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Respiratory Distress Syndrome in Premature InfantPhase 2NCT01941745

Efficacy of Recombinant Human Clara Cell 10 Protein (rhCC10) Administered to Premature Neonates With Respiratory Distress Syndrome

A Phase 2 study testing Half normal saline, Low Dose rhCC10 and High dose rhCC10 in people with Respiratory Distress Syndrome in Premature Infant and Bronchopulmonary Dysplasia, run by Tufts Medical Center at 3 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Bronchopulmonary Dysplasia (BPD) is a multi-factorial disease process that is the end result of an immature, surfactant deficient lung that has been exposed to hyperoxia, mechanical ventilation and infection. Read more about this study

Who is it for?
Ages 24 to 29 weeks
What is being tested?
Half normal saline, Low Dose rhCC10 and High dose rhCC10
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
88 participants
Where
3 sitesUnited States
Study dates
Oct 2013to 25 Aug 2017
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 24 to 29 weeks
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Age less than or equal to 24 hours;
  • Birth weight 600 - 1250 grams;
  • Gestational age 24-29 weeks (not less than 24 weeks); at birth based on best estimate using obstetrical sonography (first or second trimester), solid dating criteria, or Ballard examination;
  • Birth weight appropriate for gestational age;
  • 5 minute Apgar score >5;
  • Diagnosis of neonatal RDS based on clinical and radiographic criteria;
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  • Requiring intubation and mechanical ventilation for treatment of RDS;
  • Received at least one dose of surfactant (prophylaxis or rescue); and
  • Written informed consent is obtained from at least one of the infant's parents or legal guardians (see section 6.2) prior to enrollment of the subject. The parent(s) or legal guardian(s) must agree to all study-related procedures and evaluations.

Who cannot join

  • 5 minute Apgar score of ≤ 5;
  • Major congenital anomaly (chromosomal, renal, cardiac, hepatic, neurologic, or pulmonary malformations; minor anomalies such as cleft lip/palate are permitted);
  • Evidence of severe neonatal depression (as defined by cord blood acid-base balance (pH) ≤ 7.00 and/or an Apgar score of < 4 at 10 minutes);
  • Evidence of congenital infection;
  • Requires a major surgical procedure prior to administration of Study drug
  • Enrollment in any other study involving administration of another investigational drug;
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  • Any condition which could preclude receiving study drug or performing any study-related procedures;
  • Use of postnatal corticosteroids prior to administration of r-hCC10, except as specified in the protocol;
  • Use of inhaled nitric oxide prior to administration of r-hCC10;
  • Mother is known to be seropositive for HIV (per maternal medical records);
  • Parent or guardian is unable or unwilling to complete the study diary;
  • Parent or guardian is unable to bring the infant back to the study center for follow-up evaluations.

Trial locations and contacts

3 sites in 1 country.

United States3 sites
  • Tufts Medical Center

    Boston, Massachusetts, 02111

  • Brigham and Women's Hospital

    Boston, Massachusetts, 02115

  • Baystate Medical Center

    Springfield, Massachusetts, 01199

Other trials in United States

About this study

Official title: Efficacy of Recombinant Human Clara Cell Protein (rhCC10) Administered to Premature Neonates With Respiratory Distress Syndrome

Bronchopulmonary Dysplasia (BPD) is a multi-factorial disease process that is the end result of an immature, surfactant deficient lung that has been exposed to hyperoxia, mechanical ventilation and infection. These conditions initiate an inflammatory response characterized by elevated inflammatory cell infiltrates and proinflammatory cytokines that lead to the development of significant acute and chronic lung injury.

The study drug, rhCC10, is a recombinant version of natural human CC10 protein. Native CC10 is produced primarily by non-ciliated respiratory epithelial cells, called Clara cells and is the most abundant protein in the mucosal fluids in normal healthy lungs.

