Trial Outcomes & Findings for Long Term Administration of Inhaled Mannitol in Cystic Fibrosis (NCT NCT00630812)

NCT ID: NCT00630812

Last Updated: 2020-10-09

Results Overview

Change from baseline in forced expiratory volume at one second (FEV1) averaged over 26 weeks (measured at 6,14 and 26 weeks) The mean absolute change from baseline FEV1 (mL) over 26 weeks (measured at week 6, 14 and 26) will be compared between the two treatment groups with a REML (restricted maximum likelihood) based repeated measures approach.Least square means presented are for the average change over the 6, 14, and 26 week visits.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

318 participants

Primary outcome timeframe

26 weeks

Results posted on

2020-10-09

Participant Flow

Patients underwent a mannitol tolerance test (MTT) to gauge tolerance to a test dose of mannitol. 318 patients were then randomised - only 305 of the randomised patients went on to receive a dose of study medication. Patients who did not start medication (13) were not included in the modified ITT population (mITT)

Participant milestones

Participant milestones
Measure
Mannitol 400mg
active treatment inhaled mannitol: 400 mg twice a day (BD) for 26 + 26 weeks
Control
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Randomisation to First Dose
STARTED
192
126
Randomisation to First Dose
COMPLETED
184
121
Randomisation to First Dose
NOT COMPLETED
8
5
Double Blind Treatment Period
STARTED
184
121
Double Blind Treatment Period
COMPLETED
153
107
Double Blind Treatment Period
NOT COMPLETED
31
14

Reasons for withdrawal

Reasons for withdrawal
Measure
Mannitol 400mg
active treatment inhaled mannitol: 400 mg twice a day (BD) for 26 + 26 weeks
Control
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Randomisation to First Dose
Adverse Event
1
1
Randomisation to First Dose
Withdrawal by Subject
2
3
Randomisation to First Dose
Lost to Follow-up
1
0
Randomisation to First Dose
Protocol Violation
4
1
Double Blind Treatment Period
Adverse Event
13
5
Double Blind Treatment Period
Lost to Follow-up
1
0
Double Blind Treatment Period
Physician Decision
2
1
Double Blind Treatment Period
Protocol Violation
1
0
Double Blind Treatment Period
Withdrawal by Subject
13
7
Double Blind Treatment Period
Wanted to take drug in non-protocol way
1
0
Double Blind Treatment Period
Non-compliance
0
1

