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PreeclampsiaPhase 2CRUSHNCT04725812

Complement Regulation to Undo Systemic Harm in Preeclampsia

A Phase 2 study testing Eculizumab in people with Preeclampsia and Severe Preeclampsia, run by Cedars-Sinai Medical Center at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This is a Phase II, single arm, open-label study to determine if treatment with eculizumab prolongs pregnancy compared to historical controls in women with preeclampsia between 23-30 weeks gestation. Read more about this study

Who is it for?
Ages 13 years and older, women only
Conditions the study is for
Preeclampsia, Severe Preeclampsia, Eculizumab
What is being tested?
Eculizumab
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
2 participants
Where
1 siteUnited States
Study dates
13 Sep 2021to 7 Dec 2021
Phase
Phase 2
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 13 years and older
  • Women only
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Provision of signed and dated informed consent form
  • Stated willingness to comply with all study procedures \& availability for study duration
  • Biologically female, aged ≥13, body weight ≥40kg
  • Diagnosed with preeclampsia between 23-29+6/7 weeks gestation, by following criteria:
  • Blood pressure ≥160 mmHg systolic or ≥110 mmHg diastolic OR
  • Blood pressure ≥140 mmHg systolic or ≥90 mmHg diastolic and at least one of the following
Show all 9Show fewer
  • Proteinuria (spot protein/creatinine ≥0.3mg/mg or 24Hr protein ≥300 mg) ii. Platelet count <100,000/μl iii. Aspartate or alanine transaminase >2x upper limit of normal iv. Creatinine >1.1 mg/dl or oliguria v. Pulmonary edema
  • Ability to take intravenous medication and be willing to adhere to the eculizumab regimen
  • Ability to receive meningococcal vaccine and be willing to adhere to antibiotic regimen

Who cannot join

  • An individual who meets any of the following criteria prior to enrollment will be excluded from participation in this study:
  • Known allergic reactions eculizumab or meningococcal vaccine
  • Febrile illness within prior 2 weeks
  • Treatment with another investigational drug within previous 6 months
  • Inpatient expectant management for preeclampsia >72 hours prior to enrollment
  • Fetal contraindication to expectant management of pregnancy
Show all 42Show fewer
  • Platelet count <50,000/μl
  • Diagnosis of hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome
  • Must meet all of the following criteria to be excluded: LDH >600 U/L, platelet count < 100,000/μl, AST >2x upper limit of normal, ALT >2x upper limit of normal
  • Diagnosis of Eclampsia
  • Diagnosis of Placental abruption
  • Intrauterine fetal demise
  • Coagulopathy (INR ≥ 1.5)
  • Fibrinogen <200 mg/dl
  • Persistent, severe headache unresponsive to medications
  • Persistent, severe visual disturbances
  • Persistent, severe epigastric or RUQ pain unresponsive to medications
  • Diagnosis of Systemic lupus erythematosus
  • Diagnosis of Anti-phospholipid antibody syndrome
  • Diagnosis of Atypical hemolytic uremic syndrome
  • Diagnosis of Paroxysmal nocturnal hemoglobinuria
  • Known complement deficiency
  • Diagnosis of Venous thromboembolism active or within 6 months of enrollment
  • Diagnosis of Human immunodeficiency virus (HIV)
  • Diagnosis of Hepatitis C virus (active viremia)
  • Diagnosis of Cancer (not in remission)
  • History of Solid organ transplant
  • Systemic viral or bacterial infection (active, untreated)
  • Active use of eculizumab at time of enrollment
  • Contraindication to eculizumab treatment or complement system blockade
  • Contraindication to meningococcal vaccine
  • Body weight <40kg
  • Age <13
  • Neutropenia (<1500/mm3)
  • Gonorrhea, chlamydia, or syphilis in current pregnancy
  • Illicit substance use in current pregnancy
  • Currently homeless or incarcerated
  • Alcoholism
  • Liver cirrhosis
  • Insulin dependent diabetes
  • Active use of immunosuppressive therapies, other than use of corticosteroids for fetal lung maturity
  • Use of prophylactic or therapeutic heparin, or low molecular weight heparin, in pregnancy for hypercoagulable condition

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Cedars-Sinai Medical Center

    Los Angeles, California, 90048

Other trials in United States

About this study

Official title: Complement Regulation to Undo Systemic Harm in Preeclampsia: The CRUSH Study

This is a Phase II, single arm, open-label study to determine if treatment with eculizumab prolongs pregnancy compared to historical controls in women with preeclampsia between 23-30 weeks gestation.

Read the detailed description

The purpose of this study is to determine if eculizumab is an effective treatment to prolong pregnancy in women with preeclampsia, compared to a historical control group of women that received standard of care alone. Eligible subjects will be women with preeclampsia before 30 weeks gestation, who have been deemed suitable for prolongation of pregnancy.

The primary research procedure is administration of the study drug, eculizumab, by intravenous infusions weekly for four weeks, then every other week. Eculizumab is approved by the FDA for the treatment of women with atypical hemolytic uremic syndrome and paroxysmal nocturnal hemoglobinuria and is frequently used in pregnant women with these disorders. However, eculizumab is considered investigational in this study because it has not been approved by the FDA for use in patients with preeclampsia. Subject participation will last approximately 8-12 weeks on average, and the study drug will be continued until 48 hours after delivery in the treatment arm. All subjects will be followed at 2 weeks and 6 weeks after delivery to assess maternal and neonatal outcomes. A later visit may be required to complete the meningococcal vaccine schedule.

The investigators believe that eculizumab will prolong pregnancy in women with preeclampsia diagnosed before 30 weeks gestation with overactive complement. As there is no effective treatment for preeclampsia other than delivery currently, women with preeclampsia before 30 weeks gestation are managed using a "watch and wait" approach (i.e., expectant management). Due to the unpredictable nature of preeclampsia, expectant management places mother and child at significant risk until delivery occurs. Eculizumab may be an improvement over current standard of care as it provides a treatment option for patients who would otherwise be managed with expectant management alone. If the study aims are achieved, eculizumab will emerge as an effective treatment option for women with preeclampsia.

Being tested
Eculizumab
Medical subject headings
Pre-Eclampsia, HELLP Syndrome

What participants receive

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

  • EculizumabDrug

    Also called Soliris

    Eculizumab Intravenous Solution

Study groups in NCT04725812
Study groupRoleWhat they receive
EculizumabExperimentalTwelve subjects in the interventional arm will receive eculizumab at an induction dose of 900mg IV weekly (q7 days) for 4 weeks followed by a dose of 1200mg IV at week 5. Thereafter, patients will receive a maintenance dose of 1200mg IV every two weeks (q14 days). The last dose of eculizumab will be given up to 48 hours post-partum, with a dose that is dependent on the dosing schedule (i.e. whether the last dose is given within the 4-week induction period or is during the maintenance phase).
Receives: Drug: Eculizumab

What is being measured

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

  1. Latency (in Days) From Enrollment to Delivery

    The difference in mean number of days (latency) from enrollment in the study (or hospital admission for controls) to delivery between participant receiving eculizumab compared to historical controls.

    • For treatment-arm participants latency is determined from enrollment to delivery.
    • For historical controls latency is determined from hospital admission (or initial diagnosis for controls hospitalized for other indication) for preeclampsia until delivery.
    • Subjects and historical controls all defined as women with preeclampsia between 23-30 weeks gestation.

    Measured: 24 months

Secondary outcomes (16)
  1. Composite Adverse Maternal Outcomes

    The difference in the composite number of adverse maternal outcomes between subjects receiving eculizumab compared to historical controls

    •Adverse maternal outcomes directly attributed to preeclampsia defined as the following: syndrome of hemolysis, elevated liver enzyme, and low platelet count (HELLP), eclampsia, placental abruption, stroke, venous thrombosis or pulmonary embolism, pulmonary edema, posterior reversible encephalopathy syndrome, postpartum hemorrhage (>1000 cc), blood transfusion, admission to the intensive care unit, acute kidney injury, acute tubular necrosis, dialysis, or death

    Measured: 24 months

  2. Composite Adverse Neonatal Outcomes

    The difference in the composite number of adverse neonatal outcomes between subjects receiving eculizumab compared to historical controls.

    •Adverse neonatal outcomes directly attributable to preeclampsia or indirectly attributable due to preterm delivery due to preeclampsia defined as the following: Respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, seizure, hypoxic-ischemic encephalopathy, metabolic acidosis, infection, sepsis, previously unrecognized major malformation detected at birth, patent ductus arteriosus requiring indomethacin, or death.

    Measured: 24 months

  3. Changes in Blood and Urine Concentrations of Terminal Complement Protein C5a Before and After Each Treatment.

    The Difference in the concentration of C5a in blood and urine, before treatment ( ex. visit day 1) compared to after treatment in each participant receiving eculizumab.

    •Concentrations of C5a in blood and urine will be determined by enzyme linked immunosorbent assays (ELISA).

