrared tympanic thermometer) will start to be recorded to identify when these parameters have stabilized in room temperature (set at 25oC). Blood pressure will be taken using an arm cuff. Then a Finometer cuff will be attached to the left middle finger to record cardiovascular parameters (Blood pressure /heart rate/ cardiac output) and a laser Doppler probe will be attached to the dorsum of both index fingers to assess skin blood flow. Once the finger skin temperature has remained stable for 6 minutes, baseline Finometer and laser Doppler measurements will be recorded and the skin and 'core' temperature will be noted. Then, the right hand will be placed in a temperature regulated box which is set at an air temperature of 0oC. The hand will be cooled to a finger skin temperature of 15oC, then the box temperature will be modified to maintain the skin temperature at 15oC. The time that it takes for the skin temperature on the fingers to reach 15oC will be recorded. With the finger skin temperature stable at 15oC, Finometer and laser Doppler measurements will be repeated and the 'core' temperature at this point noted. Then, the hand will be removed from the chamber, and allowed to equilibrate in room temperature. The time taken for the skin temperature to reach stability will be recorded, as will the absolute temperature that it stabilises to. Measures above will be repeated once hand temperature is stable. Once these measures have been made, all equipment will be removed and a 15ml blood sample will be taken (for epicatechin, glucose and insulin analysis). The participant will be asked to complete 3 questionnaires (SF-36, Raynaud's symptoms and a food frequency questionnaire). Participants will also return a 4-day diet diary at visits 1 and 4, and their symptom diary at visit 4.

Visits 2 (end of month 1) and 3 (end of month 2); participants will return a 4-day diet diary, symptom diary and any unused capsules. They will also have a resting blood pressure measurement made, weight measured and be asked to complete 3 questionnaires (SF-36, Raynaud's symptoms and a food frequency questionnaire).

At the end of Visits 1, 2 and 3, participants will be given a months' supply of capsules, a symptom diary and a diet diary (to be completed in the week prior to the next visit).

Being tested
High Flavanol Cocoa extract, Alkalised cocoa
Keywords
cocoa flavanols

What participants receive

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

  • High Flavanol Cocoa extractDietary supplement

    Experimental group

  • Alkalised cocoaDietary supplement

    Control group

Study groups in NCT03815162
Study groupRoleWhat they receive
High Flavanol Cocoa extractExperimental278mg total flavanols (38.3mg epicatechin) per opaque cellulose capsule 3 capsules consumed once per day (836 mg total flavanols; 115mg epicatechin) for 3 months
Receives: Dietary Supplement: High Flavanol Cocoa extract
Alkalised cocoaPlacebo comparator0mg total flavanols (0mg epicatechin) per opaque cellulose capsule 3 capsules consumed once per day (0mg total flavanols; 0mg epicatechin) for 3 months
Receives: Dietary Supplement: Alkalised cocoa

What is being measured

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

  1. Vasospasm

    frequency of vasospasm

    Measured: 3 months

Secondary outcomes (30)
  1. Severity of vasospasm symptoms

    visual analogue score for pain associated with each vasospasm occasion. Participants indicate pain intensity by placing a vertical line on a 100mm horizontal line where the start of the line (left-hand side; 0mm) represents 'no pain' and the end of the line (right-hand side; 100mm) represents 'most severe pain'. Distance of the vertical line from 0 provides the visual analogue score. A lower score indicates a more favourable outcome.

    Measured: 3 months

  2. Duration of vasospasm symptoms

    duration that symptoms persist for on each vasospasm occasion

    Measured: 3 months

  3. Raynaud's Condition score

    Assessment of Raynaud's symptoms using the validated Raynaud's Condition Score. This is a 1 to 10 Likert scale, with 0 representing 'no difficulty' and 10 indicating 'extreme difficulty' with symptoms; collected daily for 3 months, a lower score indicates a more favourable outcome.

    Measured: 3 months

  4. Blood pressure

    blood pressure measured by automated oscillometric blood pressure

    Measured: pre-intervention

  5. Blood pressure

    blood pressure measured by automated oscillometric blood pressure

    Measured: 4 weeks after starting intervention

  6. Blood pressure

    blood pressure measured by automated oscillometric blood pressure

    Measured: 8 weeks after starting intervention

  7. Blood pressure

    blood pressure measured by automated oscillometric blood pressure

    Measured: 12 weeks after starting the intervention

  8. Dietary polyphenol intake

    estimation of dietary polyphenols made by food frequency questionnaire

    Measured: pre-intervention

  9. Dietary polyphenol intake

    estimation of dietary polyphenols made by food frequency questionnaire

    Measured: 4 weeks after starting intervention

  10. Dietary polyphenol intake

    estimation of dietary polyphenols made by food frequency questionnaire

    Measured: 8 weeks after starting intervention

  11. Dietary polyphenol intake

    estimation of dietary polyphenols made by food frequency questionnaire

    Measured: 12 weeks after starting the intervention

  12. Ambient skin temperature

    skin temperature of a finger exposed to an environmental temperature of 25oC, before cooling

    Measured: pre-intervention

  13. Ambient skin temperature

    skin temperature of a finger exposed to an environmental temperature of 25oC, before cooling

    Measured: 12 weeks after starting the intervention

  14. Ambient skin blood flow

    finger blood flow (measured using laser Doppler flowmetry) when exposed to an environmental temperature of 25oC, before cooling

    Measured: pre-intervention

  15. Ambient skin blood flow

    finger blood flow (measured using laser Doppler flowmetry) when exposed to an environmental temperature of 25oC, before cooling

    Measured: 12 weeks after starting the intervention

  16. Skin temperature response to acute cooling

    The time taken for skin temperature of the finger to stabilise in response to localised cooling (in an air temperature of 0oC)

    Measured: pre-intervention

  17. Skin temperature response to acute cooling

    The time taken for skin temperature of the finger to stabilise in response to localised cooling (in an air temperature of 0oC)

    Measured: 12 weeks after starting the intervention

  18. Skin blood flow response to acute cooling

    Finger Skin blood flow; measurement (using laser Doppler flowmetry) made once finger skin temperature has stabilised in response to localised cooling (in an air temperature of 0oC)

    Measured: pre-intervention

  19. Skin blood flow response to acute cooling

    Finger Skin blood flow; measurement (using laser Doppler flowmetry) made once finger skin temperature has stabilised in response to localised cooling (in an air temperature of 0oC)

    Measured: 12 weeks after starting the intervention

  20. Skin temperature response to re-warming

    The time taken for skin temperature of finger to stabilise in an environmental temperature of 25oC following localised cooling (in an air temperature of 0oC)

    Measured: pre-intervention

  21. Skin temperature response to re-warming

    The time taken for skin temperature of finger to stabilise in an environmental temperature of 25oC following localised cooling (in an air temperature of 0oC)

    Measured: 12 weeks after starting the intervention

  22. Skin temperature after re-warming

    skin temperature that a finger exposed to an environmental temperature of 25oC stabilises to after localised cooling

    Measured: pre-intervention

  23. Skin temperature after re-warming

    skin temperature that a finger exposed to an environmental temperature of 25oC stabilises to after localised cooling

    Measured: 12 weeks after starting the intervention

  24. Quality of life score

    Assessed using SF-36 questionnaire. Responses are coded and normalised to the UK population, as per standard methods, and a score for mental and physical health calculated; a higher score indicating a more favourable outcome

    Measured: pre-intervention

  25. Quality of life score

    Assessed using SF-36 questionnaire. Responses are coded and normalised to the UK population, as per standard methods, and a score for mental and physical health calculated; a higher score indicating a more favourable outcome

    Measured: 4 weeks after starting intervention

  26. Quality of life score

    Assessed using SF-36 questionnaire. Responses are coded and normalised to the UK population, as per standard methods, and a score for mental and physical health calculated; a higher score indicating a more favourable outcome

    Measured: 8 weeks after starting intervention

  27. Quality of life score

    Assessed using SF-36 questionnaire. Responses are coded and normalised to the UK population, as per standard methods, and a score for mental and physical health calculated; a higher score indicating a more favourable outcome

    Measured: 12 weeks after starting the intervention

  28. Attrition rate

    Number of participants completing the protocol as a proportion of those who were randomised to the study

    Measured: 2 years

  29. Adverse events

    Any injury, accident or illness experienced over the intervention period will be documented

    Measured: 3 months

  30. Recruitment rate

    number of people volunteering to take part in the study as a proportion of those expressing initial interest

    Measured: 2 years

Timeline

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

  1. First posted24 Jan 2019
  2. Study start16 Oct 2018
  3. Primary completion30 Apr 2020
  4. Study completion31 Jul 2021

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
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Double-blinded, placebo controlled study. Block randomised with equal allocation of participants between groups.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
27 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03815162
Sponsor's protocol ID
112-1809
Status last verified
Nov 2021
First submitted
18 Jan 2019
Last updated
4 Nov 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual data will not be shared with other researchers

Publications

  • Herrick A. Raynaud's phenomenon. Curr Treat Options Cardiovasc Med. 2008 Apr;10(2):146-55. doi: 10.1007/s11936-008-0016-y.

    PubMed 18325317
  • Chung L, Shapiro L, Fiorentino D, Baron M, Shanahan J, Sule S, Hsu V, Rothfield N, Steen V, Martin RW, Smith E, Mayes M, Simms R, Pope J, Kahaleh B, Csuka ME, Gruber B, Collier D, Sweiss N, Gilbert A, Dechow FJ, Gregory J, Wigley FM. MQX-503, a novel formulation of nitroglycerin, improves the severity of Raynaud's phenomenon: a randomized, controlled trial. Arthritis Rheum. 2009 Mar;60(3):870-7. doi: 10.1002/art.24351.

    PubMed 19248104

Questions about this trial

What is this clinical trial studying?

A study testing High Flavanol Cocoa extract and Alkalised cocoa in people with Primary Raynaud Phenomenon, run by University of Nottingham at 1 site in United Kingdom.

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 3 inclusion and 10 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: finished, as of the sponsor's last update on 4 Nov 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. 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. Some participants in this study may receive a placebo. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Vasospasm (time frame: 3 months). 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 NCT03815162, which also lists 2 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 4 Nov 2021.

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