Effects of TNX-832 (Sunol cH36) in Subjects With Acute Lung Injury/Acute Respiratory Distress Syndrome
Primary Purpose
Sepsis, Acute Lung Injury, Acute Respiratory Distress Syndrome
Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
TNX-832
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Sepsis focused on measuring Sepsis, Acute Lung Injury, Acute Respiratory Distress Syndrome, ALI/ARDS, Lung Disease
Eligibility Criteria
Inclusion Criteria:
- ≥ 18 years
- Suspected or proven bacterial infection
- Receiving positive pressure ventilation through an endotracheal tube
Have ALI/ARDS, defined as having all of the following:
- bilateral infiltrates consistent with pulmonary edema
- Hypoxemia
- no clinical evidence of left atrial hypertension
- Provide signed informed consent
Exclusion Criteria:
- Mechanically or chemically-induced ALI/ARDS (including burns, trauma, and near drowning)
- End-stage lung disease
- Decompensated congestive heart failure
- Authorization to withdraw life support
- Hemoglobin persistently <8.0 g/dL
Subjects who have any one of the following:
- platelet count <50,000/mm^3
- prolonged prothrombin time (PT)
- prolonged activated partial thromboplastin time (aPTT)
- having significant potential for disseminated intravascular coagulation (DIC)
Subjects who have two or more of the following:
- prolonged aPTT
- fibrinogen level below the lower limit of normal
- presence of petechiae, ecchymoses, or other evidence of coagulopathy
Subjects who have a history of one or more of the following:
- hematuria (microscopic or gross)
- urinary tract neoplasia
- nephrolithiasis
- glomerulonephritis
- active urinary tract infection (UTI)
- Bleeding disorders within the past 6 weeks or vasculitis with diffused alveolar hemorrhage
- Diagnosis of bleeding peptic ulcer disease within the previous 2 months
- Congenital bleeding diatheses such as hemophilia
Treatment with anti-platelet, anti-coagulant agents, or non-steroidal anti-inflammatory drugs (NSAIDs)within 72 hours following infusion of study drug
Therapeutic heparin:
- Unfractionated heparin within eight hours prior to study drug infusion
- Low molecular weight heparins within the 12 hours prior to study drug infusion
Prophylactic heparin:
- Unfractionated heparin >15,000 units/day
- Low molecular weight heparins
- Warfarin if used within 7 days prior to study drug infusion
- Thrombolytic treatment within 3 days prior to study drug infusion
- 8Glycoprotein IIb/IIIa antagonists within 7 days prior to study drug infusion
- Aspirin or any aspirin containing compound within 3 days prior to study drug infusion
- APC infusion within 72 hours prior to study drug infusion
- Major trauma or trauma subjects at an increased risk of bleeding
- History of severe head trauma that required hospitalization, intracranial surgery, or stroke or any history of intracerebral arteriovenous malformation, cerebral aneurysm, or central nervous system mass lesion with an epidural catheter or who anticipate receiving an epidural catheter during study drug infusion
- Major surgery within the previous 3 days, any postoperative subject with evidence of active bleeding, or any subject with planned or anticipated surgery within 72 hours after study drug infusion. History of abnormal bleeding during surgical procedures
- Chronic renal failure, defined as a calculated glomerular filtration rate (GFR) ≤20 mL/min
- Subjects with baseline aspartate transaminase (AST) or alanine transaminase (ALT) level >5 times the upper limit of normal. Subjects with known esophageal varices, chronic jaundice, biopsy proven cirrhosis, or chronic ascites
- History of organ transplant (including bone marrow)
- Subjects with malignancy having a life expectancy <6 months
- Known human immunodeficiency virus (HIV) positive with CD4+ T Cell count <200/uL
- Women who are pregnant or nursing
- Participation in another clinical research study within 30 days before administration of study drug, with the exception of participation in studies involving noninvasive monitoring medical devices
- Any prior treatment with a murine or chimeric antibody
- Subjects who are moribund and where death is perceived to be imminent (within 72 hours after screening)
- Subjects who have persistent hypotension not responding to fluid or vasopressor administration; subjects who require more than two vasopressors 26. Any medical condition which in the opinion of the investigator would interfere with optimal participation in the study or that would produce a significant risk to a subject
Sites / Locations
- University of Miami
- Beth Israel Deconess Medical Center
- Washington University
- Wake Forest University
- Akron General Medical Center
- Baylor School of Medicine
- Capital Health
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
TNX-832
Drug Placebo
Arm Description
Anti-tissue factor antibody
Placebo control
Outcomes
Primary Outcome Measures
Safety assessed by number of adverse events, and changes in vital signs, ECGs, laboratory, coagulation and pulmonary function parameters.
To evaluate the safety of escalating dose levels of TNX-832 in subjects with suspected or proven bacteria-induced ALI/ARDS. Safety was assessed by number of treatment emergent adverse events, and changes in vital signs, ECGs, laboratory, coagulation and pulmonary function parameters from baseline. Immunogenicity (serum anti-TNX-832 antibody response) was evalutated.
Composite of pharmacokinetics
To evaluate the pharmacokinetics of escalating dose levels of TNX-832 in subjects with suspected or proven bacteria-induced ALI/ARDS. Pharmacokinetic parameters assessed are terminal half life, maximum serum concentration, volume of distribution, total body clearance, area under the drug concentration versus time curve extrapolated to infinity.
Secondary Outcome Measures
Full Information
NCT ID
NCT01438853
First Posted
September 20, 2011
Last Updated
September 21, 2011
Sponsor
Altor BioScience
Collaborators
Genentech, Inc., Tanox
1. Study Identification
Unique Protocol Identification Number
NCT01438853
Brief Title
Effects of TNX-832 (Sunol cH36) in Subjects With Acute Lung Injury/Acute Respiratory Distress Syndrome
Official Title
The Safety, Pharmacokinetics, and Pharmacodynamic Effects of TNX-832 (Sunol cH36) in Subjects With Acute Lung Injury/Acute Respiratory Distress Syndrome
Study Type
Interventional
2. Study Status
Record Verification Date
September 2011
Overall Recruitment Status
Completed
Study Start Date
December 2004 (undefined)
Primary Completion Date
July 2006 (Actual)
Study Completion Date
February 2008 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Altor BioScience
Collaborators
Genentech, Inc., Tanox
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This Phase I/IIa, multi-center, randomized, placebo-controlled, single-blinded dose-escalation study evaluated TNX-832 (also referred to as ALT-836 and Sunol cH36) in subjects with suspected or proven bacteria-induced ALI/ARDS. Up to five cohorts of at least six subjects each were originally planned. Subjects were to be randomized in a 5:1 ratio to receive TNX-832 or placebo,respectively, administered as a single bolus infusion over 15 minutes. Three cohorts of subjects were enrolled to the study and safety and pharmacokinetics of the study treatment were evaluated.
Detailed Description
Tissue factor (TF) is a transmembrane glycoprotein that acts as the principal initiator of the extrinsic coagulation pathway. TF is a key mediator between the immune system and coagulation and is the principal activator of coagulation. The TF-FVIIa complex activates FX and FIX, resulting in the cleavage of prothrombin to thrombin. Normally, localized activation of the coagulation cascade associated with inflammatory responses plays a role in controlling the spread of infectious agents; however, aberrant TF expression often leads to serious thrombotic disorders. TF-dependent thrombosis has been associated with many diseases including septic shock, coronary artery disease (CAD), cancer, and many inflammatory and autoimmune disorders such as lupus, rheumatoid arthritis, psoriasis, and inflammatory bowel disease.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are forms of acute respiratory failure characterized by diffuse pulmonary infiltrates, pulmonary hypertension, refractory hypoxemia, loss of pulmonary compliance and normal hydrostatic pressures. ALI and ARDS commonly occur in patients with acute catastrophic events such as sepsis, trauma and severe pulmonary infections. The incidence of ALI and ARDS is extremely high in patients with sepsis. By blocking the initiating events of extrinsic coagulation activation, their effects on pro-inflammatory events in the lungs and disordered fibrin deposition may be corrected and the evolution of severe structural and functional injury may be averted during ALI/ARDS. TNX-832 (formerly known as Sunol-cH36), directed against human TF, which can block the pathological complications of TF-dependent thrombus formation. The blockage by TNX-832 of initiating events in the extrinsic coagulation pathway may attenuate the effects on pro-inflammatory events in ALI/ARDS patients, thereby averting or decreasing disordered fibrin deposition and averting the evolution of severe structural and functional injury.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sepsis, Acute Lung Injury, Acute Respiratory Distress Syndrome
Keywords
Sepsis, Acute Lung Injury, Acute Respiratory Distress Syndrome, ALI/ARDS, Lung Disease
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
Investigator
Allocation
Randomized
Enrollment
18 (Actual)
8. Arms, Groups, and Interventions
Arm Title
TNX-832
Arm Type
Experimental
Arm Description
Anti-tissue factor antibody
Arm Title
Drug Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo control
Intervention Type
Biological
Intervention Name(s)
TNX-832
Other Intervention Name(s)
ALT-836, Sunol cH36
Intervention Description
Single intravenous dose of TNX-832 at 0.06, 0.08 or 0.10 mg/kg
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Single intravenous dose of saline control
Primary Outcome Measure Information:
Title
Safety assessed by number of adverse events, and changes in vital signs, ECGs, laboratory, coagulation and pulmonary function parameters.
Description
To evaluate the safety of escalating dose levels of TNX-832 in subjects with suspected or proven bacteria-induced ALI/ARDS. Safety was assessed by number of treatment emergent adverse events, and changes in vital signs, ECGs, laboratory, coagulation and pulmonary function parameters from baseline. Immunogenicity (serum anti-TNX-832 antibody response) was evalutated.
Time Frame
Throughout the 4 weeks following treatment
Title
Composite of pharmacokinetics
Description
To evaluate the pharmacokinetics of escalating dose levels of TNX-832 in subjects with suspected or proven bacteria-induced ALI/ARDS. Pharmacokinetic parameters assessed are terminal half life, maximum serum concentration, volume of distribution, total body clearance, area under the drug concentration versus time curve extrapolated to infinity.
Time Frame
predose; 15 and 30 min; 1, 4, 6, 12 and 24 hrs; 2, 3, 4, 5, 6, and 7 days, 2, 3, 4 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
≥ 18 years
Suspected or proven bacterial infection
Receiving positive pressure ventilation through an endotracheal tube
Have ALI/ARDS, defined as having all of the following:
bilateral infiltrates consistent with pulmonary edema
Hypoxemia
no clinical evidence of left atrial hypertension
Provide signed informed consent
Exclusion Criteria:
Mechanically or chemically-induced ALI/ARDS (including burns, trauma, and near drowning)
End-stage lung disease
Decompensated congestive heart failure
Authorization to withdraw life support
Hemoglobin persistently <8.0 g/dL
Subjects who have any one of the following:
platelet count <50,000/mm^3
prolonged prothrombin time (PT)
prolonged activated partial thromboplastin time (aPTT)
having significant potential for disseminated intravascular coagulation (DIC)
Subjects who have two or more of the following:
prolonged aPTT
fibrinogen level below the lower limit of normal
presence of petechiae, ecchymoses, or other evidence of coagulopathy
Subjects who have a history of one or more of the following:
hematuria (microscopic or gross)
urinary tract neoplasia
nephrolithiasis
glomerulonephritis
active urinary tract infection (UTI)
Bleeding disorders within the past 6 weeks or vasculitis with diffused alveolar hemorrhage
Diagnosis of bleeding peptic ulcer disease within the previous 2 months
Congenital bleeding diatheses such as hemophilia
Treatment with anti-platelet, anti-coagulant agents, or non-steroidal anti-inflammatory drugs (NSAIDs)within 72 hours following infusion of study drug
Therapeutic heparin:
Unfractionated heparin within eight hours prior to study drug infusion
Low molecular weight heparins within the 12 hours prior to study drug infusion
Prophylactic heparin:
Unfractionated heparin >15,000 units/day
Low molecular weight heparins
Warfarin if used within 7 days prior to study drug infusion
Thrombolytic treatment within 3 days prior to study drug infusion
8Glycoprotein IIb/IIIa antagonists within 7 days prior to study drug infusion
Aspirin or any aspirin containing compound within 3 days prior to study drug infusion
APC infusion within 72 hours prior to study drug infusion
Major trauma or trauma subjects at an increased risk of bleeding
History of severe head trauma that required hospitalization, intracranial surgery, or stroke or any history of intracerebral arteriovenous malformation, cerebral aneurysm, or central nervous system mass lesion with an epidural catheter or who anticipate receiving an epidural catheter during study drug infusion
Major surgery within the previous 3 days, any postoperative subject with evidence of active bleeding, or any subject with planned or anticipated surgery within 72 hours after study drug infusion. History of abnormal bleeding during surgical procedures
Chronic renal failure, defined as a calculated glomerular filtration rate (GFR) ≤20 mL/min
Subjects with baseline aspartate transaminase (AST) or alanine transaminase (ALT) level >5 times the upper limit of normal. Subjects with known esophageal varices, chronic jaundice, biopsy proven cirrhosis, or chronic ascites
History of organ transplant (including bone marrow)
Subjects with malignancy having a life expectancy <6 months
Known human immunodeficiency virus (HIV) positive with CD4+ T Cell count <200/uL
Women who are pregnant or nursing
Participation in another clinical research study within 30 days before administration of study drug, with the exception of participation in studies involving noninvasive monitoring medical devices
Any prior treatment with a murine or chimeric antibody
Subjects who are moribund and where death is perceived to be imminent (within 72 hours after screening)
Subjects who have persistent hypotension not responding to fluid or vasopressor administration; subjects who require more than two vasopressors 26. Any medical condition which in the opinion of the investigator would interfere with optimal participation in the study or that would produce a significant risk to a subject
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hing Wong, PhD
Organizational Affiliation
Altor BioScience
Official's Role
Study Director
Facility Information:
Facility Name
University of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33125
Country
United States
Facility Name
Beth Israel Deconess Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
Washington University
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63130
Country
United States
Facility Name
Wake Forest University
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157
Country
United States
Facility Name
Akron General Medical Center
City
Akron
State/Province
Ohio
ZIP/Postal Code
44307
Country
United States
Facility Name
Baylor School of Medicine
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Capital Health
City
Halifax
State/Province
Nova Scotia
ZIP/Postal Code
B3H 1V7
Country
Canada
12. IPD Sharing Statement
Citations:
PubMed Identifier
22340260
Citation
Morris PE, Steingrub JS, Huang BY, Tang S, Liu PM, Rhode PR, Wong HC. A phase I study evaluating the pharmacokinetics, safety and tolerability of an antibody-based tissue factor antagonist in subjects with acute lung injury or acute respiratory distress syndrome. BMC Pulm Med. 2012 Feb 16;12:5. doi: 10.1186/1471-2466-12-5.
Results Reference
derived
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Effects of TNX-832 (Sunol cH36) in Subjects With Acute Lung Injury/Acute Respiratory Distress Syndrome
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