Clinical trial NCT01059565: Safety and Efficacy Study of Aztreonam for Inhalation Solution (AZLI) in Patients With Cystic Fibrosis and Chronic Burkholderia Species Infection
Official title: Phase 3b Randomized, Double-Blind, Placebo-Controlled Two-Part Trial to Assess the Safety and Efficacy of Continuous Aztreonam for Inhalation Solution (AZLI) in Subjects With Cystic Fibrosis (CF) and Chronic Burkholderia Species Infection
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Cystic Fibrosis
Burkholderia Infections
Keywords: Cystic Fibrosis
Aztreonam Lysine
lung infection
Burkholderia
CFQ-R
inhaled antibiotic
Lead sponsor: Gilead Sciences
Sponsor class: INDUSTRY
First posted: 2010-02-01
Enrollment: 102
Sex: ALL
Minimum age (years): 6
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: TREATMENT

Brief summary: The purpose of this research study was to determine if an experimental drug called Aztreonam for Inhalation Solution (AZLI) was safe and effective to treat Burkholderia lung infections in patients with cystic fibrosis (CF).

Spirometry was used to assess pulmonary function, and the revised Cystic Fibrosis Questionnaire (CFQ-R) was used to assess quality of life. The CFQ-R is a validated, patient-reported outcome tool used to measure health-related quality of life for children and adults with CF.

The study consisted of a 24-week randomized phase, and a 24-week open-label phase. Primary and secondary efficacy analyses were conducted for the 24-week randomized phase only. Safety data were collected for both the randomized and open-label phases.


Eligibility criteria: Inclusion Criteria:

1. Male or female ≥ 6 years of age
2. Subjects with CF as diagnosed by one of the following:

   * Documented sweat chloride ≥ 60 milliequivalent (mEq)/L by quantitative pilocarpine iontophoresis test
   * Documented sweat sodium ≥ 60 mmol/L
   * Two well-characterized genetic mutations in the CF transmembrane conductance regulator (CFTR) gene
   * Abnormal nasal potential difference (NPD) with accompanying symptoms characteristic of CF
3. Chronic infection with Burkholderia spp. defined by:

   * One sputum (or bronchoalveolar lavage) culture positive for Burkholderia spp. within 6 months prior to baseline assessment,
   * At least 50% of sputum (or bronchoalveolar lavage) cultures collected at least one month apart over the previous 12 months prior to baseline assessment positive for Burkholderia spp. (minimum of 2 positive cultures), and
   * At least one positive sputum (or bronchoalveolar lavage) culture (obtained at any point in time) confirmed to be Burkholderia spp. by the Cystic Fibrosis Foundation (CFF) Burkholderia cepacia Research Laboratory and Repository at the University of Michigan (or equivalent Canadian reference laboratory).
4. Concomitant aerosolized antibiotic treatment: subjects receiving intermittent (alternating month on/month off) aerosolized antibiotic treatment were eligible, but must have been at least 1 week into their off-treatment cycle at the time of baseline assessment. Subjects receiving continuous aerosolized antibiotic treatment were eligible without restriction on their aerosolized antibiotic treatment.
5. Chest radiograph, computed tomography (CT), or magnetic resonance imaging (MRI) (most recent, obtained within 90 days of screening) without significant acute findings (eg, infiltrates \[lobar or diffuse interstitial\], pleural effusion, pneumothorax), and no significant intercurrent illness; chronic, stable findings (eg, chronic scarring or atelectasis) were allowed.
6. Subjects (and parent/guardian as required) must have been able to provide written informed consent/assent prior to any study-related procedures,
7. Ability to perform reproducible pulmonary function tests
8. Sexually active females of childbearing potential must have agreed to use a highly effective method of contraception during heterosexual intercourse throughout the study period and for 30 days following discontinuation of study drug. A highly effective method of birth control was defined as a method that would result in a low failure rate (ie, less than 1% per year) when used consistently and correctly, such as implants, injectables, combined oral contraceptives, some intrauterine devices (IUDs), or a vasectomized partner.

Exclusion Criteria:

1. Administration of any investigational drug or use of any investigational device within 28 days of randomization/baseline and within six half-lives of the investigational drug (whichever is longer)
2. Administration of AZLI treatment within the 28 days prior to randomization/baseline
3. Known local or systemic hypersensitivity to monobactam antibiotics
4. History of lung transplantation
5. Abnormal renal or hepatic function results at most recent test within the previous 90 days, defined as:

   * Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \> 5 times the upper limit of the normal range (ULN)
   * Serum creatinine \> 2 times ULN
6. Known portal hypertension or complications of CF hepatopathy
7. Positive urine pregnancy test (confirmed by serum pregnancy test) at screening; all women of childbearing potential were tested
8. Any female of childbearing potential who was lactating or not practicing a highly effective method of birth control as defined in the protocol
9. Any serious or active medical or psychiatric illness which, in the opinion of the investigator, would have interfered with subject treatment, assessment or compliance with the protocol

Primary outcomes:
measure: AUCave of Relative Change in FEV1 % Predicted From Baseline to Week 24
timeFrame: Baseline to Week 24
Secondary outcomes:
measure: Total Number of Systemic and/or Inhaled Antibiotic Courses for Respiratory Events
timeFrame: Baseline to Week 24
measure: AUCave of Change in CFQ-R RSS Scores From Baseline to Week 24
timeFrame: Baseline to Week 24
measure: AUCave of Relative Change From Baseline to Week 24 in FEV1
timeFrame: Baseline to Week 24
measure: AUCave of Relative Change From Baseline to Week 24 in FVC
timeFrame: Baseline to Week 24
measure: AUCave of Relative Change From Baseline to Week 24 in FEF25-75
timeFrame: Baseline to Week 24
measure: AUCave of the Change From Baseline to Week 24 in Physical Functioning Score as Assessed by the CFQ-R
timeFrame: Baseline to Week 24
measure: AUCave of the Change From Baseline to Week 24 in Weight Score as Assessed by the CFQ-R
timeFrame: Baseline to Week 24
measure: AUCave of the Change From Baseline to Week 24 in Treatment Burden Score as Assessed by the CFQ-R
timeFrame: Baseline to Week 24
measure: Change in BMI From Baseline to Week 24
timeFrame: Baseline to Week 24
measure: Change in Burkholderia Spp. CFU in Sputum From Baseline to Week 24
timeFrame: Baseline to Week 24
measure: Percentage of Days Participants Used Antibiotics
timeFrame: Baseline to Week 24
measure: Percent of Days Hospitalized
timeFrame: Baseline to Week 24
measure: Percentage of Missed School or Work Days
timeFrame: Baseline to Week 24
Other outcomes:
Locations:
city: Mobile
country: United States
state: Alabama
city: Phoenix
country: United States
state: Arizona
city: Little Rock
country: United States
state: Arkansas
city: Denver
country: United States
state: Colorado
city: Hartford
country: United States
state: Connecticut
city: Wilmington
country: United States
state: Delaware
city: Jacksonville
country: United States
state: Florida
city: Miami
country: United States
state: Florida
city: Tampa
country: United States
state: Florida
city: Glenview
country: United States
state: Illinois
city: Boston
country: United States
state: Massachusetts
city: Worcester
country: United States
state: Massachusetts
city: Detroit
country: United States
state: Michigan
city: Minneapolis
country: United States
state: Minnesota
city: St. Louis
country: United States
state: Missouri
city: Las Vegas
country: United States
state: Nevada
city: Morristown
country: United States
state: New Jersey
city: New Brunswick
country: United States
state: New Jersey
city: Albuquerque
country: United States
state: New Mexico
city: New Hyde Park
country: United States
state: New York
city: Chapel Hill
country: United States
state: North Carolina
city: Akron
country: United States
state: Ohio
city: Columbus
country: United States
state: Ohio
city: Toledo
country: United States
state: Ohio
city: Oklahoma City
country: United States
state: Oklahoma
city: Portland
country: United States
state: Oregon
city: Hershey
country: United States
state: Pennsylvania
city: Philadelphia
country: United States
state: Pennsylvania
city: Pittsburgh
country: United States
state: Pennsylvania
city: Charleston
country: United States
state: South Carolina
city: Columbia
country: United States
state: South Carolina
city: Richmond
country: United States
state: Virginia
city: Morgantown
country: United States
state: West Virginia
city: Milwaukee
country: United States
state: Wisconsin
city: Toronto
country: Canada
state: Ontario
Study officials:
affiliation: Gilead Sciences
name: Mark Bresnik, MD
role: STUDY_DIRECTOR
References: