Cystic Fibrosis Microbiome-determined Antibiotic Therapy Trial in Exacerbations: Results Stratified (CFMATTERS)

Antimicrobial resistance is a significant challenge facing global healthcare. The unnecessary use of antibiotics is a key driver in the development of antibiotic resistance. Cystic Fibrosis (CF) represents a unique disease model to study bacterial resistance and to explore therapeutic strategies for same, as chronic lung infection overlaps with acute lung exacerbation's caused by a multitude of organisms. With time, chronic polymicrobial infection develops, with the most dominant infecting organism being Pseudomonas aeruginosa. In acute CF infections, empiric intravenous antibiotics are usually given for two weeks. Recurrent infections and treatments result in increasing antimicrobial resistance, and alterations in pathogen host interactions in the lung and gut flora. Next-generation DNA sequencing technology now offers DNA-based personalised diagnostics and treatment strategies. Enhancing our knowledge of the microbiome allows the use of stratified targeted antibacterial therapy that can be compared with standard empirical antibacterial therapy currently used. Cystic Fibrosis Microbiome-determined Antimicrobial Therapy Trial in Exacerbations: Results Stratified (CFMATTERS) will provide a randomized multi-centre controlled trial of microbiome-derived antimicrobial treatments versus current empirical therapy.

Study Overview

• Status: Completed
• Conditions: Cystic Fibrosis
• Intervention / Treatment: Drug: Tobramycin; Drug: Ceftazidime

• Study Type: Interventional
• Enrollment (Actual): 223
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Ireland
  • Cork, Ireland
    • University College Cork

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 80 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Written and informed consent, and assent where required.
• Age 16 years or older at enrolment
• Diagnosis of CF by standard sweat test and/or genetic analysis
• Persistent pulmonary Pseudomonas aeruginosa colonization confirmed on at least 2 occasions in the preceding 12 months
• Screening FEV1 predicted of >25%
• Able to perform spirometry reproducibly prior to enrolment
• Able to expectorate and provide a sputum sample at least once daily
• ≥1 non-elective course of intravenous antibiotics in the preceding year
• Able to understand and comply with protocol requirements, restrictions and instructions and likely to complete the study as planned, as judged by the investigator

Exclusion Criteria:

• Life expectancy less than 6 months
• They are a solid organ transplant recipient
• Have a requirement for immunosuppression ≥10mg corticosteroids per day
• Previous positive culture of non-tuberculosis mycobacteria species M.avium, M.abscessus or M.intracellulare within the last 12 months or undergoing active therapy
• Positive culture of any Burkholderia cepacia species within the last 12 months or undergoing active therapy
• Allergic bronchopulmonary aspergillosis on treatment
• Known allergies to more than 3 different classes of antibiotics, and intolerance or allergy to tobramycin.
• Liver portal hypertension, determined by identification of oesophageal varices
• Advanced kidney disease requiring a dose reduction of ceftazidime or contraindicating aminoglycosides
• History of any illness that in the opinion of the investigator, might confound the results of the study or pose an additional risk in administering study drug to the subject
• If patient undergoes a pulmonary exacerbation before the Microbiome analysis is reviewed by the Consensus Treatment Panel and i.v. antibiotics are administered. In this case, a repeat sputum will be sent for analysis 4 weeks after end of antibiotic treatment.
• Pregnant or breast-feeding at time of eligible pulmonary exacerbation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Standard Empiric Treatment; Ceftazidime or Aztreonam (in case of Ceftazidime allergy) and Tobramycin	Drug: Tobramycin; Drug: Ceftazidime
Experimental: Microbiome Guided Treatment; Ceftazidime or Aztreonam (in case of Ceftazidime allergy) and Tobramycin and 3rd Antibiotic based on the Microbiome analysis	Drug: Tobramycin; Drug: Ceftazidime

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The percentage change in recovery (post-exacerbation) FEV1 relative to the previous pre-exacerbation FEV1.	Time from enrollment into the study up to study close month 21

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The time to next pulmonary exacerbation		Time from pulmonary exacerbation day 0, to next pulmonary exacerbation up to study close month 21
The improvement in symptom burden by day 7 as determined by Cystic Fibrosis Respiratory Symptom Diary (CFRSD)	As determined by Cystic Fibrosis Respiratory Symptom Diary (CFRSD)	Time from pulmonary exacerbation day 0 to day 7 of pulmonary exacerbation
The improvement in health related quality of life at day 28 post treatment and at 3 months as determined by the Cystic Fibrosis Questionnaire Revised (CFQR)	As determined by the Cystic Fibrosis Questionnaire Revised (CFQR)	Time from pulmonary exacerbation day 0 to day 28 and month 3 post study treatment
Total number of i.v. antibiotic days (home or in hospital) from time of randomisation in the trial		Time from enrollment in the study up to study close month 21
Change in FEV1		Time from enrollment in the study up to study close month 21
Total number of exacerbations post trial treatment		Time from pulmonary exacerbation day 0 to study close month 21

Collaborators and Investigators

• Sponsor: University College Cork
• Collaborators: Assistance Publique - Hôpitaux de Paris; KU Leuven; University of Washington; Queen's University, Belfast; University Hospital Heidelberg; Papworth Hospital NHS Foundation Trust; University of Dundee; European Union; University of Paris 5 - Rene Descartes; Teagasc; Clininfo S.A.; GABO:mi

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2013
• Primary Completion (Actual): June 30, 2017
• Study Completion (Actual): June 30, 2018

Study Registration Dates

• First Submitted: August 10, 2015
• First Submitted That Met QC Criteria: August 17, 2015
• First Posted (Estimate): August 18, 2015

Study Record Updates

• Last Update Posted (Actual): June 2, 2022
• Last Update Submitted That Met QC Criteria: June 1, 2022
• Last Verified: June 1, 2022

More Information

Terms related to this study

• Keywords: Microbiome; Cystic Fibrosis; Resistance; Stratified Antibacterial therapy; Pathogen Host Interaction
• 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; Anti-Infective Agents; Anti-Bacterial Agents; Tobramycin; Ceftazidime
• Other Study ID Numbers: UCC-CFMATTERS