Efficacy Study to Evaluate B-Lock™ as an Antimicrobial Lock Solution in Dialysis Patients With a CVC

Multi-Center, Prospective, Randomized, Open-Label, Sponsor-Blinded, Active-Control (Heparin) Clinical Investigation to Evaluate the Safety and Effectiveness of B-Lock™ as an Antimicrobial Catheter Lock Solution in Dialysis Patients With a Central Venous Catheter

Hypothesis: B-Lock is a safe and effective catheter lock solution that will maintain catheter patency and reduce Central Line Associated Blood Stream Infections (CLABSI) in dialysis patients using a central venous catheter (CVC) for vascular access.

The study is a prospective, randomized, site unblinded/sponsor blinded, clinical study of a minimum of 300 dialysis patients using a central venous catheter (CVC) for vascular access. Patients will be randomized 1:1 to receive either the investigational medical device (B-Lock or IMD) or active control heparin (5000 U/mL) (ACH) and observed for a minimum of 45 days or a maximum of 273 (expected average 160 days). IMD or ACH will be instilled into the catheter lumens (dual lumen catheters) at the end of each dialysis session and removed prior to the initiation of the next dialysis session.

The primary objectives of this study are:

• To demonstrate the safety of B-Lock in dialysis patients
• To demonstrate the non-inferiority or, if proven to be non-inferior, superiority of B-Lock relative to ACH with respect to maintaining catheter patency as defined by the use of recombinant tissue plasminogen activator for maintaining adequate blood flow through the dialysis catheter
• To demonstrate the superiority of B-Lock relative to ACH with respect to the incidence of CLABSI

Study Overview

• Status: Terminated
• Conditions: Dialysis Catheter Infections
• Intervention / Treatment: Device: B-Lock; Drug: Heparin 5,000 U/mL

• Study Type: Interventional
• Enrollment (Actual): 270
• Phase: Phase 3

Contacts and Locations

Study Locations

• Hungary
  • Budapest, Hungary
    • FMC Dialízis Központ Péterfy S. Kórház
  • Budapest, Hungary
    • FMC Dialízis Központ Szent István Kórház
  • Budapest, Hungary
    • FMC Szépvölgyi Dialízis Központ
  • Debrecen, Hungary
    • DE OEC Nephrologiai Tanszék
  • Eger, Hungary
    • FMC Dialízis Központ Eger
  • Kecskémet, Hungary
    • FMC Dialízis Központ Kecskemét
  • Miskolc, Hungary
    • FMC Nefrológiai Központ Miskolc
  • Pécs, Hungary
    • FMC Dialízis Központ Pécs
  • Pécs, Hungary
    • FMC Szatellita Dialízis Központ Pécs
  • Szeged, Hungary
    • Szegedi Tudomanyegyetem
• Poland
  • Elbląg, Poland
    • Stacja Dializ w NZOZ Centrum Chorób Wewnętrzynych "EL-VITA" w Elblągu
  • Gdansk, Poland
    • Stacja Dializ NZOZ Diaverum
  • Gdansk, Poland
    • Uniwersyteckie Centrum Kliniczne, Klinika Nefrologii, Transplantologii i Chorób Wewn
  • Gdańsk, Poland
    • Niepubliczny Zakład Opieki Zdrowotnej Diaverum Gdańsk Kartuska, Stacja Dializ
  • Legnica, Poland
    • Stacja Dializ NZOZ Avitum w Legnicy
  • Miechów, Poland
    • Stacja Dializ NZOZ Avitum w Miechowie
  • Poznań, Poland
    • Szpital Kliniczny im. H. Święcickiego, Oddział Nefrologii, Pododdział Dializ
  • Radom, Poland
    • Radomski Szpital Specjalistyczny im. T. Chałubińskiego, Oddział Dializ
  • Tczew, Poland
    • Stacja Dializ NZOZ Diaverum w Tczewie
  • Zgierz, Poland
    • Stacja Dializ NZOZ Avitum w Zgierzu
  • Łódź, Poland
    • Uniw. Szpital Kliniczny im. N.Barlickiego,Oddział Nefrologii, Pododdział Dializ

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Male or female patients age 18 to 80 years, inclusive. Patients, age 81 to 85 years, inclusive, may be included on a case-by-case basis if their health status is determined to be stable after consultation with the Medical Monitor.
• Patients with end-stage renal disease receiving hemodialysis via CVC.
• Patients must be expected to receive hemodialysis through a direct or cuffed, tunneled dual lumen catheter or 2 cuffed, tunneled single lumen catheters for a minimum of 45 catheter-days after Day 1.
• Patients must have been receiving dialysis for a minimum of 6 dialysis sessions at the study center dialysis clinic prior to the signing of the Informed Consent Form (ICF).
• Patients must have received dialysis at their prescribed blood flow rate (+/- 10%) for at least 2 consecutive dialysis sessions prior to signing the ICF.
• Patients must have 2 screening pre-pump arterial pressure measurements (collected during the first 20 minutes of dialysis) that differ by less than or equal to (≤) 20 mmHg at 2 consecutive dialysis sessions when receiving dialysis at their prescribed blood flow rate (+/- 10%) prior to randomization.

Exclusion Criteria:

• Clinical signs and/or symptoms of a local or systemic infection within 14 days prior to Day 1.
• Evidence of infection of the catheter exit site/tunnel within 14 days prior to Day 1.
• Patients who have received systemic antibiotics within 14 days prior to Day 1.
• History of fever (T > 37.5°C) or chills within 14 days prior to Day 1.
• An occluded catheter (blood flow inadequate for dialysis) or a catheter that required thrombolytic treatment within 14 days prior to Day 1.
• A catheter coated or impregnated with an antithrombotic, antimicrobial or antiseptic agent, including heparin.
• A catheter coated or impregnated with an antithrombotic, antimicrobial or antiseptic agent, including heparin.

• Catheters that are deemed by their manufacturers to be incompatible with alcohol-containing solutions. These include, but are not limited to:

  1. Angiodynamics - LifeJet® VP VascPak Catheter.
  2. Angiodynamics - Schon™ Chronic Hemodialysis Catheter.
  3. Angiotech - Hemostream™ Chronic Dialysis Catheter.
  4. Bard - all Bard Catheters.
• The use of TEGO® or TEGO-like catheter caps. Patients may be switched to standard catheter caps in order to participate in this study.
• Patients with a known or documented allergy to TMP or TMP-containing drugs, ethanol, ethylene diamine tetraacetic acid (EDTA), propylene glycol and/or glycerin.
• Patients with a history of heparin-induced thrombocytopenia or in whom the use of heparin is contraindicated. (Note: If the use of heparin is restricted for only a specified period of time, the patient may be enrolled at a later date when the use of heparin is no longer contraindicated.)
• Evidence of acute/ongoing hepatic injury (alanine aminotransferase [ALT] > 300 IU/L) or chronic hepatic insufficiency (Total bilirubin > 2.0 mg/dL and/or albumin < 3.0 g/dL during Screening or within 30 days prior to Screening). Note: A patient whose albumin level is low solely due to nephrotic syndrome may be enrolled (with Medical Monitor approval) if the albumin level has been stable for at least 3 months prior to ICF signature.
• Patients who the Investigator believes have a prognosis for survival of less than 3 months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: B-Lock (IMD); Investigational Medical Device (IMD)	Device: B-Lock; Antimicrobial Catheter Lock Solution; Other Names: IMD
Active Comparator: Heparin 5,000 U/mL (ACH); Active Comparator Heparin (ACH)	Drug: Heparin 5,000 U/mL; Standard of Care Catheter Lock Solution; Other Names: ACH

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The number of adverse events (AEs), serious adverse events (SAEs) and device deficiencies (DDs) in the experimental and control populations		39 weeks
The number of thrombolytic treatment events in the experimental and control populations.	Thrombolytic treatments may be required to maintain catheter blood flow rates when blood flow is measured under standardized conditions and compared to blood flow at study entry. The number of treatment events in the experimental and control populations is inversely related to the ability of the lock solution to maintain catheter patency.	39 weeks
The number of Central Line Associated Blood Stream Infections (CLABSI events) in the experimental and control populations.	CLABSI is defined by the CDC as a documented blood stream infection (bacterial or fungal) in a patient with a CVC with no other source of infection identified by a qualified physician.	39 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The number of Lock Solution Failures in the experimental and control populations.	"Lock Solution Failure" is defined as the sum of CLABSI events plus Occlusive Malfunction events. Occlusive malfunction is defined as the inability to return catheter blood flow rates to greater than 80% of baseline blood flow measrued at study entry under standardized conditions after treatment with tissue plasminogen activator (thrombolytic treatment).	39 weeks
The number of Occlusive Malfunction events in the experimental and control populations.		39 weeks
The number of lock solution aspirate cultures that are positive for bacterial or fungal growth in the experimental and control populations.		39 weeks
The number of catheters removed from the experimental and control patients that are found to have bacterial or fungal biofilm present inside the catheter lumen(s).		39 weeks
Catheter blood flow rates measured under standardized conditions over the duration of the study in the experimental and control populations.		39 weeks

Collaborators and Investigators

• Sponsor: Great Lakes Pharmaceuticals Inc.
• Investigators: Study Director: John C Cheronis, MD PhD, Great Lakes Pharmaceuticals Inc.

Publications and helpful links

General Publications

• Rijnders B, DiSciullo GJ, Csiky B, Rutkowski B, Appelt K, Cheronis J, Aitchison R, Gordon G, Jadoul M, Fluck R. Locking Hemodialysis Catheters With Trimethoprim-Ethanol-Ca-EDTA to Prevent Bloodstream Infections: A Randomized, Evaluator-blinded Clinical Trial. Clin Infect Dis. 2019 Jun 18;69(1):130-136. doi: 10.1093/cid/ciy840.

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2012
• Primary Completion (Actual): October 1, 2014
• Study Completion (Actual): October 1, 2014

Study Registration Dates

• First Submitted: October 30, 2013
• First Submitted That Met QC Criteria: November 14, 2013
• First Posted (Estimate): November 20, 2013

Study Record Updates

• Last Update Posted (Actual): February 27, 2017
• Last Update Submitted That Met QC Criteria: February 24, 2017
• Last Verified: February 1, 2017

More Information

Terms related to this study

• Keywords: hemodialysis; antimicrobial; kidney dialysis; locking solution; thrombolytic
• Additional Relevant MeSH Terms: Molecular Mechanisms of Pharmacological Action; Fibrinolytic Agents; Fibrin Modulating Agents; Anticoagulants; Heparin
• Other Study ID Numbers: GL-CL-0001

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No