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Efficacy and Safety Study of CA330 Hemoadsorption Device on IL-6 Removal in Septic Patients

Primary Purpose

Sepsis

Status
Unknown status
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
hemoperfusion with cytokine adsorption column (CA330)
Sponsored by
First Affiliated Hospital, Sun Yat-Sen University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sepsis focused on measuring sepsis, IL-6, hemoperfusion

Eligibility Criteria

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

Inclusion Criteria:

  1. Hospitalized patients aged 18-75 years, regardless of gender;
  2. Meet the clinical criteria of sepsis according to the Third International Consensus Definitions for Sepsis;
  3. The diagnosis of sepsis is established within last 48 hours.
  4. Written informed consent is signed, and agreement to participate in all visits, examinations and treatments as required by the research program is achieved. If a patient is not able to give consent, the legal representative is asked to consent.

Exclusion Criteria:

  1. End-stage renal disease that need maintenance hemodialysis treatment;
  2. Congenital or acquired immunodeficiency disorders or those who had received organ transplantation within one year;
  3. Prescription of immunosuppressive medications (tripterygium wilfordii, mycophenolate mofetil, cyclophosphamide, FK506, etc.) or prednisolone for more than 10 mg/day (or the same dose of other hormone therapy) within 30 days;
  4. Coagulation dysfunction, severe bleeding tendency (prothrombin time, activated partial thromboplastin time prolonged significantly with bleeding, or fibrinogen less than 1.2 g/L with bleeding), active bleeding or uncontrolled acute massive bleeding within 24 hours;
  5. Malignant tumors, consumptive diseases, site of infection cannot be cleared (ie surgical patients who cannot be operated on) or body weight less than 35kg;
  6. A terminal state of organ failure (end stage of chronic obstructive pulmonary disease, pulmonary heart disease, heart dysfunction stage-IV, brain death or persistent vegetative state, chronic liver disease with hepatic encephalopathy, coagulation dysfunction, fluid retention and hepatocellular jaundice);
  7. Following results are detected during screening: platelet count < 50 *10^9/L, neutrophil count < 0.5 *10^9/L, hemoglobin < 70 g/L;
  8. Despite of adequate volume resuscitation, vasopressors and hormones, the mean arterial blood cannot maintain above 65 mmHg;
  9. Those who have been participating in or participated in another interventional clinical study within 30 days prior to enrollment, such as the clinical study of related drugs or medical devices affecting immunity (ie Xuebijing, ulinastatin, continuous renal replacement therapy, etc.);
  10. Anaphylaxis to materials of cardiopulmonary bypass, anticoagulants and hemoperfusion or other serious allergic history;
  11. Those who are not suitable for this clinical trial, which is determined by researchers, such as pregnant or lactating women, current drug addicts, patients with severe mental or neurological disorders, and those who have a history of alcohol abuse and cannot be terminated.

Sites / Locations

  • the First Affiliated Hospital of Sun Yat-sen UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

Control Group

Experimental Group

Arm Description

The control group receive routine treatment of sepsis only. All sites agree, when feasible, to follow the tenets of the Surviving Sepsis Campaign clinical practice guidelines for management of sepsis.

The experimental group receive routine treatment of sepsis combined with hemoperfusion with cytokine adsorption column (CA330).

Outcomes

Primary Outcome Measures

the reduction rate of IL-6 serum concentration at the initiation of first adsorption and at the end of the second adsorption
(1-Concentration IL-6 end of second adsorption/ Concentration IL-6 initiation of first adsorption) ×100%

