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Septic ShockPhase 2/3SEPSIS-ACTNCT02508649

Selepressin Evaluation Programme for Sepsis-Induced Shock - Adaptive Clinical Trial

A Phase 2/3 study testing selepressin in people with Septic Shock, run by Ferring Pharmaceuticals at 21 sites in 5 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This is a double-blind, randomised, placebo-controlled, two-part adaptive clinical trial. The trial is designed to investigate the efficacy and safety of multiple dosing regimens of selepressin and to confirm the efficacy and safety of one dosing regimen in treatment of adult patients with septic shock requiring… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Septic Shock
What is being tested?
selepressin
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
868 participants
Where
21 sitesin 5 countries
Study dates
Jul 2015to 26 Feb 2018
Phase
Phase 2/3
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 18 years of age or older
  • Proven or suspected infection
  • Septic shock defined as hypotension requiring vasopressor treatment despite adequate fluid resuscitation
  • Informed consent obtained in accordance with local regulations

Who cannot join

  • Not possible to initiate trial drug treatment within 12 hours from onset of vasopressor treatment for septic shock
  • Primary cause of hypotension not due to sepsis
  • Previous severe sepsis with intensive care unit admission within this hospital stay
  • Known/suspected acute mesenteric ischaemia
  • Suspicion of concomitant acute coronary syndrome based on clinical symptoms and/or ECG during this episode of septic shock
  • Chronic mechanical ventilation for any reason OR severe chronic obstructive pulmonary disease (COPD) requiring either continuous daily oxygen use during the preceding 30 days or mechanical ventilation (for acute exacerbation of COPD) during the preceding 30 days
Show all 12Show fewer
  • Received bone marrow transplant during the preceding 6 months or chemotherapy during the preceding 30 days for lymphoma or leukemia
  • Known to be pregnant
  • Decision to limit full care taken before obtaining informed consent
  • Use of vasopressin in the past 12 hours prior to start of trial drug treatment or use of terlipressin within 7 days prior to start of trial drug treatment
  • Prior enrolment in the trial
  • Prior use of an investigational medicinal product within the last month OR planned or concurrent participation in a clinical trial for any investigational drug or investigational device

Trial locations and contacts

21 sites in 5 countries.

21 sites in 5 countries

United States17 sites
  • Cooper University Hospital

    Camden, New Jersey, 08103

  • Rush University Medical Center

    Chicago, Illinois, 60612

  • Memorial Hospital

    Colorado Springs, Colorado, 80909

  • Ohio State University

    Columbus, Ohio, 43210-1252

  • Remington Davis Inc

    Columbus, Ohio, 43215

  • Henry Ford Hospital

    Detroit, Michigan

  • Northshore University Healthsystem Research Institute

    Evanston, Illinois, 60201

  • Eastern Idaho Regional Medical Center

    Idaho Falls, Idaho, 83404

  • University of Oklahoma Health Sciences Center

    Oklahoma City, Oklahoma

  • University of Nebraska Medical Center

    Omaha, Nebraska, 68198

  • Temple University Hospital

    Philadelphia, Pennsylvania

  • University of Pittsburgh Medical Center

    Pittsburgh, Pennsylvania

  • HealthPartners Speciality Clinics

    Saint Paul, Minnesota, 55101

  • Baystate Medical Center

    Springfield, Massachusetts, 01199

  • St Vincent Mercy Medical Center

    Toledo, Ohio, 43608

  • Stormont Vail Health Care

    Topeka, Kansas, 66604

  • Wake Forest University School of Medicine

    Winston-Salem, North Carolina, 27157

Other trials in United States

Belgium1 site
  • Cliniques Universitaires Saint-Luc (there may be other sites in this country)

    Brussels

Other trials in Belgium

Denmark1 site
  • Aalborg Universitetshospital (there may be other sites in this country)

    Aalborg

Other trials in Denmark

France1 site
  • Centre Hospitalier et Universitaire de Limoges (there may be other sites in this country)

    Limoges

Other trials in France

Netherlands1 site
  • Radboud University Nijmegen Medical Centre (there may be other sites in this country)

    Nijmegen

Other trials in Netherlands

About this study

Official title: A Double-blind, Randomised, Placebo-Controlled, Phase 2b/3 Adaptive Clinical Trial Investigating the Efficacy and Safety of Selepressin as Treatment for Patients With Vasopressor-dependent Septic Shock

This is a double-blind, randomised, placebo-controlled, two-part adaptive clinical trial. The trial is designed to investigate the efficacy and safety of multiple dosing regimens of selepressin and to confirm the efficacy and safety of one dosing regimen in treatment of adult patients with septic shock requiring vasopressor.

