Nebulized Amphotericin B Lipid Complex in Invasive Pulmonary Aspergillosis in Paediatric Patients With Acute Leukaemia

This study has been completed.
Sponsor:
Collaborator:
Ministry of Health, Spain
Information provided by (Responsible Party):
Fundació Sant Joan de Déu
ClinicalTrials.gov Identifier:
NCT01615809
First received: June 4, 2012
Last updated: November 4, 2015
Last verified: November 2015

June 4, 2012
November 4, 2015
October 2011
July 2013   (final data collection date for primary outcome measure)
Number of Participants With Adverse Events That Results in the Interruption of Treatment, as a Measure of Safety and Tolerability [ Time Frame: at the Baseline visit (week 1) and during the Last week of treatment, up to 6 weeks ] [ Designated as safety issue: Yes ]
is assessed by the proportion of patients who discontinue prophylactic treatment with Abelcet® due to an adverse event that is related or not to the study drug or for intolerability to it. The last week of treatment will have a different calendar for each participant, depending on the number of cicles needed by each patient (it has been anticipated up to 5 cicles of 2-6 weeks each).
Number of Participants With Adverse Events That Results in the Interruption of Treatment, as a Measure of Safety and Tolerability [ Time Frame: Baseline (week 1) and Last week of treatment (the number of the last week is variable by each patient, depending of the number of cicles needed by each patient) ] [ Designated as safety issue: Yes ]
The primary efficacy variable will be the proportion of patients who discontinue prophylactic treatment with Abelcet® due to an adverse event that is related or not to the study drug or for intolerability to it. The last week of treatment will have a different calendar for each participant, depending on the number of cicles needed by each patient (it has been anticipated up to 5 cicles of 2-6 weeks each).
Complete list of historical versions of study NCT01615809 on ClinicalTrials.gov Archive Site
  • Efficacy of Primary Prophylaxis With Nebulized Abelcet® on the Incidence of Invasive Pulmonary Aspergillosis (IPA) in Paediatric Patients With Acute Leukaemia (AL) Undergoing Intensive Chemotherapy [ Time Frame: at the Baseline visit (week 1) and at the end of the profilaxis treatment phase, up to 6 weeks ] [ Designated as safety issue: No ]
    The Incidence of IPA during the Abelcet® prophylactic treatment period was assessed by the relation between the number of patients with IPA and the number of patients on prophylaxis.
  • Invasive Pulmonary Aspergillosis (IPA)-Related Mortality During Primary Prophylaxis With Abelcet® in Paediatric Patients With (AL) Undergoing Intensive Chemotherapy. [ Time Frame: at the Baseline visit (week 1) and at the end of the profilaxis treatment phase, up to 6 weeks ] [ Designated as safety issue: Yes ]
    Percentage of deaths related to API during the prophylactic treatment period with Abelcet® in paediatric patients with (AL) undergoing intensive chemotherapy
  • Efficacy of Primary Prophylaxis With Nebulized Abelcet® on the Incidence of Invasive Pulmonary Aspergillosis (IPA) in Paediatric Patients With Acute Leukaemia (AL) Undergoing Intensive Chemotherapy [ Time Frame: Baseline (week 1) to end of profilaxis treatment phase (after 4-5 cycles=each cycle will have 2-6 weeks of duration) ] [ Designated as safety issue: No ]
    Will be assessed by: a) Proportion of discontinued drug administrations due to a treatment related adverse event or intolerability to treatment (number of discontinued administrations/ number of administrations started; b) Total number of IPA cases; c) Incidence of IPA during the Abelcet® prophylactic treatment period (number of patients with IPA/number of patients on prophylaxis); d) IPA incidence rate during the ABLC prophylactic treatment period.
  • Invasive Pulmonary Aspergillosis (IPA)-Related Mortality During Primary Prophylaxis With Abelcet® in Paediatric Patients With (AL) Undergoing Intensive Chemotherapy. [ Time Frame: Baseline (week 1) to end of profilaxis treatment phase (after 4-5 cycles=each cycle will have 2-6 weeks of duration) ] [ Designated as safety issue: Yes ]
    It will be assessed by: a) Mortality due to IPA; b)Percentage of deaths during the prophylactic treatment period and cause of death.
Not Provided
Not Provided
 
Nebulized Amphotericin B Lipid Complex in Invasive Pulmonary Aspergillosis in Paediatric Patients With Acute Leukaemia
A Phase II Trial to Evaluate the Safety and Tolerability of Nebulised Amphotericin B Lipid Complex (ABELCET®) in the Prophylaxis of Invasive Pulmonary Aspergillosis During Prolonged Neutropenia in Paediatric Patients With Acute Leukaemia
The trial evaluates the overall tolerability of the drug and the efficacy of aerosolised amphotericin B as a lipid complex (ABLC) for primary prophylaxis of invasive pulmonary aspergillosis (IPA) in pediatric patients with acute leukemia undergoing intensive chemotherapy.

In recent years the incidence of invasive fungal infection (IFI) especially when caused by filamentous fungi has increased in patients with haematological malignancies and there exists an international consensus on diagnostic criteria. Despite diagnostic and therapeutic progress, invasive aspergillosis remains a major clinical problem of haematological patients, given the still high mortality rates and the huge economic cost of hospitalization of patients, which is attributable to aspergillosis. In addition to the morbidity and mortality rates, these infections interfere with the chemotherapy treatment plan with the risk of compromising the outcome of the antileukemic treatment.

