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Tobramycin in Bronchiectasis Colonized With Pseudmonas Aeruginosa (TORNASOL)

Primary Purpose

Bronchiectasis Adult, Pseudomonas Infections

Status
Unknown status
Phase
Phase 3
Locations
China
Study Type
Interventional
Intervention
Tobramycin Inhalant Product
usual care
Natural saline inhalation
Sponsored by
Guangzhou Institute of Respiratory Disease
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bronchiectasis Adult focused on measuring bronchiectasis, Pseudomonas aeruginosa, tobramycin, nebulization, bacterial load, quality of life

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Aged 18 to 75 years, had a history of chronic cough and sputum production, had physician-diagnosed bronchiectasis based on high-resolution chest computed tomography (effective within 12 months)
  • Remaining clinically stable (no significant changes in respiratory symptoms and free from upper respiratory tract infection or bronchiectasis exacerbations for 4 weeks)
  • Sputum culture positive to Pseudomonas aeruginosa at screening
  • Forced expiratory volume in one second > 30% predicted and < 80% predicted
  • Could tolerate to nebulization
  • At least one bronchiectasis exacerbation within the past two years
  • Can correctly nebulize the study medications and fill in the diary cards following instruction of the investigators

Exclusion Criteria:

  • Had a knwon history of allergy to tobramycin
  • Had concomitant asthma, allergic bronchopulmonary aspergillosis, active tuberculosis, or active infection with non-tuyberculous mycobacteria that warranted regular anti-mycobacterial treatment
  • Had moderate or major haemoptysis within 6 months
  • Had concomitant severe cardiovascular diseases or haematopoietic diseases (congestive heart failure, clinically significant coronary heart disease, myocardial infarction or stroke, clinically arrythmia, known anurysm of the aorta, uncontroll hypertension (systolic blood pressure > 160mmHg or diastolic pressure >100mmHg at two consecutive time points)
  • Concomitant severe psychiatric disorders
  • Uncontrolled diabetes mellitus or fasting blood glucose >10mmol/L
  • Active peptic or duodenal ulcer
  • Moderate-to-severe gastroesophageal reflux diseases
  • Malignancy
  • Severe myasthenia gravis or Parkinson's disease
  • Major abnormality of hepatic or renal function [ALT or AST >2-fold of the normal upper limit, creatinine > 1.5-fold- greater than the normal upper limit (excluding ALT > 1.5-fold greater than normal upper limit in patients with chronic stable hepatitis)]; concomitant infection with HBV and HCV;
  • Hearing loss or clinically significant tinittus
  • Use of inhaled or systemic antibiotics within 4 weeks prior to enrollment
  • Needing oral or intravenous corticosteroids, or needing systemic corticosteroids within 30 days prior to enrollment
  • Needing oral or intravenous anti-cholinergic medications, or needing systemic anti-cholinergic medications within 30 days prior to enrollment
  • Needing long-term non-invasive mechanical ventilation or oxygen therapy (> 10 hrs daily) due to chronic respiratory failure
  • Pregnancy or lactation
  • Failure to understand or cooperate with the trial procedures
  • Participation in other clinical trials within 3 months

Sites / Locations

  • The First Affiliated Hospital of Guangzhou Medical UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Placebo Comparator

Other

Arm Label

tobramycin inhalation

natural saline inhalation

usual care

Arm Description

300mg tobramycin dissolved in 5ml saline will be nebulized with an ultrasonic nebulizer within 15-20 minutes.

5ml saline will be nebulized with an ultrasonic nebulizer within 15-20 minutes.

ambroxool (30mg thrice daily), or N-acetylcysteine (0.2g thrice daily) plus chest physiotherapy (5 min, once daily)

Outcomes

Primary Outcome Measures

Changes in sputum load of Pseudomonas aeruginosa at day 29 compared with baseline
Changes in sputum load of Pseudomonas aeruginosa at day 29 compared with baseline
Changes in Quality of Life in Bronchiectasis-Respiratory Symptom Score at day 29 compared with baseline
Changes in QoL-B-RSS at day 29 compared with baseline. The respiratory symptom domain contains 9 items describing patient's self assessment of her/his respiratory symptoms that affect the daily life. The total score for this domain is 100, with higher scores indicating better quality of life. No summation was made for the total score.

