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Doxycycline in Treating Patients With Chronic Rhinosinusitis With Nasal Polyps

Primary Purpose

Polyp of Nasal Sinus

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Doxycycline
methylprednisolone
nasal saline spray
Flonase
sugar pill
Sponsored by
Icahn School of Medicine at Mount Sinai
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Polyp of Nasal Sinus focused on measuring doxycycline, oral methylprednisone, sinusitis with nasal polyps

Eligibility Criteria

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

Inclusion Criteria:

  • Nasal polyps on nasal endoscopy.
  • The patient has moderate to severe disease, defined by moderate to severe subjective symptoms (a score greater than 3 on a 10-cm VAS).
  • The patient is at least 18 years old.
  • The patient is able to understand and give informed consent.
  • The patient has clinically diagnosed chronic rhinosinusitis with nasal polyps according to the AAO-HNS diagnostic criteria: At least 2 of the following symptoms/signs:

    • Mucopurulent drainage (anterior, posterior, or both)
    • Nasal obstruction (congestion)
    • Facial pain-pressure-fullness
    • Decreased sense of smell
    • and symptoms lasting 12 weeks or longer.

Exclusion Criteria:

  • The patient has a history of treatment with oral corticosteroids in the past 4 weeks. ,
  • The patient has cystic fibrosis.
  • The patient has primary ciliary dyskinesia.
  • The patient has diabetes.
  • The patient has had sinus surgery in the past 3 months.
  • The patient has an allergy to doxycycline or related tetracyclines or glucocorticoids.
  • The patient is a minor.
  • The patient is a prisoner.
  • The patient has a psychiatric illness or developmental delay, which would interfere with understanding of the study and provision of informed consent.
  • The patient is a breastfeeding mother. The effects of the drugs used in this study (doxycycline) on breast milk are unknown and thus, these patients will be excluded from the study
  • The patient has a history of HIV or other known cause of immunosuppression, or is actively taking immunosuppressive medications due to organ transplantation, rheumatoid disease, or other medical conditions.
  • The patient is on penicillin; antacids containing aluminum, calcium, magnesium, or iron; bismuth subsalicylate; barbiturates; carbamazepine; and phenytoin; as well as tetracycline and Penthane.
  • Pregnancy. Doxycycline, a tetracycline, is a known teratogen. For this reason women of child-bearing potential are suggested to take a form of contraception for the duration that they are taking doxycycline., Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.

Pregnancy Testing. Women of childbearing potential are required to have a negative serum pregnancy test (with a sensitivity of at least 25 mIU/mL) prior to the first dose of drug. No further pregnancy tests are required since after this visit the patient will no longer be taking tetracycline after 3 weeks.

Women of childbearing potential are defined as follows:

  • Patients with regular menses
  • Patients with amenorrhea, irregular cycles, or using a contraceptive method that precludes withdrawal bleeding
  • Women who have had a tubal ligation

Women are considered not to be of childbearing potential for the following reasons:

  • The patient has undergone hysterectomy and/or bilateral oophorectomy.
  • The patient is post-menopausal defined by amenorrhea for at least 1 year in a woman > 45 years old.

Sites / Locations

  • Icahn School of Medicine at Mount Sinai

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Doxycycline

Sugar pill

Arm Description

Doxycycline plus oral methylprednisolone and nasal saline sprays

placebo pill plus oral methylprednisolone for three weeks. After this, maintenance therapy which includes nasal saline sprays and daily nasal steroid sprays.

Outcomes

Primary Outcome Measures

Sino-nasal Outcome Test (SNOT 22)
a validated 22 item quality of life questionnaire for patients with chronic rhinosinusitis. Range of 0 to 110, higher scores indicate worse outcome