    Measured: 24 months

  4. Changes in Blood and Urine Concentrations of Terminal Complement Protein C5b-9 Before and After Each Treatment.

    The difference in blood and urine concentrations of C5b-9, before treatment ( ex. visit day 1) compared to after treatment in each participant receiving eculizumab.

    Measured: 24 months

  5. Changes in Blood and Urine Concentrations of Complement Protein CD59 Before and After Each Treatment.

    The difference in blood and urine concentrations of CD59, before treatment ( ex. visit day 1) compared to after treatment in each participant receiving eculizumab.

    Measured: 24 months

  6. Aspartate and Alanine Transaminase Concentration Before and After Each Treatment.

    Differences in the concentration of aspartate and alanine transaminase (U/L) will be compared before treatment (ex. visit day 1) and after treatment in each participant receiving eculizumab.

    Measured: 24 months

  7. Hemoglobin Concentration Before and After Each Treatment.

    Differences in the concentrations of measures of hemoglobin will be compared before treatment (ex. visit day 1) and after treatment in each participant receiving eculizumab.

    Measured: 24 months

  8. Platelet Count Before and After Each Treatment.

    Differences in the platelet count will be compared before treatment (ex. visit day 1) and after treatment in each participant receiving eculizumab.

    Measured: 24 months

  9. Lactate Dehydrogenase Concentration Before and After Each Treatment.

    Differences in the concentration of serum lactate dehydrogenase will be compared before treatment (ex. visit day 1) and after treatment in each participant receiving eculizumab.

    Measured: 24 months

  10. Serum Creatinine Before and After Each Treatment.

    Differences in the concentration of serum creatinine will be compared before treatment (ex. visit day 1) and after treatment in each participant receiving eculizumab.

    Measured: 24 months

  11. Urine Protein Concentration Before and After Each Treatment.

    Differences in urine protein concentration will be compared before treatment (ex. visit day 1) and after treatment in each participant receiving eculizumab.

    Measured: 24 months

  12. Ratio of Urine Protein to Urine Creatinine Before and After Each Treatment.

    Differences in the ratio of urine protein concentration to urine creatinine concentration will be compared before treatment (ex. visit day 1) and after treatment in each participant receiving eculizumab.

    Measured: 24 months

  13. Serum Concentration of Soluble Fms-like Tyrosine Kinase 1 (sFlt-1) Before and After Each Treatment.

    Differences in the concentration of soluble fms-like tyrosine kinase 1 (sFlt-1) will be compared before treatment (ex. visit day 1) and after treatment in each participant receiving eculizumab.

    Measured: 24 months

  14. Serum Concentration of Placental Growth Factor (PlGF) Before and After Each Treatment.

    Differences in the concentration of placental growth factor (PlGF) will be compared before treatment (ex. visit day 1) and after treatment in each participant receiving eculizumab.

    Measured: 24 months

  15. Serum Ratio of Soluble Fms-like Tyrosine Kinase 1 (sFlt-1) Concentration to Placental Growth Factor (PlGF) Concentration (sFlt-1/PlGF) Before and After Each Treatment.

    Differences in the serum ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) concentration to placental growth factor (PlGF) concentration (sFlt-1/PlGF) will be compared before treatment (ex. visit day 1) and after treatment in each participant receiving eculizumab.

    Measured: 24 months

  16. Serious Adverse Events

    Assessment of serious adverse events in eculizumab treatment arm compared with historical controls.

    1. Neisseria meningitidis infection or development of invasive meningococcal disease, Neisseria gonorrhoeae, Neisseria sicca/subflava, and Neisseria spp unspecified and Aspergillus infections.
    2. Graded clinical and laboratory abnormalities, according to the U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of AIDS; DAIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1. [July 2017].

    Measured: 24 months

Timeline

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

  1. First posted27 Jan 2021
  2. Study start13 Sep 2021
  3. Primary completion7 Dec 2021
  4. Study completion7 Dec 2021

Why it stopped: PI moved institutions

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
Not applicable
Intervention model
Single group
Model description
Single arm open label study.
Masking
None (open label)
Enrolment
2 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04725812
Sponsor's protocol ID
STUDY00000039
Acronym
CRUSH
Status last verified
Nov 2023
First submitted
19 Jan 2021
Last updated
29 Nov 2023
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Eculizumab in people with Preeclampsia and Severe Preeclampsia, run by Cedars-Sinai Medical Center at 1 site in United States.

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 9 inclusion and 42 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: stopped early, as of the sponsor's last update on 29 Nov 2023. 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 States. 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 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?

Yes. Results are posted in the registry (first posted 29 Nov 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?

Latency (in Days) From Enrollment to Delivery (time frame: 24 months). 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 29 Nov 2023.

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