Assessing the safety and effectiveness of a 11-βhydroxysteroid dehydrogenase type 1 inhibitor (AZD4017), in a placebo controlled trial, in acute idiopathic intracranial hypertension (IIH) IIH is a condition of young, overweight women with characteristic raised intracranial pressure (pressure around the brain) leading to papilloedema (swelling of the nerve supplying the eye), visual loss and headaches. Medical literature (Cochrane review) demonstrates there is little evidence for the treatments used for IIH. Weight control appears the most effective method of improving symptoms but weight loss is difficult to maintain. 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) is an enzyme which regulates local steroid levels and our previous research suggests it may influence the production of brain fluid(cerebrospinal fluid or CSF). 11β-HSD1 levels fall with weight loss and this is associated with with decreased intracranial pressure. Our primary outcome is to determine whether AZD4017, an inhibitor of 11β-HSD1, will reduce the pressure in the brain and as a consequence improve IIH. Patients are eligible to enter the study if they are between 18-55 years old with acute (\<6 months) IIH, signs of active disease (papilloedema and raised CSF pressure (\>25 cmH20)), no other major illnesses and have no plans for pregnancy during the study period. This is an MRC funded single centre, phase II, double-blinded, randomised control drug trial. It will be conducted at the University Hospital Birmingham and the University of Birmingham will act as Sponsor. Eligible participants will be randomly assigned to AZD4017 or a placebo ('dummy' with no active drug) for 3 months with a follow up a month later. Investigations during the study will include bloods, urine samples, pregnancy tests, lumbar punctures, DXA scans and small fat/skin biopsies. Participants will benefit from increased monitoring and a potential improvement in their condition. We hypothesise that specific inhibition of 11β-HSD1 will decrease intracranial pressure and consequently treat patients with IIH, thus opening a new and entirely novel therapeutic avenue.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
31
University Hospital Birmingham (Queen Elizabeth Hospital)
Birmingham, West Midlands, United Kingdom
Intracranial Pressure
ICP measured by lumbar puncture in cmCSF as the change from week 0 and week 12 of treatment, measured at baseline and week 12
Time frame: 12 weeks
Tinnitus
The temporal change in IIH symptoms (presence or absence of tinnitus), measured at baseline and week 12
Time frame: 12 weeks
Anthropometric Measurements (BMI)
The temporal change in Body Mass Index (in kg/m\^2) over 12 weeks of treatment, measured at baseline and week 12
Time frame: 12 weeks
Visual Loss
The temporal change in IIH symptoms (presence or absence of visual loss, measured at baseline and week 12
Time frame: 12 weeks
Diplopia
The temporal change in IIH symptoms (presence or absence of diplopia, measured at baseline and week 12
Time frame: 12 weeks
Visual Obscuration
The temporal change in IIH symptoms (presence or absence of visual obscuration, measured at baseline and week 12
Time frame: 12 weeks
Headache
The temporal change in IIH symptoms (presence or absence of headache, measured at baseline and week 12
Time frame: 12 weeks
Visual Acuity
The temporal change in IIH visual function in both eyes (measured by LogMAR (log of the minimum angle of resolution) chart to assess visual acuity, between the baseline to week 12, measured at baseline and week 12
Time frame: 12 weeks
Papilloedema
The temporal change in papilloedema (evaluated at the end of trial follow up using stereoscopic fundus photographs by masked neuro-ophthalmologists to grade the images according to Frisen classification) measured at baseline and week 12. There are 6 grades, 0-5, 5 being the worst. The modified Frisén scale for grading papilledema using fundus photography is as follows: Grade 1 - C-Shaped halo with a temporal gap Grade 2 - The halo becomes circumferential Grade 3 - Loss of major vessels as they leave the disc Grade 4 - Loss of major vessels on the disc Grade 5 - Criteria of Grade IV + partial or total obscuration of all vessels on the disc For further details see e.g. Scott, C.J., et al., Diagnosis and grading of papilledema in patients with raised intracranial pressure using optical coherence tomography vs clinical expert assessment using a clinical staging scale. Arch. Ophthalmol, 2010. 128(6): p. 705-711.
Time frame: 12 weeks
Headache-associated Disability
The change in headache associated disability through the headache impact test-6 score (HIT 6), measured at baseline and week 12. This is scored 11-66 with higher scores indicating worse headache.
Time frame: 12 weeks
Adverse Events
The safety and tolerability profile of AZD4017 in female patients with IIH through adverse event reporting and safety bloods.
Time frame: 16 weeks
Serious Adverse Events
The safety and tolerability profile of AZD4017 in female patients with IIH through adverse event reporting and safety bloods.
Time frame: 16 weeks
OCT Total Average Retinal Nerve Fibre Layer Thickness (μm)
The temporal change in OCT Total average retinal nerve fibre layer thickness (μm), measured at baseline and week 12
Time frame: 12 weeks
Visual Field Mean Deviation
The temporal change in IIH visual function in both eyes using automated perimetry (Humphrey 24-2 central threshold) to measure the visual field mean deviation between the baseline to week 12
Time frame: 12 weeks
Log Contrast Sensitivity
The temporal change in IIH visual function in both eyes using a Pelli-Robson chart to evaluate log contrast sensitivity between the baseline to week 12
Time frame: 12 weeks
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