Human Recombinant Interferon Gamma-1b for the Prevention of Hospital-acquired Pneumonia in Critically Ill Patients: a Double-blind, International, Phase 2, Randomized, Placebo-controlled Trial - the PREV-HAP Study (PREV-HAP)

February 1, 2022 updated by: Nantes University Hospital

PREV-HAP study is part of a larger project entitled 'Host-targeted Approaches for the Prevention and the treatment of Hospital-Acquired Pneumonia' (HAP2), funded by the European Union's H2020 research and innovation programme under grant agreement N°847782. HAP2 aims to develop stratified host-directed drugs and biomarkers to enhance the prevention and the treatment of HAP and develop precision medicine in infectious diseases. Its ambition is to revolutionize the management of HAP: capitalising on the novel concept of critical-illness related immunosuppression altering the host-pathogens interactions, the aim is to propose a complete reappraisal of the physiopathology of HAP based on the concept of respiratory dysbiosis.

The main hypothesis of the PREV-HAP study is that human recombinant Interferon gamma 1b (rHuIFN-γ, Imukin) treatment can restore immunity in critically ill patients and prevent Hospital-Acquired Pneumonia.

The hypothesesis is that the in vivo investigations of the host-pathogens interactions can be used for the stratification of patients into high/low risk and responders/non-responders to host-targeted prevention of hospital-acquired infections.

The involvement of a state of critical-illness related immunosuppression in the susceptibility to hospital-acquired pneumonia is widely accepted, and an emerging trend is that the development of drugs for the treatment of this acquired immunosuppression will prevent infection and enhance outcomes of hospitalized patients.

It has been demonstrated that the productions of IFN-γ by immune cells are decreased in critically ill patients, and that these defects are associated with the susceptibility to HAP. rHuIFN-γ has neither been tested nor is recommended as adjunctive treatment of patients with HAP. Based on these specific factors identified in the host response, it is proposed in this study to use rHuIFN-γ as novel preventive approach for HAP.

Study Overview

Detailed Description

200 adult patients hospitalized in intensive care units, under mechanical ventilation in three European countries will be included in the trial, and will be randomized in 2 arms :

Arm 1 (rHu-IFNγ):

• Recombinant Interferon gamma 1b (IMUKIN®, from Clinigen®): 100 µg/0,5ml subcutaneous injections from day 1 to day 9 (5 injections, i.e. 1 injection of 100 µg every 48h),

Arm 2 (Placebo):

• Recombinant Interferon gamma 1b placebo: 5 subcutaneous injections from day 1 to day 9 (i.e. 1 injection of 0,5ml every 48h).

Study Type

Interventional

Enrollment (Actual)

109

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Angers, France
        • Angers University Hospital
      • Argenteuil, France
        • Argenteuil Hospital
      • Brest, France
        • Brest University Hospital
      • Clichy, France
        • Beaujon University Hospital
      • Limoges, France
        • Limoges University Hospital
      • Nantes, France, 44093
        • Nantes University Hospital
      • Rennes, France
        • Rennes University Hospital
      • Athen, Greece
        • Attikon University General Hospital
      • Athens, Greece
        • Aghioi Anargyroi General Oncology Hospital
      • Heraklion, Greece
        • General University Hospital of Heraklion
      • Ioannina, Greece
        • University General Hospital of Ioannina
      • Larissa, Greece
        • General University Hospital of Larissa
      • Larissa, Greece
        • Koutlimbaneio & Triantafylleio General Hospital of Larissa
      • Barcelona, Spain
        • Hospital Vall d'Hebron
      • Barcelona, Spain
        • Hospital Clinic Barcelona
      • Lleida, Spain
        • Hôpital universitaire Arnau de Vilanova
      • Madrid, Spain
        • Hospital Clinico San Carlos
      • Palma, Spain
        • Hospital Universitario de Son Llátzer

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

16 years to 83 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adult patients (18yr to 85yr).
  • Hospitalized in intensive care unit for less than 48 hours.
  • Receiving invasive mechanical ventilation at the time of inclusion.
  • One or more acute organ failure at the time of inclusion among: neurological (Glasgow coma scale <13 before sedation), hemodynamic (norepinephrine, epinephrine, or any other vasopressor at a dose of ≥ 0.1 μg per kilogram of body weight per minute or ≥0.5 mg per hour for at least 6 hours), respiratory (PaO2 / FiO2< 200) and/or renal (creatininemia > 2 fold higher than the basal value and/or oliguria < 0.5 mL/kg/hour for at less 12 hours).
  • Informed consent from a legal representative, or emergency procedure (when possible according to national regulation, see below). As is not possible to obtain the patient consent prior the inclusion (comatose patients), patient consent for the study continuation will be obtained as soon as deemed possible.
  • Person insured under a health insurance scheme.

