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NCT07281027Not yet recruitingPhase 3

COMparison Between Anakinra and Tocilizumab in NORSE - "COMBAT-NORSE"

Comparing the Effects of Anakinra and Tocilizumab on Outcomes in Patients With New-Onset Refractory Status Epilepticus

Source: ClinicalTrials.gov · Last updated 19 Aug 2026

Brief summary (registry, in English)

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.

Status (registry)
Not yet recruiting
Phase (registry)
Phase 3
Study type
Interventional
Enrollment
438 (estimated)
First submitted
21 Nov 2025
Start date
1 Dec 2026
Primary completion date
31 Mar 2030
Lead sponsor
Yale University
Diseases
Epilepsy
NCT number
NCT07281027

What you commit to

  • Study type: Interventional · Phase 3
  • Planned participants: 438
  • From 1 Dec 2026 to the primary completion date, 31 Mar 2030
  • 33 sites in 7 countries
  • Visits and tests: ask the trial team, the registry does not list them

Built from the registry fields of ClinicalTrials.gov. It describes the study, not your situation.

Who cannot take part

Copied verbatim from ClinicalTrials.gov and grouped by topic. Only the trial team decides who can take part.

Other illness

  • Any acute or active systemic medical illness such as metastatic cancer, renal failure, hepatic failure, poorly controlled diabetes, etc., in the opinion of the investigators. If this is unclear, the study PI Dr. Hirsch will determine if this criterion is met.
    • Additional Exclusion Criteria for the Randomized Control Cohort:

Lab values

  • Contraindication to either anakinra or tocilizumab as listed in the prescribing information:
    • Known hypersensitivity to E. Coli-derived proteins, anakinra, tocilizumab, or any component of the products
    • Active serious infection at the time of initiation
    • Concomitant use of TNF blocking agents; absolute neutrophil count \< 2000; platelet count \< 100,000 per mm³; or ALT or AST \> 1.5 X the upper limit of normal
    • Elevated risk of GI perforation.

Who the study is looking for

  • Age 2 and older.
  • In their usual state of health prior to their onset of SE.
  • Presenting with NORSE as defined in the consensus criteria:
    • Refractory SE (failed 2 appropriately used anti-seizure medications) in a patient without active epilepsy or other pre-existing relevant neurological disorder and without an acute or active structural, toxic, or metabolic cause found in the first 72 hours.
    • Includes patients with any RSE, not just super-refractory SE.
    • Includes patients who ultimately are discovered to have a known etiology (infectious, autoimmune, genetic, etc.), as well as those who remain cryptogenic.
    • Additional Inclusion Criteria for the Randomized Arm:
  • Anakinra and/or tocilizumab are being planned or considered as part of standard clinical care.
  • The onset of SE was in the prior 7 days at the time of enrollment.

Age in the registry: 2 years to - · Sex: All · Does not accept healthy volunteers

Full criteria on ClinicalTrials.gov

Sites (33)

Sites in registry order. Pick your city on the disease page to sort them by distance.

SiteCityCountrySite status
Western University
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LondonCanadaUnknown status
Hospital for Sick Children
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TorontoCanadaUnknown status
Salpêtrière
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ParisFranceUnknown status
Great Ormond Street Hospital
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LondonUnited KingdomUnknown status
King's College
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LondonUnited KingdomUnknown status
University of Modena
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ModenaItalyUnknown status
Seoul National University Hospital
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SeoulSouth KoreaUnknown status
Karolinska Institute
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StockholmSwedenUnknown status
Children's Hospital Colorado
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AuroraUnited StatesUnknown status
Boston Children's Hospital
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BostonUnited StatesUnknown status
Mass General (MGH)
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BostonUnited StatesUnknown status
Beth Israel Deaconess
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BostonUnited StatesUnknown status
University of Chicago
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ChicagoUnited StatesUnknown status
University of Cincinnati
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CincinnatiUnited StatesUnknown status
Cleveland Clinic
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ClevelandUnited StatesUnknown status
UT Southwestern Medical Center
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DallasUnited StatesUnknown status
Northwestern University
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EvanstonUnited StatesUnknown status
University of Florida
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GainesvilleUnited StatesUnknown status
Baylor/Texas Children's
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HoustonUnited StatesUnknown status
University of Nebraska
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LincolnUnited StatesUnknown status
University of Wisconsin
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MadisonUnited StatesUnknown status
Medical College of Wisconsin
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MilwaukeeUnited StatesUnknown status
Yale New Haven Hospital
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New HavenUnited StatesUnknown status
Columbia University
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New YorkUnited StatesUnknown status
Mount Sinai (NY)
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New YorkUnited StatesUnknown status
New York University
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New YorkUnited StatesUnknown status
University of Pennsylvania
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PhiladelphiaUnited StatesUnknown status
Children's Hospital Philadelphia (CHOP)
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PhiladelphiaUnited StatesUnknown status
Barrow Institute
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PhoenixUnited StatesUnknown status
Oregon Health and Science University
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PortlandUnited StatesUnknown status
Mayo Clinic
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RochesterUnited StatesUnknown status
Seattle Children's Hospital
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SeattleUnited StatesUnknown status
Children's National (DC)
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Washington D.C.United StatesUnknown status

This page is information, not medical advice. Discuss any trial with your doctor.