In a few uncontrolled studies inhaled amphotericin B deoxycholate showed some benefit in haematological patients, however it was not effective in a large multicenter study with neutropenic patients. Based on the outcome of that clinical trial, the use of aerosolised amphotericin B deoxycholate in neutropenic patients was abandoned for nearly a decade. During this time the use of azole agents as drugs of choice for antifungal prophylaxis in high risk patients was consolidated. However, one of the main problems in the use of triazoles with activity against filamentous fungi (itraconazole, voriconazole, posaconazole) is drug-drug interactions due to their CYP3A4 inhibitory activity. One of the most serious interactions is that which occurs with vincristine, used throughout the treatment of acute lymphoblastic leukemia, and which has lead to reports of neurotoxicity due to metabolic inhibition.

ABLC (Abelcet®) belongs to the group of polyenes with antifungal activity against a broad spectrum of fungal species, including Aspergillus spp. The active component of ABELCET®, amphotericin B, acts by binding to sterols in the cell membrane of susceptible fungi, with a resultant change in the permeability of the membrane. Mammalian cell membranes also contain sterols, and damage to human cells is believed to occur through the same mechanism of action.

Abelcet® is recommended for the intravenous treatment of a broad spectrum of systemic fungal infections in adult patients. Although it has a pediatric indication, there are numerous studies published regarding the safety levels of Abelcet® administered intravenously in children and in haematological adults patients which look very promising. In this context, the working hypothesis proposed in this project is that the administration of aerosolised ABLC for pediatric patients with acute leukemia treated with intensive chemotherapy will be an effective alternative as a prophylaxis of pulmonary fungal infections in these patients.

In the treatment of pediatric patients with haematological malignancies the use of intensive chemotherapy is required, which is immunosuppressive and therefore significantly increases the risk of IFI, especially filamentous fungi. IPA is associated with high mortality (>50%) in those patients, making it imperative to adopt effective, preventive, prophylactic measures. Drug interactions occur frequently with triazole antifungal drugs; cases of clinically significant interactions with vincristine, an anchor drug in the treatment of the majority of pediatric leukemia, are documented. On the other hand, there are promising data from previous studies regarding the safety and efficacy of the intravenous ABLC formulation (Abelcet®) in the treatment of pediatric patients with fungal infections.

If the working hypothesis is confirmed, the aerosolised ABLC treatment would be an effective, safe and reliable prophylactic option for IPA. It would offer an alternative to the systemic administration of antifungal triazoles without affecting the antileukemic treatment in pediatric patients with AL.

Interventional
Phase 2
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
  • Invasive Pulmonary Aspergillosis
  • Lymphoblastic Leukaemia
  • Myeloblastic Leukaemia
  • Lymphoblastic Leukemia
  • Myeloblastic Leukemia
Drug: AMPHOTERICIN B
The study drug will be administered by inhalation, to hospitalised patients or outpatients in the day hospital.The administration regimen for each Abelcet® nebulization will be 10 ml (50 mg) twice a week for the first week, and then from the second week onwards it will be 5 ml (25 mg) with a minimum separation of 72 hours between doses, until the neutrophil count is greater than or equal to 1500 cells/mm3.
Other Name: Abelcet® 5 mg/ml
Experimental: Amphotericin B (ABELCET®)
Patients fulfilling inclusion criteria and those giving the general informed consent for the study will initiate nebulized Amphotericin B prophylaxis treatment, twice a week, during neutropenia periods (coincident with intensive chemotherapy treatment).
Intervention: Drug: AMPHOTERICIN B

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
32
July 2013
July 2013   (final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Age: patients between 3 and 18 years.
  2. Diagnosis of myeloblastic or lymphoblastic AL during intensive chemotherapy.
  3. Informed consent of parents/guardians and/or assent of the patient has been obtained.

Exclusion Criteria:

  1. Probable or proven invasive pulmonary fungal infection before entering the trial.
  2. Previous chronic renal impairment or baseline serum creatinine > 2.5 mg /dL
  3. Severe hepatic impairment.
  4. Moderate-severe asthma being treated pharmacologically.
  5. Antifungal treatment for filamentous fungi in the last 4 weeks.
  6. Participating or have participated in a clinical trial during the last 4 weeks.
  7. Mentally retarded
  8. Known allergy or hypersensitivity to the active ingredient of the study drug or to any of its excipients.
  9. Any serious concomitant disease that in the investigator's opinion could compromise the completion of the trial or affect the patient's tolerability to this treatment.
  10. Pregnancy (in women of fertile age).
  11. Breast-feeding.

Patients are defined as having probable IFI when their radiological image is suggestive of fungal infection and they have positive antigenemia for Aspergillus. IFI would be proven when the presence of Aspergillus is confirmed in aspirate culture or by lung biopsy.

Both
3 Years to 17 Years   (Child)
No
Contact information is only displayed when the study is recruiting subjects
Spain
 
NCT01615809
FSJD-ABELNEB-2010
No
Not Provided
Not Provided
Fundació Sant Joan de Déu
Fundació Sant Joan de Déu
Ministry of Health, Spain
Principal Investigator: Jesus Estella, PhMD Hospital Sant Joan de Deu
Fundació Sant Joan de Déu
November 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP