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| ID | Type | Description | Link |
|---|---|---|---|
| 2018-000201-24 | EudraCT Number | ||
| 2018-000201-24 | Other Identifier | Registro Español de Ensayos Clínicos (REec) | |
| PIFUN44/17 | Other Grant/Funding Number | Fundación Canaria de Investigación Sanitaria (FUNCANIS) |
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Very low recruitment. During COVID-19 pandemic these are patients of high risk.
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| Name | Class |
|---|---|
| Servicio Canario de Salud | OTHER |
| Red de Investigación en Servicios de Salud en Enfermedades Crónicas | OTHER |
| Fundación Canaria Instituto de Investigación Sanitaria de Canarias | OTHER |
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The main objective of this clinical trial is to evaluate the effectiveness and cost-effectiveness of adding ozone therapy to standard management of patients with advanced ischemic heart disease refractory to medical and surgical treatment.
This study will evaluate the potential role of ozone therapy added to the standard management of patients with symptomatic refractory ischemic heart disease, III-IV functional class of the classification of the New York Heart Association (NYHA).
MAIN OBJECTIVES: 1) to evaluate clinical effect and quality of life related to health (HRQOL) of adding O3 to the standard treatment of these patients. 2) to estimate the additional costs of adding O3 to the standard treatment and to evaluate the cost-effectiveness ratio.
SECONDARY OBJECTIVES: 3) To evaluate the evolution of a) biochemical parameters; b) cardiovascular parameters; c) toxicity of O3. 4) Develop and evaluate the acceptability of a shared decision-making (SDM) tool between professionals and patients.
METHODOLOGY: Phase II-III clinical trial, randomized, triple-blind. Sample size: 18 patients.
TREATMENT: All patients will receive their standard treatment + 40 sessions of rectal insufflation:
Main Variables: 1) changes in the self-perceived quality of life (Minnesota scale). 2) Direct costs.
Secondary Variables: 1) biochemical parameters; 2) Cardiovascular parameters; 3) Side effects. 4) acceptability of patients to a shared decision-making (SDM) tool.
Length of treatment: 16 weeks.
Follow-up: 16 weeks after completion of O3.
Assessments: 1) Pre-O3 (basal), 2) pos-O3 (end of O3), 3) 4 months pos-O3.
Planned length of clinical trial: 36 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ozone Group: | Experimental | Standard treatment + Ozone therapy (O3/O2) |
|
| Control Group: | Placebo Comparator | Standard treatment + Oxygen (O2) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ozone | Drug | Ozone Group: Standard treatment + Ozone therapy (O3/O2) by rectal insufflation. O3/O2 concentration progressively increased from 10 to 30 µg/ml; 40 sessions in 16 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of Life (QoL) measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) (at the end of ozone therapy) | Self-reported evaluation of 21 physical, emotional and socioeconomic ways heart failure can adversely affect a patient's life. Each item is scored from 0 (no affected) to 5 (very much affected). Total range from 0 (best) to 105 (worst) | 16 weeks |
| Direct Hospital Cost (at the end of ozone therapy) | The direct expenses incurred by the hospital in providing services (medication, tests, medical visits...) during the 16 weeks of ozone therapy (in euros). | 16 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Change from Baseline in quality of life by the "5-level, 5-dimension EuroQol" (EQ-5D-5L) questionnaire (at the end of ozone therapy) | Self-reported evaluation of: a) 5 physical and emotional items scored in five levels, from 1 (best: I have no problem) to 5 (worst: I have extreme problem or I am unable to…) and b) additional self-assessment of health by a visual analogue scale (0 = worst health patient can imagine, 100 = best health patient can imagine) |
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Inclusion Criteria:
Exclusion Criteria:
Uncontrolled cancer disease or severe active systemic infection or HIV.
