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Effect of Losartan in Cystic Fibrosis (CF)-NIH Grant #133240

Primary Purpose

Cystic Fibrosis

Status
Recruiting
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Losartan
Sponsored by
University of Kansas Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Cystic Fibrosis

Eligibility Criteria

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

Inclusion Criteria:

  • CF patients with any known mutation combination not on CFTR augmentation therapy
  • ≥18 years of age
  • Severity of the Disease: Suitable patients will have mild to moderate lung disease, as defined by:

    • Pulmonary Function: Each patient must have an FEV1 ≥40% of predicted at the screening visit.
    • Hemoglobin saturation: Patients must have an oxygen saturation of >92% on room air as determined by pulse oximetry at the screening visit.
    • Produces sputum regularly (daily basis, at minimum)
  • FEV1 ≥ 40% of predicted at screening visit
  • Able to sign Informed consent
  • Negative COVID-19 test within 72 hours prior to MCC testing

Exclusion Criteria:

  • When enrolling female patients
  • Not willing to adhere to strict birth control (combination of two methods)
  • If female, patient must be non-pregnant and non-lactating, and those of childbearing potential must be using an acceptable method of birth control (i.e., an Intrauterine Contraceptive Device with a failure rate of <1%, hormonal contraceptives or a barrier method). If a female patient is abstinent, she must agree to use one of the acceptable methods if she becomes sexually active.
  • Unstable lung disease: As defined by a change in medical regimen during the preceding 2 weeks or an FEV1 ≥15% below value within 3 months
  • Received an investigational drug or therapy during the preceding 30 days
  • Active or former smokers with less than 1 year since quitting, or >10 pack-year smoking history
  • Unable to adequately complete study measures, including spirometry
  • Intolerance to angiotensin receptor blockers (ARB)
  • Treatment with angiotensin converting enzyme (ACE) inhibitor
  • Regular use of NSAIDs or potassium supplementation, treatment with aliskiren, on anticoagulation
  • Oral corticosteroid use within 6 weeks
  • Exacerbation requiring treatment within 6 weeks
  • Treatment of mycobacterial infections
  • Significant hypoxemia (oxygen saturation <92% on room air and rest or use of continuous oxygen treatment), chronic respiratory failure by history (pCO2 > 45 mmHg), clinical evidence of cor pulmonale
  • Untreated arterial hypertension (systolic blood pressure >140 mm Hg, diastolic blood pressure > 90 mmHg)
  • Blood pressure less than 90 mm Hg systolic while standing
  • Cardiac, renal (creatinine 1.5 times normal limit), hepatic (LFTs > 3x normal upper limit), neurological, psychiatric, endocrine or neoplastic diseases that are judged to interfere with participation in study
  • Known renal artery stenosis
  • Concomitant airway disorders other than CF, such as ABPA
  • Subjects with prior thoracic surgery
  • Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with trial participation or may interfere with the interpretation of trial results and, in the judgment of the PI, would make the subject inappropriate for enrollment.
  • Patients using intermittent inhaled or oral antibiotics will be allowed to participate in this trial. Patients on chronic, cycling antibiotics will be required to have completed at least 2 full cycles of the prescribed antibiotic prior to enrollment and should be studied during the same phase of treatment (on or off) during each study period.
  • Have had radiation exposure within the past year that would cause them to exceed Federal Regulations by participating in this study.

Sites / Locations

  • University of Kansas Medical CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

losartan

Arm Description

a daily dose of 50 mg losartan for 7 days (for tolerability). Then, the losartan dose will be increased to 100 mg daily for 12 weeks.

Outcomes

Primary Outcome Measures

Improvement of mucociliary clearance ( MCC) and cough clearance (CC)
Losartan (100 mg for >12 weeks) will improve MCC+CC clearance in CF patients not on CFTR augmentation therapy in % of baseline

Secondary Outcome Measures

Improvement on pulmonary function tests (in %predicted)
forced expiratory volume at one second (FEV1) in %predicted
Improvement on pulmonary function tests (in L)
forced expiratory volume at one second (FEV1) in liters
Decrease of inflammatory markers
Changes in serum inflammatory markers (hsCRP, WBC including absolute neutrophil count, %PMNs, serum amyloid A or SAA, calprotectin, GM-CSF, TGF-β active and total)
Nasal cytokine changes
Nasal cytokine changes (TGF-β1 active and total, TNF-α, IL-1β, IL-6, IL-8, IL-13, COX-2)

