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ASSET - a Double-Blind, Randomized Placebo-Controlled Clinical Investigation With Alteco® LPS Adsorber (ASSET)

Primary Purpose

Septic Shock

Status
Terminated
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Alteco LPS Adsorber
Placebo
Sponsored by
Alteco Medical AB
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Septic Shock

Eligibility Criteria

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

Inclusion Criteria:

Illness severity criteria: At enrolment subjects must meet inclusion criteria #1 through #3 listed below to be eligible to enter the clinical investigation:

  1. Subjects must have suspected severe infection of abdominal or urogenital origin for which the subject is receiving intravenous antimicrobial therapy as the main reason for organ support
  2. Subjects, males or females, must be 18 years or older.
  3. Subjects or legally acceptable representatives, as appropriate, are willing and able to provide signed informed consent.

    Treatment criteria: Prior to randomization, subjects must meet all inclusion criteria (#4 through #7) listed below to be assigned to a treatment group:

  4. Appropriate vascular access must have been obtained.
  5. Subjects must have received ≥ 30 mL/kg of intravenous fluid within the six (6) hours prior to randomization.
  6. Subjects must have plasma/serum lactate >2 mmol/L despite adequate resuscitation AND a continuous requirement for vasopressor support
  7. Subjects must be able to initiate the clinical investigation intervention within 12 hours of fulfilment of the illness severity criteria.

Exclusion Criteria:

  1. Subjects who meet any of the exclusion criteria listed below will NOT be permitted to enter the clinical investigation: Sepsis-induced organ dysfunction for longer than 12 hours prior to the time-point for achieving "Illness severity criteria fulfilled"
  2. Vasopressor therapy (at any dose) for longer than 12 hours (not included the time spent in the operation theatre) prior to the start of treatment with the investigational device.
  3. Pre-existing uncorrectable medical condition as:

    • Poorly controlled neoplasms or hematologic disease (i.e. indication of disseminated cancer outside the suspected primary tumour and hematologic disease not in remission,
    • End-stage cardiac disease,
    • Cardiac arrest requiring cardiopulmonary resuscitation or with pulseless electrical activity or asystole within the past 7 days
    • End-stage lung disease
    • End-stage liver disease
    • HIV/AIDS with known end-stage processes
    • Other uncorrectable medical condition(s) deemed by the Clinical Investigator to hinder the subject to adhere to the fulfilment of the activities described in the Clinical Investigation Plan.
  4. Extreme illness, i.e. subjects is moribund and death is perceived to be imminent (within 24 hours).
  5. Recent or current participation (≤ 30 days) in another interventional sepsis trial.
  6. Recent or current treatment (≤ 30 days) with an adsorption product, including Alteco® LPS Adsorber.
  7. Treatment with an investigational medicinal product for any indication within the last 30 days before enrolment in the clinical investigation.
  8. Pregnancy.
  9. Contraindications to the use heparin or protamine
  10. Other abdominal inflammatory conditions
  11. Perforation of hollow organ linked to trauma within 48 hours before enrolment in the clinical investigation.
  12. Laparotomy reveals isolated gastric ulcer.
  13. Subjects and/or their immediate family are directly affiliated to investigative site personnel in this clinical investigation. (Immediate family is defined as a spouse, parent, child, or sibling, whether biological or legally adopted).

Sites / Locations

  • Kuopio University Hospital
  • Tampere University Hospital
  • Haukeland Universitetssykehus
  • Oslo Universitetssykehus
  • Linköping University Hospital
  • Uppsala University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Alteco LPS Adsorber

Placebo

Arm Description

Hemoperfusion and Standard therapy

Placebo and Standard therapy. The placebo comparator device differs from Alteco® LPS Adsorber only in that no peptide component (i.e. active component) has been attached to the matrix.

Outcomes

Primary Outcome Measures

Characterization of all reported USADEs and ASADEs.