Read more

The purpose of this study is to evaluate the pharmacokinetics, safety, tolerability and anti-inflammatory effects of a single intratracheal (IT) dose of rhCC10 to intubated premature infants receiving positive pressure ventilation for treatment of respiratory distress syndrome (RDS) to prevent long term respiratory complications referred to as bronchopulmonary dysplasia, and, more recently, as Chronic Pulmonary Insufficiency of Prematurity (CPIP; asthma, cough, wheezing, multiple respiratory infections).

CC10 regulates inflammatory responses and protects the structural integrity of pulmonary tissue while preserving pulmonary mechanical function during various insults (eg. viral infection, bacterial endotoxin, ozone, allergens, hyperoxia). Together these properties suggest that administration of rhCC10 may help to facilitate development of normal airway epithelia and prevent the inflammation that leads to CPIP in these infants.

This study is funded by the FDA Office of Orphan Product Development (OOPD).

Read the detailed description

Recombinant human CC10 protein (rhCC10) is a novel therapeutic agent used to prevent the development of chronic respiratory morbidity (CPIP; repeated respiratory infections, asthma, re-hospitalizations) in preterm infants. Native CC10 is a natural anti-inflammatory and immunomodulatory factor produced by Clara Cells in the lung and is the most abundant protein in respiratory mucosa. Animal data demonstrate that a single intratracheal dose of rhCC10 administered shortly after birth reduces lung inflammation (important biomarkers linked to lung injury in preterm infants), promotes normal lung development, preserves lung architecture, improves pulmonary function, suppresses the response to endotoxin and enhances resistance to pulmonary infections. In preterm infants who die or develop lung inflammation and subsequent bronchopulmonary dysplasia (BPD), both the concentration and activity of CC10 are significantly reduced indicating that CC10 is essential for preventing lung injury and promoting normal lung development. In a small phase I study, rhCC10 significantly decreased several indices of pulmonary inflammation in the lungs of premature infants who were at risk of developing BPD and associated CPIP. The drug appeared to be safe, well-tolerated, and reduce risk of re-hospitalization due to respiratory illness for 9-10 months after a single intratracheal dose at the time of birth (0/11 rhCC10-treated infants vs. 3/6 placebo-treated). This supports the protective role of rhCC10 against damage from hyperoxia, mechanical ventilation, inflammation, and infection in the immature lung. A more normal airway epithelium will produce significantly more endogenous CC10, with both factors contributing to enhanced resistance to infections, less asthma, and improved long-term respiratory outcome. We propose to conduct a Phase 2 clinical trial to evaluate rhCC10 in extremely premature infants (<29 weeks gestation) for the prevention of BPD and CPIP. This will be a randomized, double-blind, placebo-controlled dose escalation study in 88 premature infants. A single intratracheal dose of study drug (rhCC10 or placebo) will be administered to preterm infants receiving surfactant and mechanical ventilation for treatment of RDS. Infants will be followed to evaluate safety, pharmacokinetics, and short and long term efficacy of this approach. Safety will be evaluated through serious adverse event (SAE) and adverse event monitoring and by Bayley neurodevelopmental assessments at 18 months corrected gestational age (CGA). Efficacy measurements will include the primary combined endpoint of alive without evidence of CPIP through 12 months CGA (defined by parental diaries and pulmonary questionnaires) comparing rhCC10 treated to placebo controls. The availability of a therapy which prevents lung injury, promotes lung development, and prevents serious respiratory infections and asthma in high risk preterm infants would be a highly significant advancement in care.

Being tested
Half normal saline, Low Dose rhCC10, High dose rhCC10
Medical subject headings
Bronchopulmonary Dysplasia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Half normal salineDrug

    2 ml/kg

  • Low Dose rhCC10Drug

    1.5 mg/kg study drug (rhCC10)

  • High dose rhCC10Drug

    5 mg/kg in 2 ml/kg

Study groups in NCT01941745
Study groupRoleWhat they receive
half normal salinePlacebo comparatorSingle dose of half normal saline at 2 ml/kg given intratracheally times one dose
Receives: Drug: Half normal saline
Low Dose rhCC10Experimental1.5 mg/kg study drug (rhCC10)in 2 ml/kg given intratracheally times one dose
Receives: Drug: Low Dose rhCC10
High dose rhCC10Experimental5 mg/kg of rhCC10 given in 2 ml/kg and administered intratracheally times one dose
Receives: Drug: High dose rhCC10

