Traumatic Brain Injury Clinical Trial
Official title:
Sildenafil for the Treatment of Cerebrovascular Dysfunction During the Chronic Stage After Traumatic Brain Injury.
The purpose of this study is to determine whether sildenafil (Viagra®) is effective in improving cerebral blood flow and cerebrovascular reactivity inpatients who have persistent symptoms at least 6 months after a traumatic brain injury (TBI).
The goal of this Phase II study is to generate pilot data that will allow for the design of
a clinical trial of sildenafil (Viagra®) to treat patients with traumatic vascular injury in
the chronic state after traumatic brain injury (TBI). Injury to small and medium-sized blood
cerebral blood vessels is a well-recognized consequence of traumatic brain injury (TBI).
Non-invasive imaging with positron emission tomography (PET) and single photon emission
computerized tomography (SPECT) have long demonstrated deficits in cerebral blood flow in
TBI, including in symptomatic patients years after mild TBI (mTBI). Recently, magnetic
resonance imaging (MRI) methods have been developed which allow reliable and non-invasive
measurement of cerebrovascular reactivity (CVR) to vasodilatory stimuli such as hypercapnia
in humans. These techniques have never been applied to symptomatic patients in the chronic
stage after mTBI. These methods are particularly promising due to the recent discovery that
phosphodiesterase-5 (PDE5) inhibitors improve cerebral blood flow, induce angiogenesis and
neurogenesis, and improve functional recovery in animals after experimental stroke and
cryoinjury. This pilot study will use novel MRI methods (Blood Oxygen Level Dependent (BOLD)
response to hypercapnia) to noninvasively measure cerebrovascular reactivity in the chronic
stage after TBI, and the first to use sildenafil in patients with chronic TBI.
The study has one primary objective and 10 secondary objectives:
Primary objective:
1. Single dose treatment with sildenafil (50 mg orally) is effective in increasing the
global BOLD response to hypercapnia in symptomatic patients in the chronic stage after
TBI.
Secondary objective (Safety and Tolerability):
2. Sildenafil therapy (25 mg orally twice daily) is well tolerated in symptomatic patients
in the chronic stage after TBI, with few adverse effects and treatment discontinuations
in less than 10% of patients.
Tertiary (Exploratory) objectives:
3. Single dose treatment with sildenafil (50 mg orally) is effective in increasing the
regional BOLD response to hypercapnia in symptomatic patients in the chronic stage
after TBI.
4. Patients with persistent symptoms in the chronic stage after TBI have deficits in
cerebrovascular reactivity compared to uninjured healthy controls.
5. Patients with persistent symptoms in the chronic stage after TBI have deficits in
cerebrovascular reactivity compared to asymptomatic patients after TBI.
6. Patients with persistent symptoms in the chronic stage after TBI have reduced numbers
of circulating EPCs compared to uninjured healthy controls.
7. Patients with persistent symptoms in the chronic stage after TBI have reduced numbers
of circulating EPCs compared to asymptomatic patients after TBI.
8. The effect on cerebrovascular reactivity of single dose treatment with sildenafil
persists after 8 weeks of chronic therapy (25 mg orally, twice daily).
9. Treatment with sildenafil for 8 weeks (25 mg orally twice daily) increases the number
of circulating endothelial progenitor cells (EPCs) in symptomatic chronic TBI patients.
10. Treatment with sildenafil for 8 weeks (25 mg orally twice daily) reduces the prevalence
of post-concussive symptoms, compared to placebo treatment.
11. Treatment with sildenafil for 8 weeks (25 mg orally twice daily) improves performance
in neuropsychometric tests, compared to placebo treatment.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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