Using N-acetylcysteine to treat Retinitis Pigmentosa

NAC Attack, A Phase III, Multicenter, Randomized, Parallel, Double Masked, Placebo-Controlled Study Evaluating the Efficacy and Safety of Oral N-Acetylcysteine in Patients With Retinitis Pigmentosa

This study is testing if taking N-acetylcysteine can help slow vision loss in people with Retinitis Pigmentosa.

Quick facts

• Phase: PHASE3
• Study type: Interventional
• Enrollment: 483 (estimated)
• Ages: 18 Years to 65 Years
• Sex: All
• Sponsor: Johns Hopkins University (other)
• Locations: 31 sites (Davis, California and 30 other locations)
• Trial ID: NCT05537220 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the effects of oral N-acetylcysteine (NAC) on patients with Retinitis Pigmentosa (RP), a genetic condition leading to progressive vision loss. The study aims to determine if long-term NAC administration can slow the degeneration of cone photoreceptors, which are crucial for vision. Participants will be monitored for changes in visual acuity and light sensitivity over several years, comparing results with a placebo group. The trial is being conducted at multiple institutions across the US, Canada, and Europe.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 to 65 with a confirmed diagnosis of Retinitis Pigmentosa and specific ocular characteristics.

Not a fit: Patients with advanced Retinitis Pigmentosa or those who do not meet the ocular inclusion criteria may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly slow vision loss in patients with Retinitis Pigmentosa.

How similar studies have performed: Previous studies have shown some success with NAC in animal models and early-phase trials, suggesting potential for this approach.

Eligibility criteria

Inclusion Criteria:

General

* Ability and willingness to provide informed consent
* Age ≥ 18 and ≤65 years at time of signing Informed Consent Form
* Ability and willingness to comply with the study protocol and to participate in all study visits and assessments in the investigator's judgement
* For candidates of childbearing potential: willingness to use a method of contraception
* Agreement not to take supplements other than vitamin A

Ocular Inclusion Criteria

* Both eyes must exhibit the RP phenotype with evidence of loss of night vision, gradual constriction of visual fields, and maintenance of visual acuity;
* In addition, an eye must meet the following criteria to be included in the study:
* Gradable EZ on a horizontal SD-OCT scan through the fovea center with width ≤ 8000 µm and ≥1500 µm and with well-defined truncation at both the nasal and temporal sides;
* BCVA ≥ ETDRS letter score of 61 (20/60 Snellen equivalent);
* Sufficiently clear ocular media and adequate pupillary dilation to allow good quality images sufficient for analysis and grading by central reading center.

Exclusion Criteria:

General Exclusion Criteria

* Active cancer within the past 12 months, except for appropriately treated carcinoma in situ of the cervix, non-melanoma skin carcinoma, or prostate cancer with Gleason score ≤ 6 and stable prostate specific antigen for \> 12 months
* Renal failure requiring renal transplant, hemodialysis, peritoneal dialysis, or anticipated to require hemodialysis or peritoneal dialysis during the study
* Liver disease, cystic fibrosis, asthma, or chronic obstructive pulmonary disease (COPD), history of thrombocytopenia not due to a reversible cause or other blood dyscrasia
* Uncontrolled blood pressure (defined as systolic \> 180 and/or diastolic \> 100 mmHg while at rest) at screening. If a patient's initial measurement exceeds these values, a second reading may be taken 30 or more minutes later. If the patient's blood pressure must be controlled by antihypertensive medication, the patient may become eligible if medication is taken continuously for at least 30 days.
* History of other disease, physical examination finding, or clinical laboratory finding giving reasonable suspicion that oral NAC may be contraindicated or that follow up may be jeopardized
* Cerebrovascular accident or myocardial infarction within 6 months of screening
* Participation in an investigational study that involves treatment with any drug or device within 6 months of screening
* Three relatives already enrolled in study
* Pregnant, breast feeding, or intending to become pregnant during the study treatment period. Women of childbearing potential who have not had tubal ligation must have a urine pregnancy test at screening.
* Known history of allergy to NAC
* Having taken NAC in any form in the past 4 months
* Phenylketonuria
* Fructose intolerance
* Glucose-galactose malabsorption
* Sucrase-isomaltase insufficiency
* Abnormal laboratory value including the value of alanine aminotransferase (ALT), aspartate aminotransferase (AST), or bilirubin being greater than 1.5 x the upper limit of normal
* Any major abnormal findings on blood chemistry, hematology, and renal function lab tests that in the opinion of the Site Investigator and/or the Study Chair makes the candidate not suitable to participate in the trial
* HIV or hepatitis B infection

