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D-PLEX 302: Efficacy and Safety of D-PLEX in the Prevention of Sternal Infection Post Cardiac Surgery

Primary Purpose

Surgical Site Infection, Sternal Infection, Cardiac Surgery

Status
Terminated
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
D-PLEX
Standard of Care
Sponsored by
PolyPid Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Surgical Site Infection focused on measuring Cardiac, Surgery, Sternotomy, Heart, CABG, Valve-replacement, Aorta-replacement

Eligibility Criteria

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

Inclusion Criteria:

  1. Subjects scheduled to elective and/or urgent median sternotomy for cardiac surgery, who are preoperative hemodynamically stable.
  2. Males and females.
  3. Subjects age of 18 and older.
  4. Subjects with both Diabetes Mellitus AND BMI≥30 OR

    Diabetes Mellitus/BMI≥30 AND at least one of the following:

    • Current/Previous smoking history ≥30 pack year
    • Chronic Obstructive Pulmonary Disease (COPD)
  5. Female of childbearing potential should have a negative serum pregnancy test prior to index procedure.

    Note: All female of childbearing potential must agree to use a highly effective method of contraception (such as double barrier, oral or parenteral hormonal, intrauterine device and spermicide) consistently and correctly for the duration of the study.

  6. Subject is willing and able to provide a signed Informed Consent Form and is willing and able to comply with study's procedures including follow-up visits.

Exclusion Criteria:

  1. Subjects undergoing partial sternotomy.
  2. Subjects with any preoperative active significant infection.
  3. Subjects that received oral or IV doxycycline during the last 4 weeks prior to screening.
  4. Subjects with sensitivity to doxycycline and/or to tetracycline family of drugs and/or other study drug ingredients.
  5. Subjects with known allergies to more than 3 substances. (An allergy questionnaire will be filled during the screening process).
  6. Subjects with history of allergic/hypersensitivity reaction to any substance having required hospitalization and/or treatment with intra-venous steroids/epinephrine or in the opinion of the investigator the patient is at high risk of developing severe allergic/hypersensitivity reactions.
  7. Subjects with uncontrolled Asthma (GINA III-IV).
  8. Subjects with chronic urticaria.
  9. Immunocompromised subjects from any reason, at screening.
  10. Subjects with renal failure requiring dialysis.
  11. Subjects scheduled to major organ transplantation and/or to other significant concomitant surgical procedure.
  12. Subjects scheduled for mechanical assist device.
  13. Subjects scheduled to be treated with preventive negative pressure devices.
  14. Subjects undergone Cerebro-Vascular Accident (CVA)/Transient Ischemic Attack (TIA) within the past 3 months prior to randomization.
  15. Subjects that have undergone previously, any cardiac surgery through sternotomy.
  16. Subjects with active or previous malignancy in the chest area.
  17. Any subject with active malignancy or with malignancy that has not been in complete remission for at least 5 years. Subjects who have had carcinoma in situ of the cervix, squamous cell carcinoma of the skin and basal cell carcinoma of the skin, are eligible.
  18. Pregnant or breast-feeding women or women of childbearing age not protected by an effective contraceptive method of birth control (such as double barrier, oral or parenteral hormonal, intrauterine device and spermicide).
  19. Subjects enrolled in any intervention study with an investigational medicinal product and/or received any investigational medicinal product within 30 days or 5½ half-lives of the product prior to enrollment (whichever is longer).
  20. In the opinion of investigator, subject is not eligible to participate in the study and/or to comply with protocol requirements (e.g. due to a cognitive, medical condition or residency distanced from site that may jeopardize Follow-Up visits attendance etc.).

Sites / Locations

  • Mayo Clinic
  • Memorial Hermann
  • Soroka Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Other

Arm Label

D-PLEX + SOC

Standard of Care

Arm Description

For subjects randomized to the investigational treatment arm, D-PLEX treatment will be applied at the end of the index surgery just before closing the chest, as an adjunct to the SOC prophylactic antibiotic treatment.

