- ICH GCP
- Register voor klinische proeven in de VS.
- Klinische proef NCT01282879
Evaluation of Antifungal Prophylaxis on Graft-versus-host Disease (GVHD) Patients (ITRAG)
Evaluation of Antifungal Prophylaxis Against Invasive Fungal Infections During Corticosteroid Containing Therapy for Graft-versus-host Disease Following Allogeneic Hematopoietic Stem Cell Transplantation
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
Eligible patients who provided an informed consent form will be administered itraconazole oral solution (200mg bid initially, swash and swallow) in either an in patient or outpatient setting. Treatment can be initiated at the same time of or within 10 days after starting systemic immunosuppressive therapy.
Itraconazole oral solution dose can be adjusted according to the liver function test: 1) in case of - AST/ALT level 5-10 times UNL or bilirubin/ALP level 2-5 times UNL, itraconazole dose can be reduced to half (i.e. itraconazole 200mg po once daily or 100mg bid); 2) in case of - AST/ALT level > 10 times UNL or bilirubin/ALP level > 5 times UNL, itraconazole can be stopped.
GVHD treatment can be given per center's policy: With respect to acute GVHD, prednisone (1-2mg/Kg/day) oral or iv can be given on top of calcineurin inhibitor (CNI) GVHD prophylaxis. For chronic GVHD, various type of frontline regimen can be permitted including CNI+prednisone (PD), PD alone, CNI+PD+mycophenolate mofetil (MMF), or MMF+PD. Various dose of PD will be accepted if it is at least from 0.5mg/Kg/day. For example, at SMC, in case of mild grade cGVHD with high risk feature, or of moderate grade cGVHD, CNI plus PD, 0.5mg/kg/day can be given initially. In case of severe grade cGVHD, CNI plus PD, 1.0mg/Kg/day will be given.
Itraconazole will be maintained until PD is tapered to 10mg/day in case of PD alone therapy group, or until PD is stopped in case of CNI+PD or CNI+PD+MMF or MMF+PD group, etc. In addition, patients will receive itraconazole oral suspension until: 1) Development of proven or probable IFIs, 2) Severe toxicity (such as liver function abnormality - AST/ALT level > 10 times UNL or bilirubin/ALP level > 5 times UNL, 3) Worsening GVHD that requires second line therapy for steroid refractory GVHD (in this situation, investigator could stop itraconazole oral solution if there is a potential drug interaction between itraconazole oral solution and 2nd line GVHD drug or prolonged use of itraconazole oral solution could be hazardous to the patient), 4) Need to switch antifungal agent for the treatment of prolonged febrile episode related to systemic infection, thus requiring systemic antifungal treatment, 6) Withdrawal from study participation (patient's decision), or 7) Death.
Studietype
Inschrijving (Werkelijk)
Fase
- Fase 4
Contacten en locaties
Studie Locaties
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Incheon, Korea, republiek van
- Inha University Hospital
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Incheon, Korea, republiek van
- Gachon University Gil Hospital
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Pusan, Korea, republiek van
- Inje University Pusan Paik Hospital
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Seoul, Korea, republiek van
- Seoul National University Hospital
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Seoul, Korea, republiek van, 135-710
- Samsung Medical Center
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Seoul, Korea, republiek van
- Chung-Ang University Hospital
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Seoul, Korea, republiek van
- SoonChunHyang University Seoul Hospital
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Jeollanam-do
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Hwasun, Jeollanam-do, Korea, republiek van
- Chonnam National University Hwasun Hospital
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Kyounggi-do
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Bucheon, Kyounggi-do, Korea, republiek van
- SoonChunHyang University Bucheon Hospital
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
Patients developing or developed acute or chronic GVHD within the last 10 days which require systemic immunosuppressive therapy of corticosteroids with- or-without other immunosuppressive agents including calcineurin inhibitors.
- acute GVHD, grade 2-4
- chronic GVHD, mild grade with high risk or moderate to severe grade
- Written informed consent form
Exclusion Criteria:
- Aspartate transaminase or alanine transaminase level > 10 times UNL or Bilirubin or alkaline phosphatase level > 5 times UNL
- Active or chronic hepatitis virus B or C infection requiring antiviral therapy
- Estimated life expectancy < 30 days
- History of allergy, sensitivity, or any serious reaction to itraconazole oral solution
- Previous history of Zygomycosis
- Evidence of active fungal disease including high galactomannan titer above 0.5, within 2 weeks.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Preventie
- Toewijzing: NVT
- Interventioneel model: Opdracht voor een enkele groep
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Experimenteel: itraconazole, prophylaxis, Oral solution
For GVHD patients who are required systemic glucocorticoids therapy, itraconazole oral solution will be administered at a dose of 200mg every 12 hours.
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200mg bid, oral solution, until a dose of prednisone was tapered to 10mg/day in case of prednisone alone therapy group, or until prednisone was stopped in case of CNIs plus prednisone, CNIs plus prednisone plus mycophenolate mofetil, or mycophenolate mofetil plus prednisone group, etc.
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
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incidence of proven or probable invasive fungal infections
Tijdsspanne: at day 100 after starting graft-versus-host disease (GVHD) treatment with corticosteroids based regimen in adjunction to itraconazole oral solution antifungal prophylaxis.
