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Cystic FibrosisPhase 3OPTIMIZENCT02054156

OPTIMIZing Treatment for Early Pseudomonas Aeruginosa Infection in Cystic Fibrosis

A Phase 3 study testing azithromycin and Tobramycin solution for inhalation in people with Cystic Fibrosis, run by Bonnie Ramsey at 45 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

The purpose of this trial is to compare the effects of treatment with tobramycin solution for inhalation (TIS) with and without azithromycin in people with cystic fibrosis (CF) age 6 months to 18 years who have early isolation of Pseudomonas aeruginosa (Pa) from a respiratory culture. Read more about this study

Who is it for?
Ages 6 months to 18 years
Conditions the study is for
Cystic Fibrosis
What is being tested?
azithromycin and Tobramycin solution for inhalation
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
221 participants
Where
45 sitesUnited States
Study dates
Jun 2014to 23 Aug 2018
Phase
Phase 3
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 6 months to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Age ≥ 6 months to ≤ 18 years
  • Documentation of a CF diagnosis as evidenced by one or more clinical features consistent with the CF phenotype or positive CF Newborn Screening result for immunoreactive trypsinogen (IRT) IRT/DNA or IRT/IRT and one or more of the following criteria:
  • sweat chloride ≥ 60 milliequivalent (mEq)/liter by quantitative by pilocarpine iontophoresis test (QPIT)
  • two well-characterized mutations in the cystic fibrosis transmembrane conductive regulator (CFTR) gene
  • Abnormal nasal potential difference (NPD) (change in NPD in response to a low chloride solution and isoproteronol of less than - 5 mV)
  • Documented new positive oropharyngeal, sputum or lower respiratory tract culture for Pa within 30 days of the Baseline Visit (Visit 1), defined as: a) first lifetime documented Pa positive culture; or b) Pa recovered after at least a two-year history of Pa negative respiratory cultures (≥ 1 culture/ year)
  • Clinically stable with no evidence of any significant respiratory symptoms at the Baseline Visit that would require administration of intravenous anti- pseudomonal antibiotics, oxygen supplementation, and/or hospitalization as determined by the study physician
  • Written informed consent obtained from participant or participant's legal representative (and assent when applicable) and ability for participant to comply with the requirements of the study

Who cannot join

  • Macrolide antibiotic use within 30 days of the Baseline Visit
  • Initiation of current course of treatment with TIS >14 days prior to Baseline Visit
  • Weight <6.0 kg at the Baseline Visit
  • History of aminoglycoside hypersensitivity or adverse reaction to inhaled aminoglycoside
  • History of azithromycin hypersensitivity or adverse reaction to azithromycin or allergy to macrolide antibiotics
  • History of positive respiratory culture for Non-tuberculous mycobacteria (NTM) or Burkholderia cepacia complex within 2 years of the Baseline Visit
Show all 15Show fewer
  • History of unresolved, abnormal renal function (defined as serum creatinine greater than 1.5 times the upper limit of normal for age).
  • History of unresolved, abnormal liver function tests (defined as alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) greater than 4 times the upper limit of normal range) or history of portal hypertension
  • History of unresolved, abnormal neutropenia (ANC ≤ 1000)
  • Abnormal ECG test at the Baseline Visit defined as a QT interval corrected (QTc) (B) of ≥460 msec or history of ventricular arrhythmia
  • History of abnormal hearing sensitivity defined as hearing threshold levels >25 dB HL (decibels Hearing Level) for visual reinforcement audiometry (VRA) at any frequency (500-4000Hz) or >20 Decibels Hearing Level (dBHL) for play or standard audiometry at any two frequencies (500-8000Hz) in either ear, not associated with middle ear disease (including infection) or a flat (Type B) tympanogram
  • New initiation of chronic therapy (greater than 21 days) with drugs known to prolong QT interval (refer to Appendix III) within 30 days prior to the Baseline Visit or coadministration of nelfinavir or oral anticoagulants
  • Positive serum or urine pregnancy test at the Baseline Visit (to be performed on all females of child-bearing potential) or for females of child bearing potential: pregnant, breastfeeding, or unwilling to use barrier contraception during participation in the study
  • Administration of any investigational drug within 30 days prior to the Baseline Visit
  • Presence of a condition or abnormality (e.g., pre-existing heart disease) that in the opinion of the site investigator would compromise the safety of the participant or the quality of the data

Trial locations and contacts

45 sites in 1 country.

45 sites in 1 country

United States45 sites
  • CFF Care Center & Pediatric Program Akron Children's Hospital

    Akron, Ohio, 44308

  • CFF Affiliate Program Providence Medical Center

    Anchorage, Alaska, 99519-6604

  • CFF Care Center & Pediatric Program University of Michigan

    Ann Arbor, Michigan, 48109-5212

  • CFF Care Center & Pediatric Program Emory University

    Atlanta, Georgia, 30324

  • CFF Affiliate Program Children's Healthcare of Atlanta

    Atlanta, Georgia, 30342

  • CFF Care Center & Pediatric Program Children's Hospital Colorado

    Aurora, Colorado, 80045

  • CFF Care Center & Pediatric Program Dell Children's Medical Center of Central Texas

    Austin, Texas, 78723

  • CFF Care Center St. Luke's CF Clinic

    Boise, Idaho, 83712

  • CFF Care Center & Pediatric Program Children's Hospital Boston

    Boston, Massachusetts, 02115

  • CFF Care Center & Pediatric Program University of North Carolina at Chapel Hill

    Chapel Hill, North Carolina, 27599

  • CFF Care Center & Pediatric Program Ann & Robert H. Lurie Children's Hospital of Chicago

    Chicago, Illinois, 60611-2605

  • CFF Care Center & Pediatric Program Cincinnati Children's Hospital Medical Center

    Cincinnati, Ohio, 45229

  • CFF Care Center & Pediatric Program Rainbow Babies and Children's Hospital

    Cleveland, Ohio, 44106

  • CFF Care Center & Pediatric Program Nationwide Children's Hospital

    Columbus, Ohio, 43205

  • CFF Care Center & Pediatric Program The Children's Medical Center

    Dayton, Ohio, 45404

  • CFF Care Center & Pediatric Program Children's Hospital of Michigan

    Detroit, Michigan, 48201

  • CFF Care Center & Pediatric Program Hershey Medical Center

    Hershey, Pennsylvania, 17033

  • CFF Care Center & Pediatric Program Riley Hospital for Children

    Indianapolis, Indiana, 46202-5271

  • CFF Care Center & Pediatric Program University of Iowa

    Iowa City, Iowa, 52242

  • CFF Care Center & Pediatric Program Nemours Children's Clinic - Jacksonville

    Jacksonville, Florida, 32207

  • CFF Care Center The Children's Mercy Hospital

    Kansas City, Missouri, 64108

  • CFF Care Center & Pediatric Program Arkansas Children's Hospital

    Little Rock, Arkansas, 72202

  • CFF Care Center & Pediatric Program Monmouth Medical Center

    Long Branch, New Jersey, 07740

  • Childrens Hospital Los Angeles

    Los Angeles, California, 90027

  • CFF Care Center & Pediatric Program University of Wisconsin

    Madison, Wisconsin, 53792

  • CFF Care Center & Pediatric Program University of Tennessee

    Memphis, Tennessee, 38103

  • CFF Care Center & Pediatric Program Children's Hospital of Wisconsin

    Milwaukee, Wisconsin, 53226

  • CFF Care Center & Pediatric Program Yale University

    New Haven, Connecticut, 06520

  • CFF Care Center & Pediatric Program Columbia University

    New York, New York, 10032

  • CFF Care Center & Pediatric Program Children's Hospital of the King's Daughters

    Norfolk, Virginia, 23507

  • CFF Care Center & Pediatric Program University of Nebraska Medical Center

    Omaha, Nebraska, 68198

  • CFF Care Center & Pediatric Program Stanford University

    Palo Alto, California, 94304

  • CFF Care Center & Pediatric Program Children's Hospital of Pittsburgh

    Pittsburgh, Pennsylvania, 15224

  • CFF Care Center & Pediatric Program Maine Medical Center

    Portland, Maine, 04102

  • CFF Care Center & Pediatric Program Oregon Health & Sciences University

    Portland, Oregon, 97239

  • CFF Care Center Medical College of Virginia

    Richmond, Virginia, 23298

  • University of Utah

    Salt Lake City, Utah, 84132

  • CFF Care Center & Pediatric Program Seattle Children's Hospital

    Seattle, Washington, 98145

  • CFF Care Center & Pediatric Program Sanford USD Medical Center

    Sioux Falls, South Dakota, 57117

  • CFF Care Center & Pediatric Program Cardinal Glennon Children's Hospital/Saint Louis University

    St Louis, Missouri, 63104

  • CFF Care Center & Pediatric Program St. Louis Children's Hospital

    St Louis, Missouri, 63110

  • CFF Care Center & Pediatric Program All Children's Hospital

    St. Petersburg, Florida, 33701

  • CFF Care Center & Pediatric Program SUNY Upstate Medical University

    Syracuse, New York, 13210

  • CFF Care Center Arizona Health Science Center

    Tucson, Arizona, 85724

  • CFF Care Center New York Medical College

    Valhalla, New York, 10595

Other trials in United States

About this study

Official title: OPTIMIZing Treatment for Early Pseudomonas Aeruginosa Infection in Cystic Fibrosis: The OPTIMIZE Multicenter, Placebo-Controlled, Double-Blind, Randomized Trial

The purpose of this trial is to compare the effects of treatment with tobramycin solution for inhalation (TIS) with and without azithromycin in people with cystic fibrosis (CF) age 6 months to 18 years who have early isolation of Pseudomonas aeruginosa (Pa) from a respiratory culture. Specimens of blood and sputum or throat swabs will be taken during the study along with pulmonary function testing. Participants will receive initial treatment with TIS followed additional treatment with TIS if quarterly respiratory cultures are positive for Pa in addition to either azithromycin or placebo for 18 months.

Read the detailed description

Cystic fibrosis (CF) lung disease begins in the first few months of life and follows a course of recurrent lower airway bacterial infection and inflammation and progression of disease over years and decades at a variable pace. With the development of chronic lung infection, obstructive disease progressively worsens, ultimately leading to respiratory failure. Pseudomonas aeruginosa (Pa) is the most important pathogen infecting the CF lower airways, and its acquisition early in life is associated with a pro-inflammatory effect, lower lung function, poor nutritional outcomes, and decreased survival.

Pseudomonas aeruginosa (Pa) infection of the cystic fibrosis (CF) airway typically proceeds from early infection to chronic infection. Although some studies have shown that a minority of individuals with CF spontaneously clear early Pseudomonas aeruginosa (Pa) infection, data from multiple studies suggest that antibiotics are superior to no treatment in clearing Pseudomonas aeruginosa (Pa) from respiratory cultures. Understanding the transition period from early to chronic Pseudomonas aeruginosa (Pa) infection is thus of critical importance in identifying strategies to prevent this progression.

The study will assess the clinical and microbiologic efficacy and safety of azithromycin given three times weekly in combination with standardized tobramycin solution for inhalation (TIS) therapy among children with early Pseudomonas aeruginosa (Pa). TIS therapy is defined as an initial eradication treatment with 1-2 courses of 28 days TIS and subsequent 28 day treatments only at times a quarterly respiratory culture is positive for Pseudomonas aeruginosa (Pa). Eligible participants will be randomized within one month of their Pseudomonas aeruginosa (Pa) positive culture to receive one of the following two treatment strategies for 18 months: (1) oral placebo in addition to standardized TIS therapy, or (2) oral azithromycin in addition to standardized TIS therapy.

At the first study visit, participants will undergo a physical examination and a review of their medical history. Lung function will be measured via spirometry (in children greater than four years of age who are able to perform spirometry), electrocardiogram (ECG) testing will be conducted, and hearing ability will be measured via audiometry. Blood will be drawn for laboratory tests and a specimen will be obtained for a respiratory culture before randomization and study drug dispensing occurs. Subsequent study visits will take place at Day 21, Weeks 13, 26, 39, 52, 65, and 78. At each visit, participants will undergo a physical examination, a spirometry test (as appropriate), a respiratory specimen for Pseudomonas aeruginosa (Pa) culture will be collected and study drug will be dispensed (except at Week 78). Participants will complete self-report or parent-completed respiratory symptom questionnaires and signs and symptoms evaluations will be performed at all visits. Repeat hearing and laboratory tests will be performed at Weeks 39 and 78 and ECG testing will be repeated at Day 21 and Week 78. Participants will be required to maintain a medication diary throughout the study.

Conditions
Cystic Fibrosis
Being tested
azithromycin, placebo, Tobramycin solution for inhalation
Keywords
Cystic fibrosis (CF), Azithromycin, Tobramycin solution for inhalation (TIS), Pseudomonas aeruginosa (Pa), Early Pseudomonas aeruginosa infection, Pulmonary exacerbation, Standardized anti-pseudomonal therapy
Medical subject headings
Cystic Fibrosis, Pseudomonas Infections

What participants receive

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

  • azithromycinDrug

    3 times weekly, oral suspension, 10 mg/kg/dose up to 500 mg, for 18 months

  • placeboDrug

    3 times weekly, oral suspension, volume-matched to azithromycin, for 18 months

  • Tobramycin solution for inhalationDrug

    Also called TIS

    300 mg, twice daily for 28 days when respiratory cultures are found positive for Pa at study visits for 18 months

Study groups in NCT02054156
Study groupRoleWhat they receive
azithromycin and TISActive comparatorazithromycin and tobramycin solution for inhalation (TIS) Azithromycin 3 times weekly, oral suspension, 10 mg/kg/dose up to 500 mg, for 18 months Tobramycin solution for inhalation (TIS), 300 mg, twice daily for 28 days when respiratory cultures are found positive for Pa at study visits for 18 months
Receives: Drug: azithromycin; Drug: Tobramycin solution for inhalation
placebo and TISPlacebo comparatorplacebo and tobramycin solution for inhalation (TIS) Placebo 3 times weekly, oral suspension, volume-matched to azithromycin, for 18 months Tobramycin solution for inhalation (TIS), 300 mg, twice daily for 28 days when respiratory cultures are found positive for Pa at study visits for 18 months
Receives: Drug: placebo; Drug: Tobramycin solution for inhalation

What is being measured

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

  1. Time to a Protocol-defined Pulmonary Exacerbation

    Time to a protocol-defined pulmonary exacerbation requiring oral, inhaled, or intravenous antibiotics, using a prespecified definition available in the study protocol.

    Measured: Over the 18-month study period

Secondary outcomes (3)
  1. Time to Pseudomonas Aeruginosa (Pa) Recurrence

    Time to Pseudomonas aeruginosa (Pa) recurrence after the first quarter of treatment

    Measured: Over the 18-month study period

  2. Adverse Events (AEs) and Serious Adverse Events (SAEs)

    The number and percentage of participants with at least one event over the 18-month study period.

    Measured: Over the 18-month study period

  3. Rate of Adverse Events (AEs) and Serious Adverse Events (SAEs)

    Rate is defined as the number of events per participant follow-up month.

    Measured: Over the 18-month study period

Timeline

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

  1. First posted4 Feb 2014 (estimated)
  2. Study startJun 2014
  3. Primary completion23 Aug 2018
  4. Study completion23 Aug 2018

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
221 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02054156
Sponsor's protocol ID
OPTIMIZE-IP-12
Other IDs
1U01HL114623-01A1, 1U01HL114589-01A1
Acronym
OPTIMIZE
Status last verified
Sep 2019
First submitted
1 Feb 2014
Last updated
1 Oct 2019
Data monitoring committee
Yes

Publications

  • Mayer-Hamblett N, Retsch-Bogart G, Kloster M, Accurso F, Rosenfeld M, Albers G, Black P, Brown P, Cairns A, Davis SD, Graff GR, Kerby GS, Orenstein D, Buckingham R, Ramsey BW; OPTIMIZE Study Group. Azithromycin for Early Pseudomonas Infection in Cystic Fibrosis. The OPTIMIZE Randomized Trial. Am J Respir Crit Care Med. 2018 Nov 1;198(9):1177-1187. doi: 10.1164/rccm.201802-0215OC.

    PubMed 29890086

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing azithromycin and Tobramycin solution for inhalation in people with Cystic Fibrosis, run by Bonnie Ramsey at 45 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 8 inclusion and 15 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 1 Oct 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 45 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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 1 Oct 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?

Time to a Protocol-defined Pulmonary Exacerbation (time frame: Over the 18-month study period). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02054156, which also lists 1 linked publication.

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 1 Oct 2019.

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