Baseline Characteristics

Long Term Administration of Inhaled Mannitol in Cystic Fibrosis

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Mannitol 400mg
n=184 Participants
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=121 Participants
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Total
n=305 Participants
Total of all reporting groups
Hospitalisations in year prior to study participation
3 hospitalisations
4 Participants
n=5 Participants
4 Participants
n=7 Participants
8 Participants
n=5 Participants
Hospitalisations in year prior to study participation
>3 hospitalisations
4 Participants
n=5 Participants
2 Participants
n=7 Participants
6 Participants
n=5 Participants
Age, Categorical
<=18 years
91 Participants
n=5 Participants
63 Participants
n=7 Participants
154 Participants
n=5 Participants
Age, Categorical
Between 18 and 65 years
93 Participants
n=5 Participants
58 Participants
n=7 Participants
151 Participants
n=5 Participants
Age, Categorical
>=65 years
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Sex: Female, Male
Female
90 Participants
n=5 Participants
58 Participants
n=7 Participants
148 Participants
n=5 Participants
Sex: Female, Male
Male
94 Participants
n=5 Participants
63 Participants
n=7 Participants
157 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Asian
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
2 Participants
n=5 Participants
2 Participants
n=7 Participants
4 Participants
n=5 Participants
Race (NIH/OMB)
White
182 Participants
n=5 Participants
119 Participants
n=7 Participants
301 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Region of Enrollment
Canada
11 participants
n=5 Participants
9 participants
n=7 Participants
20 participants
n=5 Participants
Region of Enrollment
Argentina
48 participants
n=5 Participants
32 participants
n=7 Participants
80 participants
n=5 Participants
Region of Enrollment
Netherlands
2 participants
n=5 Participants
2 participants
n=7 Participants
4 participants
n=5 Participants
Region of Enrollment
Belgium
10 participants
n=5 Participants
6 participants
n=7 Participants
16 participants
n=5 Participants
Region of Enrollment
United States
85 participants
n=5 Participants
54 participants
n=7 Participants
139 participants
n=5 Participants
Region of Enrollment
France
14 participants
n=5 Participants
9 participants
n=7 Participants
23 participants
n=5 Participants
Region of Enrollment
Germany
14 participants
n=5 Participants
9 participants
n=7 Participants
23 participants
n=5 Participants
Hospitalisations in year prior to study participation
0 hospitalisations
114 Participants
n=5 Participants
76 Participants
n=7 Participants
190 Participants
n=5 Participants
Hospitalisations in year prior to study participation
1 hospitalisation
41 Participants
n=5 Participants
30 Participants
n=7 Participants
71 Participants
n=5 Participants
Hospitalisations in year prior to study participation
2 hospitalisations
21 Participants
n=5 Participants
9 Participants
n=7 Participants
30 Participants
n=5 Participants
Pulmonary exacerbations in year prior to study participation
0 exacerbations
104 Participants
n=5 Participants
74 Participants
n=7 Participants
178 Participants
n=5 Participants
Pulmonary exacerbations in year prior to study participation
1 exacerbation
45 Participants
n=5 Participants
28 Participants
n=7 Participants
73 Participants
n=5 Participants
Pulmonary exacerbations in year prior to study participation
2 exacerbations
26 Participants
n=5 Participants
14 Participants
n=7 Participants
40 Participants
n=5 Participants
Pulmonary exacerbations in year prior to study participation
3 exacerbations
4 Participants
n=5 Participants
3 Participants
n=7 Participants
7 Participants
n=5 Participants
Pulmonary exacerbations in year prior to study participation
>3 exacerbations
5 Participants
n=5 Participants
2 Participants
n=7 Participants
7 Participants
n=5 Participants
CF mutation
Both deltaF508
77 Participants
n=5 Participants
45 Participants
n=7 Participants
122 Participants
n=5 Participants
CF mutation
One deltaF508
57 Participants
n=5 Participants
52 Participants
n=7 Participants
109 Participants
n=5 Participants
CF mutation
At least one other known mutation
15 Participants
n=5 Participants
5 Participants
n=7 Participants
20 Participants
n=5 Participants
CF mutation
Both unknown
35 Participants
n=5 Participants
19 Participants
n=7 Participants
54 Participants
n=5 Participants

PRIMARY outcome

Timeframe: 26 weeks

Population: mITT (modified intent to treat) - patients randomised and treated with at least one dose of study medication)

Change from baseline in forced expiratory volume at one second (FEV1) averaged over 26 weeks (measured at 6,14 and 26 weeks) The mean absolute change from baseline FEV1 (mL) over 26 weeks (measured at week 6, 14 and 26) will be compared between the two treatment groups with a REML (restricted maximum likelihood) based repeated measures approach.Least square means presented are for the average change over the 6, 14, and 26 week visits.

Outcome measures

Outcome measures
Measure
Mannitol 400mg
n=184 Participants
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=121 Participants
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Change in Absolute FEV1 From Baseline Over 26 Weeks
106.53 mL
Interval 62.43 to 150.62
52.38 mL
Interval 2.09 to 102.68

SECONDARY outcome

Timeframe: 26 weeks

Population: Note these are subset of dornase users - effect in dornase users was estimated using a model fitted using data from all patients

In the subset of dornase users, the mean absolute change from baseline FEV1 (mL) averaged over 26 weeks (measured at week 6, 14 and 26) will be compared between the two treatment groups with a REML (restricted maximum likelihood) based repeated measures approach. Least square means presented are for the average change over the 6, 14, and 26 week visits. Change from baseline over 26 weeks (measured at 6,14, 26 weeks) in subset of dornase users

Outcome measures

Outcome measures
Measure
Mannitol 400mg
n=137 Participants
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=92 Participants
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Change in FEV1 From Baseline Over 26 Weeks - Dornase Users
78.60 mL
Interval 27.64 to 129.56
35.11 mL
Interval -20.99 to 91.21

SECONDARY outcome

Timeframe: 26 weeks

Population: mITT (randomised and treated)

Exacerbations treated with IV antibiotics and with at least 4 signs and symptoms according to Fuchs criteria (1994). Summary table presents the number with 0, 1,2 and 3 PDPEs during the 26 week treatment period.

