Scandinavian Cystic Fibrosis Azithromycin Study

NCT ID: NCT00411736

Last Updated: 2014-03-14

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 45 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2008-05-31
• Study Completion Date: 2014-03-31

Brief Summary

In patients with Cystic Fibrosis, recurrent airway infection caused by Pseudomonas aeruginosa ultimately leads to chronic airway infection. The purpose of this study is to determine whether supplementary low-dose azithromycin to standard inhaled colistin and oral ciprofloxacin in the treatment of intermittent pseudomonas airway-infection can postpone the next episode of intermittent pseudomonas airway-infection and prevent development of chronic airway-infection.

Detailed Description

Cystic Fibrosis is the most common genetic, inherited, deadly disease in caucasians. The disease is characterized by recurrent airway-infections caused by Pseudomonas aeruginosa, ultimately leading to chronic airway-infection, which is the main cause of the increased morbidity and mortality seen in this disease.

P. aeruginosa has the ability to change to mucoid phenotype - producing alginate and growing in biofilm, which protects the microorganisms from antibiotics and leukocytes. The change in phenotype is seen as chronic infection is established and eradication becomes impossible. Treatment with long-term, low-dose azithromycin in chronically infected CF-patients can improve the clinical condition of the patients. The exact mechanism for this is not known, but is possibly a combination of anti-inflammatory effects and the ability of azithromycin to inhibit alginate-production. Inhibition of biofilm-formation leaves the bacteria more susceptible to the actions of antibiotics and leukocytes.

Prior to establishment of chronic infection, recurrent, intermittent colonization of the airways with non-mucoid P. aeruginosa is seen. Intermittent infections can be treated using a combination of antibiotics, thereby postponing the next episode of airway-infection with P. aeruginosa.

The purpose of this study is to clarify wether supplementary azithromycin in the treatment of intermittent pseudomonas-infection in CF-patients can lead to further postponement of next pseudomonas-colonization and maybe prevent development of chronic infection. This is done in a randomised, double-blinded, placebo-controlled multicentre study.

2 treatments will be compared:

1. Inhaled colistin and oral ciprofloxacin in combination with oral azithromycin

2. Inhaled colistin and oral ciprofloxacin in combination with oral placebo.

The treatment will be given for 3 weeks, and the primary end-point is the time until next colonization with P. aeruginosa in the airways of the patients, comparing the 2 treatment-groups.

Conditions

Cystic Fibrosis

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

A

Stratification group: Age under 8 years, no CF siblings at home.

Group Type: EXPERIMENTAL

Study medication, azithromycin or placebo

Intervention Type: DRUG

Granulate for syrup in the group under 8 years, 40 mg/ml. Dose: 5 mg/kg/day in one daily dose.

B

Stratification group: Age \>/= 8 years, no CF siblings at home.

Group Type: EXPERIMENTAL

Azithromycin or placebo tablets

Intervention Type: DRUG

Tablets of 250 mg, azithromycin or placebo. Dosage: 1 tablet every other day for participants with a weight less than 40 kg´s. 1 tablet every day for participants weighing 40 kg´s or more.

C

Stratification group: Age \>/= 8 years, CF siblings at home.

Group Type: EXPERIMENTAL

Azithromycin or placebo tablets

Intervention Type: DRUG

Tablets of 250 mg, azithromycin or placebo. Dosage: 1 tablet every other day for participants with a weight less than 40 kg´s. 1 tablet every day for participants weighing 40 kg´s or more.

Interventions

Study medication, azithromycin or placebo

Granulate for syrup in the group under 8 years, 40 mg/ml. Dose: 5 mg/kg/day in one daily dose.

Intervention Type: DRUG

Azithromycin or placebo tablets

Tablets of 250 mg, azithromycin or placebo. Dosage: 1 tablet every other day for participants with a weight less than 40 kg´s. 1 tablet every day for participants weighing 40 kg´s or more.

