The Effect of rhDNase on Ventilation Inhomogeneity in Patients With Cystic Fibrosis

Randomized, Placebo-controlled Trial on the Effect of rhDNase on Ventilation Inhomogeneity in Patients With Cystic Fibrosis

This study will assess whether rhDNase treatment improves ventilation inhomogeneity as assessed by lung clearance index (LCI) in patients with cystic fibrosis (CF).

Study Overview

• Status: Completed
• Conditions: Cystic Fibrosis
• Intervention / Treatment: Drug: rhDNAse; Other: Placebo

Detailed Description

Life expectancy in CF patients has greatly increased due to improved clinical care. While this is certainly beneficial to CF patients, it has made it more difficult to assess the effect of therapeutic interventions. Currently, FEV1 remains the primary outcome parameter for most clinical trials, but many CF patients have normal pulmonary function and the annual rate of decline is now less than 2 %. Therefore, additional parameters are needed that are more sensitive to define abnormalities in CF patients and that can be used in therapeutic trials.

Gas mixing techniques have been shown to be sensitive parameters to define abnormalities in patients with cystic fibrosis, but it is unclear how useful this technique is to detect changes after a therapeutic intervention. Abnormalities in gas clearance from the lung are largely due to retention of inhaled gases due to mucous obstruction in the lower airways and can be assessed with the lung clearance index (LCI). Interventions that improve mucous accumulation are expected to improve lung clearance as assessed by this technique. RhDNase has been demonstrated to improve lung function and reduce pulmonary exacerbations in patients with cystic fibrosis due to improved mucus clearance.

Lung clearance index (LCI) has been shown to be more sensitive than spirometry in detecting abnormalities in CF patients. Clear cut-offs have been found which can differentiate normal patients from even newly diagnosed CF patients. However, little is known about how LCI may change with treatment.

• Study Type: Interventional
• Enrollment (Actual): 17
• Phase: Phase 4

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5G 1X8
      • The Hospital for Sick Children

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 18 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosis of CF as defined by clinical features of CF and a documented sweat chloride > 60 mEq/L by quantitative pilocarpine iontophoresis test or a genotype showing two well characterized disease causing mutations
• Informed consent and verbal assent (as appropriate) has been provided by the subject's parent or legal guardian and the subject
• 6-18 years of age at enrolment
• Able to perform reproducible spirometry
• Clinically stable at enrolment
• Ability to comply with medication use, study visits and study procedures as judged by the site investigator
• FEV1 % predicted > 70 % as calculated by the Wang reference equations

Exclusion Criteria:

• Respiratory culture positive for:

  • NTM within past year or AFB positive at screening (sputum only)
  • B. cepacia complex within past year or at screening
• Use of intravenous antibiotics or oral quinolones within 14 days of screening
• Investigational drug use within 30 days of screening
• History of alcohol, illicit drug or medication abuse within 1 year of screening
• Other major organ dysfunction excluding pancreatic dysfunction
• History of lung transplantation or currently on lung transplant list
• Physical findings at screening that would compromise the safety of the participant or the quality of the study data

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: 1; This arm will receive the active treatment for 28 days, followed by a 28 day washout period and then the placebo treatment for 28 days.	Drug: rhDNAse; 2.5 mg rhDNase will be dispensed in 2.5 ml vials and administered once a day for 28 days. Treatment will be administered by inhalation.; Other Names: Brand Name: Pulmozyme; Other: Placebo; 2.5 mg of the placebo will be dispensed in 2.5 ml vials and administered once a day over 28 days. Treatment will be administered by inhalation.
Other: 2; This arm will receive the placebo treatment for 28 days, followed by a 28 day washout period and then the active treatment for 28 days.	Drug: rhDNAse; 2.5 mg rhDNase will be dispensed in 2.5 ml vials and administered once a day for 28 days. Treatment will be administered by inhalation.; Other Names: Brand Name: Pulmozyme; Other: Placebo; 2.5 mg of the placebo will be dispensed in 2.5 ml vials and administered once a day over 28 days. Treatment will be administered by inhalation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The change in LCI from baseline to end of treatment in rhDnase treated patients versus patients receiving placebo	The duration of the patient's involvement in the study (approximately 3 months)

Secondary Outcome Measures

Outcome Measure	Time Frame
Change in FEV1 % predicted	The duration of the patient's involvement in the study (approximately 3 months)
Change in FVC (in litres)	The duration of the patient's involvement in the study (approximately 3 months)
Change in FVC % predicted	The duration of the patient's involvement in the study (approximately 3 months)
Change in FEF25-75 (liters/sec)	The duration of the patient's involvement in the study (approximately 3 months)
Change in FEF25-75 % predicted	The duration of the patient's involvement in the study (approximately 3 months)
Change in exhaled nitric oxide concentrations	The duration of the patient's involvement in the study (approximately 3 months)
Incidence of adverse events and serious adverse events	Duration of the study (approximately 1 year)

Collaborators and Investigators

• Sponsor: The Hospital for Sick Children
• Investigators: Principal Investigator: Felix Ratjen, MD, The Hospital for Sick Children, Toronto Canada

Publications and helpful links

General Publications

• Yang C, Montgomery M. Dornase alfa for cystic fibrosis. Cochrane Database Syst Rev. 2021 Mar 18;3(3):CD001127. doi: 10.1002/14651858.CD001127.pub5.
• Amin R, Subbarao P, Lou W, Jabar A, Balkovec S, Jensen R, Kerrigan S, Gustafsson P, Ratjen F. The effect of dornase alfa on ventilation inhomogeneity in patients with cystic fibrosis. Eur Respir J. 2011 Apr;37(4):806-12. doi: 10.1183/09031936.00072510. Epub 2010 Aug 6.

Study record dates

Study Major Dates

• Study Start: January 1, 2008
• Primary Completion (Actual): June 1, 2009
• Study Completion (Actual): June 1, 2009

Study Registration Dates

• First Submitted: November 9, 2007
• First Submitted That Met QC Criteria: November 9, 2007
• First Posted (Estimate): November 12, 2007

Study Record Updates

• Last Update Posted (Estimate): September 2, 2013
• Last Update Submitted That Met QC Criteria: August 30, 2013
• Last Verified: August 1, 2013

More Information

Terms related to this study

• Keywords: Cystic Fibrosis; Pediatrics; Lung Clearance Index; rhDNAse
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Respiratory Tract Diseases; Lung Diseases; Infant, Newborn, Diseases; Genetic Diseases, Inborn; Pancreatic Diseases; Fibrosis; Cystic Fibrosis
• Other Study ID Numbers: 1000010903