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Survival Without Evidence of Chronic Pulmonary Insufficiency of Prematurity (CPIP) at 12 Months Corrected Gestational Age (CGA)

    Number of events of survived participants without one or more of the CPIP components defined below:

    1. Medical/ER visits (CPIP-DV): At least one non-routine medical visit for respiratory causes.
    2. Respiratory re-hospitalizations (CPIP-RH): One or more re-hospitalizations for respiratory causes.
    3. Respiratory Symptoms (CPIP-SS): Evidence of respiratory symptoms (e.g. coughing and wheezing) or use of respiratory medications by parental diaries or pulmonary questionnaires.
    4. Respiratory Medications (CPIP-RM): Administration of respiratory medications (including oxygen).

    CPIP is defined as the presence of one or more parent-reported outcomes at 12 months CGA, validated by Respiratory diaries (presence of wheezing, coughing, and/or respiratory medication use ≥2 days per week for 3 consecutive weeks), and Pulmonary questionnaires (decrease in respiratory illness requiring medications, unscheduled medical visits and/or ER or hospital admissions).

    Measured: 12 Months Corrected Gestational Age (*no imputation for missing data)

Secondary outcomes (3)
  1. Long Term Efficacy - Survival Without Evidence of Chronic Pulmonary Insufficiency of Prematurity (CPIP) at 6 Months Corrected Gestational Age (CGA)

    Number of events of survived participants, graded as not having 1, 2, 3, or 4 of the CPIP components defined below:

    Medical/ER visits (CPIP-DV): ≥1 non-routine medical visit(s) for respiratory causes.

    Respiratory re-hospitalizations (CPIP-RH): ≥1 re-hospitalization(s) for respiratory causes Respiratory Symptoms (CPIP-SS): Parent-reported evidence of respiratory symptoms (e.g. coughing and wheezing) or use of respiratory medications Respiratory Medications (CPIP-RM): Administration of respiratory medications (including oxygen)

    A participant graded without 4 CPIP components is considered in better health than a participant graded without 1 CPIP component. CPIP components were parent-validated via respiratory diaries (wheezing, coughing, and/or respiratory medication use ≥2 days/wk for 3 consecutive wks), and pulmonary questionnaires (decrease in respiratory illness requiring medications, unscheduled medical visits and/or ER or hospital admissions).

    Measured: 6 months Corrected Gestational Age

  2. Safety and Efficacy - Number of Participants With Adverse Events

    The safety of the study drug was assessed by accounting the number of participants with Adverse Events (AEs) in the treatment and placebo groups.

    Measured: Adverse events are monitored through 36 wks post-menstrual age (PMA)

  3. Short Term Efficacy - Number of Neonates With Oxygen Requirement at 36 Weeks Post Menstrual Age

    Short term efficacy evaluations involve number of neonates with oxygen requirement at 36 weeks post menstrual age.

    Measured: 36 weeks post-menstrual age

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Sep 2013 (estimated)
  2. Study startOct 2013
  3. Primary completion25 Aug 2017
  4. Study completion25 Aug 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
88 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01941745
Sponsor's protocol ID
rhCC10 Study 2013
Other IDs
Grant #3899
Status last verified
Aug 2019
First submitted
29 Aug 2013
Last updated
10 Sep 2019
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Half normal saline, Low Dose rhCC10 and High dose rhCC10 in people with Respiratory Distress Syndrome in Premature Infant and Bronchopulmonary Dysplasia, run by Tufts Medical Center at 3 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 10 Sep 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 10 Sep 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Survival Without Evidence of Chronic Pulmonary Insufficiency of Prematurity (CPIP) at 12 Months Corrected Gestational Age (CGA) (time frame: 12 Months Corrected Gestational Age (*no imputation for missing data)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Sep 2019.

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