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Safety and Efficacy Study of Aztreonam for Inhalation Solution (AZLI) in Cystic Fibrosis Patients With P. Aeruginosa (AIR-CF2)

Primary Purpose

Cystic Fibrosis

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
AZLI 75 mg two times a day (BID)/three times a day (TID)
Placebo two times a day (BID)/three times a day (TID)
Sponsored by
Gilead Sciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cystic Fibrosis focused on measuring Cystic Fibrosis, Pseudomonas aeruginosa, Pulmonary Cystic Fibrosis

Eligibility Criteria

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

Inclusion Criteria: CF as diagnosed by: Documented sweat chloride greater than or equal to 60 mEq/L by quantitative pilocarpine iontophoresis test; or Two well-characterized genetic mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene; or Abnormal nasal potential difference with accompanying symptoms characteristic of CF. PA present in expectorated sputum or throat swab culture at Screening. Participants must have received three or more courses of TIS within the previous 12 months. Participants on chronic azithromycin must have had no change in regimen in the previous 3 months and must have had a need for TIS and/or additional antipseudomonal therapy since initiation of azithromycin. Forced expiratory volume in 1 second (FEV1) between (and including) 25% and 75% predicted at Screening. Ability to perform reproducible pulmonary function tests. Arterial oxygen saturation (SaO2) greater than or equal to 90% on room air at Screening. Exclusion Criteria: Current use of oral corticosteroids in doses exceeding the equivalent of 10 mg prednisone a day or 20 mg prednisone every other day. History of sputum or throat culture swab yielding Burkholderia cepacia in the past 2 years. History of daily continuous oxygen supplementation or requirement for more than 2 liters/minute at night. Administration of any investigational drug or device within 28 days of Screening (Visit 1) or within 6 half-lives of the investigational drug (whichever was longer). Known local or systemic hypersensitivity to monobactam antibiotics. Inability to tolerate inhalation of a short acting Beta-2 agonist. Changes in antimicrobial, bronchodilator, anti-inflammatory, or corticosteroid medications within 7 days before Screening or between Screening and the next visit. Changes in physiotherapy technique or schedule within 7 days before Screening or between Screening and the next visit. History of lung transplantation. A chest X-ray indicating abnormal findings at Screening or within the previous 90 days. Abnormal renal or hepatic function or serum chemistry at Screening (aspartate aminotransferase [AST], alanine aminotransferase [ALT] greater than 5 times the upper limit of normal range; Creatinine greater than 2 times the upper limit of normal range). Positive pregnancy test at Screening. Female of childbearing potential who was lactating or in the opinion of the investigator was not practicing acceptable birth control. Any serious or active medical or psychiatric illness, which in the opinion of the investigator would have interfered with participant treatment, assessment, or compliance with the protocol.

Sites / Locations

  • Phoenix Children's Hospital
  • University of Arkansas for Medical Sciences
  • University of California, San Diego
  • Children's Hospital Los Angeles
  • Kaiser Permanente Medical Care Program
  • Children's Hospital, Orange Co.
  • Stanford University Hospital and Medical Center
  • UC Davis Medical Center
  • Children's Hospital
  • Connecticut Children's Medical Center
  • University of Florida Health Sciences Center
  • Nemours Children's Clinic, Jacksonville
  • University of Miami School of Medicine
  • Nemours Children's Clinic
  • Pediatric Pulmonary Associates, Florida
  • Emory Healthcare
  • Medical College of Georgia
  • Children's Memorial Hospital/Northwestern University
  • Chicago Children's Asthma Respiratory and Exercise Specialists
  • Loyola University Medical Center
  • North Suburban Pulmonary / Critical Care Consultants
  • Indiana University
  • University of Kansas Medical Center
  • Maine Medical Center
  • Children's Hospital, Boston
  • Floating Hospital for Children
  • Massachusetts General Hospital
  • University of Michigan
  • Children's Hospital of Michigan/Wayne State University
  • University of Minnesota
  • Children's Lung Specialists, Ltd.
  • Morristown Memorial Hospital
  • Albany Medical College
  • Long Island College Hospital
  • Children's Hospital of Buffalo
  • Long Island Jewish Medical Center
  • Columbia University Medical Center
  • State University of New York Stony Brook
  • Children's Hospital of Westchester Medical Center/New York Medical College
  • Akron Children's Hospital
  • Columbus Children's Hospital, Ohio State University
  • Children's Medical Center
  • Dr. Santiago Reyes
  • Oregon Health & Science University
  • Penn State University Hershey Medical Center
  • Drexel University College of Medicine
  • St. Christopher's Hospital for Children
  • Children's Hospital of Pittsburg
  • Rhode Island Hospital
  • Medical University of South Carolina
  • Pediatric Pulmonary Associates, South Carolina
  • Baylor College of Medicine
  • Alamo Clinical Research Associates
  • Pediatric Pulmonary Center
  • Children's Hospital and Regional Medical Center
  • West Virginia University

