Systemic and Local Diffusion of Ethanol After Administration of Ethanol 96% Formulated in a Gel and Ethanol 98% Solution by the Percutaneous Route, in Patients With Congenital Venous Malformations:Pharmacokinetic, Pharmacodynamic and Clinical Study.

Study Overview
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Brief Summary
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Absolute ethanol has been used off-label as an unmodified formulation (solution) in Congenital Venous Malformations (CVM). Despite its effectiveness, absolute ethanol appears difficult to handle because of its high diffusion capacity outside the CVM and in the blood circulation. A less diffusible ethanol-based product (ethanol gel) has been developed in order to minimize systemic and local diffusion capacities of ethanol. Therefore, the pharmacokinetic parameters and their clinical and paraclinical outcomes between ethanol gel 96% and absolute ethanol need to be carried out. FDA Office of Orphan Products Development (FDA OOPD) : Funding source.

Official Title
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Systemic and Local Diffusion of Ethanol After Administration of Ethanol 96% Formulated in a Gel and Ethanol 98% Solution by the Percutaneous Route, in Patients With Congenital Venous Malformations:Pharmacokinetic, Pharmacodynamic and Clinical Study.

Conditions
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Congenital Venous Malformation

Intervention / Treatment
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* Drug: Ethanol 96% Gel
* Drug: Ethanol 98% Solution


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients of both sexes, of at least 12 years of age, For women of childbearing potential, negative pregnancy test at baseline, Patients with one clinically and radiologically (MRI) documented lesion diagnosed as CVM (pure or predominant), Patients for which an embolosclerotherapy by the percutaneous route is indicated as first line therapy of the test lesion, or for which previous treatments (i.e. surgery, embolosclerotherapy, laser) have been unsuccessful or insufficient, Patients with CVM lesional size of at least 12 cm3 (maximum craniocaudal dimension X mean dimension of 3 transverse equispaced measurements X mean dimension of 3 deepness equispaced measurements dimension) at MRI, Patients with focal or multifocal CVM lesion, i.e. with one or several well-interconnecting venous spaces and well-defined margins, Patients or parents able to follow study instructions and attend study visits, Written informed consent from the patients or parents. Exclusion criteria: Patients under 12 years of age, Pregnant women, nursing mothers and women of childbearing potential with no reliable contraception from more than 2 months, Women of childbearing potential with a positive pregnancy test at baseline, Patients with CVM of non venous predominance, Patients with CVM that are not reachable by the percutaneous route, Patients with extensive superficial skin CVM (i.e. with high risk of skin necrosis), Patients with a test lesion adjacent to major nerves (e.g. facial nerve in the parotid region, intramuscular regions adjacent to major nerves), Patients with facial CVM or bone involvement, Patients with small CVM lesion (<12 cm3 at MRI), Patients requiring more than 1 ml/Kg body weight (b.w.) in USA or more than 0.5 ml/Kg b.w. in France, or more than 30 mL of absolute ethanol to infuse, Patients with a known allergy to one of the components of the test products, Patients with a suspected allergy to iodinate.ed products, Patients with abnormal clotting parameters (platelets, partial thromboplastin, prothrombin time), Patients with an active inflammatory episode of the test lesion (i.e. acute or subacute swelling of the test lesion), Patients with complex malformations (e.g. Klippel-Trenaunay syndrome, Blue Rubber Bled Nevus syndrome, Muco-cutaneous familial venous malformations, Mafucci's syndrome), Patients in which a surgery, laser therapy or embolosclerotherapy of the test lesion has been performed within the last 12 weeks prior to study entry, Asthmatic patients who require daily medications, Patients with a non treated or non stabilized cardiac disease, Patients with a suspected right-left shunt, Patients with an intercurrent condition or a concomitant treatment which may interfere with a good conduct or the evaluation parameters of the study, Patients who participated in a study within the 12 weeks prior to study entry, Patients or parents who are not able or willing to follow the study instructions, Patients or parents who refuse to give written informed consent.

Ages Eligible for Study
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Minimum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Ethanol gel | Drug: Ethanol 96% Gel<br> <br> |
| Active Comparator: 2<br>Ethanol solution | Drug: Ethanol 98% Solution<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Systemic Exposure to Ethanol With the Two Test Products: Determination of the Maximum Plasma Concentration (Cmax) | Blood samples were performed, just before infusion, then 5 min, 10 min, 20 min, 40 min, 60 min, 90 min, and 120 min after infusion at the first site, then every 60 min onwards until ethanol levels are found under the detection limit. Cmax was estimated directly from experimental data. If all the ethanol concentrations of a patient was below the limit of quantification of the laboratory (LOQ), Cmax was reported as LOQ/2 for this patient. | Baseline visit (just before and during test product infusion procedure) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Systemic (Cardiopulmonary, Hematological, Metabolic) and Local Outcome of the Two Test Products. |  | Study end | 
| Change in Volume of Congenital Venous Malformation (CVM) From Screening to Study End (Day 112 Visit). |  | Screening and study end (Day 112) | 
| Patient Benefit |  | study end |