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Wilson DiseasePhase 3NCT03539952

Trientine Tetrahydrochloride (TETA 4HCL) for the Treatment of Wilson's Disease

A Phase 3 study testing Penicillamine (D1-W12), TETA 4HCL (W12-60) and Penicillamine (W12-W60) in people with Wilson Disease, run by Orphalan at 15 sites in 9 countries.

Completed

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

Official record
Search all trials

Trial summary

This is a multicenter, randomized, open-label study with an active standard-of-care comparator (penicillamine) Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Wilson Disease
What is being tested?
Penicillamine (D1-W12), TETA 4HCL (W12-60) and Penicillamine (W12-W60)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
77 participants
Where
15 sitesin 9 countries
Study dates
3 Sep 2018to 18 Jan 2022
Phase
Phase 3
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 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient is able to provide, and has provided, written informed consent
  • Written documentation has been obtained in accordance with the relevant country and local privacy requirements, where applicable, including: For US sites: Authorization for Use and Release of Health Research Study Information and for EU sites: Data Protection Consent
  • Male or female, aged ≥ 18 and ≤ 75 years of age at time of consent
  • Patient has a diagnosis of Wilson's disease, as defined by a prior or current Leipzig score of ≥ 4
  • Patient's Wilson's disease is clinically stable, in the opinion of the investigator, and being treated with penicillamine for at least 1 year (52 weeks) prior to the screening/enrolment visit
  • Patient is on a stable dose and regimen of penicillamine for at least 4 months (16 weeks) prior to the screening/enrolment visit (other prescribed treatments for Wilson's disease not permitted during this study)
Show all 23Show fewer
  • No anticipated need that patient will require additional pharmacological therapies other than study medication, including prescribed zinc therapy, for the management of copper levels during the study
  • Patient must be willing to maintain stable diet throughout the study, and avoid foods with high copper content, including the Penicillamine Baseline Period
  • Patient considered suitable to receive therapy with both TETA 4HCl and penicillamine administered twice a day
  • Negative central laboratory tests for HIV and viral hepatitis (results will be available after start of run-in period)
  • For female patients of childbearing potential, negative urine pregnancy test (at screening/enrolment visit and prior to randomization)
  • For females of childbearing potential, use of a reliable form of contraceptive
  • Patient is considered as able to complete study requirements and attend the study visits, in the opinion of the investigator
  • Additional inclusion criteria following receipt of Screening laboratory results
  • Patient is adequately controlled and tolerating penicillamine therapy as defined by fulfilment of all of the following: a. Serum non-ceruloplasmin bound copper (NCC) level between ≥ 25 and ≤ 150 μg/L* b. 24-hour urinary copper excretion of between ≥ 100 and ≤ 900 μg/24 hours* c. Alanine transaminase (ALT) < 2 times upper limit of normal* d. No other laboratory or clinical findings that would prevent continuation of maintenance therapy, in the opinion of the investigator
  • Based on results from screening/enrolment visit samples for which can be taken within ± 7 days of visit. Result should be within the assay limits of quantification for the sample. The ranges in μmol of copper are 0.40 to 2.38 μmol/L for NCC and 1.59 to 14.29 for 24-hour urinary copper excretion (using division by 63 of value in μg per Walshe, 2011). In the event that one or more of the above lab values fall outside the specified range, it can be repeated, including at the Week 4 and Week 8 visits.
  • Additional inclusion criteria at Week 12 visit (end of Penicillamine Baseline Period) and prior to randomization
  • Patient is adequately controlled and tolerating penicillamine therapy as defined by fulfilment of all of the following criteria:
  • Serum non-ceruloplasmin bound copper (NCC) level between ≥ 25 and ≤ 150 μg/L*
  • 24-hour urinary copper excretion of between ≥ 100 and ≤ 900 μg/24 hours**
  • Alanine transaminase (ALT) < 2 times upper limit of normal*
  • No other laboratory or clinical findings that would prevent continuation of maintenance therapy, in the opinion of the investigator
  • Based on lab values from Week 8 visit; ** Based on lab value from Week 4 visit as routinely not performed at Week 8 visit, however can also be based on value at Week 8 visit if a repeat (unscheduled) urinary copper excretion was performed at this visit. Result should be within the assay limits of quantification for the sample. The ranges in μmol of copper are 0.40 to 2.38 μmol/L for NCC and 1.59 to 14.29 for 24-hour urinary copper excretion (using division by 63 of value in μg per Walshe, 2011). In the event that one or more of the above lab values fall outside the specified range, it can be repeated. The repeat value(s) must be available prior to randomization at Week 12 and, if within specified range, the patient can continue to randomization. If a patient fails this additional criterion at the end of the Penicillamine Baseline Period, the patient can return to the start of the run-in period i.e. Day 1 (but only once). A negative urinary pregnancy test is also required prior to randomization for females of childbearing potential.

