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A Study of the Dosing, Efficacy, and Safety of Oral Cysteamine in Adult Patients With Cystic Fibrosis Exacerbations (CARE-CF1)

Primary Purpose

Cystic Fibrosis

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Cysteamine
Placebo Oral Capsule
Sponsored by
NovaBiotics Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cystic Fibrosis focused on measuring Exacerbation, CF, Lung disease, Lung infection, Gram negative, Bacterial Infection, pneumonia, bronchitis

Eligibility Criteria

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

Inclusion Criteria:

  1. CF-associated lung disease with documented history of chronic infection with Gram-negative organism(s)
  2. Established patient of the Principal Investigator's CF Multi Disciplinary Team (MDT)
  3. Age ≥18 years
  4. Weight >40 kg
  5. FEV1 >30% of predicted within the 6 months prior to study exacerbation
  6. At the baseline visit: experiencing a new exacerbation of CF-associated lung disease (based on Investigator assessment of ≥4 symptoms present on the Fuchs' criteria) requiring treatment that includes an aminoglycoside antibiotic
  7. Females of childbearing potential will be included if they are either sexually inactive (sexually abstinent for 14 days prior to the first study drug dose continuing through 28 days after the last study drug dose, or using one of the following highly effective contraceptive (i.e. results in <1% failure rate when used consistently and correctly) methods in this trial:

    1. intrauterine device (IUD);
    2. surgical sterilization of the partner (vasectomy for 6 months minimum);
    3. combined (estrogen or progestogen containing) hormonal contraception associated with the inhibition of ovulation (either oral, intravaginal, or transdermal);
    4. progestogen only hormonal contraception associated with the inhibition of ovulation (either oral, injectable, or implantable);
    5. intrauterine hormone releasing system (IUS);
    6. bilateral tubal occlusion.
  8. Females of childbearing potential agree to remain sexually inactive or to keep the same birth control method for at least 28 days following the last dose.
  9. A female of non-childbearing potential must have undergone one of the following sterilization procedures at least 6 months prior to the first study drug dose:

    1. hysteroscopic sterilization;
    2. bilateral tubal ligation or bilateral salpingectomy;
    3. hysterectomy;
    4. bilateral oophorectomy; or be postmenopausal with amenorrhea for at least 1 year prior to the first study drug dose and follicle stimulating hormone (FSH) serum levels consistent with postmenopausal status.
  10. A non-vasectomized male subject agrees to use a condom with spermicide or abstain from sexual intercourse during the study until 90 days beyond the last dose of study medication and the female partner agrees to comply with inclusion 7 or 9. For a vasectomized male who has had his vasectomy 6 months or more prior to study start, it is required that they use a condom during sexual intercourse. A male who has been vasectomized less than 6 months prior to study start must follow the same restrictions as a non-vasectomized male.
  11. If male, agrees not to donate sperm from the first study drug dose until 90 days after dosing.
  12. Willing and able to comply with all protocol requirements and procedures, including induction of sputum, if necessary
  13. Willing and able to provide signed and dated informed consent

Exclusion Criteria:

  1. Hypersensitive to cysteamine or to any of the excipients
  2. Hypersensitive to penicillamine
  3. Transplant recipient
  4. Participation in any other interventional clinical research study (participation in observational studies is not exclusionary) within 30 days of Baseline (Day 0), and any planned participation in an interventional clinical research study for the duration of this study
  5. If female, pregnancy, planned pregnancy, or breast-feeding
  6. Any other significant disease/disorder which, in the Investigator's opinion, either puts the patient at risk due to study participation, or may influence the results of the study or the patient's ability to participate in the study

Sites / Locations

  • Banner University of Arizona Medical Center
  • San Francisco Critical Care Medical Group California Pacific Medical Center
  • University of Florida
  • Central Florida Pulmonary
  • Albany Medical College
  • Nationwide Children's Hospital
  • West Virginia University
  • The Medical College of Wisconsin/Froedtert Hospital
  • Ospedale Padiatrico Bambino Gesu Centro Fibrosi Cistica
  • Azienda Ospedaliera Universitaria Integrato di Verona Borgo Trento Centro Fibrosi Cistica
  • Aberdeen Royal Infirmary
  • Ninewells Hospital Scottish Adult Cystic Fibrosis Service
  • Western General Hospital Edinburgh, CF Adults / CF Unit
  • NHS GGC
  • Raigmore Hospital
  • St. James University Hospital
  • Royal Victoria Infirmary Adult CF Centre

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Active Comparator

Active Comparator

Active Comparator

Placebo Comparator

Active Comparator

Active Comparator

Arm Label

High Dose, Once per day

High Dose, Twice per day

High Dose, Three times per day

Placebo

Low Dose, Three times per day

Mid-Range Dose, Three times per day

Arm Description

Patient takes one oral dose of Cysteamine (high dose) per day, in the morning. The patient takes two oral placebo doses, one at mid-day and one in the evening.

Patient takes two oral doses of Cysteamine (high dose) per day, one in the morning and one in the evening. The patient takes one oral placebo dose, at mid-day.

Patient takes three oral doses of Cysteamine (high dose) per day, one in the morning, one at mid-day and one in the evening.

Patient takes three oral doses of placebo, one in the morning, one at mid-day and one in the evening.

Patient takes three oral doses of Cysteamine (low dose) per day, one in the morning, one at mid-day and one in the evening.

Patient takes three oral doses of Cysteamine (mid-range dose) per day, one in the morning, one at mid-day and one in the evening.

Outcomes

Primary Outcome Measures

Change From Baseline in Sputum Bacterial Load
Change from baseline through to Day 21 in log10 cfu/ml transformed total gram negative sputum bacterial load
Safety and Tolerability Assessed by the Number of Subjects With Adverse Events
Assessed by variables such as adverse events (AEs), laboratory assessments, physical examinations, and vital signs.

Secondary Outcome Measures

Change From Baseline in Neutrophil Elastase Levels
Actual values and change from baseline in neutrophil elastase levels were summarized using descriptive statistics by visit for each treatment group and each TDD group for the ITT Population.
Change From Baseline in Sputum IL8
Sputum IL-8 Levels by Visit - Covariate Adjusted ANCOVA with Observed Data ITT Population
Change From Baseline in FEV1
Change from Baseline in FEV1 Percent Predicted (%) - Covariate Adjusted ANCOVA with Observed Data ITT Population
Change From Baseline in BMI
BMI (kg/m^2) by Visit - ANCOVA with Observed Data ITT Population
Change From Baseline in C-Reactive Protein
Change from baseline in C-Reactive Protein at visits 7, 14 and 21
Change From Baseline in Blood Leukocyte Count
Blood Leukocyte Count (10^9 leucocytes/L) by Visit - ANCOVA with Observed Data ITT Population
Assessment of Blood Cysteamine Levels
Study Drug Plasma at Day 14 Safety Population
Assessment of Sputum Cysteamine Levels
Study Drug Sputum Concentrations at Day 14 Safety Population
Change From Baseline in CFRSD-CRISS
Mean Change from Baseline in Cystic Fibrosis Respiratory Symptom Diary (CFRSD)-Chronic Respiratory Infection Symptom Scale (CRISS) CRFSD-CRISS:The CFRSD is a 16-item PROM to evaluate the effect of treatment on the severity of symptoms of acute respiratory infections associated with CF (i.e., CFRSD-CRISS) and to assess the emotional and activity impacts of these symptoms. The overall CRISS score range is 0-100 with 100 being the most severe symptoms.The CFRSD-CRISS is a validated unidimensional scale based on a subset of 8 items from the CFRSD questionnaire that quantifies symptom severity for the previous 24 hours to capture the magnitude of symptoms in stable CF, during medically treated CF exacerbations, and during recover from an exacerbation. The 8 items on the CFRSD-CRISS were scored using a 5-point Likert scale ranging from 0 (no symptom) to 4 (the highest magnitude of severity). So score range of 0-32.
Change From Baseline in CFQ-R
The CFQ-R is a disease-specific HRQOL (Health related quality of life) measure containing both generic and CF-specific scales and measures functioning during the previous 2 weeks. Each CFQ-R scale yielded standardized scores ranging from 0 to 100; higher scores indicated better HRQOL
Change From Baseline in Jarad and Sequeiros Symptom Score Questionnaire
The Jarad and Sequeiros Symptom Questionnaire (Jarad, 2012) is a simple participant-completed questionnaire that assesses and evaluates change in participant symptoms related to different aspects of respiratory function during a CF exacerbation. The questionnaire consists of 4 questions, each answered on a 4-point scale ranging from 1 (best) to 4 (worst). A range of minimum 4 to maximum16.Jarad and Sequeiros Questionnaire Score - changes from baseline at day 7 and day 14
Change From Baseline in Weight
Weight (kg) by visit - ANCOVA with observed data

Full Information

First Posted
December 11, 2016
Last Updated
April 13, 2021
Sponsor
NovaBiotics Ltd.
Collaborators
Agility Clinical, Inc., PSR Group B.V.
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1. Study Identification

Unique Protocol Identification Number
NCT03000348
Brief Title
A Study of the Dosing, Efficacy, and Safety of Oral Cysteamine in Adult Patients With Cystic Fibrosis Exacerbations
Acronym
CARE-CF1
Official Title
A Randomized, Double-Blind, Parallel Group, Placebo-Controlled Study Investigating the Optimal Dose Regimen, Efficacy, and Safety of Adding Oral Cysteamine in Adult Patients Being Treated for an Exacerbation of CF-associated Lung Disease
Study Type
Interventional

2. Study Status

Record Verification Date
April 2021
Overall Recruitment Status
Completed
Study Start Date
December 2016 (undefined)
Primary Completion Date
April 2018 (Actual)
Study Completion Date
April 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
NovaBiotics Ltd.
Collaborators
Agility Clinical, Inc., PSR Group B.V.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study investigates the use of cysteamine in the treatment of adults with Cystic Fibrosis who are experiencing an exacerbation of CF-associated lung disease. There are six different potential dosing regimens, including one that is placebo.
Detailed Description
This is a multicenter, double-blind, randomized, placebo-controlled, 6-arm study to investigate the optimal dose regimen, efficacy, and safety of cysteamine in the treatment of adult patients with CF who are experiencing an exacerbation of CF-associated lung disease. Patients will be screened for the study and eligible patients will be randomized to receive either cysteamine or placebo as add-on therapy to their standard of care treatment for CF-associated lung disease.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cystic Fibrosis
Keywords
Exacerbation, CF, Lung disease, Lung infection, Gram negative, Bacterial Infection, pneumonia, bronchitis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
91 (Actual)

8. Arms, Groups, and Interventions

Arm Title
High Dose, Once per day
Arm Type
Active Comparator
Arm Description
Patient takes one oral dose of Cysteamine (high dose) per day, in the morning. The patient takes two oral placebo doses, one at mid-day and one in the evening.
Arm Title
High Dose, Twice per day
Arm Type
Active Comparator
Arm Description
Patient takes two oral doses of Cysteamine (high dose) per day, one in the morning and one in the evening. The patient takes one oral placebo dose, at mid-day.
Arm Title
High Dose, Three times per day
Arm Type
Active Comparator
Arm Description
Patient takes three oral doses of Cysteamine (high dose) per day, one in the morning, one at mid-day and one in the evening.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patient takes three oral doses of placebo, one in the morning, one at mid-day and one in the evening.
Arm Title
Low Dose, Three times per day
Arm Type
Active Comparator
Arm Description
Patient takes three oral doses of Cysteamine (low dose) per day, one in the morning, one at mid-day and one in the evening.
Arm Title
Mid-Range Dose, Three times per day
Arm Type
Active Comparator
Arm Description
Patient takes three oral doses of Cysteamine (mid-range dose) per day, one in the morning, one at mid-day and one in the evening.
Intervention Type
Drug
Intervention Name(s)
Cysteamine
Other Intervention Name(s)
Lynovex, NM001, Lynovex Oral
Intervention Description
Oral Cysteamine Capsule
Intervention Type
Drug
Intervention Name(s)
Placebo Oral Capsule
Intervention Description
Placebo Oral Capsule
Primary Outcome Measure Information:
Title
Change From Baseline in Sputum Bacterial Load
Description
Change from baseline through to Day 21 in log10 cfu/ml transformed total gram negative sputum bacterial load
Time Frame
Baseline through Day 21/End of Study
Title
Safety and Tolerability Assessed by the Number of Subjects With Adverse Events
Description
Assessed by variables such as adverse events (AEs), laboratory assessments, physical examinations, and vital signs.
Time Frame
Baseline through Day 21/End of Study
Secondary Outcome Measure Information:
Title
Change From Baseline in Neutrophil Elastase Levels
Description
Actual values and change from baseline in neutrophil elastase levels were summarized using descriptive statistics by visit for each treatment group and each TDD group for the ITT Population.
Time Frame
Baseline through Day 21/End of Study
Title
Change From Baseline in Sputum IL8
Description
Sputum IL-8 Levels by Visit - Covariate Adjusted ANCOVA with Observed Data ITT Population
Time Frame
Baseline through Day 21/End of Study
Title
Change From Baseline in FEV1
Description
Change from Baseline in FEV1 Percent Predicted (%) - Covariate Adjusted ANCOVA with Observed Data ITT Population
Time Frame
Baseline through Day 21/End of Study
Title
Change From Baseline in BMI
Description
BMI (kg/m^2) by Visit - ANCOVA with Observed Data ITT Population
Time Frame
Baseline through Day 21/End of Study
Title
Change From Baseline in C-Reactive Protein
Description
Change from baseline in C-Reactive Protein at visits 7, 14 and 21
Time Frame
Baseline through Day 21
Title
Change From Baseline in Blood Leukocyte Count
Description
Blood Leukocyte Count (10^9 leucocytes/L) by Visit - ANCOVA with Observed Data ITT Population
Time Frame
Baseline through Day 21/End of Study
Title
Assessment of Blood Cysteamine Levels
Description
Study Drug Plasma at Day 14 Safety Population
Time Frame
Day 14
Title
Assessment of Sputum Cysteamine Levels
Description
Study Drug Sputum Concentrations at Day 14 Safety Population
Time Frame
Day 14
Title
Change From Baseline in CFRSD-CRISS
Description
Mean Change from Baseline in Cystic Fibrosis Respiratory Symptom Diary (CFRSD)-Chronic Respiratory Infection Symptom Scale (CRISS) CRFSD-CRISS:The CFRSD is a 16-item PROM to evaluate the effect of treatment on the severity of symptoms of acute respiratory infections associated with CF (i.e., CFRSD-CRISS) and to assess the emotional and activity impacts of these symptoms. The overall CRISS score range is 0-100 with 100 being the most severe symptoms.The CFRSD-CRISS is a validated unidimensional scale based on a subset of 8 items from the CFRSD questionnaire that quantifies symptom severity for the previous 24 hours to capture the magnitude of symptoms in stable CF, during medically treated CF exacerbations, and during recover from an exacerbation. The 8 items on the CFRSD-CRISS were scored using a 5-point Likert scale ranging from 0 (no symptom) to 4 (the highest magnitude of severity). So score range of 0-32.
Time Frame
Baseline through to Day 21
Title
Change From Baseline in CFQ-R
Description
The CFQ-R is a disease-specific HRQOL (Health related quality of life) measure containing both generic and CF-specific scales and measures functioning during the previous 2 weeks. Each CFQ-R scale yielded standardized scores ranging from 0 to 100; higher scores indicated better HRQOL
Time Frame
Baseline through Day 21/End of Study
Title
Change From Baseline in Jarad and Sequeiros Symptom Score Questionnaire
Description
The Jarad and Sequeiros Symptom Questionnaire (Jarad, 2012) is a simple participant-completed questionnaire that assesses and evaluates change in participant symptoms related to different aspects of respiratory function during a CF exacerbation. The questionnaire consists of 4 questions, each answered on a 4-point scale ranging from 1 (best) to 4 (worst). A range of minimum 4 to maximum16.Jarad and Sequeiros Questionnaire Score - changes from baseline at day 7 and day 14
Time Frame
changes from baseline at day 7 and day 14
Title
Change From Baseline in Weight
Description
Weight (kg) by visit - ANCOVA with observed data
Time Frame
Baseline through Day 21/End of Study

