Surgical Idiopathic Intracranial Hypertension Treatment Trial

Stopped early · Phase 3

Conditions studied: Idiopathic Intracranial Hypertension

In brief

Randomized trial of adults (≥18 years old) with idiopathic intracranial hypertension and moderate to severe visual loss without substantial recent treatment who are randomly assigned to (1) medical therapy, (2) medical therapy plus ONSF, or (3) medical therapy plus VPS. The primary outcome is visual field mean deviation change at first of Month 6 (26 weeks) or time of treatment failure of the eligible eye(s), followed by a continuation study to assess time to treatment failure. The determination of eligible eye(s) is based on meeting the eligibility criteria at baseline.

Key facts

Study ID

NCT03501966

Run by

Jaeb Center for Health Research

People needed

7

Starts

2019-02-06

Expected to finish

2019-08-28

Last updated by the study team

2022-06-16

Who can join

Age: 18 and older, up to 63. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Subject Eligibility Criteria Inclusion Criteria
• Diagnosis of IIH by modified Dandy criteria (Table 4)
• Age 18 to <64 years at time of consent
• Age 18 to <61 years at time of diagnosis (time of diagnosis is the time at which the patient meets the modified Dandy criteria, usually after the lumbar puncture results are reviewed)
• Presence of bilateral papilledema
• Lumbar puncture within 6 weeks of screening visit or completed as part of screening: Opening CSF pressure >250 mmH2O or 200 to 250 mmH2O with at least one of the following:
• Pulse synchronous tinnitus
• Cranial nerve VI palsy
• Echography for disc drusen negative and no other disc anomalies mimicking disc edema present
• Magnetic Resonance Venography (MRV) with lateral sinus collapse/stenosis, partially empty sella turcica on coronal or sagittal views of MRI, and optic nerve sheaths with filled out CSF spaces next to the globe on T2 weighted axial MRI scans If the patient was treated with intracranial pressure lowering agents (e.g., acetazolamide) prior to obtaining a lumbar puncture, the agent(s) must be discontinued for at least 24 hours prior to performing the diagnostic lumbar puncture.
• At least one eye meeting all eligible eye inclusion criteria and no exclusion criteria.
• Able to provide informed consent
• Investigator believes participant is a good candidate for the study, including the probability of returning for follow-up.
• Eye-Level Eligibility Criteria Subjects must have at least one eye meeting all of the inclusion criteria and none of the exclusion criteria.
• If both eyes meet eligibility criteria at the baseline examination, both will be included in the primary outcome analysis.
• Inclusion
• Visual field loss meeting the following criteria based on two full threshold 24-2 size V tests reviewed by the VFRC:
• PMD from -6 decibel (dB) to -27 dB
• Reproducible visual loss present on automated perimetry including no more than 15% false positive response
• Visual acuity better than 20/200 (39 or more letters correct)

