A Phase 3 interventional study of AZLI 75 mg two times a day (BID)/three times a day (TID) and Placebo two times a day (BID)/three times a day (TID) in Cystic Fibrosis, sponsored by Gilead Sciences. Completed at 56 sites in United States. Open to participants aged 6 Years and older. Per ClinicalTrials.gov, last updated 2011-03-11.
Sponsored by Gilead Sciences · Phase 3, Interventional, and Treatment
The purpose of this study was to evaluate the safety and efficacy of aztreonam for inhalation solution (AZLI) in patients with cystic fibrosis (CF) and lung infection due to Pseudomonas aeruginosa (PA).
Patients with CF often have lung infections that occur repeatedly or worsen over time. The lung infections are often caused by a bacteria called PA. Treatment with antibiotics can stop or slow down the growth of the bacteria. The antibiotics may be given by mouth, intravenously (IV), or by inhalation as a mist. The purpose of this study was to evaluate the safety and efficacy of aztreonam for inhalation solution (AZLI), an investigational formulation of the antibiotic administered using the eFlow® Electronic Nebulizer by PARI GmbH, in CF patients with PA.
In this study, participants were screened for eligibility at Visit 1 (Day -42) and returned to the center for Visit 2 after a 14-day evaluation period. At Visit 2 (Day -28), participants began a 28-day course of open-label Tobramycin Inhalation Solution (TIS). At Visit 3 (Day 0), following completion of the 28-day course of TIS, participants began randomized, blinded treatment with either AZLI twice a day (BID) or three times a day (TID) or placebo BID or TID, and continued treatment for a total of 28 days, with a clinic visit at Day 14 (Visit 4) and at the end of treatment (Visit 5 [Day 28]). Participants returned for visits every 2 weeks for 8 weeks after the end of the blinded treatment (Visits 6 to 9 [Days 42 to 84]).
Two hundred and forty-seven participants were treated in the TIS phase of this study. Two hundred and eleven subjects completed the TIS phase and were treated in the placebo-controlled phase with study drug (AZLI or placebo).
1,581 studies on the registry are indexed under Cystic Fibrosis; 190 are open to participants now.
This study's enrollment of 211 is above the median of 36 across 1,034 interventional studies indexed under Cystic Fibrosis.
Browse Cystic Fibrosis studies →Gilead Sciences is the lead sponsor of 680 studies on the registry; 24 are open to participants now.
Of its 259 completed or terminated interventional studies of FDA-regulated products, 249 (96%) have results posted.
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CF as diagnosed by:
Exclusion Criteria:
Drug: Placebo two times a day (BID)/three times a day (TID)
Drug: AZLI 75 mg two times a day (BID)/three times a day (TID)
Time to Need for Inhaled or Intravenous (IV) Antipseudomonal Antibiotics
The primary endpoint was time to need for a course of inhaled or IV antipseudomonal antibiotics with documented physician assessment of need for antibiotics. Antipseudomonal Antibiotic need was documented based on the presence of at least one of the following four symptoms predictive of pulmonary exacerbation: decreased exercise tolerance, increased cough, increased sputum / chest congestion, decreased appetite, or other.
Time frame: Day 0 to Day 84 (end of study)
Change in Cystic Fibrosis Questionnaire - Revised (CFQ-R) Respiratory Symptoms Scale (RSS) Score
The CFQ-R was administered at Day -28, baseline, Day 14, Day 28, and Day 84 (end of study). The endpoint was change in respiratory symptoms from baseline, assessed with the CFQ-R RSS (range of scores \[units\]: 0-100; higher scores indicate fewer symptoms).
Time frame: Day 0 to Day 28
Percent Change in Forced Expiratory Volume in 1 Second (FEV1) (L)
Spirometry was performed at each visit. FEV1 was recorded according to American Thoracic Society (ATS) guidelines. FEV1(L) is the measurement of the volume of air (expressed in liters) exhaled in 1 second. The percent change in this parameter from Day 0 to Day 28 was determined for each treatment group.
Time frame: Day 0 to Day 28
Number of Hospitalization Days
Details of all hospitalizations, including the dates of admission and discharge, were recorded on the electronic case report form (eCRF).
Time frame: Day 0 to Day 84
Change From Baseline in Pseudomonas Aeruginosa (PA) Log10 Colony Forming Units (CFU) Per Gram of Sputum
Sputum samples were collected at all participant visits of the study for analysis of microbiology endpoints. Sputum samples were processed for qualitative and quantitative culture of PA (each morphotype). Due to the skewness of the distribution of CFU data, the data were transformed using the base 10 logarithm, in an attempt to normalize the data and allow for parametric tests, before calculating changes. To account for zero values, 1 was added to each CFU measurement before being transformed. Any CFU data values where PA was not isolated from a valid culture were set to zero.
