ClinicalTrials.gg
CompletedNCT01962571TONEUpdated Dec 2, 2019

Treatment of Optic Neuritis With Erythropoietin: a Randomised, Double-blind, Placebo-controlled Trial

A Phase 3 interventional study of Erythropoietin alfa and Placebo in Optic Neuritis, sponsored by University Eye Hospital, Freiburg. Completed at 11 sites in Germany. Open to participants aged 18 Years to 50 Years. Per ClinicalTrials.gov, last updated 2019-12-02.

Sponsored by University Eye Hospital, Freiburg · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
108
Allocation
Randomized
Ages
18 Years to 50 Years
Sex
All
01

Study summary

This clinical trial aims at preventing visual dysfunction and optic nerve degeneration associated with autoimmune optic neuritis by systemic i.v. administration of 33.000 IU erythropoietin over 3 days. The primary objective is to determine the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone as assessed by measurements of retinal nerve fibre layer thickness and low contrast visual acuity 6 months after acute optic neuritis.

02

Conditions studied

  • Optic Neuritis

Keywords

  • Optic neuritis
  • Multiple Sclerosis
  • Clinically isolated syndrome
  • Erythropoietin
03

In context

Optic Neuritis

88 studies on the registry are indexed under Optic Neuritis; 16 are open to participants now.

This study's enrollment of 108 is above the median of 50 across 58 interventional studies indexed under Optic Neuritis.

Browse Optic Neuritis studies →

Lead sponsor

University Eye Hospital, Freiburg is the lead sponsor of 4 studies on the registry; none are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years to 50 Years
Sexes eligible
All
Accepts healthy volunteers
No

Eligibility criteria

Patients eligible for inclusion in this trial must meet all of the following criteria:

  1. Written obtained according to international guidelines and local laws
  2. Male and female patients aged ≥ 18 to ≤ 50 years
  3. Patients with ON
  4. First symptoms of ON ≤ 10 days prior to the first administration of product
  5. High contrast visual acuity (HCVA) of ≤ 0.5 (decimal system)
  6. Adequate OCT measurements available

Patients eligible for this trial must not meet any of the following criteria:

  1. Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial
  2. Simultaneous participation in another interventional trial which could interfere with this trial and/or participation in a clinical trial within the last 3 months before enrolment in this trial
  3. Refractive anomalies: Hyperopia > 5 dpt, myopia \< -7 dpt, astigmatism > 3 dpt
  4. Media opacity
  5. Severe papillitis
  6. Previous ON
  7. Any other optic nerve and retinal disease
  8. Pre-existing MS or any other neurological disease
  9. Congenital diseases:

    • thrombophilia
    • phenylketonuria
  10. Acquired diseases:

    • diseases,
    • cardiovascular diseases,
    • diabetes mellitus,
    • uncontrolled hypertension (with blood pressure > 140 / 90 mm Hg (cf. chapter 7.7.5)),
    • any ,
    • epilepsy,
    • known tuberculosis with ongoing or unknown activity,
    • acute gastrointestinal ulceration within the last 3 months prior to randomisation,
    • acute viral, bacterial or fungal infection,
    • known infection with (HIV), Virus, or Virus,
    • history of colitis ulcerosa, diverticulitis, or acute enteroanastomosis,
    • known osteoporosis,
    • history of thromboembolic events,
    • elevated level (>17 g/dl in men or >15 g/dl in women)
    • polycythaemia
    • any other significant illness potentially interfering with any trial assessment or trial treatment
  11. Performing semi-professional or professional sporting activities or physical training
  12. Pre-treatment with in the last 30 days prior to the onset of optic neuritis
  13. Pre-treatment with EPO
  14. Known or persistent abuse of medication, drugs or alcohol
  15. Active immunization within 2 weeks prior to randomisation
  16. Significant surgery within 4 weeks prior to randomisation
  17. Blood donation or bloodletting within 4 weeks prior to screening
  18. Pre-treatment with or immunomodulatory agents
  19. Persons who are in a relationship of dependence/employment with the sponsor or the investigator

    This section concerns only female patients who are able to have a child:

  20. Current or planned pregnancy; nursing period within 3 months from investigational product administration
  21. Unwillingness to use one of the following safe combination methods of within 3 months from investigational product administration to achieve a PEARL index of \<1: female condom, diaphragm or coil, each used in combination with a spermicide; hormonal intra-uterine device or hormonal contraception in combination with a mechanical method of contraception
Terms in these criteria, in plain language(11)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

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You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Autoimmune disease

A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.

Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
108 participants (actual)

Study arms

  • Experimental
    Erythropoietin alfa

    Recombinant human EPO (Epoetin alfa HEXAL®) will be given as an i.v. bolus injection on days 1, 2 and 3. The dosage per day will be 33.000 IU in accordance with previous trials.

    Drug: Erythropoietin alfa

  • Placebo comparator
    Placebo

    As matched placebo for this study, sterile normal saline (0.9% sodium chloride for i.v. administration) will be used. It will be given as a bolus injection in the same manner as EPO.

    Drug: Placebo

Interventions

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What researchers measure

Primary outcomes

  1. Global retinal nerve fibre layer thickness (RNFLT-G)

    Determination of the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone (standard of care) as assessed by measurement of global retinal nerve fibre layer thickness (RNFLT-G) in the affected eye 6 months after randomisation.

