Copenhagen Head Injury Ciclosporin Study: A Phase IIa Safety, Pharmacokinetics, and Biomarker Study of Ciclosporin in Severe Traumatic Brain Injury Patients

Research output: Contribution to journalArticle

Abstract

Traumatic brain injury (TBI) contributes to almost one third of all trauma-related deaths, and those that survive often suffer from long-term physical and cognitive deficits. Ciclosporin (cyclosporine, cyclosporin A) has shown promising neuroprotective properties in pre-clinical TBI models. The Copenhagen Head Injury Ciclosporin (CHIC) study was initiated to establish the safety profile and pharmacokinetics of ciclosporin in patients with severe TBI, using a novel parenteral lipid emulsion formulation. Exploratory pharmacodynamic study measures included microdialysis in brain parenchyma and protein biomarkers of brain injury in the cerebrospinal fluid (CSF). Sixteen adult patients with severe TBI (Glasgow Coma Scale 4-8) were included, and all patients received an initial loading dose of 2.5 mg/kg followed by a continuous infusion for 5 days. The first 10 patients received an infusion dosage of 5 mg/kg/day whereas the subsequent 6 patients received 10 mg/kg/day. No mortality was registered within the study duration, and the distribution of adverse events was similar between the two treatment groups. Pharmacokinetic analysis of CSF confirmed dose-dependent brain exposure. Between- and within-patient variability in blood concentrations was limited, whereas CSF concentrations were more variable. The four biomarkers, glial fibrillary acidic protein, neurofilament light, tau, and ubiquitin carboxy-terminal hydrolase L1, showed consistent trends to decrease during the 5-day treatment period, whereas the samples taken on the days after the treatment period showed higher values in the majority of patients. In conclusion, ciclosporin, as administered in this study, is safe and well tolerated. The study confirmed that ciclosporin is able to pass the blood-brain barrier in a TBI population and provided an initial biomarker-based signal of efficacy.

Details

Authors
Organisations
External organisations
  • Copenhagen University Hospital
  • NeuroVive Pharmaceutical AB
  • Odense University Hospital
  • University of Florida
  • Sanford Medical Center, Fargo
  • The Children's Hospital of Philadelphia
  • University of Pennsylvania
  • Malcom Randall Veterans Affairs Medical Center
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Neurology
  • Pharmaceutical Sciences

Keywords

  • biomarkers, ciclosporin, NeuroSTAT, pharmacokinetics, traumatic brain injury
Original languageEnglish
Pages (from-to)3253-3263
Number of pages11
JournalJournal of Neurotrauma
Volume36
Issue number23
Publication statusPublished - 2019
Publication categoryResearch
Peer-reviewedYes