Secondary Outcome Measures

the reduction rate of IL-10 serum concentration at the initiation of first adsorption and at the end of the second adsorption
(1-Concentration IL-10 end of second adsorption/ Concentration IL-10 initiation of first adsorption) ×100%
the reduction rate of lactic acid serum concentration at the initiation of first adsorption and at the end of the second adsorption
(1-Concentration lactic acid end of second adsorption/ Concentration lactic acid initiation of first adsorption) ×100%
the reduction rate of tumor necrosis factor-α (TNF-α) serum concentration at the initiation of first adsorption and at the end of the second adsorption
(1-Concentration TNF-α end of second adsorption/ Concentration TNF-α initiation of first adsorption) ×100%
the dynamic change of Acute Physiology and Chronic Health Evaluation (APACHE II) score
The maximum APACHE II score is 71, while the minimum score is 0. The higher values represent a worse outcome.
ventilation time
scale: hour
oxygenation index
partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2)
24hour urinary output
scale: ml/24h
length of vasopressors
scale: hour
catecholamine index
(dopamine dose*1)+(dobutamine dose*1)+(adrenaline dose*100)+(noradrenaline dose*100)+(phenylephrine dose*100), wherein all doses are expressed as µg/kg/min.
RRT incidency
the percentages of patients who receive RRT in two groups
total length of renal replacement therapy
scale: hour
ICU and hospital length of stay
scale: day
28-day all-cause mortality
the 28-day all-cause mortality in two groups

Full Information

First Posted
February 13, 2019
Last Updated
February 20, 2019
Sponsor
First Affiliated Hospital, Sun Yat-Sen University
Collaborators
Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou First People's Hospital, Zhujiang Hospital, Beijing Chao Yang Hospital, Peking University Shenzhen Hospital, Fujian Provincial Hospital, Wuhan University
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1. Study Identification

Unique Protocol Identification Number
NCT03847961
Brief Title
Efficacy and Safety Study of CA330 Hemoadsorption Device on IL-6 Removal in Septic Patients
Official Title
Efficacy and Safety Study of CA330 Hemoadsorption Device on IL-6 Removal in Septic Patients: A Multicenter Randomized Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
February 2019
Overall Recruitment Status
Unknown status
Study Start Date
December 17, 2018 (Actual)
Primary Completion Date
February 2020 (Anticipated)
Study Completion Date
October 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
First Affiliated Hospital, Sun Yat-Sen University
Collaborators
Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou First People's Hospital, Zhujiang Hospital, Beijing Chao Yang Hospital, Peking University Shenzhen Hospital, Fujian Provincial Hospital, Wuhan University

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
Sepsis persists to be the leading causes of morbidity and mortality worldwide. Moreover, the magnitude of health care resources utilized when managing septic patients is huge. All these hard facts call for constant efforts to optimize therapy. At present, the definitive therapy is adequate antibiotics and infectious source control. Fortunately, research has led to a better understanding of the pathophysiology of sepsis, in which the activation of multiple pro- and anti-inflammatory mediators plays a key role. This has led to the development of treatment strategies aimed at restoring a balanced immune response by eliminating/deactivating these inflammatory mediators. Whilst animal models of sepsis have provided encouraging results with strategies aiming at immune response modulation, clinical studies in patients using targeted pharmacological approaches have so far proved disappointing. Besides of acute kidney injury (AKI), renal replacement therapy (RRT) is applied to remove inflammatory mediators extracorporeally. Across the different modalities, the application of adsorption may help deactivate and decrease the peak elevation of these mediators in earlier course of sepsis, when levels of endotoxins and cytokines are extremely high. Recently, attempts to improve the outcome of sepsis patients with such devices, ie CytoSorb cytokine hemoadsorption and polymyxin B (Toraymyxin) endotoxin adsorption, have seen a certain renaissance. However, the clinical evidence to date supporting hemoadsorption for removal of endotoxins and/or proinflammatory mediators in sepsis remains incompetent and controversial. CA330 (Jafron Biomedical Co , Ltd, Zhuhai, China) is a hemoadsorption device containing hemocompatible, porous polymeric beads capable of removing cytokines and other mid-molecular weight toxins from blood by size exclusion and surface adsorption. Compared with HA330, improved resin synthesis technology makes CA330 a better performance in removing cytokines. This trial is the first to evaluate CA330 efficacy of cytokine reduction using the change in plasma interleukin (IL)-6 concentrations over time as a primary outcome. Although the trial was neither designed nor powered to evaluate outcome, we also evaluated organ function parameters as well as 28-day all-cause mortality.
Detailed Description
Eligible patients are stratified by site and randomly assigned in a 1:1 ratio to either CA330 hemoperfusion plus conventional medical therapy group or conventional medical therapy group. The randomization is performed by researchers on the central randomization system, provided by the Department of Biostatistics, Southern Medical University. In this study, the center coded random number table is produced by stratified and sectional randomization method. Statistical Analysis System(SAS) 9.4 statistical software is used to generate random coding tables with serial numbers (001-144) according to the number of cases allocated in each center and the proportion of experimental group and control group (1:1). The length of selected sections (block) and random seed number are sealed together as confidential data . The random number table is provided by the statisticians of the Department of Biostatistics, Southern Medical University. The experimental group receive routine treatment of sepsis combined with cytokine adsorption column (CA330) perfusion, and the control group receive routine treatment of sepsis only. Hemoperfusion treatments are performed using a perfusion machine via centrally inserted standard dialysis catheters at a prescribed blood flow rate of 100-300ml/min. In the beginning, lower flow rate is recommended, if there is no discomfort, then gradually increases. Each patient received 2 hemoperfusion treatments within 24 hours with a target duration for each treatment of 120-180 minutes (minimum of 120 minutes). The shorter the interval between the two hemoperfusion is, the better. It is suggested that the second hemoperfusion be performed within 0-5 hours after the first one. Anticoagulation was recommended with low-molecular-weight heparin in arterial line of the circuit at the dose of 60-80 international units (IU)/kg. No additional dose is required. The activity of anticoagulant factor α can be monitored at 60 minutes. It is suggested that the activity of anticoagulant factor α should be maintained at 500-1000units/L in subjects without bleeding tendency and 200-400units/L in subjects with bleeding tendency. If the clinical condition is limited, it is not mandatory to monitor this parameter.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sepsis
Keywords
sepsis, IL-6, hemoperfusion