Secondary Outcome Measures

Relative change from baseline in plasma endotoxin (p-endotoxin) levels during (i.e. at 2 hours) and immediately after end (i.e. at 6 hours) of treatment with device, on both Day 1 and Day 2.
Relative change from baseline in SOFA score
Relative change from baseline in renal function
Renal function is assessed by: S-creatinine, P-Cystatin C, P-Urea, eGFR, KDIGO stage, Fluid balance, and Daily urinary output
Relative change from baseline in liver function
Liver function is assessed by: Prothrombin complex INR, P-Albumin, and P-Bilirubin
Relative change from baseline in circulatory support
Circulatory support is assessed by: Vasopressor load, Inotropic score, MAP, Vasopressor dependence index, P-Lactate, Blood gas, and Vasopressor-free days.
Relative change from baseline in respiratory support
Respiratory support is assessed by: PaO2, FiO2 and PaO2/FiO2 ratio, Positive and expiratory pressure, Peak pressure, Tidal volume and minute volume, Respiratory rate, Pa CO2, Respiratory support need as measured by means of ventilator-free days until day for ICU discharge
Relative change from baseline in ICU mortality
Relative change from baseline in ICU length of stay
Clinical outcome during stay at Hospital following ICU-discharge of the total extension of renal support
Clinical outcome during stay at Hospital following ICU-discharge of 28-day mortality
Clinical outcome during stay at Hospital following ICU-discharge of hospital length of stay up to 28 days
Levels of inflammatory response biomarkers
Determination of the molecular components extracted from blood circulation and captured in Alteco® LPS Adsorber.
This is an exploratory outcome, there will be a screening of which molecules that have been captured.
Characterization of all reported AEs (regardless of attribution), ADEs, and device deficiencies

Full Information

First Posted
November 28, 2014
Last Updated
March 6, 2018
Sponsor
Alteco Medical AB
Collaborators
TFS Trial Form Support, Uppsala University
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1. Study Identification

Unique Protocol Identification Number
NCT02335723
Brief Title
ASSET - a Double-Blind, Randomized Placebo-Controlled Clinical Investigation With Alteco® LPS Adsorber
Acronym
ASSET
Official Title
Abdominal Septic Shock - Endotoxin Adsorption Treatment (ASSET) - a Double-Blind, Randomized Placebo-Controlled Clinical Investigation With Alteco® LPS Adsorber
Study Type
Interventional

2. Study Status

Record Verification Date
March 2018
Overall Recruitment Status
Terminated
Why Stopped
Problem to find eligible patients to include
Study Start Date
September 2015 (undefined)
Primary Completion Date
April 28, 2017 (Actual)
Study Completion Date
April 28, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Alteco Medical AB
Collaborators
TFS Trial Form Support, Uppsala University

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary objective of this clinical investigation is to investigate the feasibility and possible benefits of the Alteco® LPS Adsorber in treating patients with septic shock with presumed endotoxemia of abdominal or urogenital origin.
Detailed Description
OVERALL CLINICAL INVESTIGATION DESIGN: This is a multicentre, stratified, parallel, double-blinded, randomized, feasibility clinical investigation of the Alteco® LPS Adsorber. Subjects will be enrolled in an adaptive fashion with up to two interim analyses, and the possibility of recruiting additional patients, in order to establish an indication of the feasibility of treating a target population of subjects with septic shock and endotoxemia. Subjects will be stratified in accordance with the origin of their infection, i.e. abdominal or urogenital sepsis. Subjects in each stratum will receive either: LPS Adsorber group (i.e. investigational medical device [IMD] group): current best practice in combination with Alteco® LPS Adsorber treatment, OR Placebo device group (i.e. comparator group): current best practice in combination with placebo adsorber treatment. Allocation to either treatment arm will be performed in a 1:1 ratio. Upon enrolment (i.e. pre-treatment phase), subjects admitted to the ICU with suspected endotoxemia will be screened for fulfilment of the "Illness Severity Criteria" confirming early stage severe sepsis. Within six (6) hours of enrolment, subjects who also fulfil the "Treatment Criteria" confirming septic shock will be eligible for randomization. Randomization to either of the treatment groups will be performed as close as possible to start of treatment with the Alteco® LPS Adsorber or placebo device. Treatment with LPS Adsorber or placebo device must be initiated within six (6) hours (Day 1) following fulfilment of the "Treatment Criteria". A second device treatment will be performed 24 hours after the end of the first device treatment on Day 2, as long there is no evidence that treatment with the investigational device will not be beneficial or will indicate an unnecessary risk for subjects (for example, the subject is vasopressor support-free). Initially: 20 abdominal sepsis subjects (Stratum A) and 12 urogenital sepsis subjects (Stratum B) Optional: additional 12 subjects (abdominal, urogenital or both) after interim analysis decision.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Septic Shock

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Alteco LPS Adsorber
Arm Type
Active Comparator
Arm Description
Hemoperfusion and Standard therapy
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo and Standard therapy. The placebo comparator device differs from Alteco® LPS Adsorber only in that no peptide component (i.e. active component) has been attached to the matrix.
Intervention Type
Device
Intervention Name(s)
Alteco LPS Adsorber
Intervention Description
Alteco® LPS Adsorber is a Class IIa medical device developed in accordance with existing international standards. Alteco® LPS Adsorber does not contain any pharmaceutical or toxic components. Alteco® LPS Adsorber is used for the adsorption of LPS as endotoxins. The capturing component is a specially designed synthetic peptide developed for adsorption of endotoxin. The capturing component has high affinity to Lipid A, i.e. a constant component in the endotoxin molecule, which ensures efficient reduction of endotoxins from different bacterial species.
Intervention Type
Device
Intervention Name(s)
Placebo
Intervention Description
Exactly the same as Alteco LPS Adsorber but no peptide component has been attached to the matrix (i.e. there is no adsorber functionality)
Primary Outcome Measure Information:
Title
Characterization of all reported USADEs and ASADEs.
Time Frame
6-28 days
Secondary Outcome Measure Information:
Title
Relative change from baseline in plasma endotoxin (p-endotoxin) levels during (i.e. at 2 hours) and immediately after end (i.e. at 6 hours) of treatment with device, on both Day 1 and Day 2.
Time Frame
2 days
Title
Relative change from baseline in SOFA score
Time Frame
6-28 days
Title
Relative change from baseline in renal function
Description
Renal function is assessed by: S-creatinine, P-Cystatin C, P-Urea, eGFR, KDIGO stage, Fluid balance, and Daily urinary output
Time Frame
6-28 days
Title
Relative change from baseline in liver function
Description
Liver function is assessed by: Prothrombin complex INR, P-Albumin, and P-Bilirubin
Time Frame
6-28 days
Title
Relative change from baseline in circulatory support
Description
Circulatory support is assessed by: Vasopressor load, Inotropic score, MAP, Vasopressor dependence index, P-Lactate, Blood gas, and Vasopressor-free days.
Time Frame
6-28 days
Title
Relative change from baseline in respiratory support
Description
Respiratory support is assessed by: PaO2, FiO2 and PaO2/FiO2 ratio, Positive and expiratory pressure, Peak pressure, Tidal volume and minute volume, Respiratory rate, Pa CO2, Respiratory support need as measured by means of ventilator-free days until day for ICU discharge
Time Frame
6-28 days
Title
Relative change from baseline in ICU mortality
Time Frame
6-28 days
Title
Relative change from baseline in ICU length of stay
Time Frame
6-28 days
Title
Clinical outcome during stay at Hospital following ICU-discharge of the total extension of renal support
Time Frame
6-28 days
Title
Clinical outcome during stay at Hospital following ICU-discharge of 28-day mortality
Time Frame
6-28 days
Title
Clinical outcome during stay at Hospital following ICU-discharge of hospital length of stay up to 28 days
Time Frame
6-28 days
Title
Levels of inflammatory response biomarkers
Time Frame
6-28 days
Title
Determination of the molecular components extracted from blood circulation and captured in Alteco® LPS Adsorber.
Description
This is an exploratory outcome, there will be a screening of which molecules that have been captured.
Time Frame
6-28 days
Title
Characterization of all reported AEs (regardless of attribution), ADEs, and device deficiencies
Time Frame
6-28 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Illness severity criteria: At enrolment subjects must meet inclusion criteria #1 through #3 listed below to be eligible to enter the clinical investigation: Subjects must have suspected severe infection of abdominal or urogenital origin for which the subject is receiving intravenous antimicrobial therapy as the main reason for organ support Subjects, males or females, must be 18 years or older. Subjects or legally acceptable representatives, as appropriate, are willing and able to provide signed informed consent. Treatment criteria: Prior to randomization, subjects must meet all inclusion criteria (#4 through #7) listed below to be assigned to a treatment group: Appropriate vascular access must have been obtained. Subjects must have received ≥ 30 mL/kg of intravenous fluid within the six (6) hours prior to randomization. Subjects must have plasma/serum lactate >2 mmol/L despite adequate resuscitation AND a continuous requirement for vasopressor support Subjects must be able to initiate the clinical investigation intervention within 12 hours of fulfilment of the illness severity criteria. Exclusion Criteria: Subjects who meet any of the exclusion criteria listed below will NOT be permitted to enter the clinical investigation: Sepsis-induced organ dysfunction for longer than 12 hours prior to the time-point for achieving "Illness severity criteria fulfilled" Vasopressor therapy (at any dose) for longer than 12 hours (not included the time spent in the operation theatre) prior to the start of treatment with the investigational device. Pre-existing uncorrectable medical condition as: Poorly controlled neoplasms or hematologic disease (i.e. indication of disseminated cancer outside the suspected primary tumour and hematologic disease not in remission, End-stage cardiac disease, Cardiac arrest requiring cardiopulmonary resuscitation or with pulseless electrical activity or asystole within the past 7 days End-stage lung disease End-stage liver disease HIV/AIDS with known end-stage processes Other uncorrectable medical condition(s) deemed by the Clinical Investigator to hinder the subject to adhere to the fulfilment of the activities described in the Clinical Investigation Plan. Extreme illness, i.e. subjects is moribund and death is perceived to be imminent (within 24 hours). Recent or current participation (≤ 30 days) in another interventional sepsis trial. Recent or current treatment (≤ 30 days) with an adsorption product, including Alteco® LPS Adsorber. Treatment with an investigational medicinal product for any indication within the last 30 days before enrolment in the clinical investigation. Pregnancy. Contraindications to the use heparin or protamine Other abdominal inflammatory conditions Perforation of hollow organ linked to trauma within 48 hours before enrolment in the clinical investigation. Laparotomy reveals isolated gastric ulcer. Subjects and/or their immediate family are directly affiliated to investigative site personnel in this clinical investigation. (Immediate family is defined as a spouse, parent, child, or sibling, whether biological or legally adopted).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sten Rubertsson, Professor
Organizational Affiliation
Uppsala University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Kuopio University Hospital
City
Kuopio
ZIP/Postal Code
70210
Country
Finland
Facility Name
Tampere University Hospital
City
Tampere
ZIP/Postal Code
33521
Country
Finland
Facility Name
Haukeland Universitetssykehus
City
Bergen
ZIP/Postal Code
5021
Country
Norway
Facility Name
Oslo Universitetssykehus
City
Oslo
ZIP/Postal Code
0372
Country
Norway
Facility Name
Linköping University Hospital
City
Linköping
ZIP/Postal Code
SE-58185
Country
Sweden
Facility Name
Uppsala University Hospital
City
Uppsala
ZIP/Postal Code
SE-751 81
Country
Sweden

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31880758
Citation
Lipcsey M, Tenhunen J, Pischke SE, Kuitunen A, Flaatten H, De Geer L, Sjolin J, Frithiof R, Chew MS, Bendel S, Kawati R, Larsson A, Mollnes TE, Tonnessen TI, Rubertsson S. Endotoxin Removal in Septic Shock with the Alteco LPS Adsorber Was Safe But Showed no Benefit Compared to Placebo in the Double-Blind Randomized Controlled Trial-the Asset Study. Shock. 2020 Aug;54(2):224-231. doi: 10.1097/SHK.0000000000001503.
Results Reference
derived
PubMed Identifier
27931259
Citation
Lipcsey M, Tenhunen J, Sjolin J, Frithiof R, Bendel S, Flaatten H, Kawati R, Kuitunen A, Tonnessen TI, Rubertsson S. Abdominal Septic Shock - Endotoxin Adsorption Treatment (ASSET) - endotoxin removal in abdominal and urogenital septic shock with the Alteco(R) LPS Adsorber: study protocol for a double-blinded, randomized placebo-controlled trial. Trials. 2016 Dec 8;17(1):587. doi: 10.1186/s13063-016-1723-4.
Results Reference
derived

Learn more about this trial

ASSET - a Double-Blind, Randomized Placebo-Controlled Clinical Investigation With Alteco® LPS Adsorber

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