- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02378467
Saline Hypertonic in Preschoolers (SHIP)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
A growing body of evidence supports the importance of intervention in cystic fibrosis (CF) lung disease during early childhood, in order to potentially delay or prevent irreversible lung damage. Yet, aside from antimicrobial therapies, the CF community has no clinical trial evidence base with which to guide chronic pulmonary therapies in preschool children. Hypertonic saline (HS) is the most attractive chronic maintenance therapy to investigate in preschool children because it addresses defective mucociliary clearance, an early step in the cascade of events leading to CF lung disease that is expected to be abnormal prior to the onset of airway infection and inflammation.
Based on several studies, HS appears to be safe in children less than 6 years of age, but its effectiveness has been difficult to measure. In a previous study (ISIS), children less than 6 years old receiving HS had the same number of lung infections as children receiving a control treatment. However, the investigators think that children this young need a more sensitive test, such as lung function testing, to see if HS works in preventing lung damage. Multiple Breath Washout (MBW) is a relatively easy lung function test to perform with preschool children. It calculates a measurement called the Lung Clearance Index (LCI), a sensitive measure of airway inhomogeneity. In a sub-study of the ISIS study in 25 children, LCI improved in children that inhaled HS twice daily for 48 weeks.
This is a multicenter, randomized, double-blind, controlled, parallel group trial assessing LCI in children with CF ages 3 to 5 at enrollment. Participants will be randomized 1:1 to receive 7% HS (treatment arm) vs. 0.9 % isotonic saline (control arm) administered twice daily via jet nebulizer for 48 weeks. Study visits will occur at Screening, Enrollment, and at Weeks 12, 24, 36 and 48. Contact with a parent or legal guardian to assess adherence and interim medical history will occur at 1, 4 and 8 weeks after enrollment and then quarterly between subsequent study visits. Except for the screening visit, study visits will occur on a quarterly basis.
Total duration of participation will be up to 52 weeks. As enrollment will occur over approximately 18 months, total duration of the study is expected to be up to 30 months (18 months enrollment plus 12 months for the last participants to complete study participation).
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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British Columbia
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Vancouver, British Columbia, Canada, V6H 3V4
- British Columbia Children's Hospital
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Ontario
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Toronto, Ontario, Canada, M5G 1X8
- Hospital for Sick Kids
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Alabama
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Birmingham, Alabama, United States, 35233
- University of Alabama-Birmingham: Pulmonary, Allergy and Critical Care Medicine
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California
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Palo Alto, California, United States, 94304
- Stanford University
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Colorado
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Aurora, Colorado, United States, 80045
- Children's Hospital of Colorado
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Florida
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Orlando, Florida, United States, 32827
- Nemours Children's Hospital
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Illinois
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Chicago, Illinois, United States, 60611
- Ann & Robert H. Lurie Children's Hospital of Chicago
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Indiana
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Indianapolis, Indiana, United States, 46202
- Riley Hospital for Children-Indiana U Med Center
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Iowa
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Iowa City, Iowa, United States, 52242
- University of Iowa, Department of Pediatrics
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Maryland
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Baltimore, Maryland, United States, 21287
- Johns Hopkins University: Pediatric Pulmonary
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Massachusetts
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Boston, Massachusetts, United States, 02115
- Boston Children's Hospital
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Minnesota
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Minneapolis, Minnesota, United States, 55404
- Children's Hospitals and Clinics of Minnesota
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Missouri
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Kansas City, Missouri, United States, 64108
- Children's Mercy Hospital
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Saint Louis, Missouri, United States, 63110
- Washington University School of Medicine
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New York
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Buffalo, New York, United States, 14222
- Women & Children's Hospital of Buffalo
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North Carolina
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Chapel Hill, North Carolina, United States, 27599-7217
- University of North Carolina at Chapel Hill
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Ohio
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Cincinnati, Ohio, United States, 45229
- Cincinnati Children's Hospital Medical Center
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Cleveland, Ohio, United States, 44212
- Rainbow Babies Children's Hospital and Case Western Reserve University School of Medicine
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Columbus, Ohio, United States, 43205
- Nationwide Children's Hospital
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Oregon
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Portland, Oregon, United States, 97239
- Oregon Health Sciences University
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Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104