Secondary Outcome Measures

The time to the first bronchiectasis exacerbation since randomization
The time to the first bronchiectasis exacerbation since randomization
The frequency of bronchiectasis exacerbation since randomization
The frequency of bronchiectasis exacerbation since randomization
The rate of isolation of Pseudomonas aeruginosa at day 85
The rate of isolation of Pseudomonas aeruginosa at day 85
Changes in the load of Pseudomonas aeruginosa at day 85 compared with baseline
Changes in the load of Pseudomonas aeruginosa at day 85 compared with baseline
Changes in FEV1 pred% at days 29, 57 and 85 compared with baseline
Changes in the predicted % of forced expiratory volume in one second at days 29, 57 and 85 compared with baseline
Changes in 24-hour sputum volume at days 29, 57 and 85 compared with baseline
Changes in 24-hour sputum volume at days 29, 57 and 85 compared with baseline
Changes in sputum purulence at days 29, 57 and 85 compared with baseline
Changes in sputum purulence at days 29, 57 and 85 compared with baseline
Changes in Quality of Life in Bronchiectasis-Respiratory Symptom Score at day 85 compared with baseline
Changes in QoL-B-RSS at day 85 compared with baseline. The respiratory symptom domain contains 9 items describing patient's self assessment of her/his respiratory symptoms that affect the daily life. The total score for this domain is 100, with higher scores indicating better quality of life. No summation was made for the total score.
Changes in Bronchiectasis Health Questionnaire Sore at day 29 and 85 compared with baseline
Changes in BHQ Sore at day 29 and 85 compared with baseline. Theb BHQ contains 10 items, with higher scores indicating better quality of life. The total score was calculated as the weighted summation of the scores for the 10 individual items.
Peak and trough concentration of tobramycin at day 1 and 28 post-treatment
Peak and trough concentration of tobramycin at day 1 and 28 post-treatment
Changes in overall visual analogue scale at days 29 and 85 compared with baseline
Changes in overall VAS at days 29 and 85 compared with baseline. The VAS ranged from 0 to 10, with higher scores indicating poorer status. No summation of the score was made.
Changes in the minimal inhibitory concentration of Pseudomonas aeruginosa at days 29 and 85 compared with baseline
Changes in the MIC of Pseudomonas aeruginosa at days 29 and 85 compared with baseline (assessed with dilution methods for the sputum culture samples)

Full Information

First Posted
October 19, 2018
Last Updated
July 31, 2019
Sponsor
Guangzhou Institute of Respiratory Disease
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1. Study Identification

Unique Protocol Identification Number
NCT03715322
Brief Title
Tobramycin in Bronchiectasis Colonized With Pseudmonas Aeruginosa
Acronym
TORNASOL
Official Title
Efficacy and Safety of Inhaled Tobramycin on Bronchiectasis Colonized With Pseudomonas Aeruginosa: A Randomized, Double-blind, Parallel-group Multicenter Trial
Study Type
Interventional

2. Study Status

Record Verification Date
July 2019
Overall Recruitment Status
Unknown status
Study Start Date
October 26, 2018 (Actual)
Primary Completion Date
April 2021 (Anticipated)
Study Completion Date
June 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Guangzhou Institute of Respiratory Disease

4. Oversight

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

5. Study Description

Brief Summary
This is a phase 3 study. Patients will be enrolled from 14 medical centers in mainland China. Eligible patients will be randomly allocated to treatment group (tobramycin nebulization, 300mg bid) and control group (natural saline nebulization, 5ml bid). A total of two 28-day on-and-off cycles will be scheduled. Both tobramycin solution and natural saline and the nebulizer will be solely provided by the sponsor.
Detailed Description
This is a phase 3 study. All bronchiectasis patients will be enrolled from 14 medical centers located in different geographic regions of mainland China. After a three-week screening period, On the basis of usual care [ambroxool (30mg thrice daily) or N-acetylcysteine (0.2g thrice daily) and chest physiotherapy (5 min, once daily)], eligible patients will be randomly allocated to treatment group (tobramycin nebulization, 300mg bid, delivered via an ultrasonic nebulizer) and control group (natural saline nebulization, 5ml bid, delivered via an ultrasonic nebulizer). A total of two 28-day on-and-off cycles will be scheduled. At the end of each on-and-off cycle, sputum culture and other clinical assessments will be performed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bronchiectasis Adult, Pseudomonas Infections
Keywords
bronchiectasis, Pseudomonas aeruginosa, tobramycin, nebulization, bacterial load, quality of life

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Patients will be randomized into the treatment group and control group. No cross-over of the study group will be made.
Masking
ParticipantInvestigator
Masking Description
Both the investigators and the participants will be masked to the study allocation. The randonmization codes will be generated by a blinded medical statistician with the use of computerized program. Randomization will be achieved based on the permuted block design.
Allocation
Randomized
Enrollment
350 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
tobramycin inhalation
Arm Type
Active Comparator
Arm Description
300mg tobramycin dissolved in 5ml saline will be nebulized with an ultrasonic nebulizer within 15-20 minutes.
Arm Title
natural saline inhalation
Arm Type
Placebo Comparator
Arm Description
5ml saline will be nebulized with an ultrasonic nebulizer within 15-20 minutes.
Arm Title
usual care
Arm Type
Other
Arm Description
ambroxool (30mg thrice daily), or N-acetylcysteine (0.2g thrice daily) plus chest physiotherapy (5 min, once daily)
Intervention Type
Drug
Intervention Name(s)
Tobramycin Inhalant Product
Intervention Description
Tobramycin will be nebulized (300mg twice daily) with an ultrasonic nebulizer. A total of two 28-day on-and-off cycles will be scheduled.
Intervention Type
Other
Intervention Name(s)
usual care
Intervention Description
ambroxool (30mg thrice daily), or N-acetylcysteine (0.2g thrice daily) plus chest physiotherapy (5 min, once daily)
Intervention Type
Drug
Intervention Name(s)
Natural saline inhalation
Intervention Description
Natural saline will be nebulized (5ml twice daily) with an ultrasonic nebulizer. A total of two 28-day on-and-off cycles will be scheduled.
Primary Outcome Measure Information:
Title
Changes in sputum load of Pseudomonas aeruginosa at day 29 compared with baseline
Description
Changes in sputum load of Pseudomonas aeruginosa at day 29 compared with baseline
Time Frame
29 days
Title
Changes in Quality of Life in Bronchiectasis-Respiratory Symptom Score at day 29 compared with baseline
Description
Changes in QoL-B-RSS at day 29 compared with baseline. The respiratory symptom domain contains 9 items describing patient's self assessment of her/his respiratory symptoms that affect the daily life. The total score for this domain is 100, with higher scores indicating better quality of life. No summation was made for the total score.
Time Frame
29 days
Secondary Outcome Measure Information:
Title
The time to the first bronchiectasis exacerbation since randomization
Description
The time to the first bronchiectasis exacerbation since randomization
Time Frame
4 months
Title
The frequency of bronchiectasis exacerbation since randomization
Description
The frequency of bronchiectasis exacerbation since randomization
Time Frame
4 months
Title
The rate of isolation of Pseudomonas aeruginosa at day 85
Description
The rate of isolation of Pseudomonas aeruginosa at day 85
Time Frame
85 days
Title
Changes in the load of Pseudomonas aeruginosa at day 85 compared with baseline
Description
Changes in the load of Pseudomonas aeruginosa at day 85 compared with baseline
Time Frame
85 days
Title
Changes in FEV1 pred% at days 29, 57 and 85 compared with baseline
Description
Changes in the predicted % of forced expiratory volume in one second at days 29, 57 and 85 compared with baseline
Time Frame
85 days
Title
Changes in 24-hour sputum volume at days 29, 57 and 85 compared with baseline
Description
Changes in 24-hour sputum volume at days 29, 57 and 85 compared with baseline
Time Frame
85 days
Title
Changes in sputum purulence at days 29, 57 and 85 compared with baseline
Description
Changes in sputum purulence at days 29, 57 and 85 compared with baseline
Time Frame
85 days
Title
Changes in Quality of Life in Bronchiectasis-Respiratory Symptom Score at day 85 compared with baseline
Description
Changes in QoL-B-RSS at day 85 compared with baseline. The respiratory symptom domain contains 9 items describing patient's self assessment of her/his respiratory symptoms that affect the daily life. The total score for this domain is 100, with higher scores indicating better quality of life. No summation was made for the total score.
Time Frame
85 days
Title
Changes in Bronchiectasis Health Questionnaire Sore at day 29 and 85 compared with baseline
Description
Changes in BHQ Sore at day 29 and 85 compared with baseline. Theb BHQ contains 10 items, with higher scores indicating better quality of life. The total score was calculated as the weighted summation of the scores for the 10 individual items.
Time Frame
85 days
Title
Peak and trough concentration of tobramycin at day 1 and 28 post-treatment
Description
Peak and trough concentration of tobramycin at day 1 and 28 post-treatment
Time Frame
29 days
Title
Changes in overall visual analogue scale at days 29 and 85 compared with baseline
Description
Changes in overall VAS at days 29 and 85 compared with baseline. The VAS ranged from 0 to 10, with higher scores indicating poorer status. No summation of the score was made.
Time Frame
85 days