Outcome measures

Outcome measures
Measure
Mannitol 400mg
n=184 Participants
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=121 Participants
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Rate of Protocol Defined Pulmonary Exacerbations (PDPE)
With 1 PDPE
21 Participants
18 Participants
Rate of Protocol Defined Pulmonary Exacerbations (PDPE)
With 2 PDPE
6 Participants
4 Participants
Rate of Protocol Defined Pulmonary Exacerbations (PDPE)
With 3 PDPE
1 Participants
1 Participants
Rate of Protocol Defined Pulmonary Exacerbations (PDPE)
No PDPEs
156 Participants
98 Participants

SECONDARY outcome

Timeframe: 26 weeks

The number of hospitalisations is summarised and then the rate per person is analysed.

Outcome measures

Outcome measures
Measure
Mannitol 400mg
n=184 Participants
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=121 Participants
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Hospitalisations Associated With Protocol Defined Pulmonary Exacerbations (PDPEs)
0 hospitalisations
162 Participants
102 Participants
Hospitalisations Associated With Protocol Defined Pulmonary Exacerbations (PDPEs)
1 hospitalisation
18 Participants
14 Participants
Hospitalisations Associated With Protocol Defined Pulmonary Exacerbations (PDPEs)
2 hospitalisations
3 Participants
5 Participants
Hospitalisations Associated With Protocol Defined Pulmonary Exacerbations (PDPEs)
3 hospitalisations
1 Participants
0 Participants

SECONDARY outcome

Timeframe: 26 weeks

Number of courses per person in the 26 week period is summarised and then the rate per person analysed.

Outcome measures

Outcome measures
Measure
Mannitol 400mg
n=184 Participants
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=121 Participants
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Antibiotic Use Associated With PDPEs
0 courses
156 Participants
98 Participants
Antibiotic Use Associated With PDPEs
1 course
22 Participants
19 Participants
Antibiotic Use Associated With PDPEs
2 courses
5 Participants
2 Participants
Antibiotic Use Associated With PDPEs
3 courses
1 Participants
2 Participants

SECONDARY outcome

Timeframe: 26 weeks

Population: Baseline Observation carried forward (BOCF) implemented for those with missing values at visit 4

Change from baseline at 26 weeks in FEV1 percent predicted with BOCF for those with missing values at week 26

Outcome measures

Outcome measures
Measure
Mannitol 400mg
n=184 Participants
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=121 Participants
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Absolute Change in FEV1 Percent Predicted at 26 Weeks
3.14 % of predicted
Interval 1.49 to 4.78
0.72 % of predicted
Interval -1.18 to 2.62

SECONDARY outcome

Timeframe: 26 weeks

Change from baseline in forced vital capacity (FVC) across 26 weeks (measured at 6,14 and 26 weeks)

Outcome measures

Outcome measures
Measure
Mannitol 400mg
n=184 Participants
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=121 Participants
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Change in FVC (mL) Across 26 Weeks
136.33 mL
Interval 88.54 to 184.11
64.98 mL
Interval 10.58 to 119.37

SECONDARY outcome

Timeframe: 26 weeks

Change from baseline in forced expiratory flow at 25-75% of forced vital capacity (FEF25-75) (mL/s) averaged over 26 weeks (measured at 6,14 and 26 weeks) The mean absolute change from baseline over 26 weeks (measured at week 6, 14 and 26) was compared between the two treatment groups with a REML (restricted maximum likelihood) based repeated measures approach. Least square means presented are for the average change over the 6, 14, and 26 week visits.

