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Interstitial CystitisPhase 2NCT05275647

Efficacy and Safety of Low Energy Shock Wave Plus BotulinumToxin A in Treating Patients With Interstitial Cystitis

A Phase 2 study testing BOTOX 100U in normal saline and Normal saline in people with Interstitial Cystitis, run by Buddhist Tzu Chi General Hospital at 1 site in Taiwan.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Low energy shock wave (LESW) is known to facilitate tissue regeneration with analgesic and anti-inflammatory effects. LESW treatment has been demonstrated effective in treatment of nonbacterial prostatitis and chronic pelvic pain syndrome. Read more about this study

Who is it for?
Ages 20 years and older
Conditions the study is for
Interstitial Cystitis
What is being tested?
BOTOX 100U in normal saline and Normal saline
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
75 participants
Where
1 siteTaiwan
Study dates
18 May 2021to Sep 2024
Phase
Phase 2
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 20 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults with age of 20 years old or above
  • Patients with symptoms of frequency, urgency, and bladder pain at full bladder for more than 6 months.
  • Proven to have glomerulations (at least grade 1) by cystoscopic hydrodistention under anesthesia in recent 1 year
  • Free of active urinary tract infection
  • Free of bladder outlet obstruction on enrolment
  • Free of overt neurogenic bladder dysfunction and limitation of ambulation.
  • Patient or his/her legally acceptable representative agrees to sign the written informed consent form

Who cannot join

  • Patient's lower urinary tract symptoms can be effectively treated by conventional therapy
  • Patient or his/her legally acceptable representative cannot sign the written informed consent form
  • Patient cannot complete the consecutive 3- day voiding diary on the visiting day
  • Patient had been treated for overactive bladder by enterocystoplasty
  • Patients with severe cardiopulmonary disease and such as congestive heart failure, arrhythmia, poorly controlled hypertension, not able to receive regular follow-up
  • Patient has bladder outlet obstruction on enrollment
Show all 15Show fewer
  • Patients has post-void residual >250ml
  • Patients with uncontrolled confirmed diagnosis of acute urinary tract infection
  • Patients have laboratory abnormalities at screening including: ALT> 3 x upper limit of normal range, AST> 3 x upper limit of normal range; Patients have abnormal serum creatinine level > 2 x upper limit of normal range
  • Patient has coagulation disorder
  • Female patients who is pregnant, lactating, or with child-bearing potential without contraception.
  • Patients with any other serious disease considered by the investigator not in the condition to enter the trial
  • Patient had received intravesical hyaluronic acid insillation treatment for IC within recent 6 months before enrolment
  • Patient had received intravesical onabotulinumtoxinA treatment for IC within recent 12 months before enrolment
  • Patients participated investigational drug trial within 1 month before entering this study

Trial locations and contacts

1 site in 1 country.

Taiwan1 site, 1 recruiting
  • Buddhist Tzu Chi General Hospital

    Hualien City, 970

    Hann-Chorng Kuo, M.D., 886-3-8561825 ext. 2113, hck@tzuchi.com.tw

    Shu-Hui Liu, 886-3-8561825 ext. 2117, sa0983655492@gmail.com

    Recruiting

Other trials in Taiwan

About this study

Official title: Therapeutic Efficacy and Safety of Low Energy Shock Wave (LESW) Plus Botulinum Toxin A Instillation in Treatment of Patients With Interstitial Cystitis Refractory to Conventional Therapy - A Clinical and Immunohistochemistry Study

Low energy shock wave (LESW) is known to facilitate tissue regeneration with analgesic and anti-inflammatory effects. LESW treatment has been demonstrated effective in treatment of nonbacterial prostatitis and chronic pelvic pain syndrome. LESW reduced pain behavior and down-regulated the NGF expression, suppressed bladder overactivity by decreasing inflammation, IL-6 and COX2 expression and NGF expression. Previous rat interstitial cystitis (IC) models have shown LESW could increase urothelial permeability, facilitate intravesical botulinum toxin A (BoNT-A) delivery and block acetic acid induced hyperactive bladder, suggesting LESW might be a potential therapeutic candidate for relieving bladder inflammatory conditions and overactivity. A double-blind, randomized, placebo-controlled physician-initiated study revealed LESW treatment was associated with a statistically significant decrease in O'Leary-Saint Symptom Score and visual analog scale of pain in patients with interstitial cystitis/bladder pain syndrome (IC/BPS), but the improvement was not superior to the sham LESW treatment. Previous studies found the urothelial dysfunction and deficits of cell differentiation are fundamental pathophysiology of IC/BPS. Through intravesical platelet-rich plasma injections, the chronic inflammation in IC/BPS bladders could be reduced and improved cell differentiation of urothelium. Botox injection or liposome encapsulated Botox could also inhibit inflammation and improve IC/BPS symptoms. However, the Botox injection needs anesthesia and certain complications might occur. There is no study to test if LESW plus Botox intravesical instillation could improve bladder inflammation and relieve IC/BPS symptoms. This study aims to investigate the therapeutic efficacy and safety of concomitant LESW plus intravesical BoNT-A instillation for IC/BPS refractory to conventional treatments.

