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The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been endorsed by the ANZCTR. Before participating in a study, talk to your health care provider and refer to this
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Trial registered on ANZCTR
Registration number
ACTRN12624001339549p
Ethics application status
Not yet submitted
Date submitted
9/10/2024
Date registered
5/11/2024
Date last updated
5/11/2024
Date data sharing statement initially provided
5/11/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
COrticosteroids for Biphasic Reactions in Anaphylaxis - COBRA
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Scientific title
Randomised control trial comparing incidence of biphasic anaphylaxis reactions, in patients who were successfully treated acute anaphylaxis, given oral Prednisone/Prednisolone at discharge compared to no corticosteroid therapy
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Secondary ID [1]
313157
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Nil
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Universal Trial Number (UTN)
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Trial acronym
COBRA
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Anaphylaxis
335434
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Condition category
Condition code
Inflammatory and Immune System
331995
331995
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0
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Allergies
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Patients who are randomised to the treatment arm will be given a 2mg/kg dose of oral corticosteroid, Prednisone if they can swallow tablets or Prednisolone suspension if they cannot, prior to discharge and a prescription for two days of the same steroid and dose to take at home.
All patients will also receive an adrenaline auto-injector device '(Epi-pen)' and a script for oral antihistamine, Cetirizine - dosing as per New Zealand Formulary for age, to take as required.
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Intervention code [1]
329724
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Treatment: Drugs
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Comparator / control treatment
All patients will receive a script for, and education for use of, an adrenaline auto-injector device (Epi-pen). They will also be given a script for antihistamine to use as required.
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Control group
Active
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Outcomes
Primary outcome [1]
339592
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Incidence of biphasic reaction with 72 hours of initial anaphylactic episode
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Assessment method [1]
339592
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Study specific patient questionnaire
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Timepoint [1]
339592
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72 hours post recruitment
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Secondary outcome [1]
440538
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Number of adrenaline doses received with biphasic reaction treatment
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Assessment method [1]
440538
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Study specific patient questionnaire
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Timepoint [1]
440538
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72 hours post recruitment
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Secondary outcome [2]
440539
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Rate of admission to hospital with biphasic reaction
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Assessment method [2]
440539
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Study specific patient questionnaire
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Timepoint [2]
440539
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72 hours post recruitment
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Secondary outcome [3]
440540
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Incidence of insomnia
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Assessment method [3]
440540
0
Study specific patient questionnaire
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Timepoint [3]
440540
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72 hours post recruitment
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Eligibility
Key inclusion criteria
Successfully treated acute anaphylaxis deemed safe for hospital discharge by the senior medical doctor overseeing the patients care.
A senior medical doctor will be defined as the doctor who would normally oversee a patients care and discharge during that shift. This will usually be the Senior Medical Officer (SMO), but maybe be a Senior Registrar, Medical Officer Special Scale (MOSS) or Fellow, especially during night shifts.
Anaphylaxis will be defined using the NIAID/FAAN criteria
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Minimum age
2
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Weight under 15 kg
Received corticosteroids during treatment of initial reaction
Allergy to Prednisone/Prednisolone
- these patients can be put in non-treatment arm without randomisation
Unable to be followed up by research team
Unable to represent or seek urgent medical care due to geographic, communication or transport restraints
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
sealed opaque envelopes
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
computerised sequence generation
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
6/01/2025
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Actual
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Date of last participant enrolment
Anticipated
4/08/2026
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Actual
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Date of last data collection
Anticipated
10/08/2026
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Actual
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Sample size
Target
250
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
26627
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New Zealand
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State/province [1]
26627
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WAIKATO
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Funding & Sponsors
Funding source category [1]
317599
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Hospital
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Name [1]
317599
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Te Whatu Ora Waikato
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Address [1]
317599
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Country [1]
317599
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New Zealand
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Primary sponsor type
Hospital
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Name
Te Whatu Ora Waikato
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Address
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Country
New Zealand
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Secondary sponsor category [1]
319909
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None
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Name [1]
319909
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Address [1]
319909
0
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Country [1]
319909
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
316304
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Northern A Health and Disability Ethics Committee
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Ethics committee address [1]
316304
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https://ethics.health.govt.nz/about/northern-a-health-and-disability-ethics-committee/
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Ethics committee country [1]
316304
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New Zealand
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Date submitted for ethics approval [1]
316304
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11/11/2024
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Approval date [1]
316304
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Ethics approval number [1]
316304
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Summary
Brief summary
There is significant debate amongst clinicians on whether corticosteroids should be prescribed for patients who have presented with anaphylaxis. On one hand you have an unknown amount of risk of a biphasic reaction, which can be as severe as the initial reaction, and the known side effect profile of corticosteroids on the other. An appropriately powered, prospective randomised control trial, RCT, may help clinicians with this clinical decision and assist in both national and international guidelines on anaphylaxis treatment.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
137462
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Dr Adrian Owen
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Address
137462
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Waikato Hospital, 183 Pembroke Street, Hamilton 3204
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Country
137462
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New Zealand
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Phone
137462
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+64221885215
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Fax
137462
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Email
137462
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[email protected]
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Contact person for public queries
Name
137463
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Adrian Owen
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Address
137463
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Waikato Hospital, 183 Pembroke Street, Hamilton 3204
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Country
137463
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New Zealand
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Phone
137463
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+64221885215
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Fax
137463
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Email
137463
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[email protected]
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Contact person for scientific queries
Name
137464
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Adrian Owen
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Address
137464
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Waikato Hospital, 183 Pembroke Street, Hamilton 3204
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Country
137464
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New Zealand
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Phone
137464
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+64221885215
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Fax
137464
0
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Email
137464
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[email protected]
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Data sharing statement
Will the study consider sharing individual participant data?
No
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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