Conditions
Septic Shock
Being tested
selepressin, placebo
Medical subject headings
Shock, Septic

What participants receive

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

  • selepressinDrug

  • placeboDrug

Study groups in NCT02508649
Study groupRoleWhat they receive
PlaceboPlacebo comparatorNot described
Receives: Drug: placebo
Selepressin 1ExperimentalStarting dose 1.7 ng/kg/min
Receives: Drug: selepressin
Selepressin 2ExperimentalStarting dose 2.5 ng/kg/min
Receives: Drug: selepressin
Selepressin 3ExperimentalStarting dose 3.5 ng/kg/min
Receives: Drug: selepressin
Selepressin 4ExperimentalStarting dose 5.0 ng/kg/min The highest dosing regimen of selepressin was not investigated in the trial as the desired primary outcome for selepressin 3 arm was not achieved, and the trial was terminated for futility.
Receives: Drug: selepressin

What is being measured

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

  1. Vasopressor- and Mechanical Ventilator-free Days (PVFDs)

    Composite endpoint defined as number of days from start of treatment to 30 days thereafter during which subject is:

    1. Alive. However, if patient dies within these 30-days then PVFDs will be zero even if there is a period during which subject is alive and free of both vasopressor treatment and mechanical ventilation;
    2. Free of treatment with vasopressors: Less than 60 min during any contiguous 24-h period. If a patient requires vasopressors longer than 60 min in total during any 24-h period, the intervening intervals during which they are free of vasopressors will not be included in the determination of PVFDs;
    3. Free of any mechanical ventilation: Less than 60 min during any contiguous 24-h period. If a patient requires mechanical ventilation longer than 60 min in total during any 24-h period, the intervening intervals during which they are not receiving mechanical ventilation will not be included in the period free of mechanical ventilation in the determination of PVFDs.

    Measured: Up to Day 30

Secondary outcomes (19)
  1. All-cause Mortality

    All-cause mortality defined as the percentage of subjects that have died, regardless of cause.

    Measured: At Day 90

  2. Renal Replacement Therapy (RRT)-Free Days

    RRT-free days was defined as the number of days a subject is free of treatment with any form of RRT (continuous RRT, intermittent hemodialysis or peritoneal dialysis) and the intermittent periods were not included.

    RRT-free days was analyzed excluding subjects on RRT for chronic renal failure at time of randomization.

    Measured: Up to Day 30

  3. Intensive Care Unit (ICU)-Free Days

    The ICU free days, as for the PVFDs, reflect the time from last discharge of the ICU to Day 30 with an absolute penalty for mortality, i.e., any subject that died within this 30-day period was assigned zero value).

    Measured: Up to Day 30

  4. Vasopressor-free Days up to Day 30

    Number of days from start of treatment to 30 days thereafter during which the subject is free of treatment with vasopressors, i.e. less than 60 min during any contiguous 24-h period.

    Measured: Up to Day 30

  5. Mechanical Ventilator-free Days up to Day 30

    Number of days from start of treatment to 30 days thereafter during which the subject is free of any mechanical ventilation, i.e. less than 60 min during any contiguous 24-h period.

    Measured: Up to Day 30

  6. Duration of Septic Shock (i.e. Vasopressor Use) up to Day 30

    The duration of septic shock was defined as the cumulative periods (>1 h), from start of investigational medicinal product (IMP) treatment until Day 30, on IMP or vasopressors.

    Measured: Up to Day 30

  7. Duration of Mechanical Ventilation up to Day 30

    The duration of mechanical ventilation was defined as the cumulative periods (>1 h), from start of the IMP treatment until Day 30, on mechanical ventilation.

    Measured: Up to Day 30

  8. The Percentage of Subjects With RRT up to Day 30 (Counting Subjects Who Died as on RRT and Excluding Subjects on RRT for Chronic Renal Failure at the Time of Randomization)

    Renal replacement therapy is defined as continuous RRT, intermittent hemodialysis, or peritoneal dialysis. In order to ensure that any reduction in the incidence of RRT was not caused by an increase in mortality, all subjects dying within the 30-day period were counted as on RRT.

    Measured: Up to Day 30

  9. Duration of RRT up to Day 90 (Excluding Subjects on RRT for Chronic Failure at the Time of Randomization)

    The duration of RRT was defined as the cumulative periods (>1 h) from start of IMP until Day 90 with RRT (continuous renal replacement therapy, intermittent hemodialysis, or peritoneal dialysis).

    Subjects on RRT for chronic renal failure at time of randomization were not included in the analysis.

    Measured: Up to Day 90

  10. Overall and Individual Organ (Cardiovascular, Respiratory, Renal, Hepatic, Coagulation) Scores Using a Modified Version of the SOFA up to Day 7 or Until ICU Discharge

    The presence of 5 organ dysfunctions (cardiovascular, respiratory, renal, hepatic, coagulation) was assessed using a modified Sequential Organ Failure Assessment (SOFA) (i.e. SOFA except the Glasgow Coma Scale). In addition, any dose of vasopressors or positive ionotropes will attribute 3 or 2 points on the cardiovascular scale, respectively.

    Each organ has a possible dysfunction score of 0 (no organ dysfunction) to 4 (dysfunctional organ), for a total modified SOFA score range of 0 (no organ dysfunction) to 23 (all organs with dysfunction).

    Measured: Days 1, 3, and 7 or discharge from ICU

  11. Percentage of Subjects With New Organ Dysfunction and New Organ Failure (Based on the SOFA Score) up to Day 7 and Day 30

    The presence of 5 organ dysfunctions (cardiovascular, respiratory, renal, hepatic, coagulation) was assessed using a SOFA score. Each organ has a possible dysfunction score of 0 (no organ dysfunction) to 4 (all organs with dysfunction).

    Incidence of new organ dysfunction is defined as an increase ≥ 1 from baseline to post baseline up until the end of the period (e.g. going from 1-2) in any of the individual SOFA scores.

    Incidence of new organ failures is defined as a change in any of the individual SOFA scores from (0-2) at baseline to (3-4) post baseline up until the end of the period (Day 7 or 30) (if the SOFA scores goes from (0-2) to (3-4) and back to (0-2) again within the period, that will still count as a new organ failure).

    Percentage of subjects with new organ dysfunction and new organ failure (based on the SOFA Score) up to Day 7 and Day 30 are reported.

    Measured: Up to Day 7 and Day 30

  12. ICU Length of Stay up to Day 30

    ICU length of stay is defined as the cumulative periods (>1 h) spent in ICU from start of IMP to 30 days after.

    Measured: Up to Day 30

  13. All-cause Mortality (Defined as the Percentage of Subjects That Have Died, Regardless of Cause) at Day 30 and Day 180

    All-cause mortality defined as the percentage of subjects that have died, regardless of cause.

    Measured: At Day 30 and Day 180

  14. Daily Fluid Balance Until ICU Discharge (for a Maximum of 7 Days)

    Fluid balance (as a rate of time) calculated for fluid administered during episode of severe sepsis/septic shock will be presented until ICU discharge (for a maximum of 7 days).

    Measured: Baseline and Days 1-7

  15. Cumulative Fluid Balance Until ICU Discharge (for a Maximum of 7 Days)

    Cumulative fluid balance (total volume) calculated for fluid administered during episode of severe sepsis/septic shock will be presented until ICU discharge (for a maximum of 7 days).

    Measured: Baseline and Days 1-7

  16. Daily Urine Output Until ICU Discharge (for a Maximum of 7 Days)

    Measured: Baseline and Days 1-7

  17. Cumulative Urine Output Until ICU Discharge (for a Maximum of 7 Days)

    Cumulative urinary output (absolute values) will be presented until ICU discharge (for a maximum of 7 Days).

    Measured: Baseline and Days 1-7

  18. Utility, Based on the EuroQol Group's 5-dimension 5-level (EQ-5D-5L) Questionnaire, up to Day 180

    The EuroQoL-5-Dimensions (EQ-5D™) was used to assess the overall health of each subject. EQ-5D™ is a standardised instrument for use as a measure of health outcome. The first part of the instrument includes 5 dimensions where the subject indicates which of the given statements best describes the health state on the day of questionnaire completion. The second part contains a visual analogue scale (VAS) where the subject indicates how good or bad his or her own health is on the day of questionnaire completion.

    EQ-5D-5L will be analyzed by the index value (Range: 0-1; 0=dead state, 1=full health state), the overall quality-adjusted life year (QALY), and the VAS score (Range: 0-100; 0=worst health state, 100=best health state). The EQ-5D-5L was completed at baseline and at the scheduled follow-up days (i.e. Day 30, Day 60, Day 90, and Day 180).

    Data for EQ VAS score and EQ-5D-5L index score are reported in this endpoint.

    Measured: Baseline and Days 30, 60, 90 and 180

  19. Utility, Based on the EuroQol Group's 5-dimension 5-level (EQ-5D-5L) Questionnaire, up to Day 180

    The EQ-5D™ was used to assess the overall health of each subject. EQ-5D™ is a standardised instrument for use as a measure of health outcome. The first part of the instrument includes 5 dimensions where the subject indicates which of the given statements best describes the health state on the day of questionnaire completion. The second part contains a VAS where the subject indicates how good or bad his or her own health is on the day of questionnaire completion.

    EQ-5D-5L will be analyzed by the index value (Range: 0-1; 0=dead state, 1=full health state), the overall QALY, and the VAS score (Range: 0-100; 0=worst health state, 100=best health state). The EQ-5D-5L was completed at baseline and at the scheduled follow-up days (i.e. Day 30, Day 60, Day 90, and Day 180).

    Data for EQ-5D-5L QALY is reported in this endpoint.

    Measured: Days 30, 60, 90 and 180

Timeline

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

  1. First posted27 Jul 2015 (estimated)
  2. Study startJul 2015
  3. Primary completion3 Oct 2017
  4. Study completion26 Feb 2018

Why it stopped: Terminated due to futility

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 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
868 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02508649
Sponsor's protocol ID
000133
Other IDs
2014-003973-41, 2014
Acronym
SEPSIS-ACT
Status last verified
Sep 2020
First submitted
17 Jul 2015
Last updated
6 Apr 2021
Data monitoring committee
Yes

Publications

  • Laterre PF, Berry SM, Blemings A, Carlsen JE, Francois B, Graves T, Jacobsen K, Lewis RJ, Opal SM, Perner A, Pickkers P, Russell JA, Windelov NA, Yealy DM, Asfar P, Bestle MH, Muller G, Bruel C, Brule N, Decruyenaere J, Dive AM, Dugernier T, Krell K, Lefrant JY, Megarbane B, Mercier E, Mira JP, Quenot JP, Rasmussen BS, Thorsen-Meyer HC, Vander Laenen M, Vang ML, Vignon P, Vinatier I, Wichmann S, Wittebole X, Kjolbye AL, Angus DC; SEPSIS-ACT Investigators. Effect of Selepressin vs Placebo on Ventilator- and Vasopressor-Free Days in Patients With Septic Shock: The SEPSIS-ACT Randomized Clinical Trial. JAMA. 2019 Oct 15;322(15):1476-1485. doi: 10.1001/jama.2019.14607.

    PubMed 31577035
  • Lewis RJ, Angus DC, Laterre PF, Kjolbye AL, van der Meulen E, Blemings A, Graves T, Russell JA, Carlsen JE, Jacobsen K, Yealy DM, Opal SM, Windelov NA, Francois B, Perner A, Pickkers P, Berry SM. Rationale and Design of an Adaptive Phase 2b/3 Clinical Trial of Selepressin for Adults in Septic Shock. Selepressin Evaluation Programme for Sepsis-induced Shock-Adaptive Clinical Trial. Ann Am Thorac Soc. 2018 Feb;15(2):250-257. doi: 10.1513/AnnalsATS.201708-669SD.

    PubMed 29388815

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing selepressin in people with Septic Shock, run by Ferring Pharmaceuticals at 21 sites in 5 countries.

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 4 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: stopped early, as of the sponsor's last update on 6 Apr 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 21 sites in United States, Belgium, Denmark, France, Netherlands. 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 combined 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.

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 6 Apr 2021). 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?

Vasopressor- and Mechanical Ventilator-free Days (PVFDs) (time frame: Up to Day 30). 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 NCT02508649, which also lists 2 linked publications.

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 6 Apr 2021.

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