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Eligible patients are stratified by site and randomly assigned in a 1:1 ratio to either CA330 hemoperfusion plus conventional medical therapy group or conventional medical therapy group.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
144 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Control Group
Arm Type
No Intervention
Arm Description
The control group receive routine treatment of sepsis only. All sites agree, when feasible, to follow the tenets of the Surviving Sepsis Campaign clinical practice guidelines for management of sepsis.
Arm Title
Experimental Group
Arm Type
Experimental
Arm Description
The experimental group receive routine treatment of sepsis combined with hemoperfusion with cytokine adsorption column (CA330).
Intervention Type
Device
Intervention Name(s)
hemoperfusion with cytokine adsorption column (CA330)
Intervention Description
Hemoperfusion treatments are performed using a perfusion machine via centrally inserted standard dialysis catheters at a prescribed blood flow rate of 100-300ml/min. In the beginning, lower flow rate is recommended, if there is no discomfort, then gradually increases. Each patient received 2 hemoperfusion treatments within 24 hours with a target duration for each treatment of 120-180 minutes (minimum of 120 minutes). The shorter the interval between the two hemoperfusion is, the better. It is suggested that the second hemoperfusion be performed within 0-5 hours after the first one.
Primary Outcome Measure Information:
Title
the reduction rate of IL-6 serum concentration at the initiation of first adsorption and at the end of the second adsorption
Description
(1-Concentration IL-6 end of second adsorption/ Concentration IL-6 initiation of first adsorption) ×100%
Time Frame
from the initiation of first adsorption until the end of the second adsorption, assessed up to 24hours
Secondary Outcome Measure Information:
Title
the reduction rate of IL-10 serum concentration at the initiation of first adsorption and at the end of the second adsorption
Description
(1-Concentration IL-10 end of second adsorption/ Concentration IL-10 initiation of first adsorption) ×100%
Time Frame
from the initiation of first adsorption until the end of the second adsorption, assessed up to 24hours
Title
the reduction rate of lactic acid serum concentration at the initiation of first adsorption and at the end of the second adsorption
Description
(1-Concentration lactic acid end of second adsorption/ Concentration lactic acid initiation of first adsorption) ×100%
Time Frame
from the initiation of first adsorption until the end of the second adsorption, assessed up to 24hours
Title
the reduction rate of tumor necrosis factor-α (TNF-α) serum concentration at the initiation of first adsorption and at the end of the second adsorption
Description
(1-Concentration TNF-α end of second adsorption/ Concentration TNF-α initiation of first adsorption) ×100%
Time Frame
from the initiation of first adsorption until the end of the second adsorption, assessed up to 24hours
Title
the dynamic change of Acute Physiology and Chronic Health Evaluation (APACHE II) score
Description
The maximum APACHE II score is 71, while the minimum score is 0. The higher values represent a worse outcome.
Time Frame
from Day0 to Day28
Title
ventilation time
Description
scale: hour
Time Frame