Who cannot join

  • Patient is in 'de-coppering' phase of treatment for Wilson's disease, in the opinion of the investigator
  • Patient evidence of uncontrolled liver disease, including but not limited to:
  • Modified Nazer score of > 4 (result may not be available until after start of run in period since based on lab results*)
  • decompensated cirrhosis
  • acute hemolytic anemia
  • acute hepatitis
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  • hepatic malignancy
  • evidence of acute liver failure
  • Cause of patient's liver disease is due to another condition, in the investigator's opinion
  • Patient has severe anemia defined as hemoglobin of ≤ 9 g/dL (result will be available after start of run-in period*)
  • Patient has experienced a gastrointestinal bleed within 6 months (24 weeks) prior to screening/enrolment visit
  • Patient has renal impairment defined as creatinine clearance of ≤ 30 mL/min (result may not be available until after start of run-in period*), or patient has nephritis or nephrotic syndrome, in the opinion of the investigator
  • Patient has neurological disease that prevents swallowing of study medication (e.g., requires a nasogastric feeding tube) or requires intensive in-patient medical care
  • Patient is currently taking medication containing trientine for management of Wilson's disease or has taken it within 4 months (16 weeks) of screening/enrolment visit
  • Patient is currently receiving prescribed zinc therapy for management of Wilson's disease or has taken it within 4 months (16 weeks) of screening/enrolment visit
  • Patient is taking any of the following concomitant therapies: gold therapy, antimalarial therapy, cytotoxic drugs, oxyphenbutazone, phenyl butazone
  • Patient has a known intolerance, allergy or sensitivity to penicillamine (that is uncontrolled) or to TETA 4HCl, including any component of the study medication
  • For female patients of childbearing potential, planning a pregnancy during study period or currently nursing
  • For female patients of childbearing potential, unable or unwilling to use a reliable form of contraceptive throughout the study
  • Patient is currently participating in another therapeutic study, or has previously participated in a therapeutic study within 30 days of screening/enrolment visit (or longer, if local requirements specify this)
  • Patient has any condition or in any situation which, in the investigator's opinion, puts the patient at significant risk, could confound study results, or may interfere significantly with the patient's participation in the study

Trial locations and contacts

15 sites in 9 countries.

15 sites in 9 countries

Brazil3 sites
  • Hospital Nossa Senhora das Graças (HNSG)

    Curitiba

  • Nucleo de Pesquisa e Desenvolvimento de Medicamentos - Universidade Federal do Ceará - Rodolfo Teófilo

    Fortaleza, 60430-275

  • Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

    São Paulo

Other trials in Brazil

France2 sites
  • Hospital mother children

    Bron, 69677

  • Centre National de Référence Wilson, Hôpital Lariboisière

    Paris, 75475

Other trials in France

Germany2 sites
  • Innere Medizin

    Heidelberg, 69120

  • Poliklinik Hepatologie/Transplantationsambulanz

    Munich, 81377

Other trials in Germany

Italy2 sites
  • A.O. San Paolo Milano

    Milan, 20142

  • DiSCOG Gastroenterology Unit

    Padova, 35128

Other trials in Italy

United Kingdom2 sites
  • University of Surrey, Department of Clinical and Experimental Medicine

