Gadolinium-Based Contrast Media Effects on Motor and Cognitive Functioning

(ODYSSEY Trial)

Recruiting at 44 trial locations

Overseen By Frantz HEBERT

Age: 18 - 65

Sex: Any

Trial Phase: Phase 4

Sponsor: Guerbet

Must not be taking: Neuro-cognitive drugs

Disqualifiers: Neurological, Psychiatric, Renal, Alcoholic cirrhosis, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 8

2076 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines whether repeated use of gadolinium-based contrast agents (GBCAs) in imaging tests affects movement and mental skills over five years. It includes individuals who regularly require MRIs or similar tests due to conditions like breast cancer risk or chronic liver disease. Participants must be neurologically healthy and free of psychiatric issues. The study consists of different groups: one with no GBCA exposure and two with different types of GBCAs. Those who have had contrast dye at least once a year, or never, might be suitable candidates. As a Phase 4 trial, the treatment is already FDA-approved and proven effective, aiding researchers in understanding its benefits for more patients.

Will I have to stop taking my current medications?

The trial requires that participants do not use medications affecting neuro-cognitive or motor function. If you are taking such medications, you may need to stop them to participate.

What is the safety track record for these treatments?

Research has shown that gadolinium-based contrast agents (GBCAs) are generally safe for imaging tests like MRIs, as they help create clearer body images. Studies have found that both linear and macrocyclic GBCAs can cause minor side effects, such as discomfort at the injection site, nausea, itching, rash, headaches, and dizziness.

More serious side effects have been reported, but they are rare. Incorrect use of certain GBCAs has led to serious issues like seizures and nervous system problems, though these incidents are uncommon and typically result from improper use.

Importantly, macrocyclic GBCAs are considered more stable and are less likely to leave traces in the brain compared to linear GBCAs, making them a preferred choice for reducing long-term risks.

Overall, while minor side effects are common, serious problems are rare. GBCAs have been used safely for years, and the study aims to further understand their effects on movement and mental skills with repeated use. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Researchers are excited about this trial because it explores the effects of different types of gadolinium-based contrast agents (GBCAs) on motor and cognitive functioning. Unlike the standard of care, which doesn't typically focus on these neurological outcomes, this study specifically compares linear and macrocyclic GBCAs. Macrocyclic GBCAs, like Gadavist and Dotarem, have a more stable structure that may reduce the risk of gadolinium retention in the body. By comparing these with linear GBCAs and a control group, researchers hope to better understand the safety and neurological impacts of these contrast agents, potentially leading to safer imaging practices.

What evidence suggests that this trial's gadolinium-based contrast agents could be effective for assessing motor and cognitive functioning?

Research has shown that gadolinium-based contrast agents (GBCAs) enhance MRI scan clarity, aiding in the visualization of organs and tissues. In this trial, participants will be divided into different arms to study the effects of these agents. Studies have found no clear evidence that these agents cause long-term issues with movement or memory. Specifically, participants in the Linear GBCAs arm, receiving agents like gadodiamide, showed no nerve damage. Similarly, those in the Macrocyclic GBCAs arm, receiving agents such as gadoterate, did not experience effects on movement or memory, even after repeated use. Both types of GBCAs are generally considered safe for improving MRI images. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

Adults up to 65 years old needing regular MRI scans for conditions like medium/high-risk breast cancer, prostate cancer surveillance, or chronic liver disease. Participants must be neurologically stable with no severe kidney issues, not pregnant/nursing, and free from heavy metal exposure that could affect brain function.

Inclusion Criteria

I am participating in the GBCA Arms of the study.

Participants should have at least 1 of the following indications: a) Medium to high risk for breast cancer or dense breasts undergoing breast cancer screening with MRI, b) Elevated prostate-specific antigen (PSA) and under active diagnostic surveillance for prostate cancer, c) Chronic liver disease (eg, liver cirrhosis limited to Child class A, post-hepatitis chronic hepatopathy, or primary sclerosing cholangitis) for surveillance of hepatocellular carcinoma development, d) Low-grade colorectal cancer or neuroendocrine tumor undergoing screening for liver metastases or e) Branch-duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas (maximum size ≤2 cm) undergoing imaging surveillance.

I agree to have specific brain scans now and in 5 years, with other scans as needed in between.

Exclusion Criteria

I am participating in a trial that involves Gadolinium-Based Contrast Agents.

My kidney function is reduced with an eGFR below 60.

I need more than one MRI with contrast every 6 months.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Initial assessment of motor and cognitive functions and collection of baseline data

1 visit

1 visit (in-person)

Annual Imaging and Assessment

Participants undergo annual MRI or other imaging tests and assessments of motor and cognitive functions

5 years

7 visits (in-person) over 5 years

Follow-up

Participants are monitored for changes in motor and cognitive functions after the study period

1 year

What Are the Treatments Tested in This Trial?

Interventions

• Gadobenate dimeglumine
• Gadobutrol
• Gadodiamide
• Gadoterate meglumine
• Gadoteridol
• Gadoxetate disodium

Trial Overview The study is examining if repeated use of gadolinium-based contrast agents (GBCAs) during MRIs over five years affects motor skills and cognitive functions. It involves annual MRIs and tests on body movement/mental skills across four GBCA types versus unenhanced-MRI controls.

How Is the Trial Designed?

Group I: No GBCA (Control arm) Experimental Treatment 4 Interventions

Adult participants who were never exposed to any gadolinium-based contrast agent and matching the population characteristics of the two GBCA arms. They will not receive any gadolinium-based contrast agent over the study course, but may undergo clinically indicated imaging (e.g. unenhanced magnetic resonance imaging (MRI), unenhanced or enhanced computed tomography, ultrasound and/or X-ray).

Group II: Macrocyclic GBCAs Experimental Treatment 7 Interventions

Adult participants, who were scheduled for repeated enhanced magnetic resonance imaging (MRI), receive a macrocyclic gadolinium-based contrast agent (GBCA, i.e. Gadavist/ Gadovist, Dotarem, Magnescope or ProHance) prior to MRI. Each participant will receive the same GBCA throughout the study.

Group III: Linear GBCAs Experimental Treatment 7 Interventions

Adult participants, who were scheduled for repeated enhanced magnetic resonance imaging (MRI), receive a linear gadoliniumbased contrast agent (GBCA, i.e. Eovist/ Primovist, MultiHance or Omniscan) prior to MRI. Each participant will receive the same GBCA throughout the study.

Who Is Running the Clinical Trial?

Guerbet

Lead Sponsor

Trials

72

Recruited

94,600+

David Hale

Guerbet

Chief Executive Officer since 2020

MBA from IMD

Philippe Bourrinet

Guerbet

Chief Medical Officer since 2023

MD

Bayer AG (Sponsor)

Collaborator

Trials

1

Recruited

2,100+

Bracco (Sponsor)

Collaborator

Trials

1

Recruited

2,100+

GEHC (Sponsor)

Collaborator

Trials

1

Recruited

2,100+

Published Research Related to This Trial

In a study involving 2,048 subjects with mild cognitive impairment, galantamine did not significantly reduce the rate of conversion to dementia compared to placebo over 24 months.

Galantamine was generally well tolerated, with nausea being the most common side effect, affecting 29% of participants, while the overall mortality rate was slightly higher in the galantamine group (1.4%) compared to placebo (0.3%).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and efficacy of galantamine in subjects with mild cognitive impairment. Winblad, B., Gauthier, S., Scinto, L., et al.[2022]

In a study of 515 elderly patients, piribedil, a dopamine agonist, significantly improved memory impairment, vertigo, and tinnitus, with 20% experiencing complete resolution and 72.6% showing improvement after one month of treatment.