You may not qualify if…

• Subject Exclusion Criteria Exclusion Criteria
• Treatment of IIH within the past 3 months with either (1) the maximally tolerated dosage of acetazolamide for at least one week or (2) more than one month of acetazolamide with a cumulative dosage of more than 45 grams 'Maximally-tolerated dose' is defined as dosage was reached where dosage could not be increased further either because of side effects or because a daily total dosage of 4 grams per day was reached.
• If individual discontinued acetazolamide in the past due to side effects, individual is only eligible if investigator believes that the individual is likely to tolerate acetazolamide, as it will be prescribed in the study.
• Treatment of IIH within the past 3 months with either (1) the maximally tolerated dosage of methazolamide for at least one week or (2) more than one month of methazolamide with a cumulative dosage of more than 4.5 grams 'Maximally-tolerated dose' is defined as dosage was reached where dosage could not be increased further either because of side effects or because a daily total dosage of 400 mg per day was reached.
• Treatment with topiramate within two months and average cumulative dosage for the preceding month of more than 700 mg per week
• Previous surgery for IIH, including ONSF, CSF shunting, subtemporal decompression, or venous sinus stenting; gastric surgery for obesity is allowed
• Abnormalities on neurologic examination except for papilledema and its related visual loss or cranial nerve VI to VII paresis; if other abnormalities are present, the patient will need to be discussed with the Study Director (SD) for study entry.
• Abnormal CT or MRI scan (intracranial mass, hydrocephalus, dural sinus thrombus, or arteriovenous malformation) other than findings known to occur with increased intracranial pressure. Abnormalities on MRI that are not known to cause increased intracranial pressure are acceptable.
• Abnormal CSF contents: increased cells: > 8 cells; elevated protein: > 45 mg%; low glucose: < 30 mg% (If the lumbar puncture produces a cell count compatible with a traumatic needle insertion, the patient does not need to be excluded if the CSF white blood cell count (WBC) after correction is 8 cells/mm3 or less - see Manual of Procedures (MOP) for calculation. If > 8 cells or > 45mg% in CSF protein are documented in the CSF or calculated after conversion from a traumatic lumbar puncture, the patient can be discussed with the Study Director for possible inclusion.)
• Abnormal blood work-up indicating a medical or systemic condition associated with raised intracranial pressure
• Diabetes mellitus with diabetic retinopathy
• Ingestion of a drug or substance, or presence of a disorder, that has been associated with increased intracranial pressure within 2 months of diagnosis, such as lithium, vitamin A related products (e.g., Retin-A), or various cyclines (see MOP for conditions and drugs)
• Laboratory test results showing severe anemia, leukopenia or thrombocytopenia, renal failure, or hepatic disease, based on the Site Investigator's judgment
• Other condition requiring continued use of oral, I.V. or injectable steroids (nasal, inhaled, or topical steroids are allowed since the systemic effects are small). Patients with a condition that resulted in recent or current use of steroids but may be safely tapered off will be handled on a case-by-case basis after discussion with Study Director/co-Director. See Manual of Procedures (MOP) for details.
• Presence of a medical condition that would contraindicate use of acetazolamide or furosemide or significantly increase surgical risk
• Pregnancy or unwillingness for a subject of childbearing potential to use contraception during the first 6 months of the study Women of childbearing potential must use an acceptable form of birth control during the first 6 months of the study. Acceptable forms include oral contraceptives, transdermal contraceptives, diaphragm, intrauterine devices (IUDs), condoms with spermicide, documented surgical sterilization of either the subject or their partner, or abstinence.
• Presence of a physical, mental, or social condition likely to affect follow-up (drug addiction, terminal illness, no telephone, homeless)
• Anticipation of a move from the site area within six months and unwillingness to return for follow-up at a SIGHT study site
• Allergy to pupil dilating drops or narrow angles precluding safe dilation
• Presence of a condition that contraindicates general anesthesia
• Participation in an investigational trial within 30 days of enrollment that involved treatment with any systemic drug therapy or therapy that affects the eligible eye(s)
• Eye Level Exclusion Criteria Exclusion
• Intraocular pressure currently >28 mm Hg or >30 mm Hg at any time in the past
• Refractive error of more than -6.00 or more than +6.00 sphere or more than 3.00 cylinder with the following exceptions:
• Eyes with more than 6.00 D of myopia but less than 8.00 D of myopia are eligible if: 1) there are no abnormalities on ophthalmoscopy related to myopia that are associated with visual loss (such as staphyloma, retinal thinning in the posterior pole, or more than mild optic disc tilt), and 2) the individual will wear a contact lens for all perimetry examinations with the appropriate correction.

Where it is running

• University of Southern California — Los Angeles, California, United States
• NeuroEyeOrbit Institute — Los Angeles, California, United States
• Stanford University — Palo Alto, California, United States
• University of Colorado - Anschutz Medical Campus — Aurora, Colorado, United States
• The Eye Care Group — Orange, Connecticut, United States
• University of Miami — Miami, Florida, United States
• Northwestern Medicine — Chicago, Illinois, United States
• University of Illinois at Chicago — Chicago, Illinois, United States
• University of Iowa — Iowa City, Iowa, United States
• University of Kansas School of Medicine — Prairie Village, Kansas, United States
• University of Kentucky — Lexington, Kentucky, United States
• Johns Hopkins University School of Medicine — Baltimore, Maryland, United States
• Bethesda Neurology, LLC — North Bethesda, Maryland, United States
• Brigham and Women's Hospital — Boston, Massachusetts, United States
• University of Minnesota — Minneapolis, Minnesota, United States
• Mayo Clinic — Rochester, Minnesota, United States
• Washington University in St. Louis — St Louis, Missouri, United States
• Saint Louis University — St Louis, Missouri, United States
• University of Nebraska Medical Center — Omaha, Nebraska, United States
• State University of New York at Stony Brook — East Setauket, New York, United States
• New York Eye & Ear Infirmary of Mount Sinai — New York, New York, United States
• New York University School of Medicine — New York, New York, United States
• University of Rochester — Rochester, New York, United States
• Ohio Neuro-Ophthalmology, Orbital Disease and Oculoplastics — Columbus, Ohio, United States
• Dean McGee Eye Institute — Oklahoma City, Oklahoma, United States

Full record on ClinicalTrials.gov

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