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COMparison Between Anakinra and Tocilizumab in NORSE - "COMBAT-NORSE"
Sponsor: Yale University
Summary
The goal of this clinical trial is to find out whether two existing medications-anakinra and tocilizumab-can effectively treat a rare and life-threatening brain condition called NORSE (New-Onset Refractory Status Epilepticus). NORSE causes continuous seizures in previously healthy children and adults and does not respond to standard treatments. It often leads to long-term disability or death. Doctors currently use anakinra and tocilizumab as second-line treatments when first-line therapies fail, but there is no clear evidence showing which drug works better or when it should be given. This study aims to answer those questions. The study will enroll patients across 33 hospitals in the United States, Canada, Europe, and Asia. It includes two groups: 1. Randomized Cohort Patients will be randomly assigned to receive either anakinra or tocilizumab within the first 7 days of their illness. Only patients whose doctors were already planning to use one of these medications as part of standard care will be eligible for randomization. Researchers will monitor their recovery and compare outcomes between the two treatments. 2. Observational Cohort Patients who cannot be randomized-usually because they were diagnosed too late-will still be followed to study how the timing of treatment affects recovery. Participants will: * Receive one of the two medications (depending on their group assignment). * Take part in follow-up assessments over the course of one year, including medical evaluations and surveys. Some participants may be followed annually beyond one year. * Optionally participate in a 60-minute interview to share their or their caregiver's experience with NORSE.
Official title: Comparing the Effects of Anakinra and Tocilizumab on Outcomes in Patients With New-Onset Refractory Status Epilepticus
Key Details
Gender
All
Age Range
2 Years - Any
Study Type
INTERVENTIONAL
Enrollment
438
Start Date
2026-03-01
Completion Date
2030-09-30
Last Updated
2025-12-15
Healthy Volunteers
No
Conditions
Interventions
Anakinra
SOC will be followed , Suggested Dose: 10 mg/kg/day IV, divided into 4 daily doses (q6h) Maximum dose: 400 mg/day
Tocilizumab
SOC will be followed, Suggested Dose: If \<30 kg: 12 mg/kg IV once every 2 weeks If ≥30 kg: 8 mg/kg IV once every 2 weeks Maximum dose: 800 mg per dose
Standard medical treatment
For patients who could not be randomized by day 7, standard clinical care will be followed and patients will be followed prospectively and observationally.
Locations (33)
Barrow Institute
Phoenix, Arizona, United States
Children's Hospital Colorado
Aurora, Colorado, United States
Yale New Haven Hospital
New Haven, Connecticut, United States
Children's National (DC)
Washington D.C., District of Columbia, United States
University of Florida
Gainesville, Florida, United States
University of Chicago
Chicago, Illinois, United States
Northwestern University
Evanston, Illinois, United States
Mass General (MGH)
Boston, Massachusetts, United States
Beth Israel Deaconess
Boston, Massachusetts, United States
Boston Children's Hospital
Boston, Massachusetts, United States
Mayo Clinic
Rochester, Minnesota, United States
University of Nebraska
Lincoln, Nebraska, United States
New York University
New York, New York, United States
Columbia University
New York, New York, United States
Mount Sinai (NY)
New York, New York, United States
University of Cincinnati
Cincinnati, Ohio, United States
Cleveland Clinic
Cleveland, Ohio, United States
Oregon Health and Science University
Portland, Oregon, United States
Children's Hospital Philadelphia (CHOP)
Philadelphia, Pennsylvania, United States
University of Pennsylvania
Philadelphia, Pennsylvania, United States
UT Southwestern Medical Center
Dallas, Texas, United States
Baylor/Texas Children's
Houston, Texas, United States
Seattle Children's Hospital
Seattle, Washington, United States
University of Wisconsin
Madison, Wisconsin, United States
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Western University
London, Canada
Hospital for Sick Children
Toronto, Canada
Salpêtrière
Paris, France
University of Modena
Modena, Italy
Seoul National University Hospital
Seoul, South Korea
Karolinska Institute
Stockholm, Sweden
Great Ormond Street Hospital
London, United Kingdom
King's College
London, United Kingdom