For subjects randomized to the control arm, the surgical treatment will be as per the SOC.

Outcomes

Primary Outcome Measures

Sternal Wound Infection rate
Infection rate as measured by the proportion of subjects with a sternal wound infection event. Sternal wound infection is composed of Deep Sternal Wound Infection (DSWI) & Superficial Sternal Wound Infection (SSWI). Mortality from any reason within 90 days (3 months) post sternotomy, will be analyzed as treatment failure.

Secondary Outcome Measures

Hospitalization days
Average number of Hospitalization days post sternotomy due to sternal infection.
Average ASEPSIS assessment score
ASEPSIS (Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissue, Isolation of bacteria, Stay duration as inpatient), for wound assessment and treatment parameters, which provides numerically score during an inspection of the surgical site. The final score is being interpreted to severity of wound appearance and the clinical consequences of infections.
Number of surgical re-interventions
Number of surgical re-intervention due to sternal surgical site infection.
Superficial Sternal Wound Infections (SSWI)
Incidence of Superficial Sternal Wound Infections (SSWI)
Deep Sternal Wound Infections (DSWI)
Incidence of Deep Sternal Wound Infections (DSWI)
Mortality rate associated with Sternal Wound Infection (SWI)
Mortality rate associated with Sternal Wound Infection (SWI)
Determination of susceptibility to Doxycycline
Determination of susceptibility to Doxycycline of any organism recovered from a Sternal Surgical Site Infection.

Full Information

First Posted
June 5, 2018
Last Updated
November 9, 2022
Sponsor
PolyPid Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT03558984
Brief Title
D-PLEX 302: Efficacy and Safety of D-PLEX in the Prevention of Sternal Infection Post Cardiac Surgery
Official Title
Prospective, Multicenter, Randomized, Parallel Controlled, Two Arms, Single Blind, Study to Assess the Efficacy and Safety of D-PLEX Administered Concomitantly With the SOC IV Prophylactic Antibiotic Treatment vs. SOC in Prevention of Post-Cardiac Surgery Sternal Infections
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Terminated
Why Stopped
company prioritization reasons
Study Start Date
December 17, 2019 (Actual)
Primary Completion Date
October 24, 2022 (Actual)
Study Completion Date
October 24, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
PolyPid Ltd.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Prospective, Multinational, Multicenter, Randomized, Parallel Controlled, Two arms, Single Blind, Study to Assess the Efficacy and Safety of D-PLEX Administered Concomitantly with the Standard of Care (SOC) IV Prophylactic Antibiotic Treatment vs. SOC in Prevention of Post-Cardiac Surgery Sternal Infections. Study to assess D-PLEX efficacy and safety in preventing sternal infections over a period of 90 days (3 months) post cardiac surgery with median sternotomy, in patients with high risk for infection compared to the control arm.
Detailed Description
This is Phase III study to evaluate the anti-infective efficacy and safety of D-PLEX, a new formulation of extended release of Doxycycline, over a period of 3 months post operation by preventing sternal infection post cardiac surgery in patients above the age of 18, including high risk patients for infection. Study will be conducted in about 45 sites in US (about 15 sites), Europe and Israel, recruitment period will last about 18 months. D-PLEX will be administered as a single application. For subjects randomized to the investigational treatment arm, D-PLEX treatment will be applied at the end of the index surgery just before closing the chest, as an adjunct to the SOC prophylactic antibiotic treatment. For subjects randomized to the control arm, the surgical treatment will be as per the SOC. Pre- and post-operative care for both arms will be performed per site SOC. Patients will followed-up during 6 months after surgery.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Surgical Site Infection, Sternal Infection, Cardiac Surgery
Keywords
Cardiac, Surgery, Sternotomy, Heart, CABG, Valve-replacement, Aorta-replacement

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Eligible subjects will be randomized to either the treatment arm (D-PLEX + SOC prophylactic antibiotic treatment) or to control arm (SOC prophylactic antibiotic treatment only), in a 1:1 ratio. Subjects will be blinded to the study arm.
Masking
ParticipantOutcomes Assessor
Masking Description
Subjects will be blinded to the treatment arm assignment. The study site personnel present at the baseline procedure as well as the physician performing the procedure will be trained not to disclose the treatment arm to the subject, his/her family, to health care providers outside of the surgery department and to the study sponsor. Two independent of the sponsor/investigator committees will be involved in the assessment of study outcomes.
Allocation
Randomized
Enrollment
2 (Actual)

8. Arms, Groups, and Interventions

Arm Title
D-PLEX + SOC
Arm Type
Experimental
Arm Description
For subjects randomized to the investigational treatment arm, D-PLEX treatment will be applied at the end of the index surgery just before closing the chest, as an adjunct to the SOC prophylactic antibiotic treatment.
Arm Title
Standard of Care
Arm Type
Other
Arm Description
For subjects randomized to the control arm, the surgical treatment will be as per the SOC.
Intervention Type
Drug
Intervention Name(s)
D-PLEX
Intervention Description
D-PLEX is a new formulation of extended release of Doxycycline (active ingredient)
Intervention Type
Other
Intervention Name(s)
Standard of Care
Intervention Description
The SOC prophylactic antibiotic treatment will be consistent and standardized for all sites in the clinical study. is based on "The society of thoracic surgeons practice guideline series: antibiotic prophylaxis in cardiac surgery, part II: antibiotic choice."
Primary Outcome Measure Information:
Title
Sternal Wound Infection rate
Description
Infection rate as measured by the proportion of subjects with a sternal wound infection event. Sternal wound infection is composed of Deep Sternal Wound Infection (DSWI) & Superficial Sternal Wound Infection (SSWI). Mortality from any reason within 90 days (3 months) post sternotomy, will be analyzed as treatment failure.
Time Frame
within 90 days (3 months) post sternotomy for cardiac surgery
Secondary Outcome Measure Information:
Title
Hospitalization days
Description
Average number of Hospitalization days post sternotomy due to sternal infection.
Time Frame
90 days
Title
Average ASEPSIS assessment score
Description
ASEPSIS (Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissue, Isolation of bacteria, Stay duration as inpatient), for wound assessment and treatment parameters, which provides numerically score during an inspection of the surgical site. The final score is being interpreted to severity of wound appearance and the clinical consequences of infections.
Time Frame
90 days (3 months) post sternotomy
Title
Number of surgical re-interventions
Description
Number of surgical re-intervention due to sternal surgical site infection.
Time Frame
90 days (3 months) post sternotomy
Title
Superficial Sternal Wound Infections (SSWI)
Description
Incidence of Superficial Sternal Wound Infections (SSWI)
Time Frame
90 days (3 months) post sternotomy
Title
Deep Sternal Wound Infections (DSWI)
Description
Incidence of Deep Sternal Wound Infections (DSWI)
Time Frame
90 days (3 months) post sternotomy
Title
Mortality rate associated with Sternal Wound Infection (SWI)
Description
Mortality rate associated with Sternal Wound Infection (SWI)
Time Frame
90 days (3 months) post sternotomy
Title
Determination of susceptibility to Doxycycline
Description
Determination of susceptibility to Doxycycline of any organism recovered from a Sternal Surgical Site Infection.
Time Frame
90 days (3 months) post sternotomy
Other Pre-specified Outcome Measures:
Title
Overall hospitalization days
Description
Overall Hospitalization days, for any reason.
Time Frame
6 months
Title
Readmission due to Sternal Surgical Site Infection
Description
Number of readmissions due to Sternal Surgical Site Infection
Time Frame
90 days (3 months) post sternotomy
Title
Time to Sternal Wound Infection
Description
Time to sternal wound infection (Post Operating Day) post sternotomy.
Time Frame
90 days (3 months) post sternotomy
Title
Analgesic treatment
Description
Average number of analgesic treatment days
Time Frame
6 months
Title
Visual Analogue Score (VAS) assessment
Description
VAS score assessment, self-completed by the respondent, from 0 (no pain) to 10 (worst imaginable pain)
Time Frame
6 months
Title
Antibiotic treatment due to Sternal Surgical Site Infections (all routes of administration).
Description
Average number of Antibiotic Treatment (overall IV and other administration modes, e.g. oral) days due to sternal Surgical Site Infection (SSWI & DSWI)
Time Frame
90 days (3 months) post sternotomy
Title
Antibiotic treatment due to Sternal Surgical Site Infections (IV administration).
Description
Average number of Antibiotic Treatment (IV administration) days due to sternal Surgical Site Infection (SSWI & DSWI)
Time Frame
90 days (3 months) post sternotomy

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects scheduled to elective and/or urgent median sternotomy for cardiac surgery, who are preoperative hemodynamically stable. Males and females. Subjects age of 18 and older. Subjects with both Diabetes Mellitus AND BMI≥30 OR Diabetes Mellitus/BMI≥30 AND at least one of the following: Current/Previous smoking history ≥30 pack year Chronic Obstructive Pulmonary Disease (COPD) Female of childbearing potential should have a negative serum pregnancy test prior to index procedure. Note: All female of childbearing potential must agree to use a highly effective method of contraception (such as double barrier, oral or parenteral hormonal, intrauterine device and spermicide) consistently and correctly for the duration of the study. Subject is willing and able to provide a signed Informed Consent Form and is willing and able to comply with study's procedures including follow-up visits. Exclusion Criteria: Subjects undergoing partial sternotomy. Subjects with any preoperative active significant infection. Subjects that received oral or IV doxycycline during the last 4 weeks prior to screening. Subjects with sensitivity to doxycycline and/or to tetracycline family of drugs and/or other study drug ingredients. Subjects with known allergies to more than 3 substances. (An allergy questionnaire will be filled during the screening process). Subjects with history of allergic/hypersensitivity reaction to any substance having required hospitalization and/or treatment with intra-venous steroids/epinephrine or in the opinion of the investigator the patient is at high risk of developing severe allergic/hypersensitivity reactions. Subjects with uncontrolled Asthma (GINA III-IV). Subjects with chronic urticaria. Immunocompromised subjects from any reason, at screening. Subjects with renal failure requiring dialysis. Subjects scheduled to major organ transplantation and/or to other significant concomitant surgical procedure. Subjects scheduled for mechanical assist device. Subjects scheduled to be treated with preventive negative pressure devices. Subjects undergone Cerebro-Vascular Accident (CVA)/Transient Ischemic Attack (TIA) within the past 3 months prior to randomization. Subjects that have undergone previously, any cardiac surgery through sternotomy. Subjects with active or previous malignancy in the chest area. Any subject with active malignancy or with malignancy that has not been in complete remission for at least 5 years. Subjects who have had carcinoma in situ of the cervix, squamous cell carcinoma of the skin and basal cell carcinoma of the skin, are eligible. Pregnant or breast-feeding women or women of childbearing age not protected by an effective contraceptive method of birth control (such as double barrier, oral or parenteral hormonal, intrauterine device and spermicide). Subjects enrolled in any intervention study with an investigational medicinal product and/or received any investigational medicinal product within 30 days or 5½ half-lives of the product prior to enrollment (whichever is longer). In the opinion of investigator, subject is not eligible to participate in the study and/or to comply with protocol requirements (e.g. due to a cognitive, medical condition or residency distanced from site that may jeopardize Follow-Up visits attendance etc.).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hartzell V. Schaff, M.D.
Organizational Affiliation
Mayo Clinic, 220 First Street SW, Rochester, MN. 55902
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55902
Country
United States
Facility Name
Memorial Hermann
City
Houston
State/Province
Texas
ZIP/Postal Code
77024
Country
United States
Facility Name
Soroka Medical Center
City
Beer Sheva
Country
Israel

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

D-PLEX 302: Efficacy and Safety of D-PLEX in the Prevention of Sternal Infection Post Cardiac Surgery

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