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Sponsors and Collaborators: |
Erasmus Medical Center Gilead Sciences Nexstar Pharmaceuticals |
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Information provided by: | Erasmus Medical Center |
ClinicalTrials.gov Identifier: | NCT00263315 |
A Phase II/III randomized double-blind study comparing the safety and the efficacy of a weekly administration of 25 mg nebulized AmBisome with nebulized placebo solution to prevent invasive pulmonary aspergillosis in neutropenic hemato-oncologic patients.
Condition | Intervention | Phase |
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Aspergillosis |
Drug: nebulised liposomal amphotericin B |
Phase II Phase III |
Study Type: | Interventional |
Study Design: | Prevention, Randomized, Double-Blind, Placebo Control, Parallel Assignment, Safety/Efficacy Study |
Official Title: | Nebulized Liposomal Amphotericin B (Ambisome) Versus Nebulized Placebo for the Prophylaxis of Invasive Pulmonary Aspergillosis in Haematological Patients With Prolonged Neutropenia. A Randomized Clinical Trial. |
Estimated Enrollment: | 320 |
Study Start Date: | January 2000 |
Estimated Study Completion Date: | May 2006 |
The morbidity, mortality and costs of invasive pulmonary aspergillosis (IPA) in neutropenic patients are high. An effective intervention to prevent IPA would therefore be welcome. The incidence of IPA in neutropenic hematology patients in our institution was recently estimated to be 5-10%. Currently, only HEPA filtration is routinely used for the prevention of IPA. In 1988, Schmitt et al. showed a significant delayed mortality in rat model of IPA when rats were treated with aerosolized conventional amphotericin-B (amB) two days before infection (1). Conventional amB may interfere with surfactant function in the lungs. In contrast, liposomal amphotericin-B contains phospholipids that are structurally related to surfactant and inhibits natural surfactant function only slightly. Furthermore, in rats, mean concentrations of AmB in lungs were 3.7 times higher at day one and almost 6 times higher at day seven after a single dose treatment with aerosolized liposomal amB when compared with conventional AmB (2). Only one non-placebo controlled randomized clinical trial evaluated the prophylactic use of inhalation therapy with conventional amB for the prevention of IPA and a non-significant 43% reduction was observed (3). We postulate that the weekly inhalation of liposomal AmB in neutropenic hematology patients can prevent IPA.
In this randomised placebo controlled clinical trial we compare the safety and efficacy of the administration of nebulized liposomal AmB (2x/week) with placebo for the prevention of IPA in haematological patients with an expected duration of neutropenia of >10d. To demonstrate a reduction in incidence of invasive pulmonary aspergillosis from 7% to 1%, a total of 170 neutropenic episodes in each arm will be included (power 80%, two-tailed alfa=0.05). The primary efficacy endpoint is the cumulative percentage of patients developing a proven or probable IPA. Per protocol serum galactomannan levels are monitored 2x/week and a HR-CT of the lungs will be performed for unexplained fever (>5d) unresponsive to broad-spectrum antibiotic therapy. EORTC/MSG criteria are used for diagnosis of IPA. The primary safety endpoint is a premature discontinuation of the study drug for >1week due to intolerance.
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
Netherlands | |
Erasmus MC locatie Daniel den Hoed | |
Rotterdam, Netherlands | |
Erasmus MC centrumlocatie | |
rotterdam, Netherlands |
Principal Investigator: | Bart JA Rijnders, MD, PhD | Erasmus MC |
Principal Investigator: | Siem de Marie, MD, PhD | Erasmus MC |
Principal Investigator: | Jan J Cornelissen, MD, PhD | Erasmus MC |
Principal Investigator: | Lennert Slobbe, MD | Erasmus MC |
Principal Investigator: | A Vulto, PhD | Erasmus MC |
Principal Investigator: | M J Becker, PhD | Erasmus MC |
Study ID Numbers: | METC 191.137/2000/088 |
Study First Received: | December 7, 2005 |
Last Updated: | August 17, 2006 |
ClinicalTrials.gov Identifier: | NCT00263315 |
Health Authority: | Netherlands: The Central Committee on Research Involving Human Subjects (CCMO) |
aspergillosis mycosis neutropenia primary prevention |
hematologic diseases amphotericin B AmBisome liposomal amphotericin B |
Abelcet Amphotericin B Neutropenia Mycoses Clotrimazole |
Hematologic Diseases Miconazole Tioconazole Aspergillosis Liposomal amphotericin B |
Anti-Bacterial Agents Anti-Infective Agents Antiparasitic Agents Antiprotozoal Agents Antifungal Agents |
Therapeutic Uses Antibiotics, Antifungal Amebicides Pharmacologic Actions |