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Trial record 9 of 26 for:    Recruiting, Not yet recruiting, Available Studies | "Aspergillosis"

A Randomized Trial of Itraconazole in Acute Stages of Allergic Bronchopulmonary Aspergillosis (RIA)

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ClinicalTrials.gov Identifier: NCT02440009
Recruitment Status : Recruiting
First Posted : May 12, 2015
Last Update Posted : April 27, 2017
Sponsor:
Information provided by (Responsible Party):
Ritesh Agarwal, Postgraduate Institute of Medical Education and Research

Brief Summary:
The study evaluates the addition of itraconazole to glucocorticoids in management of acute stages of allergic bronchopulmonary aspergillosis (ABPA). Half of the participants will receive glucocorticoids while the other half will receive itraconazole and glucocorticoids

Condition or disease Intervention/treatment Phase
Allergic Bronchopulmonary Aspergillosis Drug: Itraconazole Drug: Glucocorticoids Phase 2 Phase 3

Detailed Description:

The management of allergic bronchopulmonary aspergillosis (ABPA) includes two important aspects namely institution of immunosuppressive therapy in the form of glucocorticoids to control the immunologic activity, and close monitoring for detection of relapses. Another possible target is to use antifungal agents to attenuate the fungal burden secondary to the fungal colonization in the airways. Oral corticosteroids are currently the treatment of choice for ABPA associated with bronchial asthma. They not only suppress the immune hyperfunction but are also anti-inflammatory.

Itraconazole, an oral triazole with relatively low toxicity, is active against Aspergillus spp. in vitro and in vivo. The activity of itraconazole against Aspergillus spp. is more than that of ketoconazole. The administration of itraconazole can eliminate Aspergillus in the airways and can theoretically reduce the allergic responses in ABPA. We hypothesize that itraconazole when given in the acute stages of ABPA will decrease the chances of relapse and progression to glucocorticoid-dependent ABPA.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 150 participants
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized Trial of Itraconazole in Acute Stages of Allergic Bronchopulmonary Aspergillosis
Study Start Date : May 2015
Estimated Primary Completion Date : June 2017
Estimated Study Completion Date : June 2017


Arm Intervention/treatment
Active Comparator: Glucocorticoid group
Oral prednisolone 0.5 mg/kg/day for 4 weeks; 0.25 mg/kg/day for 4 weeks; 0.125 mg/kg/day for 4 weeks. Then taper by 5 mg every 4 weeks and discontinue by the end of 4 months. Patients will also receive inhaled formoterol/fluticasone (6/125 mcg) 1 puff BD and as needed as per the SMART approach for control of asthma
Drug: Glucocorticoids
Oral prednisolone 0.5 mg/kg/day for 4 weeks; 0.25 mg/kg/day for 4 weeks; 0.125 mg/kg/day for 4 weeks. Then taper by 5 mg every 4 weeks and discontinue by the end of 4 months.
Other Name: Steroid
Experimental: Itraconazole plus glucocorticoid group
Oral itraconazole 200 mg BD for 6 months AND oral prednisolone 0.5 mg/kg/day for 4 weeks; 0.25 mg/kg/day for 4 weeks; 0.125 mg/kg/day for 4 weeks. Then taper by 5 mg every 4 weeks and discontinue by the end of 4 months. Patients will also receive inhaled formoterol/fluticasone (6/125 mcg) 1 puff BD and as needed as per the SMART approach for control of asthma.
Drug: Itraconazole
Oral itraconazole 200 mg BD for 6 months
Other Name: Azole
Drug: Glucocorticoids
Oral prednisolone 0.5 mg/kg/day for 4 weeks; 0.25 mg/kg/day for 4 weeks; 0.125 mg/kg/day for 4 weeks. Then taper by 5 mg every 4 weeks and discontinue by the end of 4 months.
Other Name: Steroid



Primary Outcome Measures :
  1. Relapse rates [ Time Frame: 12 months ]
    Doubling of the baseline IgE levels irrespective of the patient's symptoms or appearance of radiologic infiltrates; or clinical and/or radiological worsening with 50% increase in IgE over the previous baseline value

  2. Glucocorticoid-dependent ABPA [ Time Frame: 24 months ]
    If the patient has relapse on two or more consecutive occasions within 6 months of stopping treatment or requires oral steroids for control of asthma


Secondary Outcome Measures :
  1. Proportion of patients with a response rates [ Time Frame: Six weeks ]
  2. Percentage decline in IgE [ Time Frame: Six weeks ]
  3. Time to first relapse [ Time Frame: Two years ]
  4. Treatment-related adverse effects [ Time Frame: Six months ]


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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Treatment naive patients of allergic bronchopulmonary aspergillosis (ABPA) defined by the presence of all the following:

  • asthma
  • immediate cutaneous hyperreactivity on Aspergillus skin test or A.fumigatus specific IgE levels >0.35 kUA/L
  • elevated total IgE levels >1000 IU/mL and, two of the following features:
  • presence of precipitating antibodies against A.fumigatus in serum
  • fixed or transient radiographic pulmonary opacities
  • total eosinophil count >1000/µL
  • bronchiectasis on HRCT chest

Exclusion Criteria:

  • Intake of systemic glucocorticoids for more than three weeks in the preceding six months
  • Exposure to azoles in the last six months
  • Immunosuppressive states such as uncontrolled diabetes mellitus, chronic renal failure, chronic liver failure and others
  • Patient on immunosuppressive drugs
  • Pregnancy
  • Enrollment in another trial of ABPA
  • Failure to provide informed consent

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02440009


Contacts
Contact: Ritesh Agarwal, MD, DM 2756825 riteshpgi@gmail.com
Contact: Ashutosh N Aggarwal, MD, DM 2756824 aggarwal.ashutosh@outlook.com

Locations
India
Chest Clinic, PGIMER Recruiting
Chandigarh, India, 160012
Contact: Ritesh Agarwal, MD, DM    0172-2756825    riteshpgi@gmail.com   
Contact: Ashutosh Aggarwal, MD, DM    0172-2756824    dr.anaggarwal@gmail.com   
Sponsors and Collaborators
Postgraduate Institute of Medical Education and Research

Responsible Party: Ritesh Agarwal, Professor, Department of Pulmonary Medicine, Principal Investigator, Postgraduate Institute of Medical Education and Research
ClinicalTrials.gov Identifier: NCT02440009     History of Changes
Other Study ID Numbers: Histo-15-IMEC-313
First Posted: May 12, 2015    Key Record Dates
Last Update Posted: April 27, 2017
Last Verified: April 2017

Additional relevant MeSH terms:
Aspergillosis
Pulmonary Aspergillosis
Aspergillosis, Allergic Bronchopulmonary
Mycoses
Hyalohyphomycosis
Dermatomycoses
Lung Diseases, Fungal
Skin Diseases, Infectious
Skin Diseases
Lung Diseases
Respiratory Tract Diseases
Respiratory Hypersensitivity
Respiratory Tract Infections
Hypersensitivity, Immediate
Hypersensitivity
Immune System Diseases
Prednisolone
Glucocorticoids
Itraconazole
Hydroxyitraconazole
Anti-Inflammatory Agents
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Antifungal Agents
Anti-Infective Agents
14-alpha Demethylase Inhibitors
Cytochrome P-450 Enzyme Inhibitors