    Guildford, Surrey, GU2 7XH

  • Leeds Teaching Hospitals NHS Trust

    Leeds, LS9 7TF

Other trials in United Kingdom

United States1 site
  • Yale University School of Medicine

    New Haven, Connecticut, 06510

Other trials in United States

Belgium1 site
  • KU Leuven, Department of Clinical and Experimental Medicine

    Leuven

Other trials in Belgium

Denmark1 site
  • Hepato-gastroenterologisk afd

    Aarhus

Other trials in Denmark

Poland1 site
  • Institute of Psychiatry and Neurology

    Warsaw, 02 957

Other trials in Poland

About this study

Official title: CHELATE STUDY: Trientine Tetrahydrochloride (TETA 4HCL) for the Treatment of Wilson's Disease

This is a multicenter, randomized, open-label study with an active standard-of-care comparator (penicillamine)

Read the detailed description

This is a multicenter, randomized, open label study with an active standard-of-care comparator.

Stable patients who are already considered to be stable on their standard-of-care penicillamine chelation therapy for at least 1 year will enroll in the study and enter a 12-week Penicillamine Baseline Period comprising of 1 month (4 weeks) run-in period followed by a 2 month (8 weeks) evaluation period. During this time all patients will continue to take their current penicillamine under study conditions. At the end of the Penicillamine Baseline Period, patients who fulfill the protocol definition of being adequately controlled and tolerating penicillamine will be randomized in a 1:1 ratio to receive either TETA 4HCl or to continue to receive penicillamine. There is then a 24-week Post-randomization Phase comprising of a 1 month (4 weeks) run-in period for both treatment arms and a 5 month (20 weeks) evaluation period.

Patients who successfully complete the 24-week Post-randomization Phase of the study will have the opportunity to enter an Extension Phase. In the first version of the clinical trial protocol, the intention was to have an 18 month (72 weeks) Extension Phase. During the first 24 weeks of the Extension Phase, subjects would continue receiving their allocated TETA 4HCl or penicillamine (i.e., up to Week 60 of the study). Thereafter all patients were receiving TETA 4HCl for a further 48 weeks (i.e., from Week 60 to Week 108). Study clinic visits occur were scheduled every 6 months in the Extension Phase.

With the final version of the protocol, the Extension Phase stopped at Week 60. Patients who already passed the Week 60 visit were allowed to end the study at the next planned visit.

As a consequece end of treatment varied Week 60 and Week 108

Conditions
Wilson Disease
Being tested
Penicillamine (D1-W12), TETA 4HCL (W12-60), Penicillamine (W12-W60), TETA 4HCL (60-<W108)
Medical subject headings
Hepatolenticular Degeneration

What participants receive

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

  • Penicillamine (D1-W12)Drug

    Also called D-penicillamine

    Penicillamine during baseline period (D1-W12)

  • TETA 4HCL (W12-60)Drug

    Also called trientine tetrahydrochloride

    TETA 4HCL during post randomisation and 1st extension period (W12-W60)

  • Penicillamine (W12-W60)Drug

    Also called D-Penicillamine

    Penicillamine during rondomisation and 1st extension period period (W12-W60)

  • TETA 4HCL (60-<W108)Drug

    Also called trientine tetrahydrochloride

    TETA 4HCL during 2nd extension period (W60-<W108)

Study groups in NCT03539952
Study groupRoleWhat they receive
Penicillamine armActive comparatorPatients randomized to penicillamine during the postrandomisation and 1st extension period
Receives: Drug: Penicillamine (D1-W12); Drug: Penicillamine (W12-W60); Drug: TETA 4HCL (60-<W108)
Trientine armExperimentalPatients randomized to TETA 4HCl during the postrandomisation and 1st extension period
Receives: Drug: Penicillamine (D1-W12); Drug: TETA 4HCL (W12-60); Drug: TETA 4HCL (60-<W108)

What is being measured

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

  1. Serum NCC Concentration

    The primary outcome of efficacy was serum NCC by speciation assay (μg/L), with comparative analysis of mean difference between the two groups 24 weeks after randomization. The non-inferiority margin was set at -50 μg/L.

