Macrolide Therapy to Improve Forced Expiratory Volume in 1 Second in Adults With Sickle Cell Disease

NCT ID: NCT02960503

Last Updated: 2018-10-02

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: PHASE1/PHASE2
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-09-30
• Study Completion Date: 2018-10-31

Brief Summary

Sickle cell anemia (SCA) is a life-threatening, monogenic disorder associated with early death when compared to individuals without SCA. Pulmonary complications, namely acute chest syndrome, obstructive lung disease and pulmonary hypertension, are the most common causes of death in patients with SCA. Recent studies suggest that lung specific inflammation is a hallmark of SCA and underlies pulmonary pathology. To date, no therapy has been shown to improve the pulmonary complications of SCA. Macrolides have pleomorphic effects in the lung with improvement in pulmonary function, symptoms and inflammatory markers demonstrated in several inflammatory pulmonary conditions such as cystic fibrosis, asthma, COPD and post-transplant bronchiolitis obliterans. Investigators hypothesize that low dose macrolide therapy is well tolerated and can improve pulmonary function and symptoms in patients with SCA. The objective of this project is to assess the feasibility of macrolides to attenuate or reverse the decrease in %predicted FEV1 in adults with SCA in a single-site, randomized, placebo-controlled feasibility trial.

Detailed Description

Specific aim 1: To determine acceptability of a clinical trial in which participants are randomly allocated to either a placebo or azithromycin 500 mg 3 days a week for 6 months for adults with SCD who have FEV1<80%.

To assess acceptability of this intervention, investigators will measurement recruitment rate, retention and adherence to the study medication. Recruitment will be assessed by proportion of eligible participants that agree to be randomized. Retention will be measured as proportion randomly allocated who complete the trial. Dropout due to toxicity will be categorized using a questionnaire. Medication adherence will be assessed using the previously validated 8 item modified Morisky medication adherence scale (MMAS-8), where responses are categorized: high adherence (8 points), average adherence (6-7 points), and poor adherence (0-5 points). If recruitment rate is < 60%, the retention rate < 80%, or average adherence rate is ≤5 points, the original protocol will be examined and alternative strategies to enhance recruitment, retention, and adherence will be considered.

Specific aim 2: To evaluate the effect of 6 months of low dose azithromycin therapy on FEV1 and respiratory symptoms in patients with SCA. Baseline FEV1 testing with a portable, in-office spirometer will be completed at study enrollment and at the end of the study period (6 months). The previously validated American Thoracic Society (ATS-DLD-78 for adults) questionnaire will also be used to evaluate respiratory symptoms at baseline and end of the study. Under a separate protocol, investigators will calculate the coefficient of variation for FEV1% predicted in adults with sickle cell disease in order to define the within-subject variability for tests of respiratory function in this specific population, which has not been previously described within the medical literature. Calculation of the coefficient of variation for FEV1 % predicted will be essential for the interpretation of clinically and statistically meaningful changes in spirometry for participants who are treated with azithromycin to improve their baseline pulmonary function when compared to controls.

Conditions

Sickle Cell Disease

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: OTHER
• Blinding Strategy: QUADRUPLE

Study Groups

Treatment arm (azithromycin)

Treatment arm: azithromycin 500 mg three times a week for 6 months

Group Type: ACTIVE_COMPARATOR

Azithromycin

Intervention Type: DRUG

Study participants will be randomized to the treatment arm (azithromycin 500 mg three times a week for 6 months).

Placebo arm

Control arm: placebo three times a week for 6 months

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: OTHER

Study participants will be randomized to the control arm (placebo three times a week for 6 months).

Interventions

Azithromycin

Study participants will be randomized to the treatment arm (azithromycin 500 mg three times a week for 6 months).

Intervention Type: DRUG

Placebo

Study participants will be randomized to the control arm (placebo three times a week for 6 months).

Intervention Type: OTHER

Other Intervention Names

Zithromax, zmax, z-pack

Eligibility Criteria

Inclusion Criteria

1. Established diagnosis of sickle cell disease (HbSS, HbSC, HbS/β+, HbS/β0)

2. Age between 18-50 years

3. FEV1 < 80% predicted

4. Willingness to make return visits and availability by telephone for the duration of the study.

Exclusion Criteria

1. Acute respiratory symptoms

2. FEV1>80%

3. Inability to swallow pills

4. Hypersensitivity to macrolides.

5. History of cardiac arrhythmias

6. Prolonged QTc interval (>500 ms) at on baseline EKG

7. Baseline impairment of hearing by pure tone audiometry defined as patients with age-adjusted hearing thresholds >95th percentile at any one frequency of 500, 1000, 2000 and 4000 Hz.

8. The presence of a diagnosis other than SCD that results in the patient being medically unstable, or having a predicted life expectancy less than 1 year.

9. Special patient groups: prisoners, pregnant women, institutionalized patients

10. Women who are at risk of becoming pregnant during the study, and who refuse to use an acceptable means of birth control (hormonal based oral, intrauterine device or barrier contraception) for the duration of the study.

11. Patients taking tacrolimus, pimozide, disopyramide, cyclosporine, nelfinavir, bromocriptine, or hexobarbital.

12. Patients taking any medications that prolong QTc interval.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Vanderbilt University

OTHER

Sponsor Role: lead

Responsible Party

Michael DeBaun

Professor of Pediatrics and Medicine, Vice Chair for Clinical and Translational Research, J.C. Peterson Chair in Pediatric Pulmonology, Director, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Michael R. DeBaun, M.D., M.P.H.

Role: PRINCIPAL_INVESTIGATOR

Vanderbilt University Medical Center

Locations

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Countries

United States

References

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Reference Type: BACKGROUND

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Other Identifiers

161332

Identifier Type: -

Identifier Source: org_study_id