from Day0 to Day28
Title
oxygenation index
Description
partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2)
Time Frame
from Day0 to Day28
Title
24hour urinary output
Description
scale: ml/24h
Time Frame
from Day0 to Day28
Title
length of vasopressors
Description
scale: hour
Time Frame
from Day0 to Day28
Title
catecholamine index
Description
(dopamine dose*1)+(dobutamine dose*1)+(adrenaline dose*100)+(noradrenaline dose*100)+(phenylephrine dose*100), wherein all doses are expressed as µg/kg/min.
Time Frame
from Day0 to Day28
Title
RRT incidency
Description
the percentages of patients who receive RRT in two groups
Time Frame
from Day0 to Day28
Title
total length of renal replacement therapy
Description
scale: hour
Time Frame
from Day0 to Day28
Title
ICU and hospital length of stay
Description
scale: day
Time Frame
from Day0 to Day28
Title
28-day all-cause mortality
Description
the 28-day all-cause mortality in two groups
Time Frame
from Day0 to Day28
Other Pre-specified Outcome Measures:
Title
body temperature
Description
scale: ℃
Time Frame
from Day0 to Day28
Title
heart rate
Description
scale: beats per minute (bpm)
Time Frame
from Day0 to Day28
Title
respiratory rate
Description
scale: times per minute
Time Frame
from Day0 to Day28
Title
blood pressure
Description
Both systolic and diastolic pressure will be measured. Scale: mmHg
Time Frame
from Day0 to Day28
Title
count of white blood cell
Description
scale: cells/L
Time Frame
from Day0 to Day28
Title
count of neutrophils
Description
scale: cells/L
Time Frame
from Day0 to Day28
Title
concentration of hemoglobin
Description
scale: g/dl
Time Frame
from Day0 to Day28
Title
hematocrit value
Description
hematocrit value
Time Frame
from Day0 to Day28
Title
count of platelet
Description
scale: cells/L
Time Frame
from Day0 to Day28
Title
prothrombin time (PT)
Description
scale: second
Time Frame
from Day0 to Day28
Title
activated partial thromboplastin time (APPT)
Description
scale: second
Time Frame
from Day0 to Day28
Title
level of fibrinogen
Description
scale: g/dl
Time Frame
from Day0 to Day28
Title
thrombin time (TT)
Description
scale: second
Time Frame
from Day0 to Day28
Title
level of serum Alanine transaminase (ALT)
Description
scale: Unit/L (U/L)
Time Frame
from Day0 to Day28
Title
level of serum Aspartate transaminase (AST)
Description
scale: Unit/L (U/L)
Time Frame
from Day0 to Day28
Title
level of total bilirubin
Description
scale: µmol/L
Time Frame
from Day0 to Day28
Title
level of direct bilirubin
Description
scale: µmol/L
Time Frame
from Day0 to Day28
Title
level of total protein
Description
scale: g/L
Time Frame
from Day0 to Day28
Title
level of albumin
Description
scale: g/L
Time Frame
from Day0 to Day28
Title
concentration of serum creatinine
Description
scale: mg/dl
Time Frame
from Day0 to Day28
Title
concentration of blood urea nitrogen
Description
scale: mmol/L
Time Frame
from Day0 to Day28
Title
concentration of serum potassium
Description
scale: mmol/L
Time Frame
from Day0 to Day28
Title
concentration of serum sodium
Description
scale: mmol/L
Time Frame
from Day0 to Day28
Title
concentration of serum calcium
Description
scale: mmol/L
Time Frame
from Day0 to Day28
Title
concentration of serum phosphorus
Description
scale: mmol/L
Time Frame
from Day0 to Day28
Title
concentration of serum magnesium
Description
scale: mmol/L
Time Frame
from Day0 to Day28