    Measured: Week 36

Secondary outcomes (2)
  1. 24-hour Urinary Copper Excretion (UCE)

    24-hour urinary copper excretion (μg/ 24 hr) from urine collected by the patient over a 24-hour period.

    Measured: Week 36

  2. Clinical Global Impression of Change (CGIC) Rating Scale

    The clinician will rate the change in the patient's Wilson's disease relative to the prior study clinic visit using a 7-point scale to a specific statement: 'Please rate the change in the overall severity of the patients Wilson's disease compared to the previous study clinic visit".

    Available options were (1) very much improved; (2) much improved; (3) minimally improved; (4) no change; (5) minimally worse; (6), much worse; or (7) very much worse.

    Measured: Week 36

Timeline

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

  1. First posted30 May 2018
  2. Study start3 Sep 2018
  3. Primary completion19 Aug 2020
  4. Study completion18 Jan 2022

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
77 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03539952
Sponsor's protocol ID
GMPO-131-002
Status last verified
Jun 2025
First submitted
4 May 2018
Last updated
2 Jul 2025
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Schilsky ML, Czlonkowska A, Zuin M, Cassiman D, Twardowschy C, Poujois A, Gondim FAA, Denk G, Cury RG, Ott P, Moore J, Ala A, D'Inca R, Couchonnal-Bedoya E, D'Hollander K, Dubois N, Kamlin COF, Weiss KH; CHELATE trial investigators. Trientine tetrahydrochloride versus penicillamine for maintenance therapy in Wilson disease (CHELATE): a randomised, open-label, non-inferiority, phase 3 trial. Lancet Gastroenterol Hepatol. 2022 Dec;7(12):1092-1102. doi: 10.1016/S2468-1253(22)00270-9. Epub 2022 Sep 30.

    PubMed 36183738
  • Ott P, Sandahl T, Ala A, Cassiman D, Couchonnal-Bedoya E, Cury RG, Czlonkowska A, Denk G, D'Inca R, de Assis Aquino Gondim F, Moore J, Poujois A, Twardowschy CA, Weiss KH, Zuin M, Kamlin COF, Schilsky ML. Evaluation of novel assays of non-ceruloplasmin copper to monitor chelation treatment in patients with Wilson disease. JHEP Rep. 2026 Jun;8(6):101822. doi: 10.1016/j.jhepr.2026.101822. Epub 2026 Mar 12.

    PubMed 41831608
  • Ott P, Sandahl T, Ala A, Cassiman D, Couchonnal-Bedoya E, Cury RG, Czlonkowska A, Denk G, D'Inca R, de Assis Aquino Gondim F, Moore J, Poujois A, Twardowschy CA, Weiss KH, Zuin M, Kamlin COF, Schilsky ML. Non-ceruloplasmin copper and urinary copper in clinically stable Wilson disease: Alignment with recommended targets. JHEP Rep. 2024 May 6;6(8):101115. doi: 10.1016/j.jhepr.2024.101115. eCollection 2024 Aug.

    PubMed 39139457

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Penicillamine (D1-W12), TETA 4HCL (W12-60) and Penicillamine (W12-W60) in people with Wilson Disease, run by Orphalan at 15 sites in 9 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 23 inclusion and 21 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 2 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 15 sites in Brazil, France, Germany, Italy, United Kingdom and 4 more countries. 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.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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

Are results available for this study?

Yes. Results are posted in the registry (first posted 20 Apr 2023). 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?

Serum NCC Concentration (time frame: Week 36). 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 NCT03539952, which also lists 3 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 2 Jul 2025.

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