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Polihexanide (PHMB) Eye Drops in Patients Affected by Acanthamoeba Keratitis

Primary Purpose

Acanthamoeba Keratitis

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
PHMB 0.08%
Propamidine 0.1%
placebo
PHMB 0.02%
Sponsored by
SIFI SpA
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acanthamoeba Keratitis focused on measuring polihexanide, propamidine, confocal microscopy

Eligibility Criteria

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

Inclusion Criteria:

  1. willing to give informed consent
  2. man or woman of any race and ≥12 years of age
  3. able to understand and willing to comply with study procedures, restrictions and requirements
  4. Clinical findings consistent with Acanthamoeba keratitis
  5. Confocal microscopy findings consistent with Acanthamoeba keratitis
  6. The following previous treatments for Acanthamoeba keratitis are eligible: antibiotics, antiviral and antifungal drugs, antiinflammatory drugs
  7. Females of childbearing potential will be included if they are either sexually inactive or using one highly effective contraceptive
  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 study drug dose
  9. A female of non-childbearing potential must have undergone one sterilization procedures at least 6 months prior to the first study drug dose
  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 drug and the female partner agrees to comply with inclusion 7 or 8. 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, they must agree not to donate sperm from the first study drug dose until 90 days after dosing

Exclusion Criteria:

  1. Subject with documented history and/or clinical signs of concomitant presence of an ocular infection caused by viruses (herpes simplex virus [HSV]) or fungi.
  2. Subject treated with drugs having effects on Acanthamoeba cysts prior to study entry, including biguanides (PHMB, chlorhexidine) and diamidines (propamidine, hexamidine).
  3. Subjects requiring systemic immunosuppression for Acanthamoeba associated scleritis.
  4. Subjects requiring urgent surgical intervention for advanced Acanthamoeba keratitis in either eye (e.g., for advanced corneal thinning/melting etc.).
  5. Subject with known or suspected allergy to biguanides, diamidines or intolerance to any other ingredient of the investigational treatments.
  6. Subject affected by immunodeficiency diseases or taking systemic immunosuppressive therapy.
  7. Subject with a major systemic disease or other illness that would, in the opinion of the investigator, compromise subject's safety or interfere with the collection or interpretation of study results.
  8. If female, pregnancy, planned pregnancy, or breast-feeding
  9. Subject is participating in another interventional clinical study with an experimental or unapproved/unlicensed therapy or has participated in another interventional clinical study within 4 weeks prior to this study.

Sites / Locations

  • San Raffaele Hospital
  • San Giovanni and Paolo Hospital
  • University Clinical Center Medical University of Silesia
  • Moorfields Hospital
  • Manchester Royal Eye Hospital
  • University Hospital Southampton

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

PHMB 0.08% plus placebo

PHMB 0.02% plus propamidine 0.1%

Arm Description

polihexanide (PHMB) 0.08% and placebo were administered in the affected eye until clinical resolution for a maximum of 12 months

polihexanide (PHMB) 0.02% and propamidine 0.1% were administered in the affected eye until clinical resolution for a maximum of 12 months

Outcomes

Primary Outcome Measures

Clinical Resolution Rate
Percentage of patients cured 30 days after discontinuing all study therapies, within 12 months of randomization

Secondary Outcome Measures

Time to Cure
Time needed to reach a clinical resolution
Visual Acuity
Final visual acuity (best corrected)

Full Information

First Posted
September 5, 2017
Last Updated
August 2, 2023
Sponsor
SIFI SpA
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1. Study Identification

Unique Protocol Identification Number
NCT03274895
Brief Title
Polihexanide (PHMB) Eye Drops in Patients Affected by Acanthamoeba Keratitis
Official Title
Randomized, Active-Controlled, Phase 3 Study to Evaluate Efficacy, Safety and Tolerability of 0.08% PHMB Ophthalmic Solution in Comparison With 0.02% PHMB + 0.1% Propamidine Combination Therapy in Subjects Affected by Acanthamoeba Keratitis
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Completed
Study Start Date
August 13, 2017 (Actual)
Primary Completion Date
June 30, 2021 (Actual)
Study Completion Date
March 30, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
SIFI SpA

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Prospective randomized study to evaluate the efficacy, safety and tolerability of 0.08% polihexanide (PHMB) eye drops in patients affected by acanthamoeba keratitis. 130 subjects were assigned to one of the following 2 treatment groups: Group 1: 0.08% polihexanide (PHMB) + placebo Group 2: 0.02% polihexanide (PHMB) + 0.1% propamidine
Detailed Description
This was a randomized, assessor-masked, active-controlled, multiple center, parallel-group phase 3 study to evaluate the efficacy, safety and tolerability of 0.08% polihexanide (PHMB) ophthalmic solution compared to the conventional 0.02% polihexanide (PHMB) + 0.1% propamidine in patients affected by acanthamoeba keratitis. The study was designed as a superiority study with the possibility to test for non-inferiority if the superiority hypothesis was not met (CPMP/EWP/482/99).The study consisted of an eligibility screening visit, a treatment period including monthly follow-up visits until a clinical resolution was obtained (within a maximum of 1 year), followed by 2 post-treatment off-therapy visits (30 and 90 days after treatment discontinuation). 130 subjects with confirmed diagnosis of acanthamoeba keratitis (clinical signs plus positive confocal microscopy findings) were assigned to one of the following treatment groups in a ratio of 1:1. Group 1: 0.08% PHMB + placebo Group 2: 0.02% PHMB + 0.1% propamidine

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acanthamoeba Keratitis
Keywords
polihexanide, propamidine, confocal microscopy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
135 (Actual)

