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Efficacy and Safety of 28 or 56 Day Treatment for Pseudomonas Aeruginosa in Children With Cystic Fibrosis

Information source: Novartis
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Cystic Fibrosis

Intervention: Tobramycin solution for inhalation 300 mg (Drug)

Phase: Phase 3

Status: Completed

Sponsored by: Novartis

Official(s) and/or principal investigator(s):
Felix Ratjen, Principal Investigator, Affiliation: Royal Victoria Infirmary

Summary

This study assessed time to recurrence of infection with Pseudomonas aeruginosa following treatment of the initial infection with tobramycin nebuliser solution. The safety profile of the initial tobramycin treatment was assessed during the first 3 months of the study and patients were followed until the end of the study, month 27.

Clinical Details

Official title: The Microbiologic Efficacy and Safety of Two Treatment Regimens of Inhaled Tobramycin Nebuliser Solution (TNS) for the Treatment of Early Onset Pseudomonas Aeruginosa Lower Respiratory Tract Infection in Subjects With Cystic Fibrosis

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: Time to Recurrence of Pseudomonas (P.) Aeruginosa (Any Genotype) in Sputum or Deep Throat Cough Swab

Secondary outcome:

Percentage of Patients With Pseudomonas (P.) Aeruginosa Eradicated From Deep Throat Cough Swab or Sputum

Time to Recurrence of Pseudomonas (P.) Aeruginosa (New or Same Genotype) in Sputum or Deep Throat Cough Swab Based on Confirmatory Assessment by the Central Laboratory

Percentage of Patients With Pseudomonas (P.) Aeruginosa Having an Increased, Decreased, or Unchanged Tobramycin Minimum Inhibitory Concentration (MIC) Value at the Final Visit Compared to Baseline

Number of Participants Hospitalized for Pulmonary Exacerbations

Detailed description: This was a multi-center, open-label, two-arm, randomized study. All patients diagnosed with CF and who fulfilled the criteria for early infection with P. aeruginosa initially received tobramycin 300 mg twice a day for 28 days. At the end of the 28-day treatment period, patients who met the inclusion criteria and none of the additional exclusion criteria were randomized in a 1: 1 ratio to either receive an additional 28 days of treatment with tobramycin 300 mg twice a day (56-day group) or to stop study medication (28-day group). All randomized patients had regular study visits until a positive P. aeruginosa sample was obtained. Once P. aeruginosa had recurred, the patient entered a follow-up phase where minimal information was collected for 27 months. During the follow-up phase, patients were treated according to their physicians' discretion. Patients who started treatment with tobramycin but were not randomized (i. e. due to a positive antibody test) and followed up during routine clinic visits. They were allowed to continue their 28-day treatment period and afterwards be treated according to their physicians' discretion.

Eligibility

Minimum age: 6 Months. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion criteria:

- Male or female patients ≥ 6 months old

- Diagnosis of cystic fibrosis (CF) based upon the following historical criteria

performed prior to study participation: 1. confirmed sweat chloride > 60 mEq/L by quantitative pilocarpine iontophoresis (at least 2 tests), OR 2. genotype with two identifiable mutations consistent with CF.

- First or early lower respiratory tract infection with Pseudomonas (P.) aeruginosa

documented by either of the following: 1. first infection defined by the first P. aeruginosa isolated from sputum or deep throat cough swab culture, OR 2. P. aeruginosa from sputum or deep throat cough swab culture following at least 1 year of negative cultures (documented with at least 4 negative cultures during this year and no positive cultures) and no anti-pseudomonal treatment during this 1-year period, OR 3. P. aeruginosa from sputum or deep throat cough swab culture following at least 2 years of negative cultures (documented with at least 2 negative cultures per year and no positive cultures) and no anti-pseudomonal treatment during this 2-year period.

- Written informed consent by the patient and/or parent/legal guardian according to

local country regulations. Exclusion criteria:

- History of aminoglycoside hypersensitivity or adverse reaction to inhaled

aminoglycoside.

- Signs and symptoms of acute pulmonary disease, eg, pneumonia, pneumothorax.

- Administration of any investigational drug within 30 days prior to enrollment.

- Administration of loop diuretics within 7 days prior to study drug administration.

- Personal/family history of abnormal hearing, other than typical hearing loss

associated with the aging process.

- Abnormal result from an audiology testing (defined as either a unilateral pure-tone

audiometry test showing a threshold elevation > 20 decibels [dB] at any frequency across the frequency range 0. 25-8 kHz or the absence of emission at the evoked otoacoustic emission test).

- Positive urine pregnancy test at Day 1 (Baseline) for all female patients who have

reached menarche.

- Use of macrolide antibiotics as a maintenance therapy for 12 or more days during the

28 days prior to Baseline.

- Antibody titers ≥ 1000 for any of the 3 P. aeruginosa exoenzymes: Exotoxin A,

alkaline protease, or elastase (status to be determined between Baseline and Day 28).

Locations and Contacts

Additional Information

Starting date: November 2003
Last updated: July 29, 2011

Page last updated: August 23, 2015

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