Time frame: Day 0 to Day 28
Number of Participants With Other Pathogens
Sputum samples were collected at all visits for quantitative and qualitative culture for Staphylococcus aureus, Burkholderia cepacia, Stenotrophomonas maltophilia, and Achromobacter xylosoxidans. Number of participants with other pathogens at baseline and at the end of treatment (28 days) are reported.
Time frame: Day 0 and Day 28
Minimum Concentration of Aztreonam Inhibiting 50% (MIC50) and 90% (MIC90) of All PA Isolates (μg/mL)
The aztreonam susceptibility of PA isolates from sputum samples (collected at all visits) was assessed. MIC50 = minimum inhibitory concentration (minimum concentration of an agent that inhibits 50% of isolates from a particular organism). MIC90 = minimum inhibitory concentration (minimum concentration of an agent that inhibits 90% of isolates from a particular organism). MIC50 and MIC90 values are single measurements for the entire population and not measured on a per-participant basis.
Time frame: Day 0 to Day 28
Participants were enrolled at 56 sites in the United States. Date of first enrollment was 24 February 2005, and date of last participant follow-up was 07 September 2006.
| Milestone | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) |
|---|---|---|
| Started | 76 | 135 |
| Completed | 26 | 64 |
| Not completed | 50 | 71 |
| Withdrew: Unrelated adverse event | 34 | 47 |
| Withdrew: Study drug intolerance | 0 | 1 |
| Withdrew: Related adverse event | 13 | 15 |
| Withdrew: Lost to follow-up | 1 | 0 |
| Withdrew: Noncompliance | 0 | 2 |
| Withdrew: Personal/administrative | 1 | 1 |
| Withdrew: Other | 1 | 5 |
The primary endpoint was time to need for a course of inhaled or IV antipseudomonal antibiotics with documented physician assessment of need for antibiotics. Antipseudomonal Antibiotic need was documented based on the presence of at least one of the following four symptoms predictive of pulmonary exacerbation: decreased exercise tolerance, increased cough, increased sputum / chest congestion, decreased appetite, or other.
| Days | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) |
|---|---|---|
| Time to Need for Inhaled or Intravenous (IV) Antipseudomonal Antibiotics | 71 (57 to 97) | 92 (89 to NA) |
The CFQ-R was administered at Day -28, baseline, Day 14, Day 28, and Day 84 (end of study). The endpoint was change in respiratory symptoms from baseline, assessed with the CFQ-R RSS (range of scores \[units\]: 0-100; higher scores indicate fewer symptoms).
| Units on a scale | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) |
|---|---|---|
| Change in Cystic Fibrosis Questionnaire - Revised (CFQ-R) Respiratory Symptoms Scale (RSS) Score | -0.66 ± 1.708 | 4.34 ± 1.27 |
Spirometry was performed at each visit. FEV1 was recorded according to American Thoracic Society (ATS) guidelines. FEV1(L) is the measurement of the volume of air (expressed in liters) exhaled in 1 second. The percent change in this parameter from Day 0 to Day 28 was determined for each treatment group.
| Percent change in FEV1 (L) | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) |
|---|---|---|
| Percent Change in Forced Expiratory Volume in 1 Second (FEV1) (L) | -2.363 ± 1.534 | 3.917 ± 1.151 |
Details of all hospitalizations, including the dates of admission and discharge, were recorded on the electronic case report form (eCRF).
| Days | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) |
|---|---|---|
| Number of Hospitalization Days | 0.5 ± 2.4 | 0.9 ± 3.9 |
Sputum samples were collected at all participant visits of the study for analysis of microbiology endpoints. Sputum samples were processed for qualitative and quantitative culture of PA (each morphotype). Due to the skewness of the distribution of CFU data, the data were transformed using the base 10 logarithm, in an attempt to normalize the data and allow for parametric tests, before calculating changes. To account for zero values, 1 was added to each CFU measurement before being transformed. Any CFU data values where PA was not isolated from a valid culture were set to zero.
| Log10 PA CFUs/gram of sputum | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) |
|---|---|---|
| Change From Baseline in Pseudomonas Aeruginosa (PA) Log10 Colony Forming Units (CFU) Per Gram of Sputum | 0.225 ± 0.209 | -0.434 ± 0.167 |
Sputum samples were collected at all visits for quantitative and qualitative culture for Staphylococcus aureus, Burkholderia cepacia, Stenotrophomonas maltophilia, and Achromobacter xylosoxidans. Number of participants with other pathogens at baseline and at the end of treatment (28 days) are reported.
| Participants | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) |
|---|---|---|
| S. aureus - Day 0 | 23 | 58 |
| S. aureus - Day 28 | 23 | 63 |
| B. cepacia - Day 0 | 0 | 0 |
| B. cepacia - Day 28 | 0 | 0 |
| S. maltophilia - Day 0 | 9 | 18 |
| S. maltophilia - Day 28 | 8 | 19 |
| A. xylosoxidans - Day 0 | 6 | 10 |
| A. xylosoxidans - Day 28 | 6 | 7 |
The aztreonam susceptibility of PA isolates from sputum samples (collected at all visits) was assessed. MIC50 = minimum inhibitory concentration (minimum concentration of an agent that inhibits 50% of isolates from a particular organism). MIC90 = minimum inhibitory concentration (minimum concentration of an agent that inhibits 90% of isolates from a particular organism). MIC50 and MIC90 values are single measurements for the entire population and not measured on a per-participant basis.
| μg/mL | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) |
|---|---|---|
| Baseline MIC50 | 1 | 2 |
| Day 28 MIC50 | 1 | 4 |
| Baseline MIC90 | 64 | 32 |
| Day 28 MIC90 | 64 | 64 |
Collected over AEs that first occurred or worsened after the first dose of study drug through 30 days after the last dose (Day 0 to Day 56) are summarized.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Placebo (Pooled BID/TID) | — | 3/76 (3.9%) | 65/76 (85.5%) |
| AZLI (Pooled BID/TID) | — | 13/135 (9.6%) | 121/135 (89.6%) |
| Event | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) |
|---|---|---|
| CoughRespiratory, thoracic and mediastinal disorders | 1/76 | 7/135 |
| Productive coughRespiratory, thoracic and mediastinal disorders | 2/76 | 6/135 |
| Pulmonary function test decreasedInvestigations | 0/76 | 4/135 |
| DyspnoeaRespiratory, thoracic and mediastinal disorders | 2/76 | 2/135 |
| Respiratory tract congestionRespiratory, thoracic and mediastinal disorders | 0/76 | 3/135 |
| WheezingRespiratory, thoracic and mediastinal disorders | 0/76 | 2/135 |
| Exercise tolerance decreasedGeneral disorders | 1/76 | 0/135 |
| FatigueGeneral disorders | 1/76 | 0/135 |
| Non-cardiac chest painRespiratory, thoracic and mediastinal disorders | 1/76 | 1/135 |
| Abdominal pain lowerGastrointestinal disorders | 0/76 | 1/135 |
| Event | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) |
|---|---|---|
| CoughRespiratory, thoracic and mediastinal disorders | 51/76 | 81/135 |
| Productive coughRespiratory, thoracic and mediastinal disorders | 27/76 | 49/135 |
| Nasal congestionRespiratory, thoracic and mediastinal disorders | 11/76 | 28/135 |
| Respiratory tract congestionRespiratory, thoracic and mediastinal disorders | 15/76 | 20/135 |
| HaemoptysisRespiratory, thoracic and mediastinal disorders | 14/76 | 17/135 |
| WheezingRespiratory, thoracic and mediastinal disorders | 9/76 | 22/135 |
| FatigueGeneral disorders | 12/76 | 14/135 |
| Decreased appetiteMetabolism and nutrition disorders | 11/76 | 11/135 |
| Pharyngolaryngeal painRespiratory, thoracic and mediastinal disorders | 9/76 | 18/135 |
| Crackles lungRespiratory, thoracic and mediastinal disorders | 10/76 | 11/135 |
| Age, Categorical(Participants) | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) | Total |
|---|---|---|---|
| <=18 years | 12 | 34 | 46 |
| Between 18 and 65 years | 63 | 101 | 164 |
| >=65 years | 1 | 0 | 1 |
| Age Continuous(years) | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) | Total |
|---|---|---|---|
| Mean | 27.9 ± 10.4 | 25.3 ± 10.2 | 26.2 ± 10.4 |
| Sex: Female, Male(Participants) | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) | Total |
|---|---|---|---|
| Female | 31 | 59 | 90 |
| Male | 45 | 76 | 121 |
| Region of Enrollment(participants) | Placebo (Pooled BID/TID) | AZLI (Pooled BID/TID) | Total |
|---|---|---|---|
| United States | 76 | 135 | 211 |
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