8. Arms, Groups, and Interventions

Arm Title
PHMB 0.08% plus placebo
Arm Type
Experimental
Arm Description
polihexanide (PHMB) 0.08% and placebo were administered in the affected eye until clinical resolution for a maximum of 12 months
Arm Title
PHMB 0.02% plus propamidine 0.1%
Arm Type
Active Comparator
Arm Description
polihexanide (PHMB) 0.02% and propamidine 0.1% were administered in the affected eye until clinical resolution for a maximum of 12 months
Intervention Type
Drug
Intervention Name(s)
PHMB 0.08%
Other Intervention Name(s)
Polihexanide 0.8 mg/ml
Intervention Description
16 drops in a day in the affected eye for 5 days followed by 8 drops in a day for 7 days,6 drops in a day for 7 days and 4 drops in a day up to clinical resolution
Intervention Type
Drug
Intervention Name(s)
Propamidine 0.1%
Other Intervention Name(s)
Brolene eye drops
Intervention Description
16 drops in a day in the affected eye for 5 days followed by 8 drops in a day for 7 days,6 drops in a day for 7 days and 4 drops in a day up to clinical resolution
Intervention Type
Drug
Intervention Name(s)
placebo
Other Intervention Name(s)
Brolene vehicle
Intervention Description
16 drops in a day in the affected eye for 5 days followed by 8 drops in a day for 7 days,6 drops in a day for 7 days and 4 drops in a day up to clinical resolution
Intervention Type
Drug
Intervention Name(s)
PHMB 0.02%
Other Intervention Name(s)
Polihexanide 0.2 mg/ml
Intervention Description
16 drops in a day in the affected eye for 5 days followed by 8 drops in a day for 7 days,6 drops in a day for 7 days and 4 drops in a day up to clinical resolution
Primary Outcome Measure Information:
Title
Clinical Resolution Rate
Description
Percentage of patients cured 30 days after discontinuing all study therapies, within 12 months of randomization
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Time to Cure
Description
Time needed to reach a clinical resolution
Time Frame
maximum 12 months
Title
Visual Acuity
Description
Final visual acuity (best corrected)
Time Frame
maximum 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
13 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: willing to give informed consent man or woman of any race and ≥12 years of age able to understand and willing to comply with study procedures, restrictions and requirements Clinical findings consistent with Acanthamoeba keratitis Confocal microscopy findings consistent with Acanthamoeba keratitis The following previous treatments for Acanthamoeba keratitis are eligible: antibiotics, antiviral and antifungal drugs, antiinflammatory drugs Females of childbearing potential will be included if they are either sexually inactive or using one highly effective contraceptive 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 study drug dose A female of non-childbearing potential must have undergone one sterilization procedures at least 6 months prior to the first study drug dose 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 drug and the female partner agrees to comply with inclusion 7 or 8. 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, they must agree not to donate sperm from the first study drug dose until 90 days after dosing Exclusion Criteria: Subject with documented history and/or clinical signs of concomitant presence of an ocular infection caused by viruses (herpes simplex virus [HSV]) or fungi. Subject treated with drugs having effects on Acanthamoeba cysts prior to study entry, including biguanides (PHMB, chlorhexidine) and diamidines (propamidine, hexamidine). Subjects requiring systemic immunosuppression for Acanthamoeba associated scleritis. Subjects requiring urgent surgical intervention for advanced Acanthamoeba keratitis in either eye (e.g., for advanced corneal thinning/melting etc.). Subject with known or suspected allergy to biguanides, diamidines or intolerance to any other ingredient of the investigational treatments. Subject affected by immunodeficiency diseases or taking systemic immunosuppressive therapy. Subject with a major systemic disease or other illness that would, in the opinion of the investigator, compromise subject's safety or interfere with the collection or interpretation of study results. If female, pregnancy, planned pregnancy, or breast-feeding Subject is participating in another interventional clinical study with an experimental or unapproved/unlicensed therapy or has participated in another interventional clinical study within 4 weeks prior to this study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John Dart, MD
Organizational Affiliation
Moorfield's Hospital London
Official's Role
Principal Investigator
Facility Information:
Facility Name
San Raffaele Hospital
City
Milano
Country
Italy
Facility Name
San Giovanni and Paolo Hospital
City
Venice
Country
Italy
Facility Name
University Clinical Center Medical University of Silesia
City
Katowice
Country
Poland
Facility Name
Moorfields Hospital
City
London
Country
United Kingdom
Facility Name
Manchester Royal Eye Hospital
City
Manchester
Country
United Kingdom
Facility Name
University Hospital Southampton
City
Southampton
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
31401556
Citation
Papa V, Rama P, Radford C, Minassian DC, Dart JKG. Acanthamoeba keratitis therapy: time to cure and visual outcome analysis for different antiamoebic therapies in 227 cases. Br J Ophthalmol. 2020 Apr;104(4):575-581. doi: 10.1136/bjophthalmol-2019-314485. Epub 2019 Aug 10.
Results Reference
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PubMed Identifier
33239413
Citation
Papa V, van der Meulen I, Rottey S, Sallet G, Overweel J, Asero N, Minassian DC, Dart JKG. Safety and tolerability of topical polyhexamethylene biguanide: a randomised clinical trial in healthy adult volunteers. Br J Ophthalmol. 2022 Feb;106(2):190-196. doi: 10.1136/bjophthalmol-2020-317848. Epub 2020 Nov 25.
Results Reference
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Polihexanide (PHMB) Eye Drops in Patients Affected by Acanthamoeba Keratitis

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