Safety and Diagnostic Efficacy of Mangoral in Participants With Focal Liver Lesions and Reduced Kidney Function

Phase 3

Completed

Conditions: Severe Renal Impairment
Known or Suspected Focal Liver Lesions

Interventions: Drug: Mangoral

Registration Number: NCT04119843

Lead Sponsor: Ascelia Pharma AB

Brief Summary: The overall objective of this study is to evaluate the safety and diagnostic efficacy of Mangoral in liver MRI in participants with known or suspected focal liver lesions and severe renal impairment. The diagnostic efficacy of Mangoral will be assessed in terms of visualization of detected focal liver lesions in combined MRI (CMRI: combined Mangoral-enhanced and unenhanced MRI) compared to unenhanced MRI.

Detailed Description: The overall objective of this multicenter, open-label, study is to evaluate the safety and diagnostic efficacy of Mangoral in participants with known or suspected focal liver lesions and severe renal impairment. Study treatment is a single oral dose of Mangoral (800 mg manganese chloride \[II\] tetrahydrate, 500 mg L-alanine, and 800 IU vitamin D3). Adult male and female participants with severe renal impairment or acute kidney injury and who are being evaluated for known or suspected focal liver lesions will be included. Primary diagnostic efficacy in terms of visualization of detected lesions will be evaluated centrally by 3 independent readers. Study MRIs will also be evaluated by the on-site radiologists for the assessment of secondary objectives and for clinical purposes.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 87

Inclusion Criteria

Male and female participants 18 years and older.
Known or suspected focal liver lesions based on medical history and previous laboratory and/or imaging examinations.
Severe renal impairment (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m^2) based on medical history and previous laboratory examinations, at least once, within the last 3 months prior to the Baseline Visit, or participants with an increase in serum creatinine ≥ 0.3 mg/dL within 48 hours or ≥ 50% within 7 days prior to the Baseline Visit.

Exclusion Criteria

Participants with simple liver cysts only.
Any investigational drug or device within 6 weeks prior to the Baseline Visit.
Any magnetic resonance imaging (MRI) contrast media within 6 weeks prior to Baseline Visit or scheduled to receive any contrast medium before the last study visit.
Participants with severe hepatic impairment (according to Child-Pugh score C).
Participants scheduled for surgery before last study visit.
Participants with encephalopathy / neurodegenerative or acute neurological disorders.
Participants with hemochromatosis.

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Mangoral	Mangoral	All participants will receive a single dose of Mangoral (800 mg Manganese (II) chloride tetrahydrate \[MnCl2 4H2O\]).

Primary Outcome Measures

Name	Time	Method
Co-primary Endpoint: Lesion Border Delineation in Combined MRI Compared to Unenhanced MRI	Unenhanced MRI: Baseline Period (Day -1 to Day 0); combined MRI: Baseline Period (Day -1 to Day 0) and 4 hours after mangoral administration on Day 0	Visualization of focal liver lesions was measured by 2 co-primary variables: 'lesion border delineation' and 'lesion contrast' compared to liver background. Qualitative assessment determined on the 4-point scales for up to 15 lesions per participant. Each lesion was assessed for lesion border delineation from 1 (poor: lesion border is poorly distinct) to 4 (excellent: lesion border is sharply and clearly distinct). Central reading sessions were undertaken by 3 independent, blinded readers. The scores were calculated for each participant by summing the individual lesion scores and calculating the mean. The total score could range from 1 to 4 for each participant with higher scores representing a better outcome.
Co-primary Endpoint: Lesion Contrast in Combined MRI Compared to Unenhanced MRI	Unenhanced MRI: Baseline Period (Day -1 to Day 0); combined MRI: Baseline Period (Day -1 to Day 0) and 4 hours after mangoral administration on Day 0	Visualization of focal liver lesions was measured by 2 co-primary variables: 'lesion border delineation' and 'lesion contrast' compared to liver background. Qualitative assessment determined on the 4-point scales for up to 15 lesions per participant. Each lesion was assessed for lesion contrast from 1 (poor: difference in signal intensity between the lesion and the surrounding normal liver tissue is poor) to 4 (excellent: difference in signal intensity between the lesion and the surrounding liver is marked). Central reading sessions were undertaken by 3 independent, blinded readers. The scores were calculated for each participant by summing the individual lesion scores and calculating the mean. The total score could range from 1 to 4 for each participant with higher scores representing a better outcome.

