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SepsisPhase 2PLEASeNCT03869073

Evolocumab for PCSK9 Lowering in Early Acute Sepsis (The PLEASe Study)

A Phase 2 study testing Evolocumab in people with Sepsis, run by University of British Columbia at 3 sites in Canada.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This study evaluates using evolocumab, a currently approved and marketed biologic drug, in a novel way. Patients who present to the emergency room or intensive care unit (ICU) with severe infection are eligible. Either the patient or their designated decision maker will be approached for consent. Read more about this study

Who is it for?
Ages 19 years and older
Conditions the study is for
Sepsis
What is being tested?
Evolocumab
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
36 participants
Where
3 sitesCanada
Study dates
11 Feb 2019to 11 Feb 2021
Phase
Phase 2
Are there results?
None posted in the registry

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 19 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Signed informed consent
  • At least 19 years of age
  • Known or suspected infection
  • AND one or more of the following organ dysfunctions judged due to sepsis:
  • Cardiovascular- refractory hypotension (a systolic blood pressure (SBP) < 90 mm Hg or mean arterial pressure (MAP) < 60 mm Hg despite an IV fluid challenge of at least 30 ml/kg fluids), or use of vasopressor(s) to maintain SAP > 90 mm Hg or MAP > 60 mm Hg, or;
  • Respiratory: PaO2/FiO2 < 300 or PaO2/FiO2 < 200 if lung is the only organ dysfunction or SaO2:FiO2 150

Who cannot join

  • Known pregnancy
  • Underlying severe congestive heart failure (New York Heart Association (NYHA) IV), severe COPD (need for chronic oxygen or mechanical ventilation), severe liver disease (Child-Pugh Class C), cancer requiring chemotherapy, or transplantation (bone marrow, heart, lung, liver, pancreas, or small bowel) in the past 6 months or likely within the next 6 months
  • Previous episode of sepsis during that hospital admission
  • Absolute Neutrophil Count < 500/mm³
  • CD4 count < 50/mm³
  • Treating physician deems aggressive care unsuitable (i.e. no commitment to active care)
Show all 10Show fewer
  • Participation in another interventional drug study within previous 1 month
  • Allergic to the study drug or any of its components
  • Lactation
  • Have signed a Do No Resuscitate (DNR) Form

Trial locations and contacts

3 sites in 1 country.

Canada3 sites, 3 recruiting
  • Surrey Memorial Hospital

    Surrey, British Columbia, V3V 1Z2

    Gregory Haljan, MD

    Not yet recruiting
  • St. Paul's Hospital

    Vancouver, British Columbia, V6Z 1Y6

    John Boyd, MD

    Recruiting
  • Vancouver General Hospital

    Vancouver, British Columbia, V6Z 1Y6

    Donald Griesdale, MD

    Not yet recruiting

Other trials in Canada

About this study

Official title: Randomized, Double-blind, Placebo-controlled Phase 2a Trial of Efficacy and Safety of Evolocumab for PCSK9 Lowering in Early Acute Sepsis

This study evaluates using evolocumab, a currently approved and marketed biologic drug, in a novel way. Patients who present to the emergency room or intensive care unit (ICU) with severe infection are eligible. Either the patient or their designated decision maker will be approached for consent. If they choose to participate they will be given either a single dose of evolocumab, a higher single dose of evolocumab,or a single dose of placebo. Participants will be followed during their stay in the ICU and will receive follow up phone calls at Day 28 and 90.

Read the detailed description

Evolocumab is currently approved and marketed in USA and Canada for lowering cholesterol levels. Evolocumab is an anti-PSCK9 monoclonal antibody, and functions by binding PSCK9 (an inhibitor of LDL removal) and blocking its function. Evidence suggests that since evolocumab increases the removal rate of low-density lipoproteins from the body, it might also help increase the removal of bacterial components that are attached to circulating lipids during sepsis. Quickly removing these bacterial components could prevent a strong and rapid immune response that often leads to organ failure and death in sepsis patients.

Conditions
Sepsis
Being tested
Evolocumab, Placebo
Keywords
Bacterial, Infection, Blood, Systemic, ICU
Medical subject headings
Sepsis, Infections

What participants receive

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

  • EvolocumabDrug

    Also called Repatha

    Three pre-filled shrouded syringes for subcutaneous injection in abdomen.

  • PlaceboDrug

    Also called Saline

    Preservative free 0.9% sodium chloride. Three pre-filled shrouded syringes for subcutaneous injection in abdomen.