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: CF-associated lung disease with documented history of chronic infection with Gram-negative organism(s) Established patient of the Principal Investigator's CF Multi Disciplinary Team (MDT) Age ≥18 years Weight >40 kg FEV1 >30% of predicted within the 6 months prior to study exacerbation At the baseline visit: experiencing a new exacerbation of CF-associated lung disease (based on Investigator assessment of ≥4 symptoms present on the Fuchs' criteria) requiring treatment that includes an aminoglycoside antibiotic Females of childbearing potential will be included if they are either sexually inactive (sexually abstinent for 14 days prior to the first study drug dose continuing through 28 days after the last study drug dose, or using one of the following highly effective contraceptive (i.e. results in <1% failure rate when used consistently and correctly) methods in this trial: intrauterine device (IUD); surgical sterilization of the partner (vasectomy for 6 months minimum); combined (estrogen or progestogen containing) hormonal contraception associated with the inhibition of ovulation (either oral, intravaginal, or transdermal); progestogen only hormonal contraception associated with the inhibition of ovulation (either oral, injectable, or implantable); intrauterine hormone releasing system (IUS); bilateral tubal occlusion. Females of childbearing potential agree to remain sexually inactive or to keep the same birth control method for at least 28 days following the last dose. A female of non-childbearing potential must have undergone one of the following sterilization procedures at least 6 months prior to the first study drug dose: hysteroscopic sterilization; bilateral tubal ligation or bilateral salpingectomy; hysterectomy; bilateral oophorectomy; or be postmenopausal with amenorrhea for at least 1 year prior to the first study drug dose and follicle stimulating hormone (FSH) serum levels consistent with postmenopausal status. A non-vasectomized male subject agrees to use a condom with spermicide or abstain from sexual intercourse during the study until 90 days beyond the last dose of study medication and the female partner agrees to comply with inclusion 7 or 9. For a vasectomized male who has had his vasectomy 6 months or more prior to study start, it is required that they use a condom during sexual intercourse. A male who has been vasectomized less than 6 months prior to study start must follow the same restrictions as a non-vasectomized male. If male, agrees not to donate sperm from the first study drug dose until 90 days after dosing. Willing and able to comply with all protocol requirements and procedures, including induction of sputum, if necessary Willing and able to provide signed and dated informed consent Exclusion Criteria: Hypersensitive to cysteamine or to any of the excipients Hypersensitive to penicillamine Transplant recipient Participation in any other interventional clinical research study (participation in observational studies is not exclusionary) within 30 days of Baseline (Day 0), and any planned participation in an interventional clinical research study for the duration of this study If female, pregnancy, planned pregnancy, or breast-feeding Any other significant disease/disorder which, in the Investigator's opinion, either puts the patient at risk due to study participation, or may influence the results of the study or the patient's ability to participate in the study
Facility Information:
Facility Name
Banner University of Arizona Medical Center
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85724
Country
United States
Facility Name
San Francisco Critical Care Medical Group California Pacific Medical Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94115
Country
United States
Facility Name
University of Florida
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32610
Country
United States
Facility Name
Central Florida Pulmonary
City
Orlando
State/Province
Florida
ZIP/Postal Code
32803
Country
United States
Facility Name
Albany Medical College
City
Albany
State/Province
New York
ZIP/Postal Code
12208
Country
United States
Facility Name
Nationwide Children's Hospital
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43205
Country
United States
Facility Name
West Virginia University
City
Morgantown
State/Province
West Virginia
ZIP/Postal Code
26506
Country
United States
Facility Name
The Medical College of Wisconsin/Froedtert Hospital
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53226
Country
United States
Facility Name
Ospedale Padiatrico Bambino Gesu Centro Fibrosi Cistica
City
Roma
ZIP/Postal Code
00165
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria Integrato di Verona Borgo Trento Centro Fibrosi Cistica
City
Verona
ZIP/Postal Code
37126
Country
Italy
Facility Name
Aberdeen Royal Infirmary
City
Aberdeen
State/Province
Scotland
ZIP/Postal Code
AB25 2ZN
Country
United Kingdom
Facility Name
Ninewells Hospital Scottish Adult Cystic Fibrosis Service
City
Dundee
ZIP/Postal Code
DD1 9SY
Country
United Kingdom
Facility Name
Western General Hospital Edinburgh, CF Adults / CF Unit
City
Edinburgh
ZIP/Postal Code
EH4 3HE
Country
United Kingdom
Facility Name
NHS GGC
City
Glasgow
ZIP/Postal Code
G51 4TF
Country
United Kingdom
Facility Name
Raigmore Hospital
City
Inverness
ZIP/Postal Code
IV2 3UJ
Country
United Kingdom
Facility Name
St. James University Hospital
City
Leeds
ZIP/Postal Code
LS9 7TF
Country
United Kingdom
Facility Name
Royal Victoria Infirmary Adult CF Centre
City
Newcastle upon Tyne
ZIP/Postal Code
NE1 4LP
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
33370348
Citation
Devereux G, Wrolstad D, Bourke SJ, Daines CL, Doe S, Dougherty R, Franco R, Innes A, Kopp BT, Lascano J, Layish D, MacGregor G, Murray L, Peckham D, Lucidi V, Lovie E, Robertson J, Fraser-Pitt DJ, O'Neil DA. Oral cysteamine as an adjunct treatment in cystic fibrosis pulmonary exacerbations: An exploratory randomized clinical trial. PLoS One. 2020 Dec 28;15(12):e0242945. doi: 10.1371/journal.pone.0242945. eCollection 2020.
Results Reference
derived
Links:
URL
http://www.novabiotics.co.uk/
Description
NovaBiotics Website

Learn more about this trial

A Study of the Dosing, Efficacy, and Safety of Oral Cysteamine in Adult Patients With Cystic Fibrosis Exacerbations

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