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CompletedNCT03274895Updated Aug 22, 2023Results posted

Polihexanide (PHMB) Eye Drops in Patients Affected by Acanthamoeba Keratitis

A Phase 3 interventional study of PHMB 0.08% and Propamidine 0.1% in Acanthamoeba Keratitis, sponsored by SIFI SpA. Completed at 6 sites in 3 countries. Open to participants aged 13 Years and older. Per ClinicalTrials.gov, last updated 2023-08-22.

Sponsored by SIFI SpA · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
135
Allocation
Randomized
Ages
13 Years and older
Sex
All
01

Study summary

Prospective randomized study to evaluate the efficacy, safety and tolerability of 0.08% polihexanide (PHMB) eye drops in patients affected by acanthamoeba keratitis.

130 subjects were assigned to one of the following 2 treatment groups: Group 1: 0.08% polihexanide (PHMB) + placebo Group 2: 0.02% polihexanide (PHMB) + 0.1% propamidine

Read the detailed description

This was a randomized, assessor-masked, active-controlled, multiple center, parallel-group phase 3 study to evaluate the efficacy, safety and tolerability of 0.08% polihexanide (PHMB) ophthalmic solution compared to the conventional 0.02% polihexanide (PHMB) + 0.1% propamidine in patients affected by acanthamoeba keratitis.

The study was designed as a superiority study with the possibility to test for non-inferiority if the superiority hypothesis was not met (CPMP/EWP/482/99).The study consisted of an eligibility screening visit, a treatment period including monthly follow-up visits until a clinical resolution was obtained (within a maximum of 1 year), followed by 2 post-treatment off-therapy visits (30 and 90 days after treatment discontinuation). 130 subjects with confirmed diagnosis of acanthamoeba keratitis (clinical signs plus positive confocal microscopy findings) were assigned to one of the following treatment groups in a ratio of 1:1.

Group 1: 0.08% PHMB + placebo Group 2: 0.02% PHMB + 0.1% propamidine

02

Conditions studied

  • Acanthamoeba Keratitis

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Keywords

  • polihexanide
  • propamidine
  • confocal microscopy
03

Who can participate

Ages eligible
13 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. willing to give informed consent
  2. man or woman of any race and ≥12 years of age
  3. able to understand and willing to comply with study procedures, restrictions and requirements
  4. Clinical findings consistent with Acanthamoeba keratitis
  5. Confocal microscopy findings consistent with Acanthamoeba keratitis
  6. The following previous treatments for Acanthamoeba keratitis are eligible: antibiotics, antiviral and antifungal drugs, antiinflammatory drugs
  7. Females of childbearing potential will be included if they are either sexually inactive or using one highly effective contraceptive
  8. Females of childbearing potential agree to remain sexually inactive or to keep the same birth control method for at least 28 days following the last study drug dose
  9. A female of non-childbearing potential must have undergone one sterilization procedures at least 6 months prior to the first study drug dose
  10. A non-vasectomized male subject agrees to use a condom with spermicide or abstain from sexual intercourse during the study until 90 days beyond the last dose of study drug and the female partner agrees to comply with inclusion 7 or 8. For a vasectomized male who has had his vasectomy 6 months or more prior to study start, it is required that they use a condom during sexual intercourse. A male who has been vasectomized less than 6 months prior to study start must follow the same restrictions as a non-vasectomized male.
  11. If male, they must agree not to donate sperm from the first study drug dose until 90 days after dosing

Exclusion criteria

Exclusion Criteria:

  1. Subject with documented history and/or clinical signs of concomitant presence of an ocular infection caused by viruses (herpes simplex virus [HSV]) or fungi.
  2. Subject treated with drugs having effects on Acanthamoeba cysts prior to study entry, including biguanides (PHMB, chlorhexidine) and diamidines (propamidine, hexamidine).
  3. Subjects requiring systemic immunosuppression for Acanthamoeba associated scleritis.
  4. Subjects requiring urgent surgical intervention for advanced Acanthamoeba keratitis in either eye (e.g., for advanced corneal thinning/melting etc.).
  5. Subject with known or suspected allergy to biguanides, diamidines or intolerance to any other ingredient of the investigational treatments.
  6. Subject affected by immunodeficiency diseases or taking systemic immunosuppressive therapy.
  7. Subject with a major systemic disease or other illness that would, in the opinion of the investigator, compromise subject's safety or interfere with the collection or interpretation of study results.
  8. If female, pregnancy, planned pregnancy, or breast-feeding
  9. Subject is participating in another interventional clinical study with an experimental or unapproved/unlicensed therapy or has participated in another interventional clinical study within 4 weeks prior to this study.
04

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
135 participants (actual)

Study arms

  • Experimental
    PHMB 0.08% plus placebo

    polihexanide (PHMB) 0.08% and placebo were administered in the affected eye until clinical resolution for a maximum of 12 months

    Drug: PHMB 0.08% · Drug: placebo

  • Active comparator
    PHMB 0.02% plus propamidine 0.1%

    polihexanide (PHMB) 0.02% and propamidine 0.1% were administered in the affected eye until clinical resolution for a maximum of 12 months

    Drug: Propamidine 0.1% · Drug: PHMB 0.02%

Interventions

  • DrugPHMB 0.08%

    16 drops in a day in the affected eye for 5 days followed by 8 drops in a day for 7 days,6 drops in a day for 7 days and 4 drops in a day up to clinical resolution

    Also known as: Polihexanide 0.8 mg/ml

  • DrugPropamidine 0.1%

    16 drops in a day in the affected eye for 5 days followed by 8 drops in a day for 7 days,6 drops in a day for 7 days and 4 drops in a day up to clinical resolution

    Also known as: Brolene eye drops

  • Drugplacebo

    16 drops in a day in the affected eye for 5 days followed by 8 drops in a day for 7 days,6 drops in a day for 7 days and 4 drops in a day up to clinical resolution

    Also known as: Brolene vehicle

  • DrugPHMB 0.02%

    16 drops in a day in the affected eye for 5 days followed by 8 drops in a day for 7 days,6 drops in a day for 7 days and 4 drops in a day up to clinical resolution

    Also known as: Polihexanide 0.2 mg/ml

05

What researchers measure

Primary outcomes

  1. Clinical Resolution Rate

    Percentage of patients cured 30 days after discontinuing all study therapies, within 12 months of randomization

    Time frame: 12 months

Secondary outcomes

  1. Time to Cure

    Time needed to reach a clinical resolution

    Time frame: maximum 12 months

  2. Visual Acuity

    Final visual acuity (best corrected)

    Time frame: maximum 12 months

06

Results

Posted Aug 2, 2023

Participant flow

Participants were recruited from August 2017 and March 2021. Of the 135 enrolled participants 134 were randomized to treatment

Participant flow — Overall Study
MilestonePHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%
Started6965
Completed5654
Not completed1311
Withdrew: Lack of efficacy10
Withdrew: Adverse event87
Withdrew: Lost to follow-up10
Withdrew: Diagnosis not confirmed34

Outcome measures

PrimaryClinical Resolution Rate

Percentage of patients cured 30 days after discontinuing all study therapies, within 12 months of randomization

Time frame:
12 months
Reported as:
Number · percentage of participants
Clinical Resolution Rate
percentage of participantsPHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%
Clinical Resolution Rate84.8 (73.9 to 92.5)88.5 (77.8 to 95.3)
Statistical analysis
  • PHMB 0.08% Plus Placebo vs PHMB 0.02% Plus Propamidine 0.1% · Difference in proportion of resolution r: -0.036 · 95% CI -0.154 to 0.081
SecondaryTime to Cure

Time needed to reach a clinical resolution

Time frame:
maximum 12 months
Reported as:
Median · days
Time to Cure
daysPHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%
Time to Cure140 (117 to 150)114 (91 to 127)
Statistical analysis
  • PHMB 0.08% Plus Placebo vs PHMB 0.02% Plus Propamidine 0.1% · Log Rank · p = 0.042
SecondaryVisual Acuity