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Experimental

Arm Label

Placebo (pooled two times a day [BID]/three times a day [TID])

AZLI (pooled two times a day [BID]/three times a day [TID])

Arm Description

Outcomes

Primary Outcome Measures

Time to Need for Inhaled or Intravenous (IV) Antipseudomonal Antibiotics
The primary endpoint was time to need for a course of inhaled or IV antipseudomonal antibiotics with documented physician assessment of need for antibiotics. Antipseudomonal Antibiotic need was documented based on the presence of at least one of the following four symptoms predictive of pulmonary exacerbation: decreased exercise tolerance, increased cough, increased sputum / chest congestion, decreased appetite, or other.

Secondary Outcome Measures

Change in Cystic Fibrosis Questionnaire - Revised (CFQ-R) Respiratory Symptoms Scale (RSS) Score
The CFQ-R was administered at Day -28, baseline, Day 14, Day 28, and Day 84 (end of study). The endpoint was change in respiratory symptoms from baseline, assessed with the CFQ-R RSS (range of scores [units]: 0-100; higher scores indicate fewer symptoms).
Percent Change in Forced Expiratory Volume in 1 Second (FEV1) (L)
Spirometry was performed at each visit. FEV1 was recorded according to American Thoracic Society (ATS) guidelines. FEV1(L) is the measurement of the volume of air (expressed in liters) exhaled in 1 second. The percent change in this parameter from Day 0 to Day 28 was determined for each treatment group.
Number of Hospitalization Days
Details of all hospitalizations, including the dates of admission and discharge, were recorded on the electronic case report form (eCRF).
Change From Baseline in Pseudomonas Aeruginosa (PA) Log10 Colony Forming Units (CFU) Per Gram of Sputum
Sputum samples were collected at all participant visits of the study for analysis of microbiology endpoints. Sputum samples were processed for qualitative and quantitative culture of PA (each morphotype). Due to the skewness of the distribution of CFU data, the data were transformed using the base 10 logarithm, in an attempt to normalize the data and allow for parametric tests, before calculating changes. To account for zero values, 1 was added to each CFU measurement before being transformed. Any CFU data values where PA was not isolated from a valid culture were set to zero.

Full Information

First Posted
March 1, 2005
Last Updated
February 16, 2011
Sponsor
Gilead Sciences
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1. Study Identification

Unique Protocol Identification Number
NCT00104520
Brief Title
Safety and Efficacy Study of Aztreonam for Inhalation Solution (AZLI) in Cystic Fibrosis Patients With P. Aeruginosa
Acronym
AIR-CF2
Official Title
A Phase 3, Double-Blind, Multicenter, Randomized, Placebo-Controlled Trial With Aztreonam Lysinate for Inhalation in Cystic Fibrosis Patients With Pulmonary P. Aeruginosa Requiring Frequent Antibiotics (AIR-CF2)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2010
Overall Recruitment Status
Completed
Study Start Date
February 2005 (undefined)
Primary Completion Date
September 2006 (Actual)
Study Completion Date
September 2006 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Gilead Sciences

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study was to evaluate the safety and efficacy of aztreonam for inhalation solution (AZLI) in patients with cystic fibrosis (CF) and lung infection due to Pseudomonas aeruginosa (PA).
Detailed Description
Patients with CF often have lung infections that occur repeatedly or worsen over time. The lung infections are often caused by a bacteria called PA. Treatment with antibiotics can stop or slow down the growth of the bacteria. The antibiotics may be given by mouth, intravenously (IV), or by inhalation as a mist. The purpose of this study was to evaluate the safety and efficacy of aztreonam for inhalation solution (AZLI), an investigational formulation of the antibiotic administered using the eFlow® Electronic Nebulizer by PARI GmbH, in CF patients with PA. In this study, participants were screened for eligibility at Visit 1 (Day -42) and returned to the center for Visit 2 after a 14-day evaluation period. At Visit 2 (Day -28), participants began a 28-day course of open-label Tobramycin Inhalation Solution (TIS). At Visit 3 (Day 0), following completion of the 28-day course of TIS, participants began randomized, blinded treatment with either AZLI twice a day (BID) or three times a day (TID) or placebo BID or TID, and continued treatment for a total of 28 days, with a clinic visit at Day 14 (Visit 4) and at the end of treatment (Visit 5 [Day 28]). Participants returned for visits every 2 weeks for 8 weeks after the end of the blinded treatment (Visits 6 to 9 [Days 42 to 84]). Two hundred and forty-seven participants were treated in the TIS phase of this study. Two hundred and eleven subjects completed the TIS phase and were treated in the placebo-controlled phase with study drug (AZLI or placebo).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cystic Fibrosis
Keywords
Cystic Fibrosis, Pseudomonas aeruginosa, Pulmonary Cystic Fibrosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
211 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo (pooled two times a day [BID]/three times a day [TID])
Arm Type
Placebo Comparator
Arm Title
AZLI (pooled two times a day [BID]/three times a day [TID])
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
AZLI 75 mg two times a day (BID)/three times a day (TID)
Intervention Type
Drug
Intervention Name(s)
Placebo two times a day (BID)/three times a day (TID)
Primary Outcome Measure Information:
Title
Time to Need for Inhaled or Intravenous (IV) Antipseudomonal Antibiotics
Description
The primary endpoint was time to need for a course of inhaled or IV antipseudomonal antibiotics with documented physician assessment of need for antibiotics. Antipseudomonal Antibiotic need was documented based on the presence of at least one of the following four symptoms predictive of pulmonary exacerbation: decreased exercise tolerance, increased cough, increased sputum / chest congestion, decreased appetite, or other.
Time Frame
Day 0 to Day 84 (end of study)
Secondary Outcome Measure Information:
Title
Change in Cystic Fibrosis Questionnaire - Revised (CFQ-R) Respiratory Symptoms Scale (RSS) Score
Description
The CFQ-R was administered at Day -28, baseline, Day 14, Day 28, and Day 84 (end of study). The endpoint was change in respiratory symptoms from baseline, assessed with the CFQ-R RSS (range of scores [units]: 0-100; higher scores indicate fewer symptoms).
Time Frame
Day 0 to Day 28
Title
Percent Change in Forced Expiratory Volume in 1 Second (FEV1) (L)
Description
Spirometry was performed at each visit. FEV1 was recorded according to American Thoracic Society (ATS) guidelines. FEV1(L) is the measurement of the volume of air (expressed in liters) exhaled in 1 second. The percent change in this parameter from Day 0 to Day 28 was determined for each treatment group.
Time Frame
Day 0 to Day 28
Title
Number of Hospitalization Days
Description
Details of all hospitalizations, including the dates of admission and discharge, were recorded on the electronic case report form (eCRF).
Time Frame
Day 0 to Day 84
Title
Change From Baseline in Pseudomonas Aeruginosa (PA) Log10 Colony Forming Units (CFU) Per Gram of Sputum
Description
Sputum samples were collected at all participant visits of the study for analysis of microbiology endpoints. Sputum samples were processed for qualitative and quantitative culture of PA (each morphotype). Due to the skewness of the distribution of CFU data, the data were transformed using the base 10 logarithm, in an attempt to normalize the data and allow for parametric tests, before calculating changes. To account for zero values, 1 was added to each CFU measurement before being transformed. Any CFU data values where PA was not isolated from a valid culture were set to zero.
Time Frame
Day 0 to Day 28
Other Pre-specified Outcome Measures:
Title
Number of Participants With Other Pathogens
Description
Sputum samples were collected at all visits for quantitative and qualitative culture for Staphylococcus aureus, Burkholderia cepacia, Stenotrophomonas maltophilia, and Achromobacter xylosoxidans. Number of participants with other pathogens at baseline and at the end of treatment (28 days) are reported.
Time Frame
Day 0 and Day 28
Title
Minimum Concentration of Aztreonam Inhibiting 50% (MIC50) and 90% (MIC90) of All PA Isolates (μg/mL)
Description
The aztreonam susceptibility of PA isolates from sputum samples (collected at all visits) was assessed. MIC50 = minimum inhibitory concentration (minimum concentration of an agent that inhibits 50% of isolates from a particular organism). MIC90 = minimum inhibitory concentration (minimum concentration of an agent that inhibits 90% of isolates from a particular organism). MIC50 and MIC90 values are single measurements for the entire population and not measured on a per-participant basis.
Time Frame
Day 0 to Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: CF as diagnosed by: Documented sweat chloride greater than or equal to 60 mEq/L by quantitative pilocarpine iontophoresis test; or Two well-characterized genetic mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene; or Abnormal nasal potential difference with accompanying symptoms characteristic of CF. PA present in expectorated sputum or throat swab culture at Screening. Participants must have received three or more courses of TIS within the previous 12 months. Participants on chronic azithromycin must have had no change in regimen in the previous 3 months and must have had a need for TIS and/or additional antipseudomonal therapy since initiation of azithromycin. Forced expiratory volume in 1 second (FEV1) between (and including) 25% and 75% predicted at Screening. Ability to perform reproducible pulmonary function tests. Arterial oxygen saturation (SaO2) greater than or equal to 90% on room air at Screening. Exclusion Criteria: Current use of oral corticosteroids in doses exceeding the equivalent of 10 mg prednisone a day or 20 mg prednisone every other day. History of sputum or throat culture swab yielding Burkholderia cepacia in the past 2 years. History of daily continuous oxygen supplementation or requirement for more than 2 liters/minute at night. Administration of any investigational drug or device within 28 days of Screening (Visit 1) or within 6 half-lives of the investigational drug (whichever was longer). Known local or systemic hypersensitivity to monobactam antibiotics. Inability to tolerate inhalation of a short acting Beta-2 agonist. Changes in antimicrobial, bronchodilator, anti-inflammatory, or corticosteroid medications within 7 days before Screening or between Screening and the next visit. Changes in physiotherapy technique or schedule within 7 days before Screening or between Screening and the next visit. History of lung transplantation. A chest X-ray indicating abnormal findings at Screening or within the previous 90 days. Abnormal renal or hepatic function or serum chemistry at Screening (aspartate aminotransferase [AST], alanine aminotransferase [ALT] greater than 5 times the upper limit of normal range; Creatinine greater than 2 times the upper limit of normal range). Positive pregnancy test at Screening. Female of childbearing potential who was lactating or in the opinion of the investigator was not practicing acceptable birth control. Any serious or active medical or psychiatric illness, which in the opinion of the investigator would have interfered with participant treatment, assessment, or compliance with the protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Karen McCoy, MD
Organizational Affiliation
Nationwide Children's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Phoenix Children's Hospital
City
Phoenix
State/Province
Arizona
Country
United States
Facility Name
University of Arkansas for Medical Sciences
City
Little Rock
State/Province
Arkansas
Country
United States
Facility Name
University of California, San Diego
City
La Jolla
State/Province
California
Country
United States
Facility Name
Children's Hospital Los Angeles
City
Los Angeles
State/Province
California
Country
United States
Facility Name
Kaiser Permanente Medical Care Program
City
Oakland
State/Province
California
Country
United States
Facility Name
Children's Hospital, Orange Co.
City
Orange
State/Province
California
Country
United States
Facility Name
Stanford University Hospital and Medical Center
City
Palo Alto
State/Province
California
Country
United States
Facility Name
UC Davis Medical Center
City
Sacramento
State/Province
California
Country
United States
Facility Name
Children's Hospital
City
Denver
State/Province
Colorado
Country
United States
Facility Name
Connecticut Children's Medical Center
City
Hartford
State/Province
Connecticut
Country
United States
Facility Name
University of Florida Health Sciences Center
City
Gainesville
State/Province
Florida
Country
United States
Facility Name
Nemours Children's Clinic, Jacksonville
City
Jacksonville
State/Province
Florida
Country
United States
Facility Name
University of Miami School of Medicine
City
Miami
State/Province
Florida
Country
United States
Facility Name
Nemours Children's Clinic
City
Orlando
State/Province
Florida
Country
United States
Facility Name
Pediatric Pulmonary Associates, Florida
City
St. Petersburg
State/Province
Florida
Country
United States
Facility Name
Emory Healthcare
City
Atlanta
State/Province
Georgia
Country
United States
Facility Name
Medical College of Georgia
City
Augusta
State/Province
Georgia
Country
United States
Facility Name
Children's Memorial Hospital/Northwestern University
City
Chicago
State/Province
Illinois
Country
United States
Facility Name
Chicago Children's Asthma Respiratory and Exercise Specialists
City
Glenview
State/Province
Illinois
Country
United States
Facility Name
Loyola University Medical Center
City
Maywood
State/Province
Illinois
Country
United States
Facility Name
North Suburban Pulmonary / Critical Care Consultants
City
Niles
State/Province
Illinois
Country
United States
Facility Name
Indiana University
City
Indianapolis
State/Province
Indiana
Country
United States
Facility Name
University of Kansas Medical Center
City
Kansas City
State/Province
Kansas
Country
United States
Facility Name
Maine Medical Center
City
Portland
State/Province
Maine
Country
United States
Facility Name
Children's Hospital, Boston
City
Boston
State/Province
Massachusetts
Country
United States
Facility Name
Floating Hospital for Children
City
Boston
State/Province
Massachusetts
Country
United States
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
Country
United States
Facility Name
University of Michigan
City
Ann Arbor
State/Province
Michigan
Country
United States
Facility Name
Children's Hospital of Michigan/Wayne State University
City
Detroit
State/Province
Michigan
Country
United States
Facility Name
University of Minnesota
City
Minneapolis
State/Province
Minnesota
Country
United States
Facility Name
Children's Lung Specialists, Ltd.
City
Las Vegas
State/Province
Nevada
Country
United States
Facility Name
Morristown Memorial Hospital
City
Morristown
State/Province
New Jersey
Country
United States
Facility Name
Albany Medical College
City
Albany
State/Province
New York
Country
United States
Facility Name
Long Island College Hospital
City
Brooklyn
State/Province
New York
Country
United States
Facility Name
Children's Hospital of Buffalo
City
Buffalo
State/Province
New York
Country
United States
Facility Name
Long Island Jewish Medical Center
City
New Hyde Park
State/Province
New York
Country
United States
Facility Name
Columbia University Medical Center
City
New York
State/Province
New York
Country
United States
Facility Name
State University of New York Stony Brook
City
Stony Brook
State/Province
New York
Country
United States
Facility Name
Children's Hospital of Westchester Medical Center/New York Medical College
City
Valhalla
State/Province
New York
Country
United States
Facility Name
Akron Children's Hospital
City
Akron
State/Province
Ohio
Country
United States
Facility Name
Columbus Children's Hospital, Ohio State University
City
Columbus
State/Province
Ohio
Country
United States
Facility Name
Children's Medical Center
City
Dayton
State/Province
Ohio
Country
United States
Facility Name
Dr. Santiago Reyes
City
Oklahoma City
State/Province
Oklahoma
Country
United States
Facility Name
Oregon Health & Science University
City
Portland
State/Province
Oregon
Country
United States
Facility Name
Penn State University Hershey Medical Center
City
Hershey
State/Province
Pennsylvania
Country
United States
Facility Name
Drexel University College of Medicine
City
Philadelphia
State/Province
Pennsylvania
Country
United States
Facility Name
St. Christopher's Hospital for Children
City
Philadelphia
State/Province
Pennsylvania
Country
United States
Facility Name
Children's Hospital of Pittsburg
City
Pittsburg
State/Province
Pennsylvania
Country
United States
Facility Name
Rhode Island Hospital
City
Providence
State/Province
Rhode Island
Country
United States
Facility Name
Medical University of South Carolina
City
Charleston
State/Province
South Carolina
Country
United States
Facility Name
Pediatric Pulmonary Associates, South Carolina
City
Columbia
State/Province
South Carolina
Country
United States
Facility Name
Baylor College of Medicine
City
Houston
State/Province
Texas
Country
United States
Facility Name
Alamo Clinical Research Associates
City
San Antonio
State/Province
Texas
Country
United States
Facility Name
Pediatric Pulmonary Center
City
Richmond
State/Province
Virginia
Country
United States
Facility Name
Children's Hospital and Regional Medical Center
City
Seattle
State/Province
Washington
Country
United States
Facility Name
West Virginia University
City
Morgantown
State/Province
West Virginia
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
19447923
Citation
Quittner AL, Modi AC, Wainwright C, Otto K, Kirihara J, Montgomery AB. Determination of the minimal clinically important difference scores for the Cystic Fibrosis Questionnaire-Revised respiratory symptom scale in two populations of patients with cystic fibrosis and chronic Pseudomonas aeruginosa airway infection. Chest. 2009 Jun;135(6):1610-1618. doi: 10.1378/chest.08-1190. Epub 2009 May 15.
Results Reference
derived
PubMed Identifier
18658109
Citation
McCoy KS, Quittner AL, Oermann CM, Gibson RL, Retsch-Bogart GZ, Montgomery AB. Inhaled aztreonam lysine for chronic airway Pseudomonas aeruginosa in cystic fibrosis. Am J Respir Crit Care Med. 2008 Nov 1;178(9):921-8. doi: 10.1164/rccm.200712-1804OC. Epub 2008 Jul 24.
Results Reference
derived

Learn more about this trial

Safety and Efficacy Study of Aztreonam for Inhalation Solution (AZLI) in Cystic Fibrosis Patients With P. Aeruginosa

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