The treatment was well tolerated, with a low incidence of side effects and high compliance among patients, indicating its acceptability as a therapeutic option for age-related dopamine decline.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of memory impairment, vertigo and tinnitus in the elderly with piribedil in an Indian general practice setting. Hastak, SM.[2013]

In a study involving 3092 subjects across 79 clinical trials, gadobenate dimeglumine (MultiHance) was found to have a safety profile comparable to placebo and other contrast agents, with only 14% of adult subjects reporting adverse events.

MultiHance was well tolerated in special populations, including children and individuals with liver or kidney impairment, showing no significant increase in adverse events or negative effects on cardiac function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety of gadobenate dimeglumine (MultiHance): Summary of findings from clinical studies and postmarketing surveillance. Shellock, FG., Parker, JR., Venetianer, C., et al.[2022]

In a study of 32 patients with posttreatment glioma, gadobutrol (one-molar) and gadoterate meglumine (half-molar) showed no significant differences in key dynamic contrast-enhanced imaging parameters, indicating they can be used interchangeably.

However, gadobutrol demonstrated a significantly higher wash-in rate and a lower washout rate compared to gadoterate meglumine, suggesting slight differences in how these agents behave during imaging.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of Dynamic Contrast-Enhancement Parameters between Gadobutrol and Gadoterate Meglumine in Posttreatment Glioma: A Prospective Intraindividual Study. Park, JE., Kim, JY., Kim, HS., et al.[2021]

In a study of 211 patients comparing gadoxetic acid and gadoteric acid for liver MRI, gadoxetic acid resulted in significantly poorer image quality during the triple arterial phases, despite better pre-contrast images.

The overall image quality improved from the first to the third arterial phases for both contrast agents, suggesting that the third arterial phase images are the most reliable for diagnostic purposes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of gadoxetic acid on image quality of arterial multiphase magnetic resonance imaging of liver: comparison study with gadoteric acid-enhanced MRI. Sim, KC., Park, BJ., Han, NY., et al.[2020]

Piribedil, at a dose of 10 mg/kg, significantly improved memory performance in aged mice, particularly in tasks assessing relational and declarative memory, while bromocriptine showed no such effects.

Both dopamine agonists enhanced memory in young adult rats, but only piribedil demonstrated lasting benefits against age-related memory impairments, suggesting its potential as a treatment for cognitive deficits in Parkinson's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative effects of the dopaminergic agonists piribedil and bromocriptine in three different memory paradigms in rodents. Marighetto, A., Valerio, S., Philippin, JN., et al.[2013]

In a study of 10,595 patients undergoing MRI with gadolinium-based contrast agents, the overall incidence of acute adverse reactions was low at 0.45%, with no severe reactions reported.

Younger patients were found to be at a higher risk for experiencing acute adverse reactions, and gadoxetate disodium had a higher incidence of reactions (0.82%) compared to gadopentetate dimeglumine (0.43%), indicating that while all agents are generally safe, some may carry slightly more risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Incidence and severity of acute adverse reactions to four different gadolinium-based MR contrast agents. Okigawa, T., Utsunomiya, D., Tajiri, S., et al.[2019]

In a study involving 60 adult patients, gadodiamide injection was found to be a safe contrast agent, with only 10 adverse events reported, most of which were transient and required no treatment.

Both gadodiamide and gadopentetate dimeglumine showed similar diagnostic utility, with contrast enhancement observed in 60% of patients using gadodiamide and 44% using gadopentetate, indicating no significant difference in overall efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Gadodiamide injection and gadopentetate dimeglumine. A double-blind study in MR imaging of the CNS. Myhr, G., Rinck, PA., Børseth, A.[2015]

In a study of 194,400 intravenous administrations of gadolinium-based contrast agents (GBCA), the overall rate of adverse reactions was low at 0.1%, with most reactions being mild.