Outcome measures

Outcome measures
Measure
Mannitol 400mg
n=184 Participants
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=121 Participants
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Change From Baseline FEF25-75 (mL/s) Over 26 Weeks
84.65 mL/s
Interval 6.66 to 162.63
50.31 mL/s
Interval -38.24 to 138.86

SECONDARY outcome

Timeframe: up to 30 mins after first dose of trial treatment

Population: Patients randomised and treated who have sputum weight results available.

Sputum was collected during and for 30 minutes following the administration of the first dose of study treatment.

Outcome measures

Outcome measures
Measure
Mannitol 400mg
n=180 Participants
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=114 Participants
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
Sputum Weight at Baseline in Response to First Dose of Treatment
4.9 g
Standard Deviation 6.18
3.5 g
Standard Deviation 4.40

Adverse Events

Mannitol 400mg

Serious events: 31 serious events
Other events: 165 other events
Deaths: 0 deaths

Control

Serious events: 30 serious events
Other events: 106 other events
Deaths: 1 deaths

Serious adverse events

Serious adverse events
Measure
Mannitol 400mg
n=184 participants at risk
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=121 participants at risk
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
General disorders
Condition Aggravated
14.7%
27/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
16.5%
20/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Respiratory, thoracic and mediastinal disorders
Haemoptysis
1.1%
2/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.00%
0/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Respiratory, thoracic and mediastinal disorders
Asthmatic Crisis
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Respiratory, thoracic and mediastinal disorders
Pleuritic Pain
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Respiratory, thoracic and mediastinal disorders
Pneumothorax
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Infections and infestations
Bronchopneumonia
0.54%
1/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.00%
0/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Infections and infestations
Lower respiratory tract infection
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
2.5%
3/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Infections and infestations
Acute tonsillitis
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Infections and infestations
Appendicitis
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Infections and infestations
Pneumonia
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Infections and infestations
Pneumonia bacterial
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Infections and infestations
Pyelonephritis
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Gastrointestinal disorders
Pancreatitis
0.54%
1/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.00%
0/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Gastrointestinal disorders
Distal intestinal obstruction syndrome
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Gastrointestinal disorders
Intestinal obstruction
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Gastrointestinal disorders
Pancreatis acute
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Gastrointestinal disorders
Vomiting
0.00%
0/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.83%
1/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Hepatobiliary disorders
Cholecystitis
0.54%
1/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.00%
0/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Metabolism and nutrition disorders
Diabetes mellitus
0.54%
1/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
0.00%
0/121 • 26 weeks
Safety information reported is for the 26 week double blind period only

Other adverse events

Other adverse events
Measure
Mannitol 400mg
n=184 participants at risk
active treatment inhaled mannitol: 400 mg BD for 26 + 26 weeks
Control
n=121 participants at risk
Control (40mg inhaled mannitol) : BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase
General disorders
Condition Aggravated
31.0%
57/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
33.9%
41/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Respiratory, thoracic and mediastinal disorders
Cough
15.2%
28/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
13.2%
16/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Nervous system disorders
Headache
14.1%
26/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
18.2%
22/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Respiratory, thoracic and mediastinal disorders
Pharyngolaryngeal pain
10.3%
19/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
10.7%
13/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
General disorders
Pyrexia
9.2%
17/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
10.7%
13/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Gastrointestinal disorders
Abdominal pain
7.6%
14/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
6.6%
8/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Respiratory, thoracic and mediastinal disorders
Haemoptysis
6.0%
11/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
2.5%
3/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Infections and infestations
Nasopharyngitis
6.0%
11/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
5.0%
6/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Infections and infestations
Upper respiratory tract infection
5.4%
10/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
9.1%
11/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Infections and infestations
Sinusitis
4.3%
8/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
5.8%
7/121 • 26 weeks
Safety information reported is for the 26 week double blind period only
Gastrointestinal disorders
Abdominal pain upper
3.3%
6/184 • 26 weeks
Safety information reported is for the 26 week double blind period only
5.8%
7/121 • 26 weeks
Safety information reported is for the 26 week double blind period only

Additional Information

Brett Charlton

Pharmaxis

Phone: 02 94547210

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place