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| Name | Affiliation | Role |
|---|---|---|
| Bernardino Clavo, MD, PhD | Dr. Negrín University Hospital, Las Palmas, Spain | Study Chair |
| Pedro G Serrano-Aguilar, MD, PhD | Servicio de Evaluación. Servicio Canario de Salud. Spain | Study Director |
| Renata Linertová, PhD | Servicio de Evaluación. Servicio Canario de Salud. Spain | Principal Investigator |
| Bernardino Clavo, MD, PhD | Dr. Negrín University Hospital, Las Palmas, Spain | Principal Investigator |
| Celestina Amador, MD, PhD | Dr. Negrín University Hospital, Las Palmas, Spain | Principal Investigator |
| Francisco Rodríguez-Esparragón, BSc, PhD | Dr. Negrín University Hospital, Las Palmas, Spain | Principal Investigator |
| Norberto Santana-Rodríguez, MD, PhD | King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Dr. Negrin University Hospital | Las Palmas de Gran Canaria | Las Palmas | 35019 | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28097518 | Background | Buyuklu M, Kandemir FM, Set T, Bakirci EM, Degirmenci H, Hamur H, Topal E, Kucukler S, Turkmen K. Beneficial Effects of Ozone Therapy on Oxidative Stress, Cardiac Functions and Clinical Findings in Patients with Heart Failure Reduced Ejection Fraction. Cardiovasc Toxicol. 2017 Oct;17(4):426-433. doi: 10.1007/s12012-017-9400-8. | |
| 19260079 |
| Label | URL |
|---|---|
| EU Clinical Trials Register (European Union Clinical Trials Register) | View source |
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| ID | Term |
|---|---|
| D017202 | Myocardial Ischemia |
| D006333 | Heart Failure |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |
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| ID | Term |
|---|---|
| D010126 | Ozone |
| D010100 | Oxygen |
| ID | Term |
|---|---|
| D005740 | Gases |
| D007287 | Inorganic Chemicals |
| D018011 | Chalcogens |
| D004602 | Elements |
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| Colegio Oficial de Médicos de Las Palmas | UNKNOWN |
| Fundación MAPFRE Guanarteme | UNKNOWN |
Standard treatment + ozone therapy (O3/O2) versus Standard treatment + oxygen (O2) as placebo
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Masking of: patients, cardiologist and cardiac surgeons (clinical assessment), investigators obtaining other parameters (quality of life, biochemical and clinical parameters), investigators for statistical analysis
|
| Oxygen | Drug | Control Group: Standard treatment + Oxygen (O2) by rectal insufflation. O3/O2 concentration = 0 µg/ml (only O2); 40 sessions in 16 weeks. |
|
|
| 16 weeks |
| Change from Baseline in quality of life by the "Short Form 36-item health survey" (SF-36) questionnaire (at the end of ozone therapy) | Self-reported evaluation of 36 items (0 = worst, 100 = best). Final accumulated total range from 0 (worst) to 100 (best) | 16 weeks |
| Change from Baseline in Montreal Cognitive Assessment (MOCA) questionnaire (at the end of ozone therapy) | Assessment of 8 types of cognitive abilities by a total 30-point test (0 = worst, 30 = best) | 16 weeks |
| Change from Baseline in Biochemical cardiac parameters (High sensitive troponin, pro-brain natriuretic peptide (proBNP)) (at the end of ozone therapy) | Serum levels of high sensitive troponin and proBNP | 16 weeks |
| Change from Baseline in Biochemical parameters of oxidative stress (at the end of ozone therapy) | Serum levels of superoxide dismutase, glutathione, glutathione peroxidase and free radicals | 16 weeks |
| Change from Baseline in Biochemical parameters of inflammation (at the end of ozone therapy) | Serum levels of pro-inflammatory interleukins and TNFalpha | 16 weeks |
| Change from Baseline (by Echocardiograpy) of: left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) (at the end of ozone therapy) | Measurement of volume (in ml) of LVEDV and LVESV. | 16 weeks |
| Change from Baseline (by Echocardiograpy) of left ventricular ejection fraction (LVEF) (at the end of ozone therapy) | Measurement (in percentage) of LVEF | 16 weeks |
| Change from Baseline in Six-minute walk test (6MWT) (at the end of ozone therapy) | Assessment of functional exercise capacity according to the walking distance covered over a time of 6 minutes (in meters) | 16 weeks |
| Change from Baseline in cerebral blood flow by Transcranial doppler (at the end of ozone therapy) | Doppler ultrasound evaluation of systolic and diastolic velocity in middle cerebral arteries (in cm/s) | 16 weeks |
| Change from Baseline in Hyperspectral image of the supraciliary area (at the end of ozone therapy) | Assessment of the percentage of reflectance for each wavelength | 16 weeks |
| Change from Baseline in lower limb blood flow by Doppler ultrasound (at the end of ozone therapy) | Doppler ultrasound evaluation of systolic and diastolic velocity in lower limbs (in cm/s) | 16 weeks |
| Change from Baseline in Hyperspectral image of lower limbs (at the end of ozone therapy) | Assessment of the percentage of reflectance for each wavelength | 16 weeks |
| Incidence of severe adverse events in accordance with the definition of the Council for International Organizations of Medical Sciences (at the end of ozone therapy) | Number of events that are fatal, life threatening, leading to or prolonging a stay in hospital, or resulting in severe disability | 16 weeks |
| Quality of Life (QoL) measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) (at 32 weeks) | Self-reported evaluation of 21 physical, emotional and socioeconomic ways heart failure can adversely affect a patient's life. Each item is scored from 0 (no affected) to 5 (very much affected). Total range from 0 (best) to 105 (worst) | 32 weeks |
| Direct Hospital Cost (at 32 weeks) | The direct expenses incurred by the hospital in providing services (medication, tests, medical visits...) during the 16 weeks of ozone therapy (in euros) | 32 weeks |
| Change from Baseline in quality of life by the "5-level, 5-dimension EuroQol" (EQ-5D-5L) questionnaire (at 32 weeks) | Self-reported evaluation of: a) 5 physical and emotional items scored in five levels, from 1 (best: I have no problem) to 5 (worst: I have extreme problem or I am unable to…) and b) additional self-assessment of health by a visual analogue scale (0 = worst health patient can imagine, 100 = best health patient can imagine) | 32 weeks |
| Change from Baseline in quality of life by the "Short Form 36-item health survey" (SF-36) questionnaire (at 32 weeks) | Self-reported evaluation of 36 items (0 = worst, 100 = best). Final accumulated total range from 0 (worst) to 100 (best) | 32 weeks |
| Change from Baseline in Montreal Cognitive Assessment (MOCA) questionnaire (at 32 weeks) | Assessment of 8 types of cognitive abilities by a total 30-point test (0 = worst, 30 = best) | 32 weeks |
| Change from Baseline in Biochemical cardiac parameters (High sensitive troponin, pro-brain natriuretic peptide (proBNP)) (at 32 weeks) | Serum levels of high sensitive troponin and proBNP | 32 weeks |
| Change from Baseline in Biochemical parameters of oxidative stress (at 32 weeks) | Serum levels of superoxide dismutase, glutathione, glutathione peroxidase and free radicals | 32 weeks |
| Change from Baseline in Biochemical parameters of inflammation (at 32 weeks) | Serum levels of pro-inflammatory interleukins and TNFalpha | 32 weeks |
| Change from Baseline (by Echocardiograpy) of: left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) (at 32 weeks) | Measurement of volume (in ml) of LVEDV and LVESV. | 32 weeks |
| Change from Baseline (by Echocardiograpy) of left ventricular ejection fraction (LVEF) (at 32 weeks) | Measurement (in percentage) of LVEF | 32 weeks |
| Change from Baseline in Six-minute walk test (6MWT) (at 32 weeks) | Assessment of functional exercise capacity according to the walking distance covered over a time of 6 minutes (in meters) | 32 weeks |
| Change from Baseline in cerebral blood flow by Transcranial doppler (at 32 weeks) | Doppler ultrasound evaluation of systolic and diastolic velocity in middle cerebral arteries (in cm/s) | 32 weeks |
| Change from Baseline in Hyperspectral image of the supraciliary area (at 32 weeks) | Assessment of the percentage of reflectance for each wavelength | 32 weeks |
| Change from Baseline in lower limb blood flow by Doppler ultrasound (at 32 weeks) | Doppler ultrasound evaluation of systolic and diastolic velocity in lower limbs (in cm/s) | 32 weeks |
| Change from Baseline in Hyperspectral image of lower limbs (at 32 weeks) | Assessment of the percentage of reflectance for each wavelength | 32 weeks |
| Incidence of severe adverse events in accordance with the definition of the Council for International Organizations of Medical Sciences (at 32 weeks) | Number of events that are fatal, life threatening, leading to or prolonging a stay in hospital, or resulting in severe disability | 32 weeks |
| Bocci V, Borrelli E, Travagli V, Zanardi I. The ozone paradox: ozone is a strong oxidant as well as a medical drug. Med Res Rev. 2009 Jul;29(4):646-82. doi: 10.1002/med.20150. |
| 21575276 | Background | Bocci VA, Zanardi I, Travagli V. Ozone acting on human blood yields a hormetic dose-response relationship. J Transl Med. 2011 May 17;9:66. doi: 10.1186/1479-5876-9-66. |
| 25699252 | Background | Bocci V, Valacchi G. Nrf2 activation as target to implement therapeutic treatments. Front Chem. 2015 Feb 2;3:4. doi: 10.3389/fchem.2015.00004. eCollection 2015. |
| 12804078 | Background | Clavo B, Perez JL, Lopez L, Suarez G, Lloret M, Rodriguez V, Macias D, Santana M, Morera J, Fiuza D, Robaina F, Gunderoth M. Effect of ozone therapy on muscle oxygenation. J Altern Complement Med. 2003 Apr;9(2):251-6. doi: 10.1089/10755530360623365. |
| 15841265 | Background | Clavo B, Catala L, Perez JL, Rodriguez V, Robaina F. Ozone Therapy on Cerebral Blood Flow: A Preliminary Report. Evid Based Complement Alternat Med. 2004 Dec;1(3):315-319. doi: 10.1093/ecam/neh039. Epub 2004 Oct 6. |
| 28853025 | Background | Clavo B, Eltobgy K, Caballero E, Abad C, Rodriguez-Esparragon F, Santana-Rodriguez N. Is There a Place for Ozone Therapy in Patients with Heart Failure? Cardiovasc Toxicol. 2017 Oct;17(4):496-497. doi: 10.1007/s12012-017-9423-1. No abstract available. |
| 18827966 | Background | Di Filippo C, Marfella R, Capodanno P, Ferraraccio F, Coppola L, Luongo M, Mascolo L, Luongo C, Capuano A, Rossi F, D'Amico M. Acute oxygen-ozone administration to rats protects the heart from ischemia reperfusion infarct. Inflamm Res. 2008 Oct;57(10):445-9. doi: 10.1007/s00011-008-7237-0. |
| 11797116 | Background | Giunta R, Coppola A, Luongo C, Sammartino A, Guastafierro S, Grassia A, Giunta L, Mascolo L, Tirelli A, Coppola L. Ozonized autohemotransfusion improves hemorheological parameters and oxygen delivery to tissues in patients with peripheral occlusive arterial disease. Ann Hematol. 2001 Dec;80(12):745-8. doi: 10.1007/s002770100377. Epub 2001 Oct 13. |
| 22796450 | Background | Martinez-Sanchez G, Delgado-Roche L, Diaz-Batista A, Perez-Davison G, Re L. Effects of ozone therapy on haemostatic and oxidative stress index in coronary artery disease. Eur J Pharmacol. 2012 Sep 15;691(1-3):156-62. doi: 10.1016/j.ejphar.2012.07.010. Epub 2012 Jul 13. |
| 21446774 | Background | Bocci V, Zanardi I, Travagli V. Ozone: a new therapeutic agent in vascular diseases. Am J Cardiovasc Drugs. 2011;11(2):73-82. doi: 10.2165/11539890-000000000-00000. |
| Spanish Clinical Studies Registry | View source |