Read the detailed description

Interstitial cystitis/ bladder pain syndrome (IC/BPS) is a bladder disorder with unknown etiology and difficult treatment. Novel treatments have been searched to adequately improved symptoms. Low energy shock wave (LESW) increased urothelial permeability, facilitated intravesical botulinum toxin A (BoNT-A) delivery and blocked acetic acid induced hyperactive bladder. Rats that received BoNT-A plus LESW showed a significantly reduced response (48.6% decreased intercontractile interval) to acetic acid instillation without compromising voiding function. Rats pre-treated with BoNT-A plus LESW showed a decreased inflammatory reaction (p <0.05), and decreased expressions of SNAP-23 (p < 0.05), SNAP-25 (p = 0.061) and COX-2 (p < 0.05) compared with the control group. These results support LESW as a promising method to deliver BoNT-A across urothelium without the need for injection. LESW is known to facilitate tissue regeneration with analgesic and anti-inflammatory effects. LESW treatment reduced pain behavior and down-regulated the NGF expression (33.3%, P < 0.05) on day 4 and IL-6 (40.9%, P < 0.05). LESW treatment suppressed bladder overactivity (intercontractile interval 77.8% increase, P < 0.05) by decreasing inflammation and COX2 (38.6%, P < 0.05) expression and NGF expression (25.2%, P = 0.0812). Previous study revealed that LESW might be a potential candidate for relieving bladder inflammatory conditions and overactivity. Recent clinical trial also revealed that Intravesical instillation of BoNT-A and LESW is a safe and effective method for the treatment of refractory overactive bladder with a durable response for 2 months. A double-blind, randomized, placebo-controlled physician-initiated study enrolled 54 patients with IC/BPS. The patients were assigned to LESW or placebo. At 4 weeks post-treatment, both groups were associated with a statistically significant decrease in OSS and VAS pain scale. A significantly higher proportion of patients on LESW responded as improved in the VAS ≥ 3 vs placebo (P = 0.035). At 12 weeks post-treatment, improvement in the VAS ≥ 3 was 57.1% vs 19.0% (LESW vs placebo; P = 0.011). No significant adverse events were found in either group. This study aims to investigate the therapeutic efficacy and safety of concomitant LESW plus intravesical BoNT-A instillation for IC/BPS patients refractory to conventional treatments.

Materials and Methods

Eligible participants of either gender with IC/BPS refractory to at least two treatments will be enrolled to this study. Participants are randomly allocated to receive either treatment in 1:1 ratio according to the permuted block randomization code as the following:

(A) LESW treatment with 3000 shocks, and followed by intravesical instillation of 30ml normal saline. (placebo group)

(B) LESW with 3000 shocks, and followed by intravesical BoNT-A 100U instillation. (treatment group)

Urine samples will be collected for urinary protein and biomarkers analysis.

Being tested
BOTOX 100U in normal saline, Normal saline
Keywords
Low energy shock wave, interstitial cystitis, botulinum toxin A, urothelium
Medical subject headings
Cystitis, Interstitial

What participants receive

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

  • BOTOX 100U in normal salineDrug

    Also called BOTOX

    LESW with 3000 shocks, frequency of 3 pulses per second, and maximum total energy flow density 0.25 mJ/mm2 , and followed by intravesical BoNT-A 100U instillation in 30ml normal saline retained in the bladder for 2 hours, every one week for 4 times.

  • Normal salineDrug

    Also called Saline

    LESW treatment with 3000 shocks, frequency of 3 pulses per second, and maximum total energy flow density 0.25 mJ/mm2 , and followed by intravesical instillation of 30ml normal saline retained in the bladder for 2 hours after LESW application, every one week for 4 times.