Among the different GBCA types, gadofosveset trisodium had the highest reaction rate at 0.80%, while gadopentetate dimeglumine had the lowest at 0.09%, indicating variability in safety profiles among these agents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse allergic reactions to linear ionic gadolinium-based contrast agents: experience with 194, 400 injections. Aran, S., Shaqdan, KW., Abujudeh, HH.[2015]

Patients who received gadobenate dimeglumine after prior exposure to gadodiamide showed a significant increase in T1 signal intensity in the dentate nucleus compared to those without previous gadodiamide exposure, indicating potential gadolinium deposition effects.

The study suggests that prior administration of less stable gadolinium-based contrast agents (like gadodiamide) may enhance the effects of subsequent administrations of more stable agents (like gadobenate dimeglumine), although the exact mechanism and implications for safety require further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Signal intensity change on unenhanced T1-weighted images in dentate nucleus following gadobenate dimeglumine in patients with and without previous multiple administrations of gadodiamide. Ramalho, J., Semelka, RC., AlObaidy, M., et al.[2020]

In a study involving 15 mild traumatic brain injury (mTBI) patients and 17 healthy controls, the mixed D1/D2 agonist pergolide improved working memory performance in mTBI patients compared to the selective D2 agonist bromocriptine.

Functional MRI results indicated that pergolide increased activation in brain regions associated with working memory, particularly in the left inferior frontal gyrus, suggesting that targeting D1 receptors may be a promising strategy for treating cognitive deficits after mTBI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Differential Effects of Pergolide and Bromocriptine on Working Memory Performance and Brain Activation after Mild Traumatic Brain Injury. Flashman, LA., McDonald, BC., Ford, JC., et al.[2022]

Antiepileptic drugs (AEDs) like topiramate, lamotrigine, and others can cause cognitive dysfunction, but the exact mechanisms behind these effects are not well understood.

Recent studies using functional MRI (fMRI) have begun to reveal how different AEDs affect brain activity during cognitive tasks, highlighting specific drug-related changes in brain function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of antiepileptic drugs on cognitive functional magnetic resonance imaging. Beltramini, GC., Cendes, F., Yasuda, CL.[2022]

A total of 424 risk signals related to adverse events (AEs) were identified from the FAERS database for four gadolinium-based contrast agents (GBCAs) over an 18-year period, highlighting significant safety concerns associated with these agents.

The study revealed that some adverse events linked to GBCAs were not included in their package inserts, indicating a need for further research to ensure patient safety and awareness of potential risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Data mining and analysis of the adverse events derived signals of 4 gadolinium-based contrast agents based on the US Food and drug administration adverse event reporting system. Wang, L., Wang, Y., Zhao, Q.[2023]

Citations

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A New Contrast Agent for MRI of the CNS and Body Compared with gadobenate dimeglumine at 0.1 mmol/kg, CNR was 32% to 45% higher with gadopiclenol at 0.1 mmol/kg (P ≤ 0.0007 for all 3 readers), ...

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7. accessdata.fda.gov accessdata.fda.gov/drugsatfda_docs/label/2018/020123s046lbl.pdf

Inactive ingredients - accessdata.fda.gov Inadvertent intrathecal use of OMNISCAN has caused convulsions, coma, sensory and motor neurologic deficits (5.1). NSF: Gadolinium-based contrast agents (GBCAs) ...

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Update on Gadolinium-Based Contrast Agent Safety, From the ... This article summarizes the latest safety evidence of commercially available GBCAs with a focus on new agents, discusses updates to the ACR NSF GBCA safety ...

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Use of Real-Life Safety Data From International ... Safety of the gadolinium-based contrast agents for magnetic resonance imaging, focusing in part on their accumulation in the brain and ...

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Safe and Informed Use of Gadolinium-Based Contrast ... Gadolinium-based contrast agents (GBCAs) have helped to improve the role of magnetic resonance imaging (MRI) for the diagnosis and treatment of diseases.