- Children's Hospital of Philadelphia, UPenn
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Pittsburgh, Pennsylvania, United States, 15224
- Children's Hospital of Pittsburgh of UPMC
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Texas
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Houston, Texas, United States, 77030
- Texas Children's Hospital and Baylor College of Medicine
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Washington
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Seattle, Washington, United States, 98105
- Seattle Children's Hospital
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Wisconsin
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Milwaukee, Wisconsin, United States, 53226
- Children's Hospital of Wisconsin
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Diagnosis of CF as evidenced by one or more clinical feature consistent with the CF phenotype or positive CF newborn screen AND one or more of the following criteria:
- A documented sweat chloride ≥ 60 milliequivalents of solute per litre (mEq/L) by quantitative pilocarpine iontophoresis (QPIT)
- A documented genotype with two disease-causing mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene
- Informed consent by parent or legal guardian
- Age ≥ 36 months and ≤72 months at Screening visit
- Ability to comply with medication use, study visits and study procedures as judged by the site investigator
- Ability to perform technically acceptable MBW measurements at the screening and enrollment visits
Exclusion Criteria:
- Acute intercurrent respiratory infection, defined as an increase in cough, wheezing, or respiratory rate with onset within 3 weeks preceding Screening or Enrollment visit
- Acute wheezing at Screening or Enrollment visit
- Oxygen saturation < 95% (<90% in centers located above 4000 feet elevation) at Screening or Enrollment visit
- Physical findings that would compromise the safety of the participant or the quality of the study data as determined by site investigator
- Investigational drug use within 30 days prior to Screening or Enrollment visit
- Treatment with inhaled hypertonic saline at any concentration within 30 days prior to Screening or Enrollment visit
- Chronic lung disease not related to CF
- Inability to tolerate first dose of study treatment at the Enrollment visit
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Active Treatment Group
7% Hypertonic Saline administered via inhalation twice daily for 48 weeks
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Administered via inhalation twice daily for 48 weeks.
The delivery system is a PARI Sprint Junior nebulizer with a PARI Baby face mask or mouthpiece driven by a PARI Vios® compressor.
Other Names:
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Active Comparator: Control Group
0.9% Isotonic Saline administered via inhalation twice daily for 48 weeks
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Administered via inhalation twice daily for 48 weeks.
The delivery system is a PARI Sprint Junior nebulizer with a PARI Baby face mask or mouthpiece driven by a PARI Vios® compressor.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Lung Clearance Index (LCI)
Time Frame: 48 weeks
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Change in Lung Clearance Index (LCI) from baseline to 48 weeks measured by N2 Multiple Breath Washout (MBW) between subjects randomized to HS and IS.
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48 weeks
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Forced Expiratory Volume (FEV)
Time Frame: 48 weeks
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Change in FEV 0.75 measured by preschool spirometry between subjects randomized to HS and IS.
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48 weeks
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Pulmonary exacerbation rate
Time Frame: 48 weeks
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Protocol defined pulmonary exacerbation rate.
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48 weeks
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Health-related quality of life
Time Frame: 48 weeks
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Health-related quality of life as measured by the modified parent-reported Cystic Fibrosis Questionnaire-Revised (CFQ-R) for preschoolers.
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48 weeks
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Respiratory Signs
Time Frame: 48 weeks
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Parent observation of respiratory signs as measured by the Cystic Fibrosis Respiratory Sign Diary for ages 0-6 (CFRSD0-6).
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48 weeks
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Respiratory Pathogen Rate
Time Frame: 48 weeks
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Rates of treatment emergent CF respiratory pathogens from clinical respiratory cultures.
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48 weeks
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Margaret Rosenfeld, MD, MPH, Seattle Children's Hospital
- Principal Investigator: Stephanie Davis, MD, Indiana University
- Principal Investigator: Richard A Kronmal, PhD, University of Washington
- Principal Investigator: Felix Ratjen, MD, PhD, FRCPC, Hospital for Sick Kids, Toronto
Publications and helpful links
General Publications
- Rosenfeld M, Ratjen F, Brumback L, Daniel S, Rowbotham R, McNamara S, Johnson R, Kronmal R, Davis SD; ISIS Study Group. Inhaled hypertonic saline in infants and children younger than 6 years with cystic fibrosis: the ISIS randomized controlled trial. JAMA. 2012 Jun 6;307(21):2269-77. doi: 10.1001/jama.2012.5214.
- Amin R, Subbarao P, Jabar A, Balkovec S, Jensen R, Kerrigan S, Gustafsson P, Ratjen F. Hypertonic saline improves the LCI in paediatric patients with CF with normal lung function. Thorax. 2010 May;65(5):379-83. doi: 10.1136/thx.2009.125831.
- Ratjen F, Davis SD, Stanojevic S, Kronmal RA, Hinckley Stukovsky KD, Jorgensen N, Rosenfeld M; SHIP Study Group. Inhaled hypertonic saline in preschool children with cystic fibrosis (SHIP): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2019 Sep;7(9):802-809. doi: 10.1016/S2213-2600(19)30187-0. Epub 2019 Jun 6.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- SHIP001
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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