Secondary Outcome Measures

Endoscopic Nasal Polyp Score
0- Absence of nasal polyps Polyps confined to the middle meatus and not beyond the inferior border of the middle turbinate Polyps reaching below the lower border of the middle turbinate Large polyps extending to the lower border of the inferior turbinate or medial to the middle turbinate Large polyps extending to the lower border of the inferior turbinate or medial to the middle turbinate Nasal polyp scores. The score is determined for each nostril, and the two scores added for a total nasal polyp score. Range of 0 to 8, graded on a size system from 0 to 4 and summed from the right and left nostrils.
Middle Meatus Culture
Culture swab for the presence or absence of microbial growth
Subjective Symptom Composite Scoring
A subjective symptom score will be extracted from the patient's score (on a scale of 0-5, where 0 defines no problems with the given symptom and 5 defines maximal problems ) on the SNOT-22 for each fo the following symptoms: "blockage/congestion," "runny nose," "post-nasal discharge," "facial pain/pressure," and "sense of taste/smell." Range of 0 to 25, with higher score reflecting worse symptoms.
Visual Analog Scale
The visual analog scale for overall symptoms will be used to define disease severity. Range of 0 to 10. As per the European Position Paper 2012, mild, moderate, and severe disease will be defined as 0 to and including 3, > 3 to and including 7, and > 7 to and including 10, respectively.

Full Information

First Posted
October 5, 2015
Last Updated
December 8, 2017
Sponsor
Icahn School of Medicine at Mount Sinai
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1. Study Identification

Unique Protocol Identification Number
NCT02569437
Brief Title
Doxycycline in Treating Patients With Chronic Rhinosinusitis With Nasal Polyps
Official Title
The Role of Doxycycline in Management of Moderate to Severe Chronic Rhinosinusitis With Nasal Polyps
Study Type
Interventional

2. Study Status

Record Verification Date
December 2017
Overall Recruitment Status
Terminated
Why Stopped
A high percentage of patients were dropping out of the study and were not able to complete the protocol.
Study Start Date
September 2014 (undefined)
Primary Completion Date
August 2016 (Actual)
Study Completion Date
August 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Icahn School of Medicine at Mount Sinai

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The Department of Otolaryngology at Mount Sinai is looking for adults with sinus disease with polyps, otherwise called chronic rhinosinusitis with nasal polyps (CRSwNP). Patients may be eligible to enroll in a study offering a cutting-edge therapy to help reduce symptoms and avoid surgery. The treatment combines an antibiotic (doxycycline) with oral steroids. Oral steroids are the mainstay of medical management for patients with CRSwNP. However, recent studies have shown that doxycycline helps improve symptoms as well by reducing inflammation and killing common bacteria that can cause symptoms. This study is the first to evaluate this combination regimen.
Detailed Description
An eligible patient may be treated with either doxycycline and oral steroids OR placebo (sugar pill) and oral steroids for three weeks. Volunteers will participate in the study for to 12 weeks, and will have 4 research visits of 1 hour duration. At each study visit, the patient will under go an endoscopic evaluation and asked to complete a questionnaire describing symptoms. There is no additional cost to be enrolled in the study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Polyp of Nasal Sinus
Keywords
doxycycline, oral methylprednisone, sinusitis with nasal polyps

