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Infant Study of Inhaled Saline in Cystic Fibrosis (ISIS)

This study has been completed.
Sponsor:
Collaborators:
Cystic Fibrosis Foundation
Information provided by (Responsible Party):
CF Therapeutics Development Network Coordinating Center
ClinicalTrials.gov Identifier:
NCT00709280
First received: July 1, 2008
Last updated: February 11, 2013
Last verified: February 2013
  Purpose

The purpose of this study is to assess whether 7% hypertonic saline (HS) is an effective and safe therapy in infants and young children with CF.


Condition Intervention
Cystic Fibrosis
Drug: 7% Hypertonic Saline (HS)
Drug: 0.9% Isotonic Saline (IS)

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Infant Study of Inhaled Saline in Cystic Fibrosis

Resource links provided by NLM:


Further study details as provided by CF Therapeutics Development Network Coordinating Center:

Primary Outcome Measures:
  • The rate of protocol-defined pulmonary exacerbations requiring treatment with oral, inhaled or intravenous antibiotics between subjects randomized to HS and IS [ Time Frame: during the 48 week treatment period ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Symptoms by parent home questionnaire administered weekly [ Time Frame: during the 48 week treatment period ] [ Designated as safety issue: Yes ]
  • Health-related quality of life as assessed by scores from Cystic Fibrosis Questionnaire-Revised Parent Report (CFQ-R), administered quarterly [ Time Frame: over the 48 week treatment period ] [ Designated as safety issue: No ]
  • Standardized cough score assessed at study visits [ Time Frame: during the 48 week treatment period ] [ Designated as safety issue: No ]
  • Change in weight, height, resting respiratory rate, and room air oxygen saturation [ Time Frame: over the 48 week treatment period ] [ Designated as safety issue: Yes ]
  • Among participants from whom Pseudomonas aeruginosa (Pa) and other CF pathogens were not isolated from respiratory cultures prior to enrollment, the proportion from whom these organisms are isolated from clinically collected respiratory cultures [ Time Frame: measured at baseline and at 48 weeks ] [ Designated as safety issue: Yes ]
  • Pulmonary function indices measured at baseline and 48 weeks in infants 4 to 15 months of age at enrollment participating in infant pulmonary function testing (N = 100, selected sites) [ Time Frame: over the 48 week treatment period ] [ Designated as safety issue: No ]

Enrollment: 321
Study Start Date: April 2009
Study Completion Date: November 2011
Primary Completion Date: October 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Active treatment group
7% Hypertonic Saline administered via inhalation twice daily for 48 ± 4 weeks
Drug: 7% Hypertonic Saline (HS)
Administered via inhalation twice daily for 48 ± 4 weeks. The delivery system is a PARI Sprint Junior nebulizer with a PARI Baby face mask or mouthpiece driven by a PARI Pro Neb compressor.
Other Name: Hyper-Sal™, inhaled saline
Active Comparator: Control group
0.9% Isotonic Saline administered via inhalation twice daily for 48 ± 4 weeks
Drug: 0.9% Isotonic Saline (IS)
Administered via inhalation twice daily for 48 ± 4 weeks. The delivery system is a PARI Sprint Junior nebulizer with a PARI Baby face mask or mouthpiece driven by a PARI Pro Neb compressor.
Other Name: Normal saline

Detailed Description:

A growing body of evidence supports the importance of intervention in Cystic Fibrosis (CF) lung disease during infancy and early childhood, in order to potentially delay or prevent irreversible lung disease. Yet, aside from antimicrobial therapies, the CF community has no clinical trial evidence base with which to guide pulmonary therapies in children <6 years of age. Hypertonic Saline (HS) is the most attractive chronic maintenance therapy to investigate in these young children because it addresses defective mucociliary clearance, an early step in the cascade of events leading to CF lung disease that is expected to be abnormal prior to the onset of airway infection and inflammation.

This study is a randomized, parallel group, controlled trial to assess the efficacy and safety of 7% HS inhaled twice daily for 48 weeks among young children with CF 4 to < 60 months of age at enrollment. The primary hypothesis is that, compared to isotonic saline (IS), HS will decrease the number of protocol-defined pulmonary exacerbations during the 48 week treatment period. The results of the proposed trial may for the first time provide evidence for early initiation of HS, which, by improving mucociliary clearance, may delay or hinder the cycle of infection and inflammation responsible for progressive airway damage in CF lung disease.

  Eligibility

Ages Eligible for Study:   4 Months to 59 Months
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Diagnosis of CF by newborn screening or at least one clinical feature of CF, AND either: (a) A documented sweat chloride ≥ 60 mEq/L by quantitative pilocarpine iontophoresis or (b) A genotype with two identifiable CF-causing mutations
  • Informed consent by parent or legal guardian
  • Age 4 months to < 60 months at Enrollment visit. If participating in Infant Pulmonary Function testing (selected sites), age 4 months to < 16 months at Enrollment visit.
  • Ability to comply with medication use, study visits, and study procedures as judged by the site investigator

Exclusion Criteria:

  • Acute intercurrent respiratory infection, defined as an increase in cough, wheezing, or respiratory rate with onset in 1 week preceding Enrollment visit
  • Acute wheezing at Enrollment visit (prior to HS test dose), or at Infant PFT visit (prior to infant pulmonary function testing), as applicable
  • Oxygen saturation < 95% (< 90% in centers located above 4000 feet elevation) at Enrollment visit (prior to HS test dose) or at Infant PFT visit (prior to infant pulmonary function testing), as applicable
  • Other major organ dysfunction, excluding pancreatic dysfunction
  • Physical findings that would compromise the safety of the subject or the quality of the study data as determined by the site investigator
  • Investigational drug use within 30 days prior to Enrollment visit, or within 30 days prior to Infant PFT visit as applicable
  • Treatment with inhaled hypertonic saline at any concentration within 30 days of Enrollment visit, or within 30 days prior to Infant PFT visit as applicable
  • Chronic lung disease not related to CF
  • Intolerance of test dose of HS at Enrollment visit
  • A sibling that has been randomized and is still enrolled in ISIS002

Additional Exclusion Criteria for Participation in Infant Pulmonary Function Testing:

  • History of adverse reaction to sedation
  • Clinically significant upper airway obstruction as determined by the Site Investigator (e.g. severe laryngomalacia, markedly enlarged tonsils, significant snoring, diagnosed obstructive sleep apnea)
  • Severe gastroesophageal reflux, defined as persistent frequent emesis despite anti-reflux therapy
  • Acute intercurrent respiratory infection, defined as an increase in cough, wheezing, or respiratory rate with onset in 2 weeks preceding visit
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00709280

  Show 30 Study Locations
Sponsors and Collaborators
CF Therapeutics Development Network Coordinating Center
Cystic Fibrosis Foundation
Investigators
Principal Investigator: Stephanie Davis, MD University of North Carolina, Chapel Hill
Principal Investigator: Margaret Rosenfeld, MD, MPH Children's Hospital and Regional Medical Center
Principal Investigator: Felix Ratjen, MD, PhD University of Toronto Hospital for Sick Children
  More Information

Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: CF Therapeutics Development Network Coordinating Center
ClinicalTrials.gov Identifier: NCT00709280     History of Changes
Other Study ID Numbers: ISIS002, U01HL092931, U01HL092932
Study First Received: July 1, 2008
Last Updated: February 11, 2013
Health Authority: United States: Institutional Review Board
Canada: Health Canada
Canada: Ethics Review Committee

Keywords provided by CF Therapeutics Development Network Coordinating Center:
Cystic Fibrosis
hypertonic saline
inhaled saline

Additional relevant MeSH terms:
Cystic Fibrosis
Fibrosis
Digestive System Diseases
Genetic Diseases, Inborn
Infant, Newborn, Diseases
Lung Diseases
Pancreatic Diseases
Pathologic Processes
Respiratory Tract Diseases

ClinicalTrials.gov processed this record on November 25, 2014