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at day 100 after starting graft-versus-host disease (GVHD) treatment with corticosteroids based regimen in adjunction to itraconazole oral solution antifungal prophylaxis.
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Secundaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
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safety profiles of itraconazole oral solution
Tijdsspanne: during GVHD treatment with corticosteroids containing regimen
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during GVHD treatment with corticosteroids containing regimen
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GVHD-specific survival (GSS) of patients receiving corticosteroids based GVHD treatment together with antifungal prophylaxis with itraconazole oral solution
Tijdsspanne: from the onset of acute or chronic GVHD to death due to GVHD itself or GVHD-related complications
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from the onset of acute or chronic GVHD to death due to GVHD itself or GVHD-related complications
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Medewerkers en onderzoekers
Sponsor
Medewerkers
Onderzoekers
- Hoofdonderzoeker: Dong Hwan Kim, M.D./Ph.D., Division of Hematology/Oncology, Department of Medicine
Publicaties en nuttige links
Algemene publicaties
- Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Segal BH, Steinbach WJ, Stevens DA, van Burik JA, Wingard JR, Patterson TF; Infectious Diseases Society of America. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008 Feb 1;46(3):327-60. doi: 10.1086/525258. No abstract available.
- Goodman JL, Winston DJ, Greenfield RA, Chandrasekar PH, Fox B, Kaizer H, Shadduck RK, Shea TC, Stiff P, Friedman DJ, et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med. 1992 Mar 26;326(13):845-51. doi: 10.1056/NEJM199203263261301.
- Winston DJ, Maziarz RT, Chandrasekar PH, Lazarus HM, Goldman M, Blumer JL, Leitz GJ, Territo MC. Intravenous and oral itraconazole versus intravenous and oral fluconazole for long-term antifungal prophylaxis in allogeneic hematopoietic stem-cell transplant recipients. A multicenter, randomized trial. Ann Intern Med. 2003 May 6;138(9):705-13. doi: 10.7326/0003-4819-138-9-200305060-00006.
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Schatting)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Infecties
- Ziekten van het immuunsysteem
- Bacteriële infecties en mycosen
- Mycosen
- Invasieve schimmelinfecties
- Graft vs Host-ziekte
- Fysiologische effecten van medicijnen
- Moleculaire mechanismen van farmacologische werking
- Anti-infectieuze middelen
- Enzymremmers
- Hormonen, hormoonvervangers en hormoonantagonisten
- Cytochroom P-450 CYP3A-remmers
- Cytochroom P-450 enzymremmers
- Hormoon antagonisten
- Antischimmelmiddelen
- Steroïde syntheseremmers
- 14-alfa-demethylaseremmers
- Itraconazol
Andere studie-ID-nummers
- 2009-08-099
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
product vervaardigd in en geëxporteerd uit de V.S.
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Klinische onderzoeken op Graft vs Host-ziekte
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Fred Hutchinson Cancer CenterFacet BiotechOnbekendGraft-vs-host-ziekteVerenigde Staten
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HomeoTherapy Co., LtdVoltooidGraft-vs-host-ziekteKorea, republiek van
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Hadassah Medical OrganizationVoltooid
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Dana-Farber Cancer InstituteWyeth is now a wholly owned subsidiary of Pfizer; PDL BioPharma, Inc.BeëindigdGraft-vs-host-ziekteVerenigde Staten
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Astellas Pharma IncVoltooidBeenmerg transplantatie | Graft-versus-host-ziekte | Graft-versus-host-ziekte | Graft-vs-host-ziekteJapan
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Astellas Pharma IncVoltooidBeenmerg transplantatie | Graft-versus-host-ziekte | Graft-versus-host-ziekte | Graft-vs-host-ziekteJapan
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University of CalgaryAlberta Health services; University of AlbertaBeëindigd
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FDA Office of Orphan Products DevelopmentVoltooid
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Massachusetts General HospitalSeagen Inc.BeëindigdGVHD | Graft-vs-host-ziekteVerenigde Staten
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University of SalamancaHaematology Service,University Hospital of Salamanca, MªConsuelo del Cañizo...Onbekend
Klinische onderzoeken op Itraconazole
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University of Maryland, BaltimoreVoltooid
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University of Alabama at BirminghamWashington University School of Medicine; University of California, DavisVoltooidInvasieve schimmelinfectiesVerenigde Staten, Panama
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Johns Hopkins UniversityMemorial Sloan Kettering Cancer CenterVoltooid
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University of Kansas Medical CenterUniversity of Texas, Southwestern Medical Center at DallasWervingBarrett-oesofagitis met dysplasieVerenigde Staten
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Sara BotrosVoltooidTinea VersicolorEgypte
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Pulmatrix Inc.Voltooid
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Halcygen Pharmaceuticals LimitedVoltooidOnychomycoseVerenigde Staten
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Jiangsu HengRui Medicine Co., Ltd.Voltooid
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Stiefel, a GSK CompanyGlaxoSmithKlineVoltooidItraconazol-tabletten versus. Itraconazol-capsules versus placebo bij onychomycose van de teennagel.OnychomycoseVerenigde Staten, Zuid-Afrika, Canada, Dominicaanse Republiek, Ecuador, Honduras, Panama
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PfizerVoltooid