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A Study in Sepsis Patients With Renal Failure

Primary Purpose

Sepsis, Bacterial Infections and Mycoses

Status
Terminated
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Placebo
BIAP
Sponsored by
AM-Pharma
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sepsis focused on measuring Sepsis, Alkaline Phosphatase, inflammation, infection, renal failure

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients between the age of 18 and 80 years.
  • Proven or suspected infection.
  • Two out of four SIRS criteria of systemic inflammation, existing for less than 24 hours after admission in the intensive care unit, as follows:

    • Core temperature higher then 38 degree Celsius or lower then 36 degree Celsius.
    • Heart rate above 90 beats/min (unless the patient has a medical condition known to increase heart rate or is receiving treatment that would prevent tachycardia).
    • Respiratory rate above 20 breaths/min, a PaCO2 lower then 32mmHg or the use of mechanical ventilation for an acute respiratory process.
    • White-cell count above 12,000/mm3 or below 4,000/mm3 or a differential count showing >10 percent immature neutrophils.
  • Acute renal failure, defined as

    • Rise in serum creatinine level to ≥150μmol/L within the previous 48 hours, in the absence of primary underlying renal disease OR
    • Minimally a stage 1 Kidney Injury according to AKIN creatinine criteria: Increase in serum creatinine ≥26.2µmol/L (0.3mg/dL) or increase to ≥150% (≥1.5 -fold) from baseline in the previous 48 hours in the absence of primary underlying renal disease and where baseline creatinine is less than 150 µmol/L) OR
    • Minimally a stage 1 Kidney Injury according to AKIN Urine Output criteria: Urine Output of ≤ 0.5mg/kg/h for ≥6h and following adequate fluid resuscitation when applicable, in the absence of underlying primary renal disease and where baseline creatinine is less than 150µmol/L)
  • Written informed consent obtained prior to any study intervention.

Exclusion Criteria:

  • Pregnant women or nursing mothers and fecund females who are not on effective contraception (chemical: pill; or mechanical: IUD)
  • Patients already on dialysis (RTT) at entry
  • Known HIV (sero-positive) patients
  • Patients receiving immunosuppressant therapy or on chronic high doses of steroids equivalent to prednisone 1mg/Kg/day
  • Patients expected to have rapidly fatal disease within 24 hours
  • Known confirmed gram-positive sepsis
  • Known confirmed fungal sepsis
  • Acute pancreatitis with no established source of infection
  • Patients not expected to survive for 28 days due to other medical conditions such as end-stage neoplasm or other diseases
  • Participation in another investigational study within 90 days prior to start of the study which might interfere with this study
  • Any previous administration of active study medication.
  • Known allergy for dairy (bovine) products including cow milk.
  • Sepsis without renal failure as defined in the Entry Criteria.
  • History of chronic renal failure or history of persistent creatinine level equal or greater than 150umol/L prior to entry for reasons other than the current sepsis condition".

Sites / Locations

  • University Medical Center Antwerp (UZA)
  • Cliniques Universitaires Saint Luc-UCL
  • ULB Hopital Erasme
  • Universitair Ziekenhuis Brussel
  • UMC Nijmegen University Medical Center St Radboud
  • Isala Clinics
  • Jeroen Bosch Ziekenhuis lokatie GZG
  • VU University Medical Center
  • Canisius Wilhelmina Ziekenhuis

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Bovine Intestinal AP

2

Arm Description

Bovine Intestinal Alkaline Phosphatase (BIAP) Intravenous administration of 10" bolus (67,5U/kg) and 48h continuous infusion (132,5U/kg)

Placebo Intravenous administration of 10" bolus and 48h continuous infusion

Outcomes

Primary Outcome Measures

Haematology, biochemistry, and microbiological evaluation. Adverse event monitoring.

Secondary Outcome Measures

To investigate the effect of AP on inflammatory parameters in sepsis patients with renal failure.
To investigate the effect of AP on clinical variables in sepsis patients with renal failure.
To investigate the effect of AP on renal function markers in sepsis patients with renal failure.

Full Information

First Posted
August 2, 2007
Last Updated
March 30, 2012
Sponsor
AM-Pharma
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1. Study Identification

Unique Protocol Identification Number
NCT00511186
Brief Title
A Study in Sepsis Patients With Renal Failure
Official Title
A Phase-IIa, Double-blind, Randomized, Placebo-controlled Study on the Safety and Early Efficacy of Alkaline Phosphatase in Sepsis Patients With Renal Failure
Study Type
Interventional

2. Study Status

Record Verification Date
March 2012
Overall Recruitment Status
Terminated
Why Stopped
sufficient POC to switch development from bovine AP to recombinant AP
Study Start Date
May 2008 (undefined)
Primary Completion Date
December 2009 (Actual)
Study Completion Date
December 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
AM-Pharma

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to investigate the safety and tolerability of AP in sepsis patients with renal failure and to investigate the effect of AP on inflammatory and clinical parameters in sepsis patients with renal failure.
Detailed Description
RATIONALE FOR THE STUDY A previous clinical study conducted in centers in The Netherlands and Belgium have shown a substantial clinical benefit of AP treatment in patients with sepsis and associated acute renal failure (see Introduction above). The latter results require confirmation in a prospective study, as the current subject of this Protocol. Choice of Drugs The proposed study medication (AP) is identical to the study medication used in the previous clinical study in sepsis patients with single or multiple end-organ failure. Since there is no current proven treatment for these patients, the controls (as in previous studies) is placebo. Choice of patient population The aim is to enroll a maximum of 26 patients positive for sepsis with an APACHE score of ≥20 and ≤28 (determined within 24 hours of entry), and who will be analyzed on an intention to treat (ITT) basis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sepsis, Bacterial Infections and Mycoses
Keywords
Sepsis, Alkaline Phosphatase, inflammation, infection, renal failure

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
36 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bovine Intestinal AP
Arm Type
Experimental
Arm Description
Bovine Intestinal Alkaline Phosphatase (BIAP) Intravenous administration of 10" bolus (67,5U/kg) and 48h continuous infusion (132,5U/kg)
Arm Title
2
Arm Type
Placebo Comparator
Arm Description
Placebo Intravenous administration of 10" bolus and 48h continuous infusion
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
placebo is administered intravenously over 48 hours. An initial loading dose of over 10-minutes is followed by continuous infusion over 48h.
Intervention Type
Drug
Intervention Name(s)
BIAP
Other Intervention Name(s)
AP
Intervention Description
AP is administered intravenously over 48 hours. An initial loading dose of 67.5U/Kg body weight over 10-minutes is followed by continuous infusion of 132.5U/Kg/24H administered over 48H
Primary Outcome Measure Information:
Title
Haematology, biochemistry, and microbiological evaluation. Adverse event monitoring.
Time Frame
28 Days
Secondary Outcome Measure Information:
Title
To investigate the effect of AP on inflammatory parameters in sepsis patients with renal failure.
Time Frame
28 Days
Title
To investigate the effect of AP on clinical variables in sepsis patients with renal failure.
Time Frame
28 Days
Title
To investigate the effect of AP on renal function markers in sepsis patients with renal failure.
Time Frame
28 Days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients between the age of 18 and 80 years. Proven or suspected infection. Two out of four SIRS criteria of systemic inflammation, existing for less than 24 hours after admission in the intensive care unit, as follows: Core temperature higher then 38 degree Celsius or lower then 36 degree Celsius. Heart rate above 90 beats/min (unless the patient has a medical condition known to increase heart rate or is receiving treatment that would prevent tachycardia). Respiratory rate above 20 breaths/min, a PaCO2 lower then 32mmHg or the use of mechanical ventilation for an acute respiratory process. White-cell count above 12,000/mm3 or below 4,000/mm3 or a differential count showing >10 percent immature neutrophils. Acute renal failure, defined as Rise in serum creatinine level to ≥150μmol/L within the previous 48 hours, in the absence of primary underlying renal disease OR Minimally a stage 1 Kidney Injury according to AKIN creatinine criteria: Increase in serum creatinine ≥26.2µmol/L (0.3mg/dL) or increase to ≥150% (≥1.5 -fold) from baseline in the previous 48 hours in the absence of primary underlying renal disease and where baseline creatinine is less than 150 µmol/L) OR Minimally a stage 1 Kidney Injury according to AKIN Urine Output criteria: Urine Output of ≤ 0.5mg/kg/h for ≥6h and following adequate fluid resuscitation when applicable, in the absence of underlying primary renal disease and where baseline creatinine is less than 150µmol/L) Written informed consent obtained prior to any study intervention. Exclusion Criteria: Pregnant women or nursing mothers and fecund females who are not on effective contraception (chemical: pill; or mechanical: IUD) Patients already on dialysis (RTT) at entry Known HIV (sero-positive) patients Patients receiving immunosuppressant therapy or on chronic high doses of steroids equivalent to prednisone 1mg/Kg/day Patients expected to have rapidly fatal disease within 24 hours Known confirmed gram-positive sepsis Known confirmed fungal sepsis Acute pancreatitis with no established source of infection Patients not expected to survive for 28 days due to other medical conditions such as end-stage neoplasm or other diseases Participation in another investigational study within 90 days prior to start of the study which might interfere with this study Any previous administration of active study medication. Known allergy for dairy (bovine) products including cow milk. Sepsis without renal failure as defined in the Entry Criteria. History of chronic renal failure or history of persistent creatinine level equal or greater than 150umol/L prior to entry for reasons other than the current sepsis condition".
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Professor J G van der Hoeven, MD, PhD
Organizational Affiliation
University Medical Center St Radboud, Nijmegen, The Netherlands
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Medical Center Antwerp (UZA)
City
Antwerp
Country
Belgium
Facility Name
Cliniques Universitaires Saint Luc-UCL
City
Brussels
Country
Belgium
Facility Name
ULB Hopital Erasme
City
Brussels
Country
Belgium
Facility Name
Universitair Ziekenhuis Brussel
City
Brussels
Country
Belgium
Facility Name
UMC Nijmegen University Medical Center St Radboud
City
Nijmegen
State/Province
Gelderland
ZIP/Postal Code
6500 HB
Country
Netherlands
Facility Name
Isala Clinics
City
Zwolle
State/Province
Overijssel
ZIP/Postal Code
8011 JW
Country
Netherlands
Facility Name
Jeroen Bosch Ziekenhuis lokatie GZG
City
's-Hertogenbosch
Country
Netherlands
Facility Name
VU University Medical Center
City
Amsterdam
Country
Netherlands
Facility Name
Canisius Wilhelmina Ziekenhuis
City
Nijmegen
Country
Netherlands

12. IPD Sharing Statement

Citations:
PubMed Identifier
22269279
Citation
Pickkers P, Heemskerk S, Schouten J, Laterre PF, Vincent JL, Beishuizen A, Jorens PG, Spapen H, Bulitta M, Peters WH, van der Hoeven JG. Alkaline phosphatase for treatment of sepsis-induced acute kidney injury: a prospective randomized double-blind placebo-controlled trial. Crit Care. 2012 Jan 23;16(1):R14. doi: 10.1186/cc11159.
Results Reference
result
Links:
URL
http://www.am-pharma.com
Description
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A Study in Sepsis Patients With Renal Failure

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