Secondary Outcome Measures

Name	Time	Method
Number of Lesions Detected by Each MRI Method	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0; and combined MRI: Baseline Period (Day -1 to Day 0) and 4 hours after mangoral administration on Day 0	Assessments of unenhanced MRI, mangoral-enhanced MRI, and combined MRI for detection of lesions were undertaken by on-site readers (assessing participants at their own site) and during central reading sessions by 3 independent, blinded readers.
Lesion Border Delineation in Mangoral-enhanced MRI Compared to Unenhanced MRI	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0	Visualization of focal liver lesions was measured by variables: 'lesion border delineation' and 'lesion contrast' compared to liver background. Qualitative assessment determined on the 4-point scales for up to 15 lesions per participant. Each lesion was assessed for lesion border delineation from 1 (poor: lesion border is poorly distinct) to 4 (excellent: lesion border is sharply and clearly distinct). Central reading sessions were undertaken by 3 independent, blinded readers. The scores were calculated for each participant by summing the individual lesion scores and calculating the mean. The total score could range from 1 to 4 for each participant with higher scores representing a better outcome.
Lesion Contrast in Mangoral-enhanced MRI Compared to Unenhanced MRI	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0	Visualization of focal liver lesions was measured by variables: 'lesion border delineation' and 'lesion contrast' compared to liver background. Qualitative assessment determined on the 4-point scales for up to 15 lesions per participant. Each lesion was assessed for lesion contrast from 1 (poor: difference in signal intensity between the lesion and the surrounding normal liver tissue is poor) to 4 (excellent: difference in signal intensity between the lesion and the surrounding liver is marked). Central reading sessions were undertaken by 3 independent, blinded readers. The scores were calculated for each participant by summing the individual lesion scores and calculating the mean. The total score could range from 1 to 4 for each participant with higher scores representing a better outcome.
Confidence in Lesion Detection Score	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0; and combined MRI: Baseline Period (Day -1 to Day 0) and 4 hours after mangoral administration on Day 0	Each lesion was evaluated on a 3-point scale: 1 (lesion is detected with low confidence), 2 (lesion is detected with moderate confidence), 3 (lesion is detected with high confidence). Higher confidence in lesion detection scores represent better outcomes. Assessments of unenhanced MRI, mangoral-enhanced MRI, and combined MRI for confidence in lesion detection were undertaken by on-site readers (assessing participants are their own site) and during central reading sessions by 3 independent, blinded readers.
Confidence in Lesion Localization Score	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0; and combined MRI: Baseline Period (Day -1 to Day 0) and 4 hours after mangoral administration on Day 0	Each lesion was evaluated on a 3-point scale: 1 (lesion is localized to a liver segment with low confidence), 2 (lesion is localized to a liver segment with moderate confidence), 3 (lesion is localized to a liver segment with high confidence). Assessments of unenhanced MRI, mangoral-enhanced MRI, and combined MRI for confidence in lesion localization were undertaken by on-site readers (assessing participants at their own site) and during central reading sessions by 3 independent, blinded readers.
Longest Diameter of Largest and Smallest Lesion	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0	Assessments of unenhanced MRI and mangoral-enhanced MRI for lesion dimensions were undertaken during central reading sessions by 3 independent, blinded readers.