Exclusion Criteria:

  • Pregnant women (serum or urine test), breastfeeding women
  • Patient under legal protection (incl. under guardianship or trusteeship)
  • Hypersensitivity to the active substance (interferon gamma-1b) or known hypersensitivity to related products, such as another interferon, or to any of the following excipients: Mannitol, Disodium succinate hexahydrate, Succinic acid, Polysorbate 20
  • Severe hepatic insufficiency ( Child Pugh score B or C)
  • Liver cytolysis with hepatic enzymes (AST and/or ALT) > 5N
  • Severe chronic renal insufficiency (MDRD Creatinine Clearance < 10 ml/min/1.73m2)
  • Immunosuppression (hematologic cancer, aplasia, chemotherapy/radiotherapy for cancer within 3 months prior to the inclusion, known infection Human immunodeficiency virus, concomitant use of any anti-graft rejection drug).
  • Coma after resuscitated cardiac arrest
  • Cervical spinal cord injury
  • Participation to a drug interventional study within 1 month prior to the inclusion
  • Hospital-acquired pneumonia before inclusion in the study during the current hospitalization.
  • Sustained hyperlactatemia > 5 mmol/L.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

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
Experimental: Recombinant Interferon gamma 1b (IMUKIN®)
100 µg/0,5ml subcutaneous injections from day 1 to day 9 (5 injections, i.e. 1 injection of 100 µg every 48h)
Placebo Comparator: Recombinant Interferon gamma 1b placebo
5 subcutaneous injections from day 1 to day 9 (i.e. 1 injection of 0,5ml every 48h).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
To demonstrate the efficiency of rHuIFN-γ for the prevention of hospital-acquired pneumonia
Time Frame: Day 28
Rate of the composite outcome at day 28 made of at least one item among the following: all cause mortality and/or hospital-acquired pneumonia
Day 28

