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    Clinical Trial Results:
    A randomized, double-blind, placebo-controlled, multicenter, parallel-group, adaptive group-sequential phase II study, to determine the efficacy and safety of BT086 as an adjunctive treatment in severe community acquired pneumonia (sCAP)

    Summary
    EudraCT number
    2010-022380-35
    Trial protocol
    DE   ES   GB   BE  
    Global end of trial date
    25 Feb 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Dec 2021
    First version publication date
    13 Dec 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    982
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01420744
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Biotest AG
    Sponsor organisation address
    Landsteinerstraße 5, Dreieich, Germany, 63303
    Public contact
    Dr. med. Andrea Wartenberg-Demand, Biotest AG, +49 61038010, andrea.wartenberg-demand@biotest.com
    Scientific contact
    Dr. med. Andrea Wartenberg-Demand, Biotest AG, +49 61038010, andrea.wartenberg-demand@biotest.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    25 May 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    25 Feb 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    25 Feb 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The objectives of this study are to evaluate the efficacy and safety of BT086 IgM concentrate in patients with sCAP(severe community acquired pneumonia)
    Protection of trial subjects
    To monitor the safety data from adult subjects and to provide advice and recommendations on the enrollment a DSMB consisting of independent experts has been implemented.
    Background therapy
    Standard of care
    Evidence for comparator
    -
    Actual start date of recruitment
    04 Oct 2011
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Spain: 108
    Country: Number of subjects enrolled
    United Kingdom: 14
    Country: Number of subjects enrolled
    Germany: 38
    Worldwide total number of subjects
    160
    EEA total number of subjects
    160
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    73
    From 65 to 84 years
    80
    85 years and over
    7

    Subject disposition

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    Recruitment
    Recruitment details
    The first subject’s first visit (date of first enrollment) was on 04-OCT-2011 and the last subject’s last visit (date of last completed) was on 25-FEB-2015

    Pre-assignment
    Screening details
    Major sCAP criterion (IDSA/ATS criteria) need for endotracheal ventilation and patient must have at least one of the minor signs and symptoms of pneumonia following IDSA/ATS criteria. Treatment of patient with BT086 must start within 12 hours but not earlier than 1 hour after start of endotracheal ventilation

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor
    Blinding implementation details
    The matching placebo had similar appearance to BT086 which enabled maintaining the treatment blinding. To ensure blinding, vials were covered with transparent colored foils in accordance with study-specific guidance for coating of vials with green foil.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    BT086
    Arm description
    Subjects were treated with BT086, human immunoglobulin (Ig) preparation enriched with IgM/IgA for intravenous administration. The approximate concentration of IgM in BT086 was 18-28% (mean 23%), IgA was 15-27% and IgG was 48-66%.
    Arm type
    Experimental

    Investigational medicinal product name
    Trimodulin
    Investigational medicinal product code
    BT086
    Other name
    IgM Concentrate
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    The dose to be administered was 3.65 mL/kg body weight (bw) administered as intravenous infusion on 5 consecutive days.

    Arm title
    Placebo
    Arm description
    Subjects were treated with placebo containing 1% human albumin solution. The dose to be administered was 3.65 mL/kg body weight (bw) administered as intravenous infusion on 5 consecutive days.
    Arm type
    Placebo

    Investigational medicinal product name
    1% human albumin solution
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    5 days infusion of 1% human albumin solution (Day 1 to 5);3.65 mL/kg bw/day

    Number of subjects in period 1
    BT086 Placebo
    Started
    81
    79
    Completed
    81
    79

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall Trial
    Reporting group description
    -

    Reporting group values
    Overall Trial Total
    Number of subjects
    160 160
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    73 73
        From 65-84 years
    80 80
        85 years and over
    7 7
    Age continuous
    Units: years
        median (standard deviation)
    65.5 ± 14.80 -
    Gender categorical
    Units: Subjects
        Female
    47 47
        Male
    113 113

    End points

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    End points reporting groups
    Reporting group title
    BT086
    Reporting group description
    Subjects were treated with BT086, human immunoglobulin (Ig) preparation enriched with IgM/IgA for intravenous administration. The approximate concentration of IgM in BT086 was 18-28% (mean 23%), IgA was 15-27% and IgG was 48-66%.

