A New Posaconazole Dosing Regimen for Paediatric Patients With Cystic Fibrosis and Aspergillus Infection (cASPerCF)
Cystic Fibrosis, Aspergillosis
About this trial
This is an interventional treatment trial for Cystic Fibrosis focused on measuring Posaconazole, Progressive lung damage, Recurrent infection, Persistent inflammation, Better tolerability, Paediatrics, Adolescents, Therapeutic drug monitoring, Pharmacokinetics, Cystic Fibrosis, Aspergillosis
Eligibility Criteria
Inclusion Criteria:
- Diagnosed with cystic fibrosis (genetic diagnosis and/or abnormal sweat test and clinical phenotype of lung disease)
- Age ≥ 8 yrs and < 18 yrs
- Body weight ≥20 kg
- Presence of Aspergillus infection as defined for this study
- Clinically stable condition without a significant change in lung function (FEV1 +/- 10%) or significant worsening of respiratory symptoms over the previous month
- Able to perform lung function test (FEV1%)
- Able to produce a sputum sample (spontaneous or induced sputum)
- Informed Consent given
- If female and of childbearing age must be using highly effective contraception (and must agree to continue for 7 days after the last dose of investigational medicinal product [IMP]
Exclusion Criteria:
- Non-CF lung disorder
- Age < 8 yrs or ≥ 18 yrs
- Body weight < 20 kg
- Not able to perform lung function test (FEV1%)
- Unable to produce a sputum sample (spontaneous or induced sputum)
- Clinically unstable condition with significant change in lung function or significant worsening of respiratory symptoms
- Unable to tolerate oral medication
- Known hypersensitivity to itraconazole or posaconazole, or it's excipients.
- On active transplant list or transplant recipient
- Azole resistant Aspergillus sp. cultured
- Patients receiving terfenadine, ergot alkaloids, astemizole, cisapride, pimozide, halofantrine, quinidine, or HMG-CoA reductase inhibitors metabolised through CYP3A4 (eg. simvastatin, lovastatin, and atorvastatin)
- Patients receiving omalizumab
- Received systemic mould-active antifungals in the last month
- Shortened or elongated QT interval
- Cardiac failure
- ALT ≥ 200 U/L
- AST ≥ 225 U/L
- Alkaline phosphatase ≥ 460 U/L
- Bilirubin ≥ 50 umol/L
- eGFR < 20 ml/min/1.73 m2 (calculated with the Schwartz formula)
- Patients with known glucose-galactose malabsorption problems
- Pregnancy2 or breastfeeding
- Females of childbearing age who do not intend to use contraception measures.
- Informed Consent not given
Sites / Locations
- Motol University Hospital
- Centre hospitalier universitaire Dijon Bourgogne
- Centre hospitalier universitaire Grenoble Alpes
- Centre hospitalier universitaire de Montpellier
- Katholisches Klinikum Bochum gGMBH, Klinik für Kinder- und Jugendmedizin der Ruhr-Universität Bochum, St. Josef Hospital
- Technische Universität Dresden, Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Kinder- und Jugendmedizin
- Universitätsklinikum Essen,Pediatric Pulmonology and Cystic Fibrosis Center
- Medizinische Hochschule Hannover, Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie
- Universitätsklinikum Jena, Klinik für Kinder- und Jugendmedizin, Pädiatrische Pneumologie/Allergologie/Mukoviszidose-Zentrum
- Cystic Fibrosis Department, "Agia Sofia" Children's Hospital
- Cystic Fibrosis Center, 3rd Paediatric Dept, Aristotle University of Thessaloniki
- Cork University Hospital
- ASST Spedali Civili Paediatric departmentRecruiting
- IRCCS Istituto Giannina Gaslini
- University of Parma Department of Medicine and Surgery
- IRCCS Ospedale Pediatrico Bambino GesùRecruiting
- University Medical Center Groningen (UMCG)
- Radboud University Medical Center (RUMC)
- Erasmus Medical Center (EMC)
- University Medical Center Utrecht (UMCU)
- Centro Hospitalar Universitário Lisboa Norte EPE
- Hospital Universitario Materno Infantil Reina Sofia
- Hospital Universitario 12 de Octubre,Unidad Multidisciplinar Fibrosis Quística
- Hospital Universitario La Paz
- Hospital Universitario Ramón y Cajal
- University Children's Hospital Zurich
- Birmingham Women's and Children's NHS Foundation Trust
- University Hospital Nottingham (Queens Medical Centre)
- Sheffield Childrens NHS Foundation Trust
- University Hospital Southampton NHS FT
- University Hospitals of North Midlands NHS Trust
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Posaconazole arm
Control arm
90 patients (out of the 135 total patients, therefore with a 2:1 randomization ratio) will receive posaconazole for 12 weeks. Patients in the posaconazole arm will be stratified for body weight and positive sputum cultures for Aspergillus species. Patients will be followed-up for a total of 12 months post-randomization.
45 patients (out of the 135 total patients, therefore with a 2:1 randomization ratio) will not receive the active treatment. Patients will be followed-up for a total of 12 months post-randomization. If participants in the control arm are deteriorating during the first 3 months after randomization, it is up to the treating physician to consider treatment for the initial asymptomatic Aspergillus infection