Final visual acuity (best corrected)

Time frame:
maximum 12 months
Reported as:
Median · LogMAR
Visual Acuity
LogMARPHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%
Visual Acuity0.000 (0.000 to 0.250)0.000 (-0.080 to 0.150)
Statistical analysis
  • PHMB 0.08% Plus Placebo vs PHMB 0.02% Plus Propamidine 0.1% · ANCOVA · p = 0.577

Adverse events

Collected over 1 year. Non-serious events are listed at a 2% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
PHMB 0.08% Plus Placebo0/69 (0%)0/69 (0%)31/69 (44.9%)
PHMB 0.02% Plus Propamidine 0.1%0/65 (0%)0/65 (0%)29/65 (44.6%)
Most frequent other events
Showing 10 of 14
Most frequent other events
EventPHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%
eye painEye disorders9/697/65
ocular hyperemiaEye disorders8/697/65
lacrimation increasedEye disorders6/692/65
eye irritationEye disorders1/694/65
conjunctival hyperemiaEye disorders2/693/65
photophobiaEye disorders2/693/65
eye inflammationEye disorders3/691/65
corneal epithelium defectEye disorders3/690/65
corneal infiltratesEye disorders3/690/65
eye pruritusEye disorders1/692/65

Baseline characteristics

Age, Continuous
Age, Continuous(years)PHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%Total
Median33 (25 to 43)36 (26 to 49)35 (25 to 46)
Sex: Female, Male
Sex: Female, Male(Participants)PHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%Total
Female413778
Male282856
Race and Ethnicity Not Collected
Race and Ethnicity Not Collected(Participants)PHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%Total
Count of participants——0
Visual acuity (best corrected)
Visual acuity (best corrected)(LogMAR)PHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%Total
Median0.350 (0.150 to 0.70)0.260 (0.100 to 0.480)0.300 (0.150 to 0.700)
Culture positivity for Acanthamoeba
Culture positivity for Acanthamoeba(Participants)PHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%Total
Count of participants191736
PCR positivity for Acanthamoeba
PCR positivity for Acanthamoeba(Participants)PHMB 0.08% Plus PlaceboPHMB 0.02% Plus Propamidine 0.1%Total
Count of participants332558
07

Study locations

6 sites
  • San Raffaele Hospital
    Milano, Italy
  • San Giovanni and Paolo Hospital
    Venice, Italy
  • University Clinical Center Medical University of Silesia
    Katowice, Poland
  • Moorfields Hospital
    London, United Kingdom
  • Manchester Royal Eye Hospital
    Manchester, United Kingdom
  • University Hospital Southampton
    Southampton, United Kingdom
08

References and documents

Publications

  • Papa V, Rama P, Radford C, Minassian DC, Dart JKG. Acanthamoeba keratitis therapy: time to cure and visual outcome analysis for different antiamoebic therapies in 227 cases. Br J Ophthalmol. 2020 Apr;104(4):575-581. doi: 10.1136/bjophthalmol-2019-314485. Epub 2019 Aug 10. PubMed 31401556 ↗
  • Papa V, van der Meulen I, Rottey S, Sallet G, Overweel J, Asero N, Minassian DC, Dart JKG. Safety and tolerability of topical polyhexamethylene biguanide: a randomised clinical trial in healthy adult volunteers. Br J Ophthalmol. 2022 Feb;106(2):190-196. doi: 10.1136/bjophthalmol-2020-317848. Epub 2020 Nov 25. PubMed 33239413 ↗

Study documents

  • Study protocol · Oct 8, 2018
  • Statistical analysis plan · Jul 1, 2021

Documents are hosted by the registry — open the source record to download them.

09

Registry details

Key details

Study ID
NCT03274895
Lead sponsor
SIFI SpA
Responsible party
Sponsor
First posted
Sep 7, 2017
Start date
Aug 13, 2017
Primary completion
Jun 30, 2021
Completion
Mar 30, 2022
Results posted
Aug 2, 2023
Last update
Aug 22, 2023

Study contacts

John Dart, MD
principal investigator · Moorfield's Hospital London

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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