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Safety of AZLI in Children With Cystic Fibrosis (CF) and Chronic Pseudomonas Aeruginosa in the Lower Airways (PALS)

Primary Purpose

Cystic Fibrosis, Pseudomonas Aeruginosa

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
AZLI
Sponsored by
Gilead Sciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cystic Fibrosis focused on measuring Cystic fibrosis, CF, PA, Pseudomonas aeruginosa, AZLI, aztreonam, Chronic Pseudomonas aeruginosa

Eligibility Criteria

undefined - 12 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosis of CF as determined by the 1997 CF Consensus Conference criteria:

    • Documented sweat chloride ≥ 60 mEq/L by quantitative pilocarpine iontophoresis test OR
    • Abnormal nasal transepithelial potential difference (NPD) test OR
    • A genotype with 2 identifiable mutations consistent with CF AND
    • One or more clinical features consistent with CF.
  • Documented positive lower respiratory tract culture for PA at the screening visit plus two documented positive lower respiratory tract cultures for PA within 12 months prior to study entry (must have been a minimum 3 months apart.)
  • Clinically stable with no evidence of significant respiratory symptoms or, if obtained for clinical evaluation, no chest radiograph findings at screening that would have required administration of IV antipseudomonal antibiotics, oxygen supplementation, or hospitalization.

Exclusion Criteria:

  • Use of IV or inhaled antipseudomonal antibiotics within 14 days of study entry
  • Presence of a condition or abnormality that would have compromised the participant's safety or the quality of study data, in the opinion of the investigator
  • History of sputum or throat swab culture yielding Burkholderia spp. within 2 years prior to screening visit
  • History of hypersensitivity/adverse reaction to aztreonam
  • History of hypersensitivity/adverse reaction to beta-agonists
  • History of lung transplantation
  • Administration of any investigational drug or device within 30 days prior to screening visit or within 6 half-lives of the investigational drug (whichever was longer)
  • Hospitalization for pulmonary-related illness within 28 days prior to screening visit
  • Changes in or initiation of chronic azithromycin treatment within 28 days prior to screening visit
  • Changes in or initiation of hypertonic saline treatment within 7 days prior to screening visit; for subjects on a stable regimen of hypertonic saline (28 days on/28 days off), beginning or ending a cycle of hypertonic saline was allowed
  • Changes in antimicrobial, bronchodilator (BD), corticosteroid or dornase alfa medications within 7 days prior to screening visit;
  • Changes in physiotherapy technique or schedule within 7 days prior to screening visit
  • Abnormal renal or hepatic function results at most recent test within the previous 90 days

Sites / Locations

  • The Children's Hospital - Denver
  • Nemours Children's Clinic - Jacksonville
  • Children's Memorial Hospital
  • Riley Hospital for Children
  • Children's Hospital Boston
  • Children's Mercy Hospital & Clinics
  • SUNY Upstate Medical University
  • Nationwide Children's Hospital
  • Baylor College of Medicine
  • University of Utah
  • C.H.U de Bordeaux
  • Centre Hospitalier Robert Bissons
  • Hopital Necker Enfants Malades
  • Charite Campus Virchow Klinikum
  • Universitatsklinik St. Josef-Hospital
  • Kinder und Jugendklinik, Abteilung Lungen Bronchialheikunde
  • Universitatsklinikum Essen
  • J.W. Goethe University Hopsital
  • Azienda Ospedaliero Universitaria - Policlinico di Catania
  • A. Meyer Children Hospital Florence
  • Azienda Ospedaliera Instituti Ospitalieri di Verona
  • Specjalistyczny Zespot Opieki Zdrowotnej nad Matka i Dzieckiem
  • Instytut Gruzlicy I Chorob Pluc
  • Instytut Matki i Dziecka
  • Pediatric Pneunmonology and Cystic Fibrosis Clinic
  • Hospital Infantil La Paz
  • Hospital Infantil Universitario Nino Jesus
  • Hospital Ramon y Cajal
  • Hosp. Mat-Inf. Carlos Haya

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Open-label AZLI

Arm Description

Participants received three 28-day courses of AZLI, each followed by 28 days off-treatment.

Outcomes

Primary Outcome Measures

Percentage of Participants Who Discontinued Study Drug Due to Safety or Tolerability Reasons
Participants who discontinued study drug due to safety or tolerability reasons were defined as those with "Adverse Event (AE)/Safety or Tolerability" on the Study Drug Completion electronic case report form as the reason for early discontinuation. The 95% confidence interval (CI) was calculated using the exact binomial method.