Ocular Exclusion Criteria

* Evidence of cone-rod dystrophy or pattern dystrophy including focal areas of atrophy or pigmentary changes in the central macula
* Cystoid spaces involving the fovea substantially reducing vision
* Glaucoma or other optic nerve disease causing visual field loss or reduced visual acuity
* Intra ocular pressure \>27 mm Hg from two measurements. If a patient's initial measurement exceeds 27 mm Hg, a second reading must be taken.
* Any retinal disease other than RP causing reduction in visual field or visual acuity
* Any prior macular laser photocoagulation
* Intraocular surgery within 3 months prior to screening
* High myopia with spherical equivalent refractive error \> 8 diopters. If an eye has had cataract surgery or refractive surgery, a pre-operative refractive error spherical equivalent \> 8 diopters is an exclusion
* Any concurrent ocular condition that might affect interpretation of results
* History of uveitis in either eye

Where this trial is running

Davis, California and 30 other locations

• University of California - Davis, Department of Ophthalmology & Vision Science — Davis, California, United States (RECRUITING)
• University of Southern California, Keck School of Medicine — Los Angeles, California, United States (RECRUITING)
• University of California - San Francisco, Department of Ophthalmology — San Francisco, California, United States (RECRUITING)
• Stanford University, Byers Eye Institute — Stanford, California, United States (RECRUITING)
• Vitreo Retinal Associates — Gainesville, Florida, United States (RECRUITING)
• University of Florida - Jacksonville, UF Health Jacksonville — Jacksonville, Florida, United States (RECRUITING)
• University of Miami, Bascom Palmer Eye Institute — Miami, Florida, United States (RECRUITING)
• Emory University, Emory Eye Center — Atlanta, Georgia, United States (RECRUITING)
• University Of Illinois At Chicago — Chicago, Illinois, United States (RECRUITING)
• Northwestern University — Evanston, Illinois, United States (RECRUITING)
• University of Iowa, Carver College of Medicine — Iowa City, Iowa, United States (RECRUITING)
• Wilmer Eye Institute- Johns Hopkins University — Baltimore, Maryland, United States (RECRUITING)
• Harvard University, Mass. Eye and Ear — Boston, Massachusetts, United States (RECRUITING)
• University of Michigan, Kellogg Eye Center — Ann Arbor, Michigan, United States (RECRUITING)
• University of Minnesota, Department of Ophthalmology and Visual Neurosciences — Minneapolis, Minnesota, United States (RECRUITING)
• Mayo Clinic, Department of Ophthalmology — Rochester, Minnesota, United States (RECRUITING)
• University of Oklahoma, Dean McGee Eye Institute — Oklahoma City, Oklahoma, United States (RECRUITING)
• Scheie Eye Institute — Philadelphia, Pennsylvania, United States (RECRUITING)
• Vanderbilt University, Vanderbilt Eye Institute — Nashville, Tennessee, United States (RECRUITING)
• Retina Foundation of the Southwest — Dallas, Texas, United States (RECRUITING)
• University of Utah, Moran Eye Center — Salt Lake City, Utah, United States (RECRUITING)
• University of Washington, Department of Ophthalmology — Seattle, Washington, United States (RECRUITING)
• University of Wisconsin - Madison, McPherson Eye Research Institute — Madison, Wisconsin, United States (RECRUITING)
• Medical College of Wisconsin, The Eye Institute — Milwaukee, Wisconsin, United States (RECRUITING)
• Medical University of Graz, Department of Ophthalmology — Graz, Styria, Austria (RECRUITING)
• McGill University, The Research Institute of the McGill University Health Center — Montréal, Quebec, Canada (RECRUITING)
• University of Tübingen, Department für Augenheilkunde — Tübingen, Baden-Württemberg, Germany (RECRUITING)
• Radboud University, Radboud University Medical Centre — Nijmegen, Gelderland, Netherlands (RECRUITING)
• University of Amsterdam, Amsterdam Medical Center — Amsterdam, Northern Holland, Netherlands (RECRUITING)
• Universitätsspital Basel, Eye Clinic — Basel, Switzerland (RECRUITING)
• University College London, Moorfields Eye Hospital — London, England, United Kingdom (RECRUITING)

Study contacts

• Study coordinator: Xiangrong Kong, PhD

Conditions: Retinitis Pigmentosa, N-acetylcysteine, Ellipsoid zone, Macular sensitivity, Best corrected visual acuity, Ellipsoid zone width, Ellipsoid zone area, Oxidative damage