Study groups in NCT05275647
Study groupRoleWhat they receive
Treatment group : BoNT-A 100 U in Normal salineExperimentalBOTOX 100U in normal saline (BoNT-A/NS) 30ml in single intravesical instillation
Receives: Drug: BOTOX 100U in normal saline
Placebo group : Normal salinePlacebo comparatorNormal saline (N/S) 30ml in single intravesical instillation
Receives: Drug: Normal saline

What is being measured

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

  1. O'Leary-Sant Symptom Score

    Change of the O'Leary-Sant symptom score (including Interstitial Cystitis Symptom Index from 0 to 10 points and Interstitial Cystitis Problem Index, from 0 to 20 points; a higher score indicates a worse symptom severity)

    Measured: from baseline to 3 month after the treatment day

  2. Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]

    Local or systemic adverse events such as hematuria, miction pain, difficult urination, or any systemic symptoms such as fever, general weakness, dyspnea, etc.)

    Measured: from baseline to 3 month after the treatment day

Secondary outcomes (14)
  1. Global response assessment (GRA)

    Global response assessment (GRA) of satisfaction by the patient (categorized into -3, -2, -1, 0, 1, 2, 3 units of scale, indicating markedly worse to markedly improved) at 1 month after the treatment day.

    An improvement of GRA by 2 units of scale at 1 month is considered effective.

    Measured: 1 month after the treatment day

  2. Visual analog score (VAS) for pain

    Net change of the Visual analog score (VAS) for pain (from 0 to 10 units of scale, indicating no pain (0) to severe pain (10))

    Measured: from baseline to 1 month and 3 months after the first treatment day

  3. Functional bladder capacity

    Net change of functional bladder capacity (FBC, in milliliter)

    Measured: from baseline to 1 month and 3 months after the first treatment day

  4. Voiding frequency per day

    Net change of voiding frequency at daytime and voiding frequency at night time as record in 3-day voiding diary

    Measured: from baseline to 1 month and 3 months after the first treatment day

  5. maximum flow rate

    Net changes of the maximum flow rate (Qmax, in milliliter/second)

    Measured: from baseline to 1 month after the first treatment day

  6. voided volume

    Net changes of the voided volume (in milliliter)

    Measured: from baseline to 1 month after the first treatment day

  7. Pos-tvoid residual volume (PVR)

    Net changes of the PVR (in milliliter)

    Measured: from baseline to 1 month after the first treatment day

  8. urinary nerve growth factor (NGF)

    Changes of urinary NGF level in urine (in nanogram/milliliter)

    Measured: from baseline to 1 month and 3 months after the first treatment day

  9. urinary brain derived neurotrophic factor (BDNF)

    Changes of urinary BDNF (in nanogram/milliliter)

    Measured: from baseline to 1 month and 3 months after the first treatment day

  10. Inflammatory cytokine IL-2 level

    Changes of cytokine IL-2 level (in nanogram/milliliter)

    Measured: from baseline to 1 month and 3 months after the first treatment day

  11. Inflammatory cytokines IL-6 level

    Changes of cytokines IL-6 level (in nanogram/milliliter)

    Measured: from baseline to 1 month and 3 months after the first treatment day

  12. Inflammatory cytokine IL-8 level

    Changes of cytokine IL-8 level (in nanogram/milliliter)

    Measured: from baseline to 1 month and 3 months after the first treatment day

  13. Inflammatory cytokine IL-1 beta level

    Changes of cytokine IL-1 beta level (in nanogram/milliliter)

    Measured: from baseline to 1 month and 3 months after the first treatment day

  14. Safety outcome (Local and systemic adverse events)

    Any adverse events occurring after treatment, including hematuria, micturition pain, difficulty in urination, urinary tract infection, or systemic symptoms

    Measured: from baseline to 1 month and 3 months after the first treatment day

Timeline

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

  1. First posted11 Mar 2022
  2. Study start18 May 2021
  3. Primary completionJul 2024 (estimated)
  4. Study completionSep 2024 (estimated)

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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a double-blind, randomized, placebo-controlled physician initiated study enrolled patients with refractory IC/BPS.
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
75 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05275647
Sponsor's protocol ID
IRB 110-078-A
Status last verified
Mar 2022
First submitted
13 Jan 2022
Last updated
25 Mar 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing BOTOX 100U in normal saline and Normal saline in people with Interstitial Cystitis, run by Buddhist Tzu Chi General Hospital at 1 site in Taiwan.

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 7 inclusion and 15 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: status not confirmed, as of the sponsor's last update on 25 Mar 2022. 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 Taiwan. 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.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

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

Contact Hann-Chorng Kuo, M.D. (886-3-8561825 ext. 2113, hck@tzuchi.com.tw), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

O'Leary-Sant Symptom Score (time frame: from baseline to 3 month after the treatment day). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 25 Mar 2022.

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