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
49 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Doxycycline
Arm Type
Experimental
Arm Description
Doxycycline plus oral methylprednisolone and nasal saline sprays
Arm Title
Sugar pill
Arm Type
Placebo Comparator
Arm Description
placebo pill plus oral methylprednisolone for three weeks. After this, maintenance therapy which includes nasal saline sprays and daily nasal steroid sprays.
Intervention Type
Drug
Intervention Name(s)
Doxycycline
Intervention Description
Doxycycline (200 mg PO X 1 dose on Day 1, then 100 mg PO daily) for Day 2-20
Intervention Type
Drug
Intervention Name(s)
methylprednisolone
Intervention Description
oral methylprednisolone: 32 mg x 5 days, 16 mg x 5 days, 8 mg x 10 days
Intervention Type
Drug
Intervention Name(s)
nasal saline spray
Intervention Description
nasal saline sprays: 2 sprays each nostril three times a day
Intervention Type
Drug
Intervention Name(s)
Flonase
Other Intervention Name(s)
nasal steroid spray
Intervention Description
daily nasal steroid sprays (Flonase, 2 sprays each nostril daily).
Intervention Type
Drug
Intervention Name(s)
sugar pill
Other Intervention Name(s)
placebo
Intervention Description
placebo pill to match doxycycline
Primary Outcome Measure Information:
Title
Sino-nasal Outcome Test (SNOT 22)
Description
a validated 22 item quality of life questionnaire for patients with chronic rhinosinusitis. Range of 0 to 110, higher scores indicate worse outcome
Time Frame
Baseline and 12 weeks
Secondary Outcome Measure Information:
Title
Endoscopic Nasal Polyp Score
Description
0- Absence of nasal polyps Polyps confined to the middle meatus and not beyond the inferior border of the middle turbinate Polyps reaching below the lower border of the middle turbinate Large polyps extending to the lower border of the inferior turbinate or medial to the middle turbinate Large polyps extending to the lower border of the inferior turbinate or medial to the middle turbinate Nasal polyp scores. The score is determined for each nostril, and the two scores added for a total nasal polyp score. Range of 0 to 8, graded on a size system from 0 to 4 and summed from the right and left nostrils.
Time Frame
Baseline and 12 weeks
Title
Middle Meatus Culture
Description
Culture swab for the presence or absence of microbial growth
Time Frame
Baseline and 12 weeks
Title
Subjective Symptom Composite Scoring
Description
A subjective symptom score will be extracted from the patient's score (on a scale of 0-5, where 0 defines no problems with the given symptom and 5 defines maximal problems ) on the SNOT-22 for each fo the following symptoms: "blockage/congestion," "runny nose," "post-nasal discharge," "facial pain/pressure," and "sense of taste/smell." Range of 0 to 25, with higher score reflecting worse symptoms.
Time Frame
Baseline and 12 weeks
Title
Visual Analog Scale
Description
The visual analog scale for overall symptoms will be used to define disease severity. Range of 0 to 10. As per the European Position Paper 2012, mild, moderate, and severe disease will be defined as 0 to and including 3, > 3 to and including 7, and > 7 to and including 10, respectively.
Time Frame
Baseline and 12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Nasal polyps on nasal endoscopy. The patient has moderate to severe disease, defined by moderate to severe subjective symptoms (a score greater than 3 on a 10-cm VAS). The patient is at least 18 years old. The patient is able to understand and give informed consent. The patient has clinically diagnosed chronic rhinosinusitis with nasal polyps according to the AAO-HNS diagnostic criteria: At least 2 of the following symptoms/signs: Mucopurulent drainage (anterior, posterior, or both) Nasal obstruction (congestion) Facial pain-pressure-fullness Decreased sense of smell and symptoms lasting 12 weeks or longer. Exclusion Criteria: The patient has a history of treatment with oral corticosteroids in the past 4 weeks. , The patient has cystic fibrosis. The patient has primary ciliary dyskinesia. The patient has diabetes. The patient has had sinus surgery in the past 3 months. The patient has an allergy to doxycycline or related tetracyclines or glucocorticoids. The patient is a minor. The patient is a prisoner. The patient has a psychiatric illness or developmental delay, which would interfere with understanding of the study and provision of informed consent. The patient is a breastfeeding mother. The effects of the drugs used in this study (doxycycline) on breast milk are unknown and thus, these patients will be excluded from the study The patient has a history of HIV or other known cause of immunosuppression, or is actively taking immunosuppressive medications due to organ transplantation, rheumatoid disease, or other medical conditions. The patient is on penicillin; antacids containing aluminum, calcium, magnesium, or iron; bismuth subsalicylate; barbiturates; carbamazepine; and phenytoin; as well as tetracycline and Penthane. Pregnancy. Doxycycline, a tetracycline, is a known teratogen. For this reason women of child-bearing potential are suggested to take a form of contraception for the duration that they are taking doxycycline., Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. Pregnancy Testing. Women of childbearing potential are required to have a negative serum pregnancy test (with a sensitivity of at least 25 mIU/mL) prior to the first dose of drug. No further pregnancy tests are required since after this visit the patient will no longer be taking tetracycline after 3 weeks. Women of childbearing potential are defined as follows: Patients with regular menses Patients with amenorrhea, irregular cycles, or using a contraceptive method that precludes withdrawal bleeding Women who have had a tubal ligation Women are considered not to be of childbearing potential for the following reasons: The patient has undergone hysterectomy and/or bilateral oophorectomy. The patient is post-menopausal defined by amenorrhea for at least 1 year in a woman > 45 years old.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Benjamin D Malkin, MD
Organizational Affiliation
Icahns School of Medicine at Mount Sinai
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Satish Govindaraj, MD
Organizational Affiliation
Icahn School of Medicine at Mount Sinai
Official's Role
Study Chair
Facility Information:
Facility Name
Icahn School of Medicine at Mount Sinai
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Doxycycline in Treating Patients With Chronic Rhinosinusitis With Nasal Polyps

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