treatment of patients with early septic shock and bio-adrenomedullin(adm) concentration > 70 pg/ml with adrecizumab

Conditions: Septic Shock

Summary: this is a double-blind, placebo-controlled, randomized, multicenter proof of concept and dose-finding phase ii study using two doses of adrecizumab in patients with early septic shock and a bio-adm plasma concentration at admission of \> 70 pg/ml.

this is a double-blind, placebo-controlled, randomized, multicenter proof of concept and dose-finding phase ii study using two doses of adrecizumab in patients with early septic shock and a bio-adm plasma concentration at admission of \> 70 pg/ml. "early" septic shock is defined as a life-threatening organ dysfunction due to dysregulated host response to a proven or suspected infection which leads to a decline of mean arterial pressure (map) \< 65 mmhg, which is refractory to fluid resuscitation and requires vasopressors. early is defined as a maximum of less than 12 hours between onset of the cardiovascular organ-dysfunction and administration of adrecizumab. refractoriness to fluid resuscitation is defined as a lack of response to the administration of 30 ml of fluid per kilogram of body weight or is determined according to a clinician's assessment of inadequate hemodynamic results. it is intended to enroll 300 patients from surgical, medical and mixed icu at multiple centers in europe. all patients will be treated according to "international guidelines for management of severe sepsis and septic shock". eligible patients (confirmed by central verification) will be randomized (1:1:2) to adrecizumab treatment arm a (2 mg/kg) or to adrecizumab treatment arm b (4 mg/kg) or to placebo as control group. patients assigned to the treatment arm a or b will be administered a single dose of adrecizumab as intravenous infusion over approximately 1 hour; patients assigned to the control group will be administered placebo as intravenous infusion over approximately 1 hour. as long as the patients are on the icu, daily measurements of clinical signs and laboratory data will be collected for safety reasons and for determination of sequential organ failure assessment score (sofa score). additional blood samples for central laboratory analyses will be taken at inclusion on day 1, day 3, day 5, day 7 or day of discharge (whatever comes first) for measurement of biomarkers. the sofa score and its components will be determined daily for all patients over the entire stay on the icu (28 days or until discharge whatever comes first). safety monitoring for each patient will begin at the time of signing the informed consent form and continue for 90 days after end of short-term infusion of study medication. at selected study centers a pharmacokinetic (pk) substudy will be performed to determine the profile of adrecizumab in 80 randomized patients. an interim analysis for efficacy is planned after 50% of patients have completed the study (n=150).

Eligibility criteria:
inclusion criteria: 1. written informed consent by patient or legal representative (according to country - specific regulations) 2. male and female patient, age ≥ 18 years 3. body weight 50 kg - 120 kg 4. bio-adm concentration \> 70 pg/ml 5. patient with early septic shock (start of vasopressor therapy \< 12 hours) 6. women of childbearing potential must have a negative serum or urine pregnancy test before randomization 7. highly effective method of contraception must be maintained for 6 months after study start by women of childbearing potential and sexually active men. 8. no care limitation exclusion criteria: 1. moribund 2. pre-existing unstable condition (e.g. a recent cerebral hemorrhage or infarct, a recent acute unstable myocardial infarction (all \< 3 months), congestive heart failure - new york heart association (nyha) class iv 3. patients that required cardiopulmonary resuscitation in the last 4 weeks prior to evaluation for enrollment 4. severe chronic obstructive pulmonary disease (copd) with chronic oxygen need at home (gold iv) 5. any organ or bone marrow transplant within the past 24 weeks 6. uncontrolled serious hemorrhage (≥ 2 units of blood / platelets in the previous 24 hrs.). patients may be considered for enrollment if bleeding has stopped and patient is otherwise qualified 7. uncontrolled hematological / oncological malignancies 8. absolute neutropenia \< 500 per µl 9. severe chronic liver disease (child-pugh c) 10. systemic fungal infection or active tuberculosis 11. neuromuscular disorders that impact breathing / spontaneous ventilation 12. burns \> 30% of body surface 13. plasmapheresis 14. breastfeeding women 15. participation in a clinical trial involving another investigational drug within 4 weeks prior to inclusion 16. unwilling or unable to be fully evaluated for all follow-up visits

Keywords: early septic shock