Title
Changes in the minimal inhibitory concentration of Pseudomonas aeruginosa at days 29 and 85 compared with baseline
Description
Changes in the MIC of Pseudomonas aeruginosa at days 29 and 85 compared with baseline (assessed with dilution methods for the sputum culture samples)
Time Frame
85 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Aged 18 to 75 years, had a history of chronic cough and sputum production, had physician-diagnosed bronchiectasis based on high-resolution chest computed tomography (effective within 12 months) Remaining clinically stable (no significant changes in respiratory symptoms and free from upper respiratory tract infection or bronchiectasis exacerbations for 4 weeks) Sputum culture positive to Pseudomonas aeruginosa at screening Forced expiratory volume in one second > 30% predicted and < 80% predicted Could tolerate to nebulization At least one bronchiectasis exacerbation within the past two years Can correctly nebulize the study medications and fill in the diary cards following instruction of the investigators Exclusion Criteria: Had a knwon history of allergy to tobramycin Had concomitant asthma, allergic bronchopulmonary aspergillosis, active tuberculosis, or active infection with non-tuyberculous mycobacteria that warranted regular anti-mycobacterial treatment Had moderate or major haemoptysis within 6 months Had concomitant severe cardiovascular diseases or haematopoietic diseases (congestive heart failure, clinically significant coronary heart disease, myocardial infarction or stroke, clinically arrythmia, known anurysm of the aorta, uncontroll hypertension (systolic blood pressure > 160mmHg or diastolic pressure >100mmHg at two consecutive time points) Concomitant severe psychiatric disorders Uncontrolled diabetes mellitus or fasting blood glucose >10mmol/L Active peptic or duodenal ulcer Moderate-to-severe gastroesophageal reflux diseases Malignancy Severe myasthenia gravis or Parkinson's disease Major abnormality of hepatic or renal function [ALT or AST >2-fold of the normal upper limit, creatinine > 1.5-fold- greater than the normal upper limit (excluding ALT > 1.5-fold greater than normal upper limit in patients with chronic stable hepatitis)]; concomitant infection with HBV and HCV; Hearing loss or clinically significant tinittus Use of inhaled or systemic antibiotics within 4 weeks prior to enrollment Needing oral or intravenous corticosteroids, or needing systemic corticosteroids within 30 days prior to enrollment Needing oral or intravenous anti-cholinergic medications, or needing systemic anti-cholinergic medications within 30 days prior to enrollment Needing long-term non-invasive mechanical ventilation or oxygen therapy (> 10 hrs daily) due to chronic respiratory failure Pregnancy or lactation Failure to understand or cooperate with the trial procedures Participation in other clinical trials within 3 months
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Nan-shan Zhong, MD
Phone
13609003622
Email
nanshan@vip.163.com
First Name & Middle Initial & Last Name or Official Title & Degree
Wei-jie Guan, PhD
Phone
+86-13826042052
Email
battery203@163.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nan-shan Zhong, MD
Organizational Affiliation
The First Affiliated Hospital of Guangzhou Medical University
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Wei-jie Guan, PhD
Organizational Affiliation
The First Affiliated Hospital of Guangzhou Medical University
Official's Role
Principal Investigator
Facility Information:
Facility Name
The First Affiliated Hospital of Guangzhou Medical University
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510120
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nan-shan Zhong, MD
Phone
+86-13609003622
Email
nanshan@vip.163.com
First Name & Middle Initial & Last Name & Degree
Wei-jie Guan, PhD
First Name & Middle Initial & Last Name & Degree
Guo-jun Zhang, MD
First Name & Middle Initial & Last Name & Degree
Yong-hua Gao, PhD
First Name & Middle Initial & Last Name & Degree
Jie-ming Qu, MD
First Name & Middle Initial & Last Name & Degree
Jin-fu Xu, MD
First Name & Middle Initial & Last Name & Degree
Yuan-lin Song, MD
First Name & Middle Initial & Last Name & Degree
Jian-ping Zhao, MD
First Name & Middle Initial & Last Name & Degree
Xiao-nan Tao, MD
First Name & Middle Initial & Last Name & Degree
Zong-an Liang, MD
First Name & Middle Initial & Last Name & Degree
Ping Chen, MD
First Name & Middle Initial & Last Name & Degree
Qi-chang Lin, MD
First Name & Middle Initial & Last Name & Degree
Yi-jiang Huang, MD
First Name & Middle Initial & Last Name & Degree
Xue-dong Liu, MD
First Name & Middle Initial & Last Name & Degree
Xing-xiang Xu, MD
First Name & Middle Initial & Last Name & Degree
Wei Zhang, MD
First Name & Middle Initial & Last Name & Degree
Chang-jun Du, MD
First Name & Middle Initial & Last Name & Degree
Xing-lin Gao, MD

12. IPD Sharing Statement

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Tobramycin in Bronchiectasis Colonized With Pseudmonas Aeruginosa

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