Study groups in NCT03869073
Study groupRoleWhat they receive
Low DoseExperimentalThis treatment arm will receive the highest dose of evolocumab currently marketed and approved: 420mg. The dose will be given at a single time point within 4 hours of randomization. The dose will be administered through three subcutaneous injections, each in a different quadrant of the abdomen.
Receives: Drug: Evolocumab
High DoseExperimentalThis treatment arm will receive double the highest dose of evolocumab currently marketed and approved: 840mg. The dose will be given at a single time point within 4 hours of randomization. The dose will be administered through three subcutaneous injections, each in a different quadrant of the abdomen.
Receives: Drug: Evolocumab
PlaceboPlacebo comparatorThis treatment arm will receive saline solution. The dose will be given at a single time point within 4 hours of randomization. The dose will be administered through three subcutaneous injections, each in a different quadrant of the abdomen.
Receives: Drug: Placebo

What is being measured

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

  1. Area under the plasma LTA and LPS curves

    Determine whether evolocumab decreases plasma levels of bacterial LPS and LTA, at 6, 24, 48 and 72 hours, and day 7 by comparing the area under the operating curve between arms.

    Measured: 7 days or less (as data is collected from participants only while they are admitted to critical care, they may be discharged or moved to a different ward before day 7 and therefore subsequent time points would be not be collected)

Secondary outcomes (24)
  1. Levels of LDL-C

    Measure levels (concentration; e.g. ug/mL) of low-density lipoprotein-cholesterol (LDL-C) at 24, 48, and 72 hours, and day 7, and compare area under the plasma cytokine curve between arms.

    Measured: 7 days or less (as data is collected from participants only while they are admitted to critical care, they may be discharged or moved to a different ward before day 7 and therefore subsequent time points would be not be collected)

  2. Levels of cytokines IL-6, TNF-alpha and IL-8

    Measure levels (concentration; e.g. ug/mL) of cytokines (IL-6, TNF-alpha and IL-8) at 24, 48, and 72 hours, and day 7, and compare area under the plasma cytokine curve between arms.

    Measured: 7 days or less (as data is collected from participants only while they are admitted to critical care, they may be discharged or moved to a different ward before day 7 and therefore subsequent time points would be not be collected)

  3. Concentration of circulating evolocumab and circulating free PCSK9 in septic patients

    Assess the concentration (e.g. umol/L) of circulating evolocumab and free (unbound by antibody) PCSK9 in evolocumab-treated patients with sepsis and compare to placebo controls.

    Measured: 7 days or less (may be discharged from critical care before day 7)

  4. Cmax of circulating evolocumab and circulating free PCSK9 in septic patients

    Assess the Cmax of circulating evolocumab and free (unbound by antibody) PCSK9 in evolocumab-treated patients with sepsis and compare to placebo controls.

    Measured: 7 days or less (may be discharged from critical care before day 7)

  5. Days alive

    Determine if changes in days alive over 28 days are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  6. Changes in 28-day mortality

    Determine whether differences in mortality rates at 28 days exist between treatment arms.

    Measured: 28 days

  7. Level of organ dysfunction

    Determine if changes in days free of organ dysfunction (cardiovascular, respiratory, renal, hematologic, and hepatic) over 28 days are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  8. Level of organ support

    Determine if changes in days free of organ support (vasopressor, ventilation and renal replacement therapy (RRT)) over 28 days are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  9. Changes in Vitals: lactate

    Determine if changes in plasma lactate levels (mmol/L) are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  10. Changes in Vitals: norepinephrine dose

    Determine if changes in norepinephrine levels (mcg/min) are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  11. Changes in Vitals: mean arterial pressure

    Determine if changes in mean arterial pressure levels (mm Hg) are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  12. Changes in Vitals: heart rate

    Determine if changes in heart rate (beats per minute) are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  13. Changes in Vitals: respiratory rate

    Determine if changes in respiratory rate (breaths per minute) are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  14. Changes in Vitals: temperature

    Determine if changes in temperature (degrees Celsius) are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  15. Changes in Vitals: fluid balance

    Determine if changes in fluid balance (Liters) are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  16. Changes in Vitals: urine output

    Determine if changes in urine output (Liters) are associated with treatment arm.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  17. Safety outcomes: Number of treatment-related adverse events as ranked by severity

    Monitor and count by category, and evaluate severity and seriousness of any adverse events related to the intervention that occurs in this critical and previously untested population.

    Measured: Day 1 to Day 90

  18. Safety outcomes: changes in blood cell counts

    Document changes in blood cell counts (cells/ml) including white blood cells, red blood cells, and platelets, and determine whether clinically significant changes are associated with treatment.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  19. Safety outcomes: changes in coagulation

    Document changes in coagulation of blood by measuring Prothrombin Time (PT) and Partial Thromboplastin Time (PTT). Both measurements determine time to clotting (in seconds) of different clotting factors and are then used to calculate International Normalized Ratio (INR) which helps monitor effects of blood thinning medication, and determine whether clinically significant changes are associated with treatment.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  20. Safety outcomes: changes in blood analytes

    Document changes in concentration (e.g. umol/mL) of blood analytes, including hemoglobin, glucose, glycated hemoglobin, potassium, sodium, chloride, bicarbonate, creatinine, calcium, triponine, magnesium, aminotransferase, and alanine aminotransferase, and determine whether clinically significant changes are associated with treatment.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  21. Safety outcomes: changes in urine density

    Document changes in urine specific gravity (density relative to water) and determine whether clinically significant changes are associated with treatment.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  22. Safety outcomes: changes in urine pH

    Document changes in urine pH and determine whether clinically significant changes are associated with treatment.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  23. Safety outcomes: changes in concentration of ketones in urine

    Document changes in concentration of ketones (e.g. umol/L) in the urine and determine whether clinically significant changes are associated with treatment.

    Measured: 28 days or less (may be discharged from critical care before day 28)

  24. Safety outcomes: document other urine abnormalities if required

    Document presence of blood, nitrites, bacteria, or urinary casts in the urine (yes or no) and determine whether clinically significant changes are associated with treatment.

    Measured: 28 days or less (may be discharged from critical care before day 28)

Timeline

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

  1. First posted11 Mar 2019
  2. Study start11 Feb 2019
  3. Primary completion11 Feb 2021 (estimated)
  4. Study completion11 Feb 2021 (estimated)

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
Model description
Upon enrolling in the study participants will be randomized into one of three possible treatment arms: 420mg single dose at baseline, 840mg single dose at baseline, or placebo
Masking
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
36 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03869073
Sponsor's protocol ID
H18-00917
Acronym
PLEASe
Status last verified
Mar 2020
First submitted
5 Mar 2019
Last updated
3 Mar 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Cirstea M, Walley KR, Russell JA, Brunham LR, Genga KR, Boyd JH. Decreased high-density lipoprotein cholesterol level is an early prognostic marker for organ dysfunction and death in patients with suspected sepsis. J Crit Care. 2017 Apr;38:289-294. doi: 10.1016/j.jcrc.2016.11.041. Epub 2016 Dec 7.

    PubMed 28013095
  • Roveran Genga K, Lo C, Cirstea M, Zhou G, Walley KR, Russell JA, Levin A, Boyd JH. Two-year follow-up of patients with septic shock presenting with low HDL: the effect upon acute kidney injury, death and estimated glomerular filtration rate. J Intern Med. 2017 May;281(5):518-529. doi: 10.1111/joim.12601. Epub 2017 Mar 19.

    PubMed 28317295
  • Levels JH, Abraham PR, van den Ende A, van Deventer SJ. Distribution and kinetics of lipoprotein-bound endotoxin. Infect Immun. 2001 May;69(5):2821-8. doi: 10.1128/IAI.69.5.2821-2828.2001.

    PubMed 11292694
  • Levels JH, Abraham PR, van Barreveld EP, Meijers JC, van Deventer SJ. Distribution and kinetics of lipoprotein-bound lipoteichoic acid. Infect Immun. 2003 Jun;71(6):3280-4. doi: 10.1128/IAI.71.6.3280-3284.2003.

    PubMed 12761109
  • Levels JH, Marquart JA, Abraham PR, van den Ende AE, Molhuizen HO, van Deventer SJ, Meijers JC. Lipopolysaccharide is transferred from high-density to low-density lipoproteins by lipopolysaccharide-binding protein and phospholipid transfer protein. Infect Immun. 2005 Apr;73(4):2321-6. doi: 10.1128/IAI.73.4.2321-2326.2005.

    PubMed 15784577
  • Topchiy E, Cirstea M, Kong HJ, Boyd JH, Wang Y, Russell JA, Walley KR. Lipopolysaccharide Is Cleared from the Circulation by Hepatocytes via the Low Density Lipoprotein Receptor. PLoS One. 2016 May 12;11(5):e0155030. doi: 10.1371/journal.pone.0155030. eCollection 2016.

    PubMed 27171436
  • Walley KR, Thain KR, Russell JA, Reilly MP, Meyer NJ, Ferguson JF, Christie JD, Nakada TA, Fjell CD, Thair SA, Cirstea MS, Boyd JH. PCSK9 is a critical regulator of the innate immune response and septic shock outcome. Sci Transl Med. 2014 Oct 15;6(258):258ra143. doi: 10.1126/scitranslmed.3008782.

    PubMed 25320235
  • Boyd JH, Fjell CD, Russell JA, Sirounis D, Cirstea MS, Walley KR. Increased Plasma PCSK9 Levels Are Associated with Reduced Endotoxin Clearance and the Development of Acute Organ Failures during Sepsis. J Innate Immun. 2016;8(2):211-20. doi: 10.1159/000442976. Epub 2016 Jan 13.

    PubMed 26756586

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Evolocumab in people with Sepsis, run by University of British Columbia at 3 sites in Canada.

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 6 inclusion and 10 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: status not confirmed, as of the sponsor's last update on 3 Mar 2020. 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 Canada. 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?

Results are not available in the source record.

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

Contact Genevieve L Rocheleau (604-682-2344 ext. 64888, grocheleau@providencehealth.bc.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Area under the plasma LTA and LPS curves (time frame: 7 days or less (as data is collected from participants only while they are admitted to critical care, they may be discharged or moved to a different ward before day 7 and therefore subsequent time points would be not be collected)). 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 NCT03869073, which also lists 8 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 3 Mar 2020.

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