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
All-cause mortality [efficiency of rHu-IFN-γ, on pneumonia-associated morbidity and mortality reduction]
Time Frame: Day 28 and Day 90
Rate of all-cause mortality at D28 and D90
Day 28 and Day 90
Rate of HAP [efficiency]
Time Frame: Day 28
Rate of HAP at D28
Day 28
Bacterial ecology of the 1st episode of HAP [efficiency]
Time Frame: Day 28
Bacterial ecology of the 1st episode of HAP (respiratory fluids)
Day 28
Rate of ventilator-associated tracheobronchitis [efficiency]
Time Frame: Day 28
Rate of ventilator-associated tracheobronchitis at D28 defined as at least two of the following criteria: body temperature >38°C; leukocytosis>12000 cells/mL, leucopenia <4000 cells/mL, or purulent pulmonary secretions and a positive culture of a respiratory tract samples, without appearance of a new infiltrate or change in an existing infiltrate on chest radiography
Day 28
Occurence of Acute Respiratory Distress Syndrome [efficiency]
Time Frame: Day 28
Acute Respiratory Distress Syndrome within 28 days after randomization
Day 28
Duration of antimicrobial therapy [efficiency]
Time Frame: Day 28
Duration of antimicrobial therapy at D28, antibiotic free days at D28
Day 28
Duration of mechanical ventilation [efficiency]
Time Frame: Day 90
Duration of mechanical ventilation at D90, mechanical ventilation free days at D90
Day 90
Duration of ICU hospitalization [efficiency]
Time Frame: Day 90
Duration of ICU hospitalization at D90, Duration of hospitalization at D90.
Day 90
Rate of SAEs and SUSARs [tolerance]
Time Frame: Day 15
Rate of serious adverse effects and suspected unexpected serious adverse reaction (SUSAR) at D15
Day 15
Rate of leukocytosis [tolerance]
Time Frame: Day 15
Rate of leukocytosis at D15.
Day 15
Rate of neutropenia [tolerance]
Time Frame: Day 15
Rate of neutropenia at D15.
Day 15
Rate of lymphopenia [tolerance]
Time Frame: Day 15
Rate of lymphopenia at D15.
Day 15
Rate of thrombopenia [tolerance]
Time Frame: Day 15
Rate of thrombopenia at D15.
Day 15
Rate of liver cytolysis [tolerance]
Time Frame: Day 15
Rate of liver cytolysis (Increases in AST and/or ALT) at D15.
Day 15
Rate of pancreatitis [tolerance]
Time Frame: Day 15
Rate of pancreatitis (Increase in Lipase) at D15.
Day 15
Rate of patients with episode of fever [tolerance]
Time Frame: Day 15
Rate of patients with episode of fever (T° > 38.3°C)
Day 15
Rate of patients with episode of headache [tolerance]
Time Frame: Day 15
Rate of patients with episode of headache
Day 15
Rate of patients with episode of nausea [tolerance]
Time Frame: Day 15
Rate of patients with episode of nausea
Day 15
Rate of allergic reaction [tolerance]
Time Frame: Day 15
Rate of major allergic reaction at D15 defined as systemic epidermic reaction, anaphylactic
Day 15
Incidence of injection site reaction [tolerance]
Time Frame: Day 15
Occurence of injection site reaction at D15
Day 15
Rate of myalgia [tolerance]
Time Frame: Day 15
Rate of myalgia at D15
Day 15
Rate of arthralgia [tolerance]
Time Frame: Day 15
Rate of arthralgia at D15
Day 15
Rate of back pain [tolerance]
Time Frame: Day 15
Rate of back pain at D15
Day 15
Economic efficiency of rHu-IFN-γ in the prevention of pneumonia
Time Frame: Day 90
Economic endpoint at 3 months: Incremental cost effectiveness ratio (ICER). Analysis using QALYs (Quality-Adjusted Life-Years) as a measure of effectiveness. QALYs are a measure of effectiveness specifically designed for economic evaluations.
Day 90
To determine the suitability of rHu-IFN-γ from the patients' and relatives' perspectives using The Short Form (36) Health Survey
Time Frame: Day 90
Changes in health-related quality of life (HRQoL) from one (M1) to three months (M3) after randomization measured with the Short Form (SF)-36 scale validated in French, Greek, and Spanish he SF-36 is a 36-item self-report questionnaire with 8 domains = Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health).The scores of each domain range from 0 to 100, a higher score indicating a better HRQoL.
Day 90
To determine the suitability of rHu-IFN-γ from the patients' and relatives' perspectives using the Hospital Anxiety and Depression scale (HADS)
Time Frame: Day 90

Changes in anxiety and depression from M1 to M3 measured with the HADS scale validated in French, Greek, and Spanish. The HADS is a 14-item self-report questionnaire with 2 domains (anxietyand depression).

The scores for anxiety and depression range from 0 (no symptoms) to 21 (significant number of symptoms).

Day 90
To determine the suitability of rHu-IFN-γ from the patients' and relatives' perspectives using Satisfaction With Life Scale (SWLS)
Time Frame: Day 90
Changes in subjective well-being from M1 to M3 measured with the Satisfaction With Life Scale (SWLS) validated in French, Greek, and Spanish. The SWLS is a 5-item self-report questionnaire. The response scores to the five items are added together to provide a total score ranging from 5 (worst satisfaction level) to 35 (best level).
Day 90
To determine the acceptability of rHu-IFN-γ from the patients' and relatives' perspectives
Time Frame: Day 90
Adaptation of the patients to their health state and its evolution from M1 to M3 using differential item functioning and response shift analyses for HRQoL, anxiety and depression. Change in the meaning of patients' self-evaluation between groups (DIF) and over time (response shift) will be inferred by the change in the items' parameters of the Partial Credit Models.
Day 90

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 29, 2021

Primary Completion (Actual)

November 7, 2021

Study Completion (Anticipated)

June 1, 2023

Study Registration Dates

First Submitted

February 24, 2021

First Submitted That Met QC Criteria

March 8, 2021

First Posted (Actual)

March 11, 2021

Study Record Updates

Last Update Posted (Actual)

February 16, 2022

Last Update Submitted That Met QC Criteria

February 1, 2022

Last Verified

February 1, 2022

More Information

Terms related to this study

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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