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: Hospitalized patients aged 18-75 years, regardless of gender; Meet the clinical criteria of sepsis according to the Third International Consensus Definitions for Sepsis; The diagnosis of sepsis is established within last 48 hours. Written informed consent is signed, and agreement to participate in all visits, examinations and treatments as required by the research program is achieved. If a patient is not able to give consent, the legal representative is asked to consent. Exclusion Criteria: End-stage renal disease that need maintenance hemodialysis treatment; Congenital or acquired immunodeficiency disorders or those who had received organ transplantation within one year; Prescription of immunosuppressive medications (tripterygium wilfordii, mycophenolate mofetil, cyclophosphamide, FK506, etc.) or prednisolone for more than 10 mg/day (or the same dose of other hormone therapy) within 30 days; Coagulation dysfunction, severe bleeding tendency (prothrombin time, activated partial thromboplastin time prolonged significantly with bleeding, or fibrinogen less than 1.2 g/L with bleeding), active bleeding or uncontrolled acute massive bleeding within 24 hours; Malignant tumors, consumptive diseases, site of infection cannot be cleared (ie surgical patients who cannot be operated on) or body weight less than 35kg; A terminal state of organ failure (end stage of chronic obstructive pulmonary disease, pulmonary heart disease, heart dysfunction stage-IV, brain death or persistent vegetative state, chronic liver disease with hepatic encephalopathy, coagulation dysfunction, fluid retention and hepatocellular jaundice); Following results are detected during screening: platelet count < 50 *10^9/L, neutrophil count < 0.5 *10^9/L, hemoglobin < 70 g/L; Despite of adequate volume resuscitation, vasopressors and hormones, the mean arterial blood cannot maintain above 65 mmHg; Those who have been participating in or participated in another interventional clinical study within 30 days prior to enrollment, such as the clinical study of related drugs or medical devices affecting immunity (ie Xuebijing, ulinastatin, continuous renal replacement therapy, etc.); Anaphylaxis to materials of cardiopulmonary bypass, anticoagulants and hemoperfusion or other serious allergic history; Those who are not suitable for this clinical trial, which is determined by researchers, such as pregnant or lactating women, current drug addicts, patients with severe mental or neurological disorders, and those who have a history of alcohol abuse and cannot be terminated.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Zimeng Liu, PhD
Phone
+8618925002766
Ext
18826471751
Email
sumslzm@163.com
First Name & Middle Initial & Last Name or Official Title & Degree
Yao Nie, PhD
Phone
+8618826471751
Ext
18826471751
Email
nieyao850622@126.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Xiangdong Guan, PhD
Organizational Affiliation
First Affiliated Hospital, Sun Yat-Sen University
Official's Role
Principal Investigator
Facility Information:
Facility Name
the First Affiliated Hospital of Sun Yat-sen University
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510080
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Xiangdong Guan, PhD
Phone
+8613802925067
Email
carlg@163.net
First Name & Middle Initial & Last Name & Degree
Zhiyong Peng, PhD
First Name & Middle Initial & Last Name & Degree
Qiuye Kou, PhD
First Name & Middle Initial & Last Name & Degree
Weixing Zhang, PhD
First Name & Middle Initial & Last Name & Degree
Rongguo Yu, PhD
First Name & Middle Initial & Last Name & Degree
Zhanguo Liu, PhD
First Name & Middle Initial & Last Name & Degree
Jun Zeng, PhD
First Name & Middle Initial & Last Name & Degree
Wenxiong Li, PhD

12. IPD Sharing Statement

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Efficacy and Safety Study of CA330 Hemoadsorption Device on IL-6 Removal in Septic Patients

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