Percentage Liver Signal Intensity (SI) Enhancement in Mangoral-enhanced MRI Compared to Unenhanced MRI	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0	Quantitative SI was measured by positioning circular regions of interest in a homogenous area in the liver and the assessed liver lesion on the same image. SI liver was defined as the SI of the liver. Liver SI enhancement (%) = (\[SI liver post contrast - SI liver pre contrast\] / \[SI liver pre contrast\]) × 100. Assessments of unenhanced MRI and mangoral-enhanced MRI for liver SI were undertaken during central reading sessions by the 3 independent, blinded readers.
Liver-to-lesion Contrast (LLC) in Mangoral-enhanced MRI Compared to Unenhanced MRI	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0	Quantitative SI was measured by positioning circular regions of interest in a homogenous area in the liver and the assessed liver lesion on the same image. Up to 5 lesions per participant of ≥ 2 cm in diameter were evaluated and these lesions were the same on pre-and post-contrast images. SI lesion was defined as the SI of these lesions. SI liver was defined as the SI of the liver. LLC = (SI liver - SI lesion) / (SI liver + SI lesion). Higher ratio scores represent a better outcome. Assessments of unenhanced MRI and mangoral-enhanced MRI for LLC ratio were undertaken during central reading sessions by the 3 independent, blinded readers.
Signal-to-noise Ratio (SNR) in Mangoral-enhanced MRI Compared to Unenhanced MRI	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0	Quantitative SI was measured by positioning circular regions of interest in a homogenous area in the liver and the assessed liver lesion on the same image. SI liver was defined as the SI of the liver. Standard deviation of the background noise was measured using the largest possible rectangular region of interest vertical to the patient's abdomen in the direction of the phase-encoding gradient. SNR = SI liver / standard deviation noise. Higher ratio scores represent a better outcome. Assessments of unenhanced MRI and mangoral-enhanced MRI for SNR were undertaken during central reading sessions by the 3 independent, blinded readers.
Contrast-to-noise Ratio (CNR) in Mangoral-enhanced MRI Compared to Unenhanced MRI	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0	Quantitative SI was measured by positioning circular regions of interest in a homogenous area in the liver and the assessed liver lesion on the same image. Up to 5 lesions per participant of ≥ 2 cm in diameter were evaluated and these lesions were the same on pre-and post-contrast images. SI lesion was defined as the SI of these lesions. SI liver was defined as the SI of the liver. Standard deviation of the background noise was measured using the largest possible rectangular region of interest vertical to the patient's abdomen in the direction of the phase-encoding gradient. CNR = (SI liver - mean of SI lesion) / standard deviation noise. Higher ratio scores represent a better outcome. Assessments of unenhanced MRI and mangoral-enhanced MRI for CNR were undertaken during central reading sessions by the 3 independent, blinded readers.
Number of Participants With Change(s) in Recommended Management Based on Diagnostic Performance of Combined MRI or Mangoral-enhanced MRI Compared to Unenhanced MRI	Unenhanced MRI: Baseline Period (Day -1 to Day 0); mangoral-enhanced MRI: 4 hours after mangoral administration on Day 0; and combined MRI: Baseline Period (Day -1 to Day 0) and 4 hours after mangoral administration on Day 0	A participant was considered to have a change in recommended management when compared to unenhanced MRI if recommended management was different following assessment of the combined MRI or mangoral-enhanced MRI, including next steps in management (i.e. chemotherapy, surgery, local ablation procedure, combination therapy, or other \[specify\]). Recommended patient management from "other" in unenhanced MRI to "other" in combined MRI or mangoral-enhanced MRI was considered not a change regardless of the free text. Assessments of unenhanced MRI, mangoral-enhanced MRI, and combined MRI for confidence in lesion detection were undertaken by on-site readers (assessing participants at their own site with access to patient records) and during central reading sessions by 3 independent, blinded readers (without access to patient records).

Trial Locations

Locations (60): Saint Louis University
🇺🇸
Saint Louis, Missouri, United States
University of Wisconsin - Madison
🇺🇸
Madison, Wisconsin, United States
Università Cattolica del Sacro Cuore
🇮🇹
Roma, Italy
National Medical Research Radiology Center Named After Herzen
🇷🇺
Moscow, Russian Federation
EuroMedis Sp. z o.o.
🇵🇱
Szczecin, Poland
Institut für Röntgendiagnostik
🇩🇪
Regensburg, Germany
State Institution of Healthcare of Omsk region
🇷🇺
Omsk, Russian Federation
Mayo Clinic - Jacksonville
🇺🇸
Jacksonville, Florida, United States
Karolinska University Hospital Huddinge
🇸🇪
Stockholm, Sweden
Universitätsklinikum Frankfurt Institut für Diagnostische und Interventionelle Radiologie
🇩🇪
Frankfurt, Germany
Hospital Pablo Tobon Uribe
🇨🇴
Medellín, Antioquia, Colombia
Mayo Clinic - Arizona
🇺🇸
Scottsdale, Arizona, United States
Clínica Universitaria Colombia
🇨🇴
Bogotá, Cundinamarca, Colombia
Ospedale del Mare
🇮🇹
Napoli, Italy
Erciyes University Medical Faculty Hospital
🇹🇷
Melikgazi, Kayseri, Turkey
Sociedad de Cirugía de Bogotá - Hospital de San José
🇨🇴
Bogotá, Cundinamarca, Colombia
Sanatorio Allende Nueva Córdoba
🇦🇷
Cordoba, Argentina
Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda
🇮🇹
Milano, Italy
Ospedale di Belcolle
🇮🇹
Viterbo, Italy
Scientific and Research Institute of Oncology named after N.N. Blokhin
🇷🇺
Moscow, Russian Federation
Szpital Uniwersytecki nr 1 im. Dr A. Jurasza, Wydział Katedra i Zakład Radiologii i Diagnostyki Obrazowej
🇵🇱
Bydgoszcz, Poland
Azienda Ospedaliero-Universitaria di Bologna Policlinico S.Orsola-Malpighi
🇮🇹
Bologna, Italy
Städtisches Klinikum KarlsruheDiagnostische und interventionelle Radiologie
🇩🇪
Karlsruhe, Germany
Klinik und Poliklinik für Radiologie Klinikum der Universität München LMU Campus
🇩🇪
Munich, Germany
LLC "Clinica YZI 4D"
🇷🇺
Pyatigorsk, Russian Federation
Hacettepe University Medical Faculty Hospital
🇹🇷
Ankara, Turkey
N.N. Petrov Research Institute of Oncology
🇷🇺
Saint Petersburg, Russian Federation
İstanbul Üniversitesi - Istanbul Tıp Fakültesi
🇹🇷
Istanbul, Turkey
University of California at Los Angeles Ronald Reagan Medical Center
🇺🇸
Los Angeles, California, United States
Johns Hopkins Bayview Medical Center
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Baltimore, Maryland, United States
Massachusetts General Hospital
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Boston, Massachusetts, United States
Boston University Medical Center
🇺🇸
Boston, Massachusetts, United States
Duke University
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Durham, North Carolina, United States
Kocaeli University
🇹🇷
İzmit, Kocaeli, Turkey
Szpital Uniwersytecki w Krakowie Zakład Diagnostyki Obrazowej CUMRiK Ul
🇵🇱
Kraków, Poland
Istituto Nazionale Tumori IRCCS Fondazione G. Pascale
🇮🇹
Napoli, Italy
Azienda Ospedaliero-Universitaria Policlinico Umberto I
🇮🇹
Rome, Italy
State Autonomous Healthcare Institution of the Tyumen Region
🇷🇺
Tyumen, Russian Federation
Schiff Center for Liver Diseases
🇺🇸
Miami, Florida, United States
Ege University Medical Faculty Hospital
🇹🇷
Bornova, İzmir, Turkey
PanAmerican Clinical Research LLC
🇺🇸
Brownsville, Texas, United States
Fundación Intecnus
🇦🇷
San Carlos De Bariloche, Río Negro, Argentina
Panamerican Clinical Research - Cuernavaca Rio Mayo
🇲🇽
Cuernavaca, Mexico
Panamerican Clinical Research Mexico
🇲🇽
Guadalajara, Mexico
Panamerican Clinical Research - Querétaro Avenida Paseo de la República
🇲🇽
Querétaro, Mexico
Azienda Socio Sanitaria Territoriale (ASST)
🇮🇹
Milano, Lombardy, Italy
State Institution of Healthcare "Regional Oncology Dispensary"
🇷🇺
Irkutsk, Russian Federation
Smolensk Clinical Hospital
🇷🇺
Smolensk, Russian Federation
Saint-Petersburg State Budgetary Healthcare Institution
🇷🇺
Saint Petersburg, Russian Federation
University of Washington Medical Center
🇺🇸
Seattle, Washington, United States
Charité - Universitätsmedizin Berlin
🇩🇪
Berlin, Germany
Stanford University School of Medicine
🇺🇸
Stanford, California, United States
Centro Rossi Body Imaging
🇦🇷
Buenos Aires, Argentina
Universitätsmedizin Göttingen
🇩🇪
Göttingen, Germany
Universitättsklinikum Schleswig-Holstein/Campus KielKlinik für Radiologie und Neuroradiologie
🇩🇪
Kiel, Germany
A.V. Vishnevsky Institute of Surgery
🇷🇺
Moscow, Russian Federation
SBIH of Pskov Regional Clinical Oncologic Dispensary
🇷🇺
Pskov, Russian Federation
Altay Regional Oncology Dispencery
🇷🇺
Barnaul, Russian Federation
JSC "Avicenna"
🇷🇺
Novosibirsk, Russian Federation
University of Kansas Medical Center
🇺🇸
Kansas City, Kansas, United States