    Reporting group title
    Placebo
    Reporting group description
    Subjects were treated with placebo containing 1% human albumin solution. The dose to be administered was 3.65 mL/kg body weight (bw) administered as intravenous infusion on 5 consecutive days.

    Primary: Ventilator Free Days

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    End point title
    Ventilator Free Days
    End point description
    The primary endpoint is the increase of ventilator-free days (VFDs) measured in sCAP patients treated with adjunctive BT086 adjunctive to the appropriate standard-of-care treatment compared to patients treated with placebo and the appropriate standard of care. VFDs were defined as the number of days between successful extubation from endotracheal ventilation and Day 28 after enrollment of the subject into the study. To account for subjects who died during the 28-day period, VFDs were set to 0 if a subject died within this period, even after successful weaning. VFDs of subjects who prematurely discontinued the study were collected and were therefore included in the analysis.
    End point type
    Primary
    End point timeframe
    Day 1-day29
    End point values
    BT086 Placebo
    Number of subjects analysed
    81
    79
    Units: Days
    81
    79
    Statistical analysis title
    Primary Analysis
    Statistical analysis description
    Testing of the null hypothesis using one-sided Wilcoxon-Mann-Whitney tests and inverse normal method, respectively.
    Comparison groups
    BT086 v Placebo
    Number of subjects included in analysis
    160
    Analysis specification
    Pre-specified
    Analysis type
    superiority [1]
    P-value
    = 0.139
    Method
    Wilcoxon (Mann-Whitney)
    Confidence interval
    Notes
    [1] - The primary efficacy analysis will focus on testing the superiority of BT086 versus placebo with regard to the primary efficacy variable, VFDs. BT086 is superior to placebo if more patients treated with BT086 survive and have more VFDs.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Observation period, Day-1 until day 29 (day 43+7 for UK only). All SAEs and related AEs had to be followed up until a final outcome (resolution of the event/recovery of the subject, recovery with sequelae, or death)
    Adverse event reporting additional description
    Treatment Emergent Adverse Events
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.1
    Reporting groups
    Reporting group title
    Safety Analysis Set (SAF)
    Reporting group description
    Full Analysis Set and Safety Analysis Set are identical and include all subjects who received ≥ 1 dose.