Full Information

First Posted
February 5, 2018
Last Updated
May 8, 2023
Sponsor
University of Kansas Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT03435939
Brief Title
Effect of Losartan in Cystic Fibrosis (CF)-NIH Grant #133240
Official Title
Anti-Inflammatory Therapy to Augment CFTR Rescue in CF Patients
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 15, 2022 (Actual)
Primary Completion Date
March 31, 2024 (Anticipated)
Study Completion Date
March 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Kansas Medical Center

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
The goal of this study is to execute a small clinical proof of concept trial: To examine the effects of losartan on mucociliary clearance (MCC) in patients not eligible for CFTR rescue therapies
Detailed Description
CF is the most common inherited disease causing a shortened life span, affecting ~30,000 people in the United States with annual health care costs of at least $1.8 billion. The median age of predicted survival of these patients has improved and is now almost 40 years in the US. Over the last two decades, investigators have identified ~2,000 mutations in the CF transmembrane conductance regulator (CFTR) gene. These mutations are imperfectly classified into 5 groups, and small molecules are being developed that rescue group-specific CFTR mutants. These agents have produced remarkable improvements in some patients. The CFTR potentiator ivacaftor (Kalydeco™), approved by the FDA mainly for class III mutations especially G551D, improves ion transport (large decrease in sweat chloride), clinical outcome (increased FEV1 and weight, decreased exacerbations), and quality of life. Furthermore, the FDA recently approved Orkambi™ (a corrector and potentiator: lumacaftor plus ivacaftor) because it reduced exacerbation rates by up to 39% in patients homozygous for F508del. It has been demonstrated in vitro that improvements in airway surface liquid (ASL) volume are highly predictive of changes seen in clinical studies and track with tracheal mucus velocities measured in sheep in vivo using the CFTR potentiator ivacaftor, inhaled hypertonic saline and other interventions (preliminary data). ASL volume is regulated by ion fluxes through ENaC, CFTR, CaCC, and BK channels, and TGF-β1-mediated inflammation in CF cells decreases activities of CaCC (8) and BK. These findings suggest that effective and safe anti-inflammatory therapy has the potential to improve mucociliary dysfunction in CF patients, even in the absence of small molecule therapy. Currently used anti-inflammatory therapies such as high-dose ibuprofen and steroids produce unwanted side effects that negate their effectiveness. Other medications showed severe side effects in clinical trials. However, experiments proposed in this application will test the hypothesis that losartan provides a safe and effective anti-inflammatory therapy needed to improve outcomes in CF patients. Briefly, 16 patients with CF, >18 years of age, who are not on CFTR augmentation therapy will be recruited for this trial (4 per year). After signing informed consent at the screening visit, spirometry will be performed, take blood for safety and inflammatory markers, and test for pregnancy where applicable. Since losartan has teratogenic effects, strict birth control in female participants will be enforced. Eligible patients will complete visits as following: Quality of life will be assessed by CF quality of life questionnaire - revised (CFQ-R). Cytokines will be measured from nasal fluid collected by Leukosorb filter paper. After assessing baselines, a daily dose of 50 mg losartan will be started, followed by a safety visit 7 days after treatment start (± 2 days). Then, the losartan dose will be increased to 100 mg daily until week 14. Since this trial assesses anti-inflammatory effects of 100 mg losartan, the total duration will be 14 weeks to achieve >12 weeks of treatment with losartan.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cystic Fibrosis

7. Study Design

Primary Purpose
Other
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
16 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
losartan
Arm Type
Experimental
Arm Description
a daily dose of 50 mg losartan for 7 days (for tolerability). Then, the losartan dose will be increased to 100 mg daily for 12 weeks.
Intervention Type
Drug
Intervention Name(s)
Losartan
Other Intervention Name(s)
Cozaar
Intervention Description
50 mg/day for 7 days followed by 100 mg/day for 12 weeks
Primary Outcome Measure Information:
Title
Improvement of mucociliary clearance ( MCC) and cough clearance (CC)
Description
Losartan (100 mg for >12 weeks) will improve MCC+CC clearance in CF patients not on CFTR augmentation therapy in % of baseline
Time Frame
12 weeks treatment
Secondary Outcome Measure Information:
Title
Improvement on pulmonary function tests (in %predicted)
Description
forced expiratory volume at one second (FEV1) in %predicted
Time Frame
12 weeks of treatment
Title
Improvement on pulmonary function tests (in L)
Description
forced expiratory volume at one second (FEV1) in liters
Time Frame
12 weeks of treatment
Title
Decrease of inflammatory markers
Description
Changes in serum inflammatory markers (hsCRP, WBC including absolute neutrophil count, %PMNs, serum amyloid A or SAA, calprotectin, GM-CSF, TGF-β active and total)
Time Frame
12 weeks
Title
Nasal cytokine changes
Description
Nasal cytokine changes (TGF-β1 active and total, TNF-α, IL-1β, IL-6, IL-8, IL-13, COX-2)
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: CF patients with any known mutation combination not on CFTR augmentation therapy ≥18 years of age Severity of the Disease: Suitable patients will have mild to moderate lung disease, as defined by: Pulmonary Function: Each patient must have an FEV1 ≥40% of predicted at the screening visit. Hemoglobin saturation: Patients must have an oxygen saturation of >92% on room air as determined by pulse oximetry at the screening visit. Produces sputum regularly (daily basis, at minimum) FEV1 ≥ 40% of predicted at screening visit Able to sign Informed consent Negative COVID-19 test within 72 hours prior to MCC testing Exclusion Criteria: When enrolling female patients Not willing to adhere to strict birth control (combination of two methods) If female, patient must be non-pregnant and non-lactating, and those of childbearing potential must be using an acceptable method of birth control (i.e., an Intrauterine Contraceptive Device with a failure rate of <1%, hormonal contraceptives or a barrier method). If a female patient is abstinent, she must agree to use one of the acceptable methods if she becomes sexually active. Unstable lung disease: As defined by a change in medical regimen during the preceding 2 weeks or an FEV1 ≥15% below value within 3 months Received an investigational drug or therapy during the preceding 30 days Active or former smokers with less than 1 year since quitting, or >10 pack-year smoking history Unable to adequately complete study measures, including spirometry Intolerance to angiotensin receptor blockers (ARB) Treatment with angiotensin converting enzyme (ACE) inhibitor Regular use of NSAIDs or potassium supplementation, treatment with aliskiren, on anticoagulation Oral corticosteroid use within 6 weeks Exacerbation requiring treatment within 6 weeks Treatment of mycobacterial infections Significant hypoxemia (oxygen saturation <92% on room air and rest or use of continuous oxygen treatment), chronic respiratory failure by history (pCO2 > 45 mmHg), clinical evidence of cor pulmonale Untreated arterial hypertension (systolic blood pressure >140 mm Hg, diastolic blood pressure > 90 mmHg) Blood pressure less than 90 mm Hg systolic while standing Cardiac, renal (creatinine 1.5 times normal limit), hepatic (LFTs > 3x normal upper limit), neurological, psychiatric, endocrine or neoplastic diseases that are judged to interfere with participation in study Known renal artery stenosis Concomitant airway disorders other than CF, such as ABPA Subjects with prior thoracic surgery Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with trial participation or may interfere with the interpretation of trial results and, in the judgment of the PI, would make the subject inappropriate for enrollment. Patients using intermittent inhaled or oral antibiotics will be allowed to participate in this trial. Patients on chronic, cycling antibiotics will be required to have completed at least 2 full cycles of the prescribed antibiotic prior to enrollment and should be studied during the same phase of treatment (on or off) during each study period. Have had radiation exposure within the past year that would cause them to exceed Federal Regulations by participating in this study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Matthias Salathe, MD
Phone
913-588-6000
Email
msalathe@kumc.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Matthias Salathe, MD
Organizational Affiliation
University of Kansas
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Kansas Medical Center
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Matthias Salathe, MD
Phone
913-588-6000
Email
msalathe@kumc.edu

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
since this study is a pilot study, participant data will not be shared to other researchers.

Learn more about this trial

Effect of Losartan in Cystic Fibrosis (CF)-NIH Grant #133240

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