First Study of Oral Cysteamine in Cystic Fibrosis
The morbidity and mortality associated with Cystic Fibrosis (CF) are the result of chronic suppurative lung disease. The aggressive use of antibiotics is one of the mainstays of treatment in CF, however, the problems of multiple drug resistance and adverse reactions are major clinical issues.
Cysteamine is a licensed drug used in the treatment of cystinosis. In vitro work suggests that cysteamine has properties of potential benefit in CF. Cysteamine is a potent mucolytic, it disrupts biofilms, it is antimicrobial, and synergises with other antibiotic agents. CF is characterised by malabsorption and it is not known whether cysteamine is absorbed in CF, furthermore it is not known if cysteamine enters the bronchial secretions. It is not possible to assume that the pharmacokinetics of cysteamine in patients with CF are the same as those reported for cystinosis.
Objectives: to characterise the pharmacokinetic profile of cysteamine in people with CF, to ascertain whether cysteamine enters the bronchial secretions and the tolerability of cysteamine by patients with CF.
Method: a single centre, single group open label investigation of the tolerability and pharmacokinetics of oral cysteamine (Cystagon) when administered to patients with Cystic Fibrosis at the dose licensed for use in cystinosis.
Setting: adult CF clinic, Aberdeen Royal Infirmary.
Target population: 12 patients aged ≥18years with CF associated lung disease who are clinically stable.
Intervention: Oral cysteamine (Cystagon) will be increased from 450mg od to 450mg qds over three weeks, they will remain on 450mg qds for two weeks.
Assessment: face to face health outcome assessments will be carried out for all participants at recruitment/baseline, 1, 2, 3, and 5 and 6 weeks. Serial blood cysteamine levels will be measured in the first 24 hours after the first dose. Sputum cysteamine will be quantified after two weeks of full dose cysteamine 450mg qds. Disease specific health status (CFQ-R) will be assessed at baseline and after two weeks of full dose. At each assessment, lung function (FEV1, FVC), adverse reactions and serious adverse events will be ascertained. Blood samples will be taken for measurement of haematological and biochemical parameters. Sputum samples at each assessment will be analysed for microbial load and spinnbarkeit.
|Study Design:||Intervention Model: Single Group Assignment
Masking: None (Open Label)
|Official Title:||An Open Label Investigation of the Tolerability and Pharmacokinetics of Oral Cysteamine in Adults With Cystic Fibrosis.|
- Elimination rate constant [k] [ Time Frame: 24 hours ]Blood cysteamine prior to the initial dose on day 1 and 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 8, 10, and 24 hours post-dose
- Concentration of cysteamine in sputum at week 5 [ Time Frame: 3 hours after final dose ]
- Change in weight from baseline at week 5 [ Time Frame: 5 weeks ]
- Number of Participants with Serious and Non-Serious Adverse Events [ Time Frame: 6 weeks ]
- Change in FEV1, FVC from baseline at week 5 [ Time Frame: 5 weeks ]
- Change in disease related health status from baseline at week 5 measured by CFQ-R [ Time Frame: 5 weeks ]
- Change in haematological and biochemical indices from baseline at week 5 [ Time Frame: 5 weeks ]
- change in sputum microbiology from baseline at week 5 [ Time Frame: 5 weeks ]
|Study Start Date:||August 2014|
|Study Completion Date:||April 2015|
|Primary Completion Date:||March 2015 (Final data collection date for primary outcome measure)|
Dosing will be in accordance with licensed use of cysteamine for cystinosis, i.e. 450mg qds.
Dose will be escalated:
450mg od for one week 450mg bd for one week 450mg tds for one week 450mg qds for two weeks
Dose will be increased weekly from 450mg od to 450mg bd, to 450mg tds to 450mg qds, will remain on highest dose for 2 weeks
Other Name: Cystagon 150mg capsules
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Please refer to this study by its ClinicalTrials.gov identifier: NCT02212431
|Aberdeen Royal Infirmary|
|Aberdeen, United Kingdom, AB25 2ZN|
|Principal Investigator:||Graham Devereux, MD||University of Aberdeen|