    Serious adverse events
    Safety Analysis Set (SAF)
    Total subjects affected by serious adverse events
         subjects affected / exposed
    124 / 160 (77.50%)
         number of deaths (all causes)
    40
         number of deaths resulting from adverse events
    40
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Bronchial neoplasm
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Laryngeal squamous cell carcinoma
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lung neoplasm malignant
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Squamous cell carcinoma of lung
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Extremity necrosis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypertension
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Jugular vein thrombosis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Peripheral ischaemia
         subjects affected / exposed
    3 / 160 (1.88%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 1
    Shock haemorrhagic
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Subclavian vein thrombosis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vena cava thrombosis
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hypertensive crisis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypertensive emergency
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hypotension
         subjects affected / exposed
    3 / 160 (1.88%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Surgical and medical procedures
    Tracheostomy
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Brain death
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Catheter site haemorrhage
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperthermia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Medical Device Complication
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Multi-organ failure
         subjects affected / exposed
    5 / 160 (3.13%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 3
    Systemic inflammatory response syndrome
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Thrombosis in device
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Acute pulmonary oedema
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Acute respiratory distress syndrome
         subjects affected / exposed
    8 / 160 (5.00%)
         occurrences causally related to treatment / all
    0 / 9
         deaths causally related to treatment / all
    0 / 1
    Acute respiratory failure
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Bronchospasm
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Diaphragmatic paralysis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diffuse alveolar damage
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Dyspnoea exertional
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypoxia
         subjects affected / exposed
    4 / 160 (2.50%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    Organising pneumonia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pleural effusion
         subjects affected / exposed
    6 / 160 (3.75%)
         occurrences causally related to treatment / all
    0 / 6
         deaths causally related to treatment / all
    0 / 0
    Pneumonia aspiration
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumothorax
         subjects affected / exposed
    7 / 160 (4.38%)
         occurrences causally related to treatment / all
    0 / 7
         deaths causally related to treatment / all
    0 / 1
    Pulmonary embolism
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary necrosis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary oedema
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Respiratory acidosis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory failure
         subjects affected / exposed
    13 / 160 (8.13%)
         occurrences causally related to treatment / all
    0 / 13
         deaths causally related to treatment / all
    0 / 3
    Stridor
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Tracheomalacia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Psychiatric disorders
    Delirium
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Investigations
    Electrocardiogram QT prolonged
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Platelet count decreased
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Endotracheal intubation complication
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Mechanical ventilation complication
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumothorax traumatic
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Procedural complication
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Vascular pseudoaneurysm
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Acute coronary syndrome
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Acute myocardial infarction
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Atrial fibrillation
         subjects affected / exposed
    12 / 160 (7.50%)
         occurrences causally related to treatment / all
    0 / 14
         deaths causally related to treatment / all
    0 / 0
    Atrial flutter
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Atrioventricular block complete
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Bradycardia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bundle branch block left
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac arrest
         subjects affected / exposed
    3 / 160 (1.88%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 2
    Cardiac disorder
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac failure
         subjects affected / exposed
    3 / 160 (1.88%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 1
    Cardiac failure acute
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardio-respiratory arrest
         subjects affected / exposed
    3 / 160 (1.88%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 1
    Cardiogenic shock
         subjects affected / exposed
    4 / 160 (2.50%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 3
    Chordae tendinae rupture
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Left ventricular failure
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mitral valve incompetence
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Myocardial infarction
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Right ventricular failure
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sinus bradycardia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ventricular fibrillation
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Ventricular tachycardia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Brain injury
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    critical illness polyneuropathy
         subjects affected / exposed
    3 / 160 (1.88%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Epilepsy
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Extrapyramidal disorder
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hydrocephalus
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ischaemic stroke
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Partial seizures
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Polyneuropathy
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    VIIth nerve paralysis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vocal cord paralysis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    50 / 160 (31.25%)
         occurrences causally related to treatment / all
    0 / 59
         deaths causally related to treatment / all
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    8 / 160 (5.00%)
         occurrences causally related to treatment / all
    1 / 8
         deaths causally related to treatment / all
    0 / 0
    Coagulopathy
