1300 Participants Needed

Dexamethasone + IVIG for Fetal AV Block

Recruiting at 40 trial locations
JB
RC
MM
Overseen ByMala Masson
Age: 18+
Sex: Female
Trial Phase: Phase 3
Sponsor: NYU Langone Health
Must be taking: Dexamethasone, IVIG
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Pivotal Trial (Near Approval)This treatment is in the last trial phase before FDA approval
Prior Safety DataThis treatment has passed at least one previous human trial

Trial Summary

What is the purpose of this trial?

This trial involves pregnant women using a home device to monitor their baby's heart. If they detect any heart issues, they get a quick follow-up test at the hospital. The goal is to catch and treat heart issues early before they become serious.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are taking more than 20 mg of prednisone daily or any dose of fluorinated steroids.

What data supports the effectiveness of the drug Dexamethasone + IVIG for Fetal AV Block?

Research shows that dexamethasone, a drug with anti-inflammatory properties, can enhance the effectiveness of other treatments, such as prolonging the duration of pain relief when combined with local anesthetics. Additionally, intravenous gamma-globulin (IVIG) has been used to prevent complications in other fetal conditions, suggesting potential benefits when combined with dexamethasone.12345

Is the combination of Dexamethasone and IVIG generally safe for humans?

In a study on Kawasaki disease, the combination of Dexamethasone and IVIG was used without any serious side effects reported. Additionally, IVIG is known to have dose-related side effects, but these are generally manageable.23678

How is the drug Dexamethasone + IVIG unique for treating fetal AV block?

The combination of Dexamethasone and IVIG for treating fetal AV block is unique because it combines a steroid (Dexamethasone) known for reducing inflammation and immune responses with IVIG, which provides antibodies to help modulate the immune system. This dual approach may offer a novel way to manage the condition, as there are no standard treatments specifically for fetal AV block.12349

Research Team

JB

Jill Buyon, MD

Principal Investigator

NYU Langone Health

BC

Bettina Cuneo, MD

Principal Investigator

University of Colorado, Denver

Eligibility Criteria

This trial is for pregnant women over 18 with high levels of anti-Ro antibodies, which are linked to fetal heart block. They must be able to monitor the baby's heart rate at home, send audio texts, live within a 6-hour drive of the cardiology site, and take oral medication. It excludes those with multi-fetal pregnancies or known allergies to the study drugs.

Inclusion Criteria

I live within a 6-hour drive of the pediatric cardiology site.
I can have my baby's heart rate and rhythm checked with a Doppler outside of the hospital.
You have a high level of anti-Ro 52 or 60 antibodies in your blood.
See 7 more

Exclusion Criteria

I am not taking more than 20 mg of prednisone or any dose of fluorinated steroids currently.
I am a woman currently incarcerated.
The fetus already has a heart condition in the current pregnancy.
See 3 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks
1 visit (in-person)

Surveillance

Mothers perform fetal heart rate and rhythm monitoring (FHRM) 3 times daily and undergo weekly echocardiograms to detect 2° AVB.

up to 25 weeks
3 daily self-monitoring sessions, weekly in-person visits

Treatment

Rapid treatment of 2° AVB identified by FHRM and confirmed by echocardiogram, aiming to reverse 2° AVB before it becomes permanent.

Immediate upon detection

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessment of AV interval and extra-nodal cardiac disease.

up to 1 year post-birth
Regular follow-up visits

Treatment Details

Interventions

  • Dexamethasone
  • IVIG
Trial OverviewThe STOP BLOQ trial tests if early detection and treatment can prevent severe fetal atrioventricular block in babies whose mothers have specific autoantibodies. It involves risk assessment, home monitoring by mothers, and rapid treatment with Dexamethasone or IVIG upon detecting abnormalities.
Participant Groups
1Treatment groups
Experimental Treatment
Group I: Mothers with Fetuses Who Have 2° AVB or AV interval > 170msExperimental Treatment2 Interventions

Dexamethasone is already approved in European Union, United States, Canada, Japan for the following indications:

🇪🇺
Approved in European Union as Dexamethasone for:
  • Inflammation
  • Allergic reactions
  • Respiratory diseases
  • Skin conditions
  • Eye diseases
  • Immune system disorders
🇺🇸
Approved in United States as Dexamethasone for:
  • Inflammatory conditions
  • Allergic states
  • Respiratory diseases
  • Blood disorders
  • Neoplastic diseases
  • Nervous system disorders
🇨🇦
Approved in Canada as Dexamethasone for:
  • Inflammation
  • Allergic reactions
  • Respiratory diseases
  • Skin conditions
  • Eye diseases
🇯🇵
Approved in Japan as Dexamethasone for:
  • Inflammatory conditions
  • Allergic states
  • Respiratory diseases
  • Blood disorders

Find a Clinic Near You

Who Is Running the Clinical Trial?

NYU Langone Health

Lead Sponsor

Trials
1,431
Recruited
838,000+

Findings from Research

In a study involving 150 patients undergoing upper limb surgery, perineural (PN) dexamethasone provided significantly longer durations of motor block (15.7 hours) and sensory block (16.8 hours) compared to intravenous (IV) dexamethasone (12.9 hours and 13.9 hours, respectively).
Both methods showed similar technical execution and success rates, but PN dexamethasone also extended postoperative analgesia duration (22.1 hours vs. 18.6 hours for IV), indicating it may be a more effective option for pain management in this context.
A Multicenter Randomized Comparison Between Intravenous and Perineural Dexamethasone for Ultrasound-Guided Infraclavicular Block.Leurcharusmee, P., Aliste, J., Van Zundert, TC., et al.[2019]
Intravenous gamma-globulin treatment effectively increased platelet counts in thrombocytopenic fetuses, with a mean increase of 69,000/microliters from the first fetal blood sampling to birth, and no cases of intracranial hemorrhage were reported.
Dexamethasone did not enhance the effectiveness of intravenous gamma-globulin, but a 'salvage' treatment with prednisone improved platelet counts in 50% of nonresponders, indicating that gamma-globulin is a suitable first-line treatment for severe alloimmune thrombocytopenia in fetuses.
Antenatal management of alloimmune thrombocytopenia with intravenous gamma-globulin: a randomized trial of the addition of low-dose steroid to intravenous gamma-globulin.Bussel, JB., Berkowitz, RL., Lynch, L., et al.[2019]
In a study of 3600 very low birth weight infants, betamethasone was found to significantly reduce the risk of neonatal death and showed trends towards lower risks for other serious conditions compared to dexamethasone.
Dexamethasone was associated with a higher risk of neonatal death compared to betamethasone, suggesting that betamethasone may be the safer option for preventing adverse neonatal outcomes.
Adverse neonatal outcomes associated with antenatal dexamethasone versus antenatal betamethasone.Lee, BH., Stoll, BJ., McDonald, SA., et al.[2022]

References

A Multicenter Randomized Comparison Between Intravenous and Perineural Dexamethasone for Ultrasound-Guided Infraclavicular Block. [2019]
Antenatal management of alloimmune thrombocytopenia with intravenous gamma-globulin: a randomized trial of the addition of low-dose steroid to intravenous gamma-globulin. [2019]
Adverse neonatal outcomes associated with antenatal dexamethasone versus antenatal betamethasone. [2022]
Effects of low dose dexamethasone treatment on basal cardiovascular and endocrine function in fetal sheep during late gestation. [2019]
Dexamethasone added to levobupivacaine in ultrasound-guided tranversus abdominis plain block increased the duration of postoperative analgesia after caesarean section: a randomized, double blind, controlled trial. [2022]
Efficacy of intravenous immune globulin therapy combined with dexamethasone for the initial treatment of acute Kawasaki disease. [2018]
A prospective study of the immediate and delayed adverse events following intravenous immunoglobulin infusions. [2022]
Lower-dose intravenous immunoglobulins for the treatment of fetal and neonatal alloimmune thrombocytopenia: a cohort study. [2018]
Efficacy of two regimens of dexamethasone for Management of preterm labour: pilot study. [2019]