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Sponsors and Collaborators: |
Hadassah Medical Organization European Society of Intensive Care Medicine International Sepsis Forum The Gorham Foundation |
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Information provided by: | Hadassah Medical Organization |
ClinicalTrials.gov Identifier: | NCT00147004 |
The purpose of the study is to determine whether steroids decrease 28-day mortality in patients with septic shock.
Condition | Intervention | Phase |
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Shock, Septic |
Drug: hydrocortisone sodium succinate Drug: Placebo |
Phase III |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Safety/Efficacy Study |
Official Title: | Corticosteroid Therapy of Septic Shock - Corticus. A Multi-National, Prospective, Double-Blind, Randomized, Placebo-Controlled Study |
Enrollment: | 500 |
Study Start Date: | March 2002 |
Study Completion Date: | November 2005 |
Primary Completion Date: | November 2005 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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1: Experimental
hydrocortisone sodium succinate
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Drug: hydrocortisone sodium succinate
50 mg intravenous bolus every six hours for 5 days, then tapered to 50 mg intravenously every 12 hours for days 6-8, 50 mg every 24 hours for days 9-11 and then stopped
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2: Placebo Comparator
Placebo
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Drug: Placebo |
The use of steroids in septic shock remains controversial. The purpose of this study is to determine whether hydrocortisone decreases 28-day mortality in patients with septic shock. The primary end point will be 28-day mortality in all the non-responders to ACTH (< or = 9 mcg/dl or 250 nmol/L post ACTH). Secondary endpoints will be 28 day all cause mortality in the total group and in responders, ICU and hospital mortality, one year mortality, organ system failure reversal especially shock, and duration of ICU and total hospitalisation.
In a double-blinded fashion (randomized on a 1:1 basis), patients receive 50 mg intravenously every 6 hours for 5 days. After 5 days, treatment will be tapered with 50 mg given intravenously every 12 hours for days 6-8, then 50 mg every 24 hours for days 9-11, and then stopped.
All concomitant treatments, including antibiotics, fluids, vasopressors and ancillary therapies will be given at the discretion of the primary care physician. Evidence-based guidelines for the management of severe sepsis and septic shock by the International Sepsis Forum (Intensive Care Med 2001;27:S124-S134) are encouraged to be followed.
All serious adverse events (SAE) which occur between days 0 and 28, which are unexpected and/or considered possibly or probably related to the study medication, must be documented and reported within 24 hours to the Safety and Efficacy Monitoring Committee. Non-serious adverse events will be listed on the case report form if they are unexpected and believed to be related to the study drug during days 0 to 14.
Specific adverse events which will be monitored closely because of their relationship to corticosteroids and shock are:
In addition, substudies will include harmonization of cortisol by comparing cortisol levels measured in local laboratories and a central laboratory, immune and neuro-endocrine interactions, neuromuscular weakness and cytokines.
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Clinical evidence of infection within the previous 72 hours (may be present longer than 72 hours) (a, b, c, or d - only 1 required)
Evidence of a systemic response to infection as defined by the presence of two or more of the following signs within the previous 24 hours. These signs may be present longer than 72 hours.
A. A systolic blood pressure < 90 mmHg or a decrease in SBP of more than 50 mmHg from baseline in previous hypertensive patients (for at least one hour) despite adequate fluid replacement OR need for vasopressors for at least one hour (infusion of dopamine ≥ 5 mcg/kg/min or any dose of adrenaline, noradrenaline, phenylephrine or vasopressin) to maintain a SBP ≥ 90 mmHg;
B. Hypoperfusion or organ dysfunction which is not the result of underlying diseases or drugs, but is attributable to sepsis, including one of the following:
4. Informed Consent
5. Cortisol level at baseline and 60 minutes after 0.25 mg cosyntropin
Exclusion Criteria:
Study Chair: | Charles L Sprung, MD | Hadasah Medical Organization |
Study Director: | Djillali Annane, MD | Hopital Raymond Poincare |
Study Director: | Josef Briegel, MD | Ludwig-Maximilian-Universitaet Muenchen |
Study Director: | Didier Keh, MD | Charite Campus Virchow-Klinikum |
Study Director: | Rui Moreno, MD | Hospital de St. António dos Capuchos |
Study Director: | Didier Pittet, MD | Geneva University Hospitals |
Study Director: | Mervyn Singer, MD | University College, London |
Responsible Party: | Hadassah Medical Organization ( Prof. Charles Sprung ) |
Study ID Numbers: | QLK2-CT-2000-00589, EC- QLK2-CT-2000-00589 |
Study First Received: | September 6, 2005 |
Last Updated: | April 23, 2008 |
ClinicalTrials.gov Identifier: | NCT00147004 |
Health Authority: | Austria: Federal Ministry for Health and Women; Belgium: Directorate general for the protection of Public health: Medicines; France: Afssaps - French Health Products Safety Agency; Germany: Federal Institute for Drugs and Medical Devices; Israel: Israeli Health Ministry Pharmaceutical Administration; Italy: National Monitoring Centre for Clinical Trials - Ministry of Health; Netherlands: The Central Committee on Research Involving Human Subjects (CCMO); Portugal: National Pharmacy and Medicines Institute; Spain: Spanish Agency of Medicines; United Kingdom: Medicines and Healthcare Products Regulatory Agency |
Septic shock Steroids Hydrocortisone |
Mortality Reversal of shock Adrenal insufficiency |
Systemic Inflammatory Response Syndrome Sepsis Adrenal Insufficiency Hydrocortisone Cortisol succinate Shock |
Shock, Septic Hydrocortisone acetate Epinephrine Hypoadrenalism Adrenal gland hypofunction Inflammation |
Anti-Inflammatory Agents Pathologic Processes Therapeutic Uses Infection Pharmacologic Actions |