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Haemolysis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Heparin-induced thrombocytopenia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypochromic anaemia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Normochromic normocytic anaemia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Abdominal compartment syndrome
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ileus paralytic
         subjects affected / exposed
    4 / 160 (2.50%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Impaired gastric emptying
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intestinal ischaemia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Mouth cyst excision
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Retroperitoneal haematoma
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Upper gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Acute hepatic failure
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Cholecystitis acute
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hepatic failure
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Liver disorder
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Skin and subcutaneous tissue disorders
    Skin necrosis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Subcutaneous emphysema
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Renal failure
         subjects affected / exposed
    5 / 160 (3.13%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    Renal failure acute
         subjects affected / exposed
    11 / 160 (6.88%)
         occurrences causally related to treatment / all
    1 / 11
         deaths causally related to treatment / all
    0 / 0
    Renal impairment
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Critical illness myopathy
         subjects affected / exposed
    6 / 160 (3.75%)
         occurrences causally related to treatment / all
    0 / 6
         deaths causally related to treatment / all
    0 / 0
    Muscular weakness
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Myopathy
         subjects affected / exposed
    4 / 160 (2.50%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Rhabdomyolysis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Arthritis bacterial
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bacteraemia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Chronic hepatitis C
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Clostridium difficile colitis
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Device related infection
         subjects affected / exposed
    6 / 160 (3.75%)
         occurrences causally related to treatment / all
    0 / 7
         deaths causally related to treatment / all
    0 / 0
    Device related sepsis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Empyema
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Endocarditis
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Enterococcal sepsis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal infection
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infection
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lung abscess
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    13 / 160 (8.13%)
         occurrences causally related to treatment / all
    0 / 13
         deaths causally related to treatment / all
    0 / 2
    Pneumonia necrotising
         subjects affected / exposed
    2 / 160 (1.25%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Postoperative wound infection
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pseudomonas infection
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pyelonephritis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    5 / 160 (3.13%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 2
    Septic embolus
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Septic shock
         subjects affected / exposed
    14 / 160 (8.75%)
         occurrences causally related to treatment / all
    0 / 14
         deaths causally related to treatment / all
    0 / 8
    Systemic candida
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Fluid imbalance
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperkalaemia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperglycaemia
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolic acidosis
         subjects affected / exposed
    1 / 160 (0.63%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Safety Analysis Set (SAF)
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    150 / 160 (93.75%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    20 / 160 (12.50%)
         occurrences all number
    22
    Hypotension
         subjects affected / exposed
    11 / 160 (6.88%)
         occurrences all number
    12
    Phlebitis
         subjects affected / exposed
    13 / 160 (8.13%)
         occurrences all number
    14
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    10 / 160 (6.25%)
         occurrences all number
    10
    Blood and lymphatic system disorders
    Thrombocytopenia
         subjects affected / exposed
    12 / 160 (7.50%)
         occurrences all number
    15
    Thrombocytosis
         subjects affected / exposed
    8 / 160 (5.00%)
         occurrences all number
    8
    General disorders and administration site conditions
    Generalised oedema
         subjects affected / exposed
    9 / 160 (5.63%)
         occurrences all number
    9
    Oedema peripheral
         subjects affected / exposed
    10 / 160 (6.25%)
         occurrences all number
    12
    Pyrexia
         subjects affected / exposed
    26 / 160 (16.25%)
         occurrences all number
    38
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    21 / 160 (13.13%)
         occurrences all number
    24
    Diarrhoea
         subjects affected / exposed
    13 / 160 (8.13%)
         occurrences all number
    13
    Impaired gastric emptying
         subjects affected / exposed
    8 / 160 (5.00%)
         occurrences all number
    8
    Vomiting
         subjects affected / exposed
    10 / 160 (6.25%)
         occurrences all number
    14
    Hepatobiliary disorders
    Cholestasis
         subjects affected / exposed
    10 / 160 (6.25%)
         occurrences all number
    10
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    9 / 160 (5.63%)
         occurrences all number
    9
    Psychiatric disorders
    Agitation
         subjects affected / exposed
    13 / 160 (8.13%)
         occurrences all number
    13
    Confusional state
         subjects affected / exposed
    12 / 160 (7.50%)
         occurrences all number
    12
    Metabolism and nutrition disorders
    Hyperglycaemia
         subjects affected / exposed
    10 / 160 (6.25%)
         occurrences all number
    12
    Hyperkalaemia
         subjects affected / exposed
    13 / 160 (8.13%)
         occurrences all number
    13
    Hypernatraemia
         subjects affected / exposed
    16 / 160 (10.00%)
         occurrences all number
    16
    Hypoglycaemia
         subjects affected / exposed
    13 / 160 (8.13%)
         occurrences all number
    17
    Hypokalaemia
         subjects affected / exposed
    13 / 160 (8.13%)
         occurrences all number
    14
    Hypophosphataemia
         subjects affected / exposed
    8 / 160 (5.00%)
         occurrences all number
    13

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    23 Dec 2011
    Changes were made to add further details and clarifications regarding assessments including addition of the Glasgow Coma score, to detail the constitution of the Data and Safety Monitoring Board (DSMB), and to correct errors and inconsistencies.
    16 Jul 2013
    Changes were made to increase the total number of patients to 160, to add additional countries, to change the study timelines, to include a second interim analysