Efficacy and Safety of Tigerase® vs. Pulmozyme® in Patients With Cystic Fibrosis

A Multicenter Prospective Randomized Comparative Study of Pharmacokinetics, Clinical Efficacy and Safety of Tigerase® (JSC GENERIUM, Russia) vs. Pulmozyme® (Hoffmann-La Roche, Switzerland) as Part of Complex Therapy in Patients With Cystic Fibrosis

It is a multicenter, open-label, randomized, parallel-group study of the efficacy and safety of Tigerase® compared Pulmozyme® in patients with Cystic Fibrosis

Study Overview

• Status: Completed
• Conditions: Fibrosis; Cystic Fibrosis
• Intervention / Treatment: Biological: Tigerase®; Biological: Pulmozyme®

Detailed Description

Cystic fibrosis (CF) is a common hereditary disease with an autosomal recessive type of inheritance, characterized by systemic damage to the exocrine glands, mainly the bronchopulmonary and gastrointestinal systems. CF is usually characterized by a severe course and poor prognosis. The severity of the disease and the life expectancy of the patient with CF is determined primarily by the state of the bronchopulmonary system; more than 90% of patients die from lung diseases.

CF Pulmonary damage develops as a result of a gene mutation - cystic fibrosis transmembrane regulator of ion conductivity Na and Cl (CFTR-cystic fibrosis transmembrane regulator). The main function of CFTR is to regulate the transport of sodium and chlorine across the cell membrane and is part of the cAMP-dependent chlorine channel. CFTR-protein dysfunction in the bronchial tree epithelial cells leads to a blockage of the chlorine ions transport and an increase in the sodium ions absorption, and impaired fluid secretion through the epithelial cells apical membrane.

Dornase alpha, a human recombinant deoxyribonuclease 1 (rhDNase, rhDNase) hydrolyzes extracellular DNA (viscous polyanion) that enters the sputum from destroyed neutrophils, thereby reducing the adhesion and viscosity of sputum. In CF patients dornase alpha is used as symptomatic therapy in combination with standard therapy in patients with a forced vital capacity (FVC) index of at least 40% of the proper value.

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Phase 3

Contacts and Locations

Study Locations

• Russian Federation
  • Chelyabinsk, Russian Federation, 454076
    • Chelyabinsk Regional Clinical Hospital
  • Moscow, Russian Federation, 105077
    • City Clinical Hospital named after D.D. Pletnev
  • Saint Petersburg, Russian Federation, 194354
    • City Multidisciplinary Hospital No. 2
  • Saratov, Russian Federation, 410053
    • Regional Clinical Hospital
  • Stavropol, Russian Federation, 355000
    • Scientific medical center of General Medicine and pharmacologies
  • Tomsk, Russian Federation, 634050
    • Tomsk national medical research Center of the Russian Academy of Sciences, Genetic Clinic Research Institute medical genetics
  • Volgograd, Russian Federation, 400066
    • Volgograd State Medical University, Department of clinical pharmacology and intensive care
  • Yaroslavl, Russian Federation, 150003
    • Children's Clinical Hospital No. 1 ", Cystic Fibrosis center
  • Yaroslavl, Russian Federation, 150010
    • Clinical hospital No. 2
  • Altai Region
    • Barnaul, Altai Region, Russian Federation, 656024
      • Regional Clinical Hospital
  • Crimea Republic
    • Simferopol, Crimea Republic, Russian Federation, 295007
      • Crimean federal university named after V.I.Vernadsky
  • Republic Of Bashkortostan
    • Ufa, Republic Of Bashkortostan, Russian Federation, 450005
      • Republican clinical hospital named after G.G. Kuvatov
  • Republic Of Tatarstan
    • Kazan, Republic Of Tatarstan, Russian Federation, 420012
      • Kazan state medical University of Ministry of health, Hospital Therapy Department
  • Sverdlovsk Region
    • Ekaterinburg, Sverdlovsk Region, Russian Federation, 620102
      • Sverdlovsk Regional Clinical Hospital No. 1

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Signed Patient Informed Consent Form for participation in the study;
2. Men and women 18 years and older;
3. Diagnosis of cystic fibrosis, defined as the presence of disease symptoms and a positive sweat test and / or detection of 2 mutations of the MVTR gene during genotyping;
4. FEV1 ≥40% and ≤100% of the proper value;
5. The ability to understand the protocol requirements, to give written consent to participate in the study (including the use and transfer of information about the patient's health status related to the study).

Exclusion Criteria:

1. Hypersensitivity to any of used study drug, to their components, as well as a history of significant allergic reactions;
2. Acute respiratory infection or exacerbation of chronic pulmonary disease within 4 weeks prior to screening and without corticosteroid or antibiotic therapy;

3. Concomitant diseases and conditions with potential impact the patients safety, including:

   • Severe renal impairment (serum creatinine more than 1.5 times higher than the upper limit of normal);
   • Severe liver impairment (alanine aminotransferase (ALT) or aspartate aminotransferase (AST) blood serum activity is 2.5 times or more higher than the upper limit of the laboratory norm);
4. A history of lung transplantation or planned transplantation during this study;
5. The presence of antibodies to HIV, active viral hepatitis B and / or C and / or cirrhosis in the history or detected on Screening;
6. Pregnancy and lactation;
7. Refusal of patients with preserved reproductive potential to use adequate contraception throughout the study and within 30 days after the end of the study;
8. Patients who underwent a blood or blood components transfusion within 10 days prior to screening;
9. Drug or alcohol abuse at the time of Screening or in the past;
10. Patient's participation in any other clinical trials and / or administration of an experimental drug within 30 days prior to the Screening Visit.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Tigerase®; Dornase alfa	Biological: Tigerase®; 2.5 mL (2.5 mg) dornase alfa nebulized once daily for 168 (+/-7) days; Other Names: dornase alfa
Active Comparator: Pulmozyme®; Dornase alfa	Biological: Pulmozyme®; 2.5 mL (2.5 mg) dornase alfa nebulized once daily for 168 (+/-7) days; Other Names: dornase alfa

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in forced expiratory volume in the first second of a forced expiratory maneuver (FEV1) compared to baseline	Week 24 ± 1	FEV1 - forced expiratory volume in the first second of a forced expiratory maneuver by standard spirometry

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in forced lung capacity (FVC) compared to baseline	FVC - forced lung capacity by standard spirometry	Week 24 ± 1
The number of exacerbations of chronic pulmonary disease	Clinical symptoms of chronic pulmonary disease exacerbation required antibiotic therapy in CF patients, include the presence of at least 4 of 12 possible signs or symptoms; A change in color or amount of sputum;; The appearance or intensification of hemoptysis;; Strengthening cough;; Increased shortness of breath;; Increased malaise, fatigue or lethargy;; Temperature above 38 ° C;; Anorexia or weight loss;; Sinuses pain or soreness;; Changes in the nature of sinuses mucus;; Changes in chest physical examination;; Pulmonary function decrease at list 10% or more;; Radiographic changes.	Week 24 ± 1
The number of days before the chronic pulmonary disease exacerbation development		Week 24 ± 1
Change in body weight compared to baseline		Week 24 ± 1
Change in the average score for the "Symptoms", "Activity", "Influence" subscales, as well as the average total score of the St. George's Respiratory Questionnaire (SGRQ), version 2.2	St. George's Respiratory Questionnaire (SGRQ), a questionnaire for patients with respiratory diseases is designed to assess the chronic obstructive pulmonary disease patients quality of life. The questionnaire consists of 76 questions, which are grouped in 3 parts: The first part - symptoms - measures the degree of anxiety caused by respiratory symptoms.; The second part - activity - measures the limitation of mobility and physical activity.; The third part - the influence - evaluates the existing psychosocial consequences of bronchial obstruction.	Week 24 ± 1

Collaborators and Investigators

• Sponsor: AO GENERIUM

Publications and helpful links

General Publications

• Amelina EL, Krasovsky SA, Akhtyamova-Givirovskaya NE, Kashirskaya NY, Abdulganieva DI, Asherova IK, Zilber IE, Kozyreva LS, Kudelya LM, Ponomareva ND, Revel-Muroz NP, Reutskaya EM, Stepanenko TA, Seitova GN, Ukhanova OP, Magnitskaya OV, Kudlay DA, Markova OA, Gapchenko EV. Comparison of biosimilar Tigerase and Pulmozyme in long-term symptomatic therapy of patients with cystic fibrosis and severe pulmonary impairment (subgroup analysis of a Phase III randomized open-label clinical trial (NCT04468100)). PLoS One. 2021 Dec 23;16(12):e0261410. doi: 10.1371/journal.pone.0261410. eCollection 2021.

Study record dates

Study Major Dates

• Study Start (Actual): August 30, 2017
• Primary Completion (Actual): May 16, 2018
• Study Completion (Actual): May 16, 2018

Study Registration Dates

• First Submitted: July 8, 2020
• First Submitted That Met QC Criteria: July 8, 2020
• First Posted (Actual): July 13, 2020

Study Record Updates

• Last Update Posted (Actual): July 13, 2020
• Last Update Submitted That Met QC Criteria: July 8, 2020
• Last Verified: July 1, 2020

More Information

Terms related to this study

• Keywords: Fibrosis; Respiratory Tract Diseases; Pathologic Processes; Cystic Fibrosis; Digestive System Diseases; Lung Diseases; Genetic Diseases, Inborn; Pancreatic Diseases; DNase; Dornase; Tigerase®
• 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: DRN-CFR-III; 348 eff date 23.06.2017 (Other Identifier: Clinical trial approval number, Ministry of Health of Russia)

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