Efficacy and Safety of FP-1201-lyo (Interferon Beta-1a) in Prevention of Multi-Organ Failure on Patients After Open Surgery for a RAAA (INFORAAA)

A Randomised, Parallel Group 2:1 Comparison of the Efficacy and Safety of FP-1201-lyo (Interferon Beta-1a) and Placebo in the Prevention of Multi-Organ Failure on Patients Surviving Open Surgery for a Ruptured Abdominal Aortic Aneurysm

A study to assess effectiveness and safety of a drug FP-1201-lyo (Recombinant Human Interferon Beta-1a) in the Prevention of Multi-Organ Failure on patients after Open Surgery for a Ruptured Abdominal Aortic Aneurysm

Study Overview

• Status: Terminated
• Conditions: Preventive Medicine; Multi Organ Failure
• Intervention / Treatment: Drug: Interferon Beta-1A; Drug: Placebo

Detailed Description

This trial is multicentre, randomised, double-blinded, Phase II, parallel group comparison study of the efficacy and safety of FP-1201-lyo compared to placebo in patients surviving emergency open surgery for an infra-renal ruptured abdominal aortic aneurysm. Investigational medicinal product will be administered as post-surgical preventive treatment either 10µg FP-1201-lyo or placebo. Treatment will be administered daily every 24 hrs for 6 days. The first dose will be given after successful surgery at the point when the patient arrives to the Intensive Care Unit (ICU).

Both treatment groups will receive standard supportive care.

Aim is randomise and initiate treatment of 152 patients. For the final analysis, a minimum of 129 evaluable patients will be required.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Phase 2

Contacts and Locations

Study Locations

• Estonia
  • Tartu, Estonia, 51014
    • Tartu University Hospital
• Finland
  • Helsinki, Finland, FI-00290
    • Helsinki University Hospital
  • Jyväskylä, Finland, FI-40620
    • Central Finland Central Hospital
  • Lappeenranta, Finland, FI-53130
    • South Karelia Central Hospital
  • Oulu, Finland, FI-90220
    • Oulu University Hospital
  • Tampere, Finland, FI-33520
    • Tampere University Hospital
  • Turku, Finland, FFI-20520
    • Turku University Hospital
• Lithuania
  • Kaunas, Lithuania, LT-50161
    • Hospital of Lithuanian University of Health Sciences Kauno Klinikos
  • Vilnius, Lithuania, LT-08661
    • Vilnius University Hospital Santaros Klinikos

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

To be eligible for inclusion into this study, each patient must fulfil the following inclusion criteria during screening and prior to the first dose of study medication being administered on D0 (criteria 1 or 2 and all 3, 4 and 5):

1. Patients (male or female) presenting with a ruptured abdominal aortic aneurysm (RAAA) diagnosed by ultrasound or CT-scan in the emergency room

   • all forms of infrarenal RAAAs with or without coexisting iliac aneurysms are included or

2. Patients (male or female) presenting with symptoms of RAAA known to have an infrarenal AAA and proceeding straight to open repair without radiological assessment and confirmed rupture (=retroperitoneal haematoma) in operation

   and

3. Aneurysma repair must be infra-renal, i.e. the proximal anastomosis must be below the renal arteries and the renal arteries have to stay intact. Temporary above the renal clamping can be used for a maximum of 30 minutes (total clamping time)

   and

4. Patients providing informed consent

   and

5. Age of 18 years or higher

Exclusion Criteria:

To be eligible for inclusion into this study, each patient must not meet any of the following exclusion criteria during screening or prior to the first dose of study medication being administered:

1. Moribund patient not eligible for treatment in ICU or expected to survive surgery
2. Markedly short life expectancy, e.g. advanced malignant disease
3. Current participation in another experimental treatment protocol
4. Significant congestive heart failure, defined as New York Heart Association (NYHA) class IV
5. Current treatment with Interferon (IFN) alpha or IFN beta
6. Dialysis therapy for chronic renal failure
7. Irreversible shock from haemorrhage
8. Unconsciousness or inability to give consent
9. Ruptured Endovascular Aortic Repair (rEVAR) first (prior attempt for endovascular aortic repair for the current rupture)
10. Diagnosed cirrhosis
11. Pregnancy and women with child bearing potential without negative pregnancy test
12. Rupture not confirmed by CT or intra-operatively (impending ruptures are excluded)

13. RAAA requiring repair of the renal arteries or the proximal aorta

    • thoracoabdominal aneurysms requiring immediate repair
    • damaged renal arteries during emergency clamping requiring repair

Note:

• temporary clamping above the renal arteries (max 30 min total clamping time above the renal arteries) does not lead to exclusion
• ligation of the left renal vein does not lead to exclusion

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: FP-1201-lyo 10 µg; FP-12-lyo 10 µg (Interferon Beta-1a) will be administered once daily as an intravenous bolus injection for 6 days. Investigational product is lyophilisate for solution for injection which will be reconstituted in water for injection.	Drug: Interferon Beta-1A; Lyophilisate for solution for injection.; Other Names: FP-1201-lyo; ATC code L03AB07
Placebo Comparator: FP-1201-lyo Placebo; FP-1201-lyo Placebo will be administered once daily as an intravenous bolus injection for 6 days. Investigational placebo is lyophilisate for solution for injection which will be reconstituted in water for injection	Drug: Placebo; Lyophilisate for solution for injection as placebo.; Other Names: Placebo for investigational drug

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Efficacy of FP-1201-lyo Compared to Placebo Concerning All Cause Mortality	Number of fatalities	Day 30

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Efficacy of FP-1201-lyo Compared to Placebo Concerning All Cause Mortality	Number of fatalities	Day 90
The Efficacy of FP-1201-lyo Compared to Placebo Concerning Number of Ventilator Free Days (VFDs)	Number of ventilator free days. VFDs to Day 30 were defined as the number of calendar days after initiating unassisted breathing (UAB) to Day 30 from first treatment, assuming that a patient survives at least 48 consecutive hours after initiating UAB. Patients who die without initiating UAB were assigned a VFD value of zero.	Day 30
The Efficacy of FP-1201-lyo Compared to Placebo Concerning Number of Days Receiving Hemodialysis	Number of days receiving hemodialysis. There were only few reported values other than zero.	Day 30 and Day 90
The Efficacy of FP-1201-lyo Compared to Placebo Concerning Number of Organ Failure Free Days by Means of the Sequential Organ Failure Assessment (SOFA) Score	Organ failure free days were defined as the number of days in the first 30 days after the first dose of study medication that the patient was alive and free of organ failure with a SOFA score of zero for the following six organ parameters: respiration, coagulation, liver, cardiovascular, central nervous system and renal function. It is graded from 0 to 4 according to the degree of dysfunction/ failure (higher scores indicate more severe organ failure). Patients who died without achieving a SOFA score of zero was assigned an organ failure free days value of zero. Note: the information for organ failure free days has been only collected when the patients have been in the Intensive Care Unit (ICU). As ICU free days have been reported in a separate variable, it was decided that presented information will be kept, without trying to conduct imputation.	Day 30
The Efficacy of FP-1201-lyo Compared to Placebo Concerning Prevalence of Abdominal Compartment Syndrome by Intra-abdominal Pressure (IAP)	Intra-abdominal pressure values, which were routinely measured during ICU stay via urine bladder catheter.	Days 1 - 6, D9 and D13 during Intensive Care Unit (ICU) stay
The Efficacy of FP-1201-lyo Compared to Placebo Concerning Neutralizing Antibodies Against IFN Beta-1a (NAbs) in Whole Blood Samples	IFN beta-1a neutralizing antibodies immune response. Blood samples for the NAbs assessments were collected at Day 0 pre-dose (baseline) and at Day 30.	Day 30
The Efficacy of FP-1201-lyo Compared to Placebo Concerning Disability by Modified Ranking Scale (mRS).	Scale gives the degree of disability or dependence in the daily activities. Single mRS value is applied for every patient based on patient or caregiver interview. The scale runs from 0-6, from perfect health without symptoms to death. Pre-operation Baseline Visit mRS value is collected for reference.	Day 90
Safety Parameters of Clinically Significant Treatment Emergent Adverse Events (TEAEs), Serious Adverse Events, Vital Signs and Clinical Laboratory Parameters	Number of TEAEs from vital signs data, laboratory data, physical examinations and spontaneous reporting when conscious.	Day 0 to Day 30
Pharmacoeconomic Information of Length of ICU Stay, Length of Hospital Stay, Length of Stay at Another Health Care Facility, Length of Hemodialysis Needed, Ventilation Free Days	Economic measurement: Length of ICU stay, in terms of ICU free days at D30; Length of hospital stay, in terms of hospital free days at D90; Length of stay at another health care facility at D90; The number of days on hemodialysis at D30 and at D90; The number of organ failure free days at D30; The number of ventilation free days at D30	Day 30 or Day 90

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Myxovirus Resistant Protein A (MxA) Concentration in Whole Blood Samples as Pharmacodynamic Marker	Concentration of Myxovirus Resistant Protein A (MxA)	Day 0 up to Day 13
Tentative Disease Specific Marker Cluster of Differentiation 73 (CD73, Ecto-5'-Nucleotidase Enzyme) Concentration in Serum Samples	CD73 (ecto-5'-nucleotidase enzyme) concentration	Day 0 up to Day 13
Tentative Disease Specific, Potential Inflammatory Marker - Interleukin 6 (IL-6) in Serum Samples	IL-6 concentration.	Day 0 up to Day 13
Tentative Disease Specific, Potential Inflammatory Marker - Hepatocyte Growth Factor [HGF]) in Serum Samples	HGF concentration.	Day 0 up to Day 13

Collaborators and Investigators

• Sponsor: Faron Pharmaceuticals Ltd
• Investigators: Principal Investigator: Harri Hakovirta, MD, Turku University Hospital; Principal Investigator: Maarit Venermo, MD, Helsinki University Central Hospital

Publications and helpful links

General Publications

• Hakovirta H, Jalkanen J, Saimanen E, Kukkonen T, Romsi P, Suominen V, Vikatmaa L, Valtonen M, Karvonen MK, Venermo M; INFORAAA Study Group. Induction of CD73 prevents death after emergency open aortic surgery for a ruptured abdominal aortic aneurysm: a randomized, double-blind, placebo-controlled study. Sci Rep. 2022 Feb 3;12(1):1839. doi: 10.1038/s41598-022-05771-1.

Study record dates

Study Major Dates

• Study Start (Actual): February 18, 2017
• Primary Completion (Actual): September 23, 2019
• Study Completion (Actual): October 3, 2019

Study Registration Dates

• First Submitted: March 3, 2017
• First Submitted That Met QC Criteria: April 13, 2017
• First Posted (Actual): April 19, 2017

Study Record Updates

• Last Update Posted (Actual): January 14, 2021
• Last Update Submitted That Met QC Criteria: December 22, 2020
• Last Verified: December 1, 2020

More Information

Terms related to this study

• Keywords: Ruptured Abdominal Aortic Aneurysm; Patients Surviving Open Surgery
• Additional Relevant MeSH Terms: Pathologic Processes; Shock; Multiple Organ Failure; Physiological Effects of Drugs; Anti-Infective Agents; Antiviral Agents; Antineoplastic Agents; Immunologic Factors; Adjuvants, Immunologic; Interferons; Interferon beta-1a; Interferon-beta
• Other Study ID Numbers: FP1CLI006; 2014-000899-25 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No