    Time frame: 6 months

  2. Low contrast visual acuity (LCVA)

    Determination of the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone (standard of care) as assessed by measurement of low contrast visual acuity (LCVA) in the affected eye 6 months after randomisation.

    Time frame: 6 months

Secondary outcomes

  1. Absolute values of the global retinal nerve fibre layer thickness

    Time frame: 6 months

  2. Retinal nerve fibre layer thickness in the papillomacular bundle

    Time frame: 6 months

  3. Retinal nerve fibre layer thickness in the temporal quadrant

    Time frame: 6 months

  4. Total macular volume

    Time frame: 6 months

  5. Visual acuity

    Time frame: 6 months

  6. Contrast sensitivity

    Time frame: 6 months

  7. Mean visual field defect

    Time frame: 6 months

  8. Latency [ms] and amplitude [µV] of visual evoked potentials (VEP)

    Time frame: 6 months

  9. Expanded Disability Status Scale (EDSS) score

    Time frame: 6 months

  10. Quality of life

    Determined by NEI-VFQ-25

    Time frame: 6 months

  11. Safety

    Assessment of AEs / SAEs

    Time frame: Screening until end of study

07

Study locations

11 sites
  • Medical Center - University of Freiburg, Eye Hospital
    Freiburg, Baden-Wuerttemberg 79106, Germany
  • Heidelberg University Hospital, Department of Neurooncology
    Heidelberg, Baden-Wuerttemberg 69120, Germany
  • Tuebingen University Hospital
    Tuebingen, Baden-Wuerttemberg 72076, Germany
  • University Hospital Erlangen
    Erlangen, Bayern 91054, Germany
  • University Hospital of Munich
    Munich, Bayern 81377, Germany
  • University Hospital Klinikum rechts der Isar, Munich
    Munich, Bayern 81675, Germany
  • University Medical Center Göttingen
    Göttingen, Niedersachsen 37075, Germany
  • Hannover Medical School
    Hannover, Niedersachsen 30625, Germany
  • Duesseldorf University Hospital
    Duesseldorf, Nordrhein-Westfalen 40225, Germany
  • University Medical Center of the Johannes Gutenberg University Mainz
    Mainz, Rheinland-Pfalz 55131, Germany
  • University Medical Center Hamburg-Eppendorf
    Hamburg, 20246, Germany
08

References and documents

Publications

  • Suhs KW, Hein K, Sattler MB, Gorlitz A, Ciupka C, Scholz K, Kasmann-Kellner B, Papanagiotou P, Schaffler N, Restemeyer C, Bittersohl D, Hassenstein A, Seitz B, Reith W, Fassbender K, Hilgers R, Heesen C, Bahr M, Diem R. A randomized, double-blind, phase 2 study of erythropoietin in optic neuritis. Ann Neurol. 2012 Aug;72(2):199-210. doi: 10.1002/ana.23573. PubMed 22926853 ↗
  • Diem R, Molnar F, Beisse F, Gross N, Druschler K, Heinrich SP, Joachimsen L, Rauer S, Pielen A, Suhs KW, Linker RA, Huchzermeyer C, Albrecht P, Hassenstein A, Aktas O, Guthoff T, Tonagel F, Kernstock C, Hartmann K, Kumpfel T, Hein K, van Oterendorp C, Grotejohann B, Ihorst G, Maurer J, Muller M, Volkmann M, Wildemann B, Platten M, Wick W, Heesen C, Schiefer U, Wolf S, Lagreze WA. Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial-study protocol. BMJ Open. 2016 Mar 1;6(3):e010956. doi: 10.1136/bmjopen-2015-010956. PubMed 26932144 ↗
  • Lagreze WA, Kuchlin S, Ihorst G, Grotejohann B, Beisse F, Volkmann M, Heinrich SP, Albrecht P, Ungewiss J, Worner M, Hug MJ, Wolf S, Diem R; TONE study group. Safety and efficacy of erythropoietin for the treatment of patients with optic neuritis (TONE): a randomised, double-blind, multicentre, placebo-controlled study. Lancet Neurol. 2021 Dec;20(12):991-1000. doi: 10.1016/S1474-4422(21)00322-7. PubMed 34800417 ↗
  • Wilhelm H, Schabet M. The Diagnosis and Treatment of Optic Neuritis. Dtsch Arztebl Int. 2015 Sep 11;112(37):616-25; quiz 626. doi: 10.3238/arztebl.2015.0616. PubMed 26396053 ↗
  • Lagreze W, Diem R. [New aspects in the therapy of multiple sclerosis and optic neuritis]. Ophthalmologe. 2014 Aug;111(8):709-14. doi: 10.1007/s00347-013-2987-7. German. PubMed 25063544 ↗
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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Dec 2, 2019, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT01962571
Lead sponsor
University Eye Hospital, Freiburg
Collaborators
German Federal Ministry of Education and Research
Responsible party
Prof. Dr. Wolf Lagrèze (Prof. Dr. med., University Eye Hospital, Freiburg) — Principal investigator
First posted
Oct 14, 2013
Start date
Nov 25, 2014
Primary completion
Jun 20, 2018
Completion
Nov 26, 2019
Last update
Dec 2, 2019

Study contacts

Wolf A. Lagrèze, Prof.
principal investigator · Eye Hospital, Medical Center - University of Freiburg

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Epoetin Alfa

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