Intervention Type: DRUG

Other Intervention Names

Projectnumber HSA06-20/1; Project number HSA06-20/1

Eligibility Criteria

Inclusion Criteria

• Diagnosis of Cystic Fibrosis based on genotype and/or positive sweat-test
• Written informed consent based on written and spoken information
• No chronic airway-infections with Gram-negative bacteria
• Fertile, sexually active women must use contraception (p-pills, IUD or other methods with a similar Pearl-index) when participating in the study

Exclusion Criteria

• P. aeruginosa in airway secretions obtained less than 3 months prior to inclusion
• Chronic infection of the airways caused by Gram-negative bacteria (Burkholderia species, Achromobacter xylosoxidans, Pandorea apista or Stenotrophomonas maltophilia)
• Chronic infection of the airways caused by P. aeruginosa (chronic infection is defined by continuing growth of the microorganism for 6 months and/or an increase in specific, precipitating antibodies to a level of at least 2)
• Previous infection with a strain of P. aeruginosa resistant to ciprofloxacin or colistin
• Previous participation in a pseudomonas-vaccination-study
• Patients younger than 1 year
• Pregnant or lactating women, or sexually active women unwilling to use safe contraception (p-pills, IUD or method with similar Pearl-index) when participating in the study
• Severe insufficiency of the liver or kidneys as judged by the local investigator

• Minimum Eligible Age: 1 Year
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Cystic Fibrosis Foundation

OTHER

Sponsor Role: collaborator

Rigshospitalet, Denmark

OTHER

Sponsor Role: lead

Responsible Party

Christine Hansen

Medical doctor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Niels Hoiby, Prof.M.D.DSc

Role: PRINCIPAL_INVESTIGATOR

Department of Clinical Microbiology, Rigshospitalet

Locations

CF-centre Skejby, Skejby Sygehus, Brendstrupgaardsvej 100

Aarhus N, , Denmark

CF-centre Copenhagen, Rigshospitalet, Blegdamsvej 9

Copenhagen, , Denmark

CF-centre Bergen, Haukeland Universitetssykehus

Bergen, , Norway

CF-centre Oslo, Ullevaal Universitetssykehus

Oslo, , Norway

CF-centre Göteborg, Drottning Silvias barn- och ungdomssjukhus

Gothenburg, , Sweden

CF-centre Lund, Universitetssjukhuset i Lund

Lund, , Sweden

CF-centre Stockholm, Karolinska Universitetssjukhuset, Huddinge

Stockholm, , Sweden

CF-centre Uppsala, Akademiska Barnsjukhuset

Uppsala, , Sweden

Countries

Denmark; Norway; Sweden

References

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Reference Type: BACKGROUND

PMID: 11106223 (View on PubMed)

Hoiby N, Frederiksen B, Pressler T. Eradication of early Pseudomonas aeruginosa infection. J Cyst Fibros. 2005 Aug;4 Suppl 2:49-54. doi: 10.1016/j.jcf.2005.05.018.

Reference Type: BACKGROUND

PMID: 16023416 (View on PubMed)

Valerius NH, Koch C, Hoiby N. Prevention of chronic Pseudomonas aeruginosa colonisation in cystic fibrosis by early treatment. Lancet. 1991 Sep 21;338(8769):725-6. doi: 10.1016/0140-6736(91)91446-2.

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Reference Type: BACKGROUND

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Reference Type: BACKGROUND

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Reference Type: BACKGROUND

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Reference Type: BACKGROUND

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Reference Type: BACKGROUND

PMID: 14519709 (View on PubMed)

Wolter J, Seeney S, Bell S, Bowler S, Masel P, McCormack J. Effect of long term treatment with azithromycin on disease parameters in cystic fibrosis: a randomised trial. Thorax. 2002 Mar;57(3):212-6. doi: 10.1136/thorax.57.3.212.

Reference Type: BACKGROUND

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Kobayashi H. Biofilm disease: its clinical manifestation and therapeutic possibilities of macrolides. Am J Med. 1995 Dec 29;99(6A):26S-30S. doi: 10.1016/s0002-9343(99)80282-4.

Reference Type: BACKGROUND

PMID: 8585531 (View on PubMed)

Other Identifiers

AZI/SCAND/01

Identifier Type: -

Identifier Source: org_study_id