Trial Outcomes & Findings for Efficacy in iNPH Shunting (PENS) Trial (NCT NCT05081128)

NCT ID: NCT05081128

Last Updated: 2026-08-27

Results Overview

Evaluation of CSF shunting in iNPH patients through a group comparison of change from baseline at three months between active and placebo-controlled groups, using the primary endpoint of gait velocity (in meters per second).

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

99 participants

Primary outcome timeframe

Baseline and 3 months

Results posted on

2026-08-27

Participant Flow

Participant milestones

Participant milestones
Measure
Open Shunt
The open-shunt group was assigned valve setting 4 (opening pressure, 110 mm of water); however, valve settings 5 and 6 (145 or 180 mm of water, respectively) were allowed at the surgeon's discretion for participant safety.
Placebo
The placebo group was assigned valve setting 8 (opening pressure, \>400 mm of water).
3 Months Post-Op
COMPLETED
49
46
3 Months Post-Op
STARTED
49
50
3 Months Post-Op
NOT COMPLETED
0
4
12 Months Active Shunting
STARTED
49
46
12 Months Active Shunting
COMPLETED
49
43
12 Months Active Shunting
NOT COMPLETED
0
3

Reasons for withdrawal

Reasons for withdrawal
Measure
Open Shunt
The open-shunt group was assigned valve setting 4 (opening pressure, 110 mm of water); however, valve settings 5 and 6 (145 or 180 mm of water, respectively) were allowed at the surgeon's discretion for participant safety.
Placebo
The placebo group was assigned valve setting 8 (opening pressure, \>400 mm of water).
3 Months Post-Op
Withdrawal by Subject
0
3
3 Months Post-Op
Death
0
1
12 Months Active Shunting
Physician Decision
0
1
12 Months Active Shunting
Death
0
2

Baseline Characteristics

Efficacy in iNPH Shunting (PENS) Trial

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Open Shunt
n=49 Participants
The open-shunt group was assigned valve setting 4 (opening pressure, 110 mm of water); however, valve settings 5 and 6 (145 or 180 mm of water, respectively) were allowed at the surgeon's discretion for participant safety.
Placebo
n=50 Participants
The placebo group was assigned valve setting 8 (opening pressure, \>400 mm of water).
Total
n=99 Participants
Total of all reporting groups
Age, Continuous
75.1 Years
STANDARD_DEVIATION 5.7 • n=31 Participants
74.9 Years
STANDARD_DEVIATION 5.8 • n=49 Participants
75.0 Years
STANDARD_DEVIATION 5.7 • n=80 Participants
Sex: Female, Male
Female
23 Participants
n=31 Participants
25 Participants
n=49 Participants
48 Participants
n=80 Participants
Sex: Female, Male
Male
26 Participants
n=31 Participants
25 Participants
n=49 Participants
51 Participants
n=80 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=31 Participants
0 Participants
n=49 Participants
0 Participants
n=80 Participants
Race (NIH/OMB)
Asian
2 Participants
n=31 Participants
3 Participants
n=49 Participants
5 Participants
n=80 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=31 Participants
0 Participants
n=49 Participants
0 Participants
n=80 Participants
Race (NIH/OMB)
Black or African American
2 Participants
n=31 Participants
1 Participants
n=49 Participants
3 Participants
n=80 Participants
Race (NIH/OMB)
White
45 Participants
n=31 Participants
45 Participants
n=49 Participants
90 Participants
n=80 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=31 Participants
0 Participants
n=49 Participants
0 Participants
n=80 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=31 Participants
1 Participants
n=49 Participants
1 Participants
n=80 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
2 Participants
n=31 Participants
0 Participants
n=49 Participants
2 Participants
n=80 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
47 Participants
n=31 Participants
50 Participants
n=49 Participants
97 Participants
n=80 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=31 Participants
0 Participants
n=49 Participants
0 Participants
n=80 Participants
Baseline Gait Velocity (m/s)
0.87 m/s
STANDARD_DEVIATION 0.25 • n=31 Participants
0.82 m/s
STANDARD_DEVIATION 0.27 • n=49 Participants
0.84 m/s
STANDARD_DEVIATION 0.26 • n=80 Participants

PRIMARY outcome

Timeframe: Baseline and 3 months

Population: One participant in the placebo group who underwent randomization was deceased at the 3-month time point and is not included in this analysis.

Evaluation of CSF shunting in iNPH patients through a group comparison of change from baseline at three months between active and placebo-controlled groups, using the primary endpoint of gait velocity (in meters per second).

Outcome measures

Outcome measures
Measure
Open Shunt
n=49 Participants
The open-shunt group was assigned valve setting 4 (opening pressure, 110 mm of water); however, valve settings 5 and 6 (145 or 180 mm of water, respectively) were allowed at the surgeon's discretion for participant safety.
Placebo
n=49 Participants
The placebo group was assigned valve setting 8 (opening pressure, \>400 mm of water).
Change in Gait Velocity
0.23 m/s
Standard Deviation 0.23
0.03 m/s
Standard Deviation 0.23

SECONDARY outcome

Timeframe: Baseline and 3 months

Population: One participant in the placebo group who underwent randomization was deceased at the 3-month time point and is not included in this analysis.

Evaluate the effect of shunting between active and placebo-controlled groups at three months using MoCA test to assess cognition. Scores on the MoCA range from 0 to 30, with a score of 26 and higher generally considered normal.

Outcome measures

Outcome measures
Measure
Open Shunt
n=49 Participants
The open-shunt group was assigned valve setting 4 (opening pressure, 110 mm of water); however, valve settings 5 and 6 (145 or 180 mm of water, respectively) were allowed at the surgeon's discretion for participant safety.
Placebo
n=49 Participants
The placebo group was assigned valve setting 8 (opening pressure, \>400 mm of water).
Change in Cognition as Assessed by the Montreal Cognitive Assessment (MoCA)
1.3 score on a scale
Standard Deviation 2.1
0.3 score on a scale
Standard Deviation 2.9

SECONDARY outcome

Timeframe: Baseline and 3 months

Population: One participant in the placebo group who underwent randomization was deceased at the 3-month time point and is not included in this analysis.

Evaluate the effect of shunting between active and placebo-controlled groups at three months using Overactive Bladder Questionnaire, short form (OAB-q sf.) to assess bladder control. Total score range 0- to 100, with lower score indicating greater effect, i.e., worse QOL.

Outcome measures

Outcome measures
Measure
Open Shunt
n=49 Participants
The open-shunt group was assigned valve setting 4 (opening pressure, 110 mm of water); however, valve settings 5 and 6 (145 or 180 mm of water, respectively) were allowed at the surgeon's discretion for participant safety.
Placebo
n=49 Participants
The placebo group was assigned valve setting 8 (opening pressure, \>400 mm of water).
Change in Bladder Control as Assessed by the Overactive Bladder Questionnaire, Short Form
-3.3 score on a scale
Standard Deviation 6.4
-1.5 score on a scale
Standard Deviation 6.3

SECONDARY outcome

Timeframe: Baseline and 3 months

Population: One participant in the placebo group who underwent randomization was deceased at the 3-month time point and is not included in this analysis.

Evaluate the effect of shunting between active and placebo-controlled groups at three months using Tinetti Score to assess balance and gait. Scores on the Tinetti range from 0 to 28. The higher the score the better the gait and balance performance.

Outcome measures

Outcome measures
Measure
Open Shunt
n=49 Participants
The open-shunt group was assigned valve setting 4 (opening pressure, 110 mm of water); however, valve settings 5 and 6 (145 or 180 mm of water, respectively) were allowed at the surgeon's discretion for participant safety.
Placebo
n=49 Participants
The placebo group was assigned valve setting 8 (opening pressure, \>400 mm of water).
Change in Balance and Gait as Assessed by the Tinetti Score
2.9 score on a scale
Standard Deviation 3.8
0.5 score on a scale
Standard Deviation 5.3

OTHER_PRE_SPECIFIED outcome

Timeframe: Baseline and 12 months of active shunting

Evaluate the effect of shunting between active and placebo-controlled groups at nine months using Overactive Bladder Questionnaire, short form (OAB-q sf.) to assess bladder control. All scale scores are transformed to a 0- to 100-point scale, with lower scores indicating greater effect, i.e., worse QOL.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: Baseline and 12 months of active shunting

Evaluate the change in gait velocity among all study participants between baseline and 12 months of active shunting, using the primary outcome of gait velocity (in meters per second).

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: Baseline and 12 months of active shunting

Evaluate the effect of shunting between active and placebo-controlled groups at nine months using MoCA test to assess cognition. Scores on the MoCA range from zero to 30, with a score of 26 and higher generally considered normal.

Outcome measures

Outcome data not reported

Adverse Events

Open Shunt

Serious events: 18 serious events
Other events: 39 other events
Deaths: 0 deaths

Placebo

Serious events: 16 serious events
Other events: 40 other events
Deaths: 3 deaths

Serious adverse events

Serious adverse events
Measure
Open Shunt
n=49 participants at risk
The open-shunt group was assigned valve setting 4 (opening pressure, 110 mm of water); however, valve settings 5 and 6 (145 or 180 mm of water, respectively) were allowed at the surgeon's discretion for participant safety.
Placebo
n=50 participants at risk
The placebo group was assigned valve setting 8 (opening pressure, \>400 mm of water).
Nervous system disorders
Seizure
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Subdural effusion
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Subdural hygroma
4.1%
2/49 • Number of events 2 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Syncope
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Psychiatric disorders
Confusional state
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Ear and labyrinth disorders
Vertigo
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Eye disorders
Visual impairment
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Gastrointestinal disorders
Gastric ulcer haemorrhage
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
General disorders
Drug-disease interaction
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
General disorders
Pyrexia
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Infections and infestations
COVID-19 pneumonia
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Infections and infestations
Erysipelas
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Infections and infestations
Osteomyelitis
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Infections and infestations
Pneumonia
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Infections and infestations
Urinary tract infection
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 3 • From enrollment up to 30 days post shunt adjustment
Injury, poisoning and procedural complications
Foreign body ingestion
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Injury, poisoning and procedural complications
Fractured sacrum
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Injury, poisoning and procedural complications
Post procedural haemorrhage
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Injury, poisoning and procedural complications
Procedural nausea
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Injury, poisoning and procedural complications
Shunt malfunction
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Cardiac disorders
Arrhythmia
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Cardiac disorders
Atrial Fibrillation
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Cardiac disorders
Sinus Node Disfunction
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Cardiac disorders
Supraventricular Tachycardia
2.0%
1/49 • Number of events 2 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Injury, poisoning and procedural complications
Subdural haematoma
8.2%
4/49 • Number of events 6 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Injury, poisoning and procedural complications
Wound decomposition
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Investigations
Troponin abnormal
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Investigations
Troponin increased
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Metabolism and nutrition disorders
Diabetic ketoacidosis
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Metabolism and nutrition disorders
Hyperglycaemia
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Metabolism and nutrition disorders
Hypokalaemia
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Musculoskeletal and connective tissue disorders
Muscular weakness
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Musculoskeletal and connective tissue disorders
Osteoarthritis
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Musculoskeletal and connective tissue disorders
Rhabdomyolysis
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Aphasia
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Cerebral haemorrhage
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Encephalopathy
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Headache
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Hydrocephalus
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Intracranial hypotension
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Ischaemic stroke
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Loss of consciousness
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Respiratory, thoracic and mediastinal disorders
Acute respiratory failure
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Respiratory, thoracic and mediastinal disorders
Choking
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Respiratory, thoracic and mediastinal disorders
Hypoxia
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Skin and subcutaneous tissue disorders
Dermatitis contact
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Social circumstances
Inadequate housing
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Surgical and medical procedures
Percutaneous coronary intervention
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Vascular disorders
Iliac artery stenosis
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Blood and lymphatic system disorders
Anaemia
2.0%
1/49 • Number of events 2 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Cardiac disorders
Acute myocardial infarction
2.0%
1/49 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment
Injury, poisoning and procedural complications
Humerus fracture
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment

Other adverse events

Other adverse events
Measure
Open Shunt
n=49 participants at risk
The open-shunt group was assigned valve setting 4 (opening pressure, 110 mm of water); however, valve settings 5 and 6 (145 or 180 mm of water, respectively) were allowed at the surgeon's discretion for participant safety.
Placebo
n=50 participants at risk
The placebo group was assigned valve setting 8 (opening pressure, \>400 mm of water).
Nervous system disorders
Subdural hygroma
14.3%
7/49 • Number of events 7 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Gastrointestinal disorders
Abdominal pain
12.2%
6/49 • Number of events 6 • From enrollment up to 30 days post shunt adjustment
6.0%
3/50 • Number of events 3 • From enrollment up to 30 days post shunt adjustment
Gastrointestinal disorders
Nausea
4.1%
2/49 • Number of events 2 • From enrollment up to 30 days post shunt adjustment
6.0%
3/50 • Number of events 3 • From enrollment up to 30 days post shunt adjustment
General disorders
Fatigue
8.2%
4/49 • Number of events 4 • From enrollment up to 30 days post shunt adjustment
2.0%
1/50 • Number of events 1 • From enrollment up to 30 days post shunt adjustment
Infections and infestations
Cystitis
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
6.0%
3/50 • Number of events 3 • From enrollment up to 30 days post shunt adjustment
Infections and infestations
Urinary tract infection
6.1%
3/49 • Number of events 3 • From enrollment up to 30 days post shunt adjustment
8.0%
4/50 • Number of events 9 • From enrollment up to 30 days post shunt adjustment
Injury, poisoning and procedural complications
Contusion
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
8.0%
4/50 • Number of events 4 • From enrollment up to 30 days post shunt adjustment
Injury, poisoning and procedural complications
Subdural haematoma
10.2%
5/49 • Number of events 7 • From enrollment up to 30 days post shunt adjustment
10.0%
5/50 • Number of events 7 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Dizziness
0.00%
0/49 • From enrollment up to 30 days post shunt adjustment
6.0%
3/50 • Number of events 3 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Headache
36.7%
18/49 • Number of events 20 • From enrollment up to 30 days post shunt adjustment
38.0%
19/50 • Number of events 27 • From enrollment up to 30 days post shunt adjustment
Nervous system disorders
Subdural effusion
6.1%
3/49 • Number of events 3 • From enrollment up to 30 days post shunt adjustment
0.00%
0/50 • From enrollment up to 30 days post shunt adjustment

Additional Information

Mark Luciano

Johns Hopkins University

Phone: 4109552259

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place