Secondary Outcome Measures

Change From Baseline in FEV1 % Predicted in Subjects Aged ≥ 6 Years
The change in FEV1 % predicted was assessed at the end of each 28-day AZLI treatment course. FEV1 % predicted is defined as FEV1 of the patient divided by the average FEV1 in the population for any person of similar age, sex, race, and body composition.
Change From Baseline in CFQ-R Respiratory Symptoms Scale (RSS) Score in Subjects Aged ≥ 6 Years
The change in CFQ-R RSS score was assessed at the end of each 28-day AZLI treatment course. The range of scores (units) was 0 to 100 with higher scores indicating fewer symptoms.
Change in Pseudomonas Aeruginosa (PA) Sputum Density
The change in PA sputum density (log10 colony-forming units per gram [cfu/g]) was assessed at the end of each 28-day AZLI treatment course.
Percentage of Participants Who Used Additional (Non-study) Antipseudomonal Antibiotics
The percentage of participants who used additional (non-study) antipseudomonal antibiotics (IV, inhaled, oral, IV/inhaled, IV/inhaled/oral) was summarized (number and percent) for all subjects.
Percentage of Participants Hospitalized at Least Once Due to a Respiratory Event
Number of Days Participants Were Hospitalized Due to a Respiratory Event
The average number of days hospitalized due to a respiratory event, among the 11 participants who were hospitalized for respiratory event, was reported.
Percentage of Participants With Pulmonary Exacerbations
Pulmonary exacerbations were defined as respiratory hospitalizations or discrete courses of non-study IV/inhaled antipseudomonal antibiotics. Use of oral antibiotics alone for respiratory signs or symptoms was considered to be representative of milder clinical events and, therefore, was not included in the definition of pulmonary exacerbations.
Time to Pulmonary Exacerbation
The median days to first pulmonary exacerbation was summarized using Kaplan-Meier (KM) summary statistics.
Percentage of Participants With Study-drug Induced Bronchospasm
Study-drug induced bronchospasm (airway reactivity) was assessed at the baseline visit as the percent change in FEV1 from the pretreatment measurement to 30 minutes following treatment for subjects ≥ 6 years or as from the Investigator's assessment for subjects < 6 years.
Adverse Event Rates Adjusted for Study Duration
Adverse events occurring in ≥ 5% of participants adjusted for study duration were summarized. The adjustment was made by using a standardized rate calculated as the sum of study duration across patients divided by 28 for the total number of patient months. Rate calculations presented are the number of adverse events (AEs) per patient month.

Full Information

First Posted
July 26, 2011
Last Updated
May 12, 2014
Sponsor
Gilead Sciences
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1. Study Identification

Unique Protocol Identification Number
NCT01404234
Brief Title
Safety of AZLI in Children With Cystic Fibrosis (CF) and Chronic Pseudomonas Aeruginosa in the Lower Airways
Acronym
PALS
Official Title
Open-Label Phase 3 Trial to Evaluate the Safety of Aztreonam 75 mg Powder and Solvent for Nebuliser Solution/Aztreonam for Inhalation Solution (AZLI) in Children With Cystic Fibrosis (CF) and Chronic Pseudomonas Aeruginosa (PA) in the Lower Airways
Study Type
Interventional

2. Study Status

Record Verification Date
May 2014
Overall Recruitment Status
Completed
Study Start Date
December 2011 (undefined)
Primary Completion Date
April 2013 (Actual)
Study Completion Date
April 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Gilead Sciences

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This was an open-label, multicenter study in children ≤ 12 years of age with cystic fibrosis (CF) and chronic Pseudomonas aeruginosa (PA) infection in the lower airways using three 28-day courses of Aztreonam for Inhalation Solution (AZLI) 75 mg three times daily, each followed by 28 days off AZLI. The total treatment duration was to be 6 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cystic Fibrosis, Pseudomonas Aeruginosa
Keywords
Cystic fibrosis, CF, PA, Pseudomonas aeruginosa, AZLI, aztreonam, Chronic Pseudomonas aeruginosa

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
61 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Open-label AZLI
Arm Type
Experimental
Arm Description
Participants received three 28-day courses of AZLI, each followed by 28 days off-treatment.
Intervention Type
Drug
Intervention Name(s)
AZLI
Other Intervention Name(s)
Cayston®
Intervention Description
AZLI 75 mg was administered 3 times daily via the investigational nebulizer.
Primary Outcome Measure Information:
Title
Percentage of Participants Who Discontinued Study Drug Due to Safety or Tolerability Reasons
Description
Participants who discontinued study drug due to safety or tolerability reasons were defined as those with "Adverse Event (AE)/Safety or Tolerability" on the Study Drug Completion electronic case report form as the reason for early discontinuation. The 95% confidence interval (CI) was calculated using the exact binomial method.
Time Frame
Baseline to Day 168
Secondary Outcome Measure Information:
Title
Change From Baseline in FEV1 % Predicted in Subjects Aged ≥ 6 Years
Description
The change in FEV1 % predicted was assessed at the end of each 28-day AZLI treatment course. FEV1 % predicted is defined as FEV1 of the patient divided by the average FEV1 in the population for any person of similar age, sex, race, and body composition.
Time Frame
Baseline to Day 28, 84, and 140
Title
Change From Baseline in CFQ-R Respiratory Symptoms Scale (RSS) Score in Subjects Aged ≥ 6 Years
Description
The change in CFQ-R RSS score was assessed at the end of each 28-day AZLI treatment course. The range of scores (units) was 0 to 100 with higher scores indicating fewer symptoms.
Time Frame
Baseline to Day 28, 84, and 140
Title
Change in Pseudomonas Aeruginosa (PA) Sputum Density
Description
The change in PA sputum density (log10 colony-forming units per gram [cfu/g]) was assessed at the end of each 28-day AZLI treatment course.
Time Frame
Baseline to Day 28, 84, and 140
Title
Percentage of Participants Who Used Additional (Non-study) Antipseudomonal Antibiotics
Description
The percentage of participants who used additional (non-study) antipseudomonal antibiotics (IV, inhaled, oral, IV/inhaled, IV/inhaled/oral) was summarized (number and percent) for all subjects.
Time Frame
Baseline to Day 168
Title
Percentage of Participants Hospitalized at Least Once Due to a Respiratory Event
Time Frame
Baseline to Day 168
Title
Number of Days Participants Were Hospitalized Due to a Respiratory Event
Description
The average number of days hospitalized due to a respiratory event, among the 11 participants who were hospitalized for respiratory event, was reported.
Time Frame
Baseline to Day 168
Title
Percentage of Participants With Pulmonary Exacerbations
Description
Pulmonary exacerbations were defined as respiratory hospitalizations or discrete courses of non-study IV/inhaled antipseudomonal antibiotics. Use of oral antibiotics alone for respiratory signs or symptoms was considered to be representative of milder clinical events and, therefore, was not included in the definition of pulmonary exacerbations.
Time Frame
Baseline to Day 168
Title
Time to Pulmonary Exacerbation
Description
The median days to first pulmonary exacerbation was summarized using Kaplan-Meier (KM) summary statistics.
Time Frame
Baseline to Day 168
Title
Percentage of Participants With Study-drug Induced Bronchospasm
Description
Study-drug induced bronchospasm (airway reactivity) was assessed at the baseline visit as the percent change in FEV1 from the pretreatment measurement to 30 minutes following treatment for subjects ≥ 6 years or as from the Investigator's assessment for subjects < 6 years.
Time Frame
Pretreatment at Baseline to 30 minutes following treatment
Title
Adverse Event Rates Adjusted for Study Duration
Description
Adverse events occurring in ≥ 5% of participants adjusted for study duration were summarized. The adjustment was made by using a standardized rate calculated as the sum of study duration across patients divided by 28 for the total number of patient months. Rate calculations presented are the number of adverse events (AEs) per patient month.
Time Frame
Baseline to Day 168

10. Eligibility

Sex
All
Maximum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of CF as determined by the 1997 CF Consensus Conference criteria: Documented sweat chloride ≥ 60 mEq/L by quantitative pilocarpine iontophoresis test OR Abnormal nasal transepithelial potential difference (NPD) test OR A genotype with 2 identifiable mutations consistent with CF AND One or more clinical features consistent with CF. Documented positive lower respiratory tract culture for PA at the screening visit plus two documented positive lower respiratory tract cultures for PA within 12 months prior to study entry (must have been a minimum 3 months apart.) Clinically stable with no evidence of significant respiratory symptoms or, if obtained for clinical evaluation, no chest radiograph findings at screening that would have required administration of IV antipseudomonal antibiotics, oxygen supplementation, or hospitalization. Exclusion Criteria: Use of IV or inhaled antipseudomonal antibiotics within 14 days of study entry Presence of a condition or abnormality that would have compromised the participant's safety or the quality of study data, in the opinion of the investigator History of sputum or throat swab culture yielding Burkholderia spp. within 2 years prior to screening visit History of hypersensitivity/adverse reaction to aztreonam History of hypersensitivity/adverse reaction to beta-agonists History of lung transplantation Administration of any investigational drug or device within 30 days prior to screening visit or within 6 half-lives of the investigational drug (whichever was longer) Hospitalization for pulmonary-related illness within 28 days prior to screening visit Changes in or initiation of chronic azithromycin treatment within 28 days prior to screening visit Changes in or initiation of hypertonic saline treatment within 7 days prior to screening visit; for subjects on a stable regimen of hypertonic saline (28 days on/28 days off), beginning or ending a cycle of hypertonic saline was allowed Changes in antimicrobial, bronchodilator (BD), corticosteroid or dornase alfa medications within 7 days prior to screening visit; Changes in physiotherapy technique or schedule within 7 days prior to screening visit Abnormal renal or hepatic function results at most recent test within the previous 90 days
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mark Bresnik, M.D.
Organizational Affiliation
Gilead Sciences
Official's Role
Study Director
Facility Information:
Facility Name
The Children's Hospital - Denver
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Nemours Children's Clinic - Jacksonville
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32207
Country
United States
Facility Name
Children's Memorial Hospital
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60614
Country
United States
Facility Name
Riley Hospital for Children
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
Children's Hospital Boston
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Children's Mercy Hospital & Clinics
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64108
Country
United States
Facility Name
SUNY Upstate Medical University
City
Syracuse
State/Province
New York
ZIP/Postal Code
13210
Country
United States
Facility Name
Nationwide Children's Hospital
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43205
Country
United States
Facility Name
Baylor College of Medicine
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
University of Utah
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84108
Country
United States
Facility Name
C.H.U de Bordeaux
City
Bordeaux
Country
France
Facility Name
Centre Hospitalier Robert Bissons
City
Lisieux
Country
France
Facility Name
Hopital Necker Enfants Malades
City
Paris Cedex 15
Country
France
Facility Name
Charite Campus Virchow Klinikum
City
Berlin
Country
Germany
Facility Name
Universitatsklinik St. Josef-Hospital
City
Bochum
Country
Germany
Facility Name
Kinder und Jugendklinik, Abteilung Lungen Bronchialheikunde
City
Erlandgen
Country
Germany
Facility Name
Universitatsklinikum Essen
City
Essen
Country
Germany
Facility Name
J.W. Goethe University Hopsital
City
Frankfurt
Country
Germany
Facility Name
Azienda Ospedaliero Universitaria - Policlinico di Catania
City
Catania
Country
Italy
Facility Name
A. Meyer Children Hospital Florence
City
Florence
Country
Italy
Facility Name
Azienda Ospedaliera Instituti Ospitalieri di Verona
City
Verona
Country
Italy
Facility Name
Specjalistyczny Zespot Opieki Zdrowotnej nad Matka i Dzieckiem
City
Gdansk
Country
Poland
Facility Name
Instytut Gruzlicy I Chorob Pluc
City
Rabka Zdroj
Country
Poland
Facility Name
Instytut Matki i Dziecka
City
Warszawa
Country
Poland
Facility Name
Pediatric Pneunmonology and Cystic Fibrosis Clinic
City
Barcelona
Country
Spain
Facility Name
Hospital Infantil La Paz
City
Madrid
Country
Spain
Facility Name
Hospital Infantil Universitario Nino Jesus
City
Madrid
Country
Spain
Facility Name
Hospital Ramon y Cajal
City
Madrid
Country
Spain
Facility Name
Hosp. Mat-Inf. Carlos Haya
City
Malaga
Country
Spain

12. IPD Sharing Statement

Learn more about this trial

Safety of AZLI in Children With Cystic Fibrosis (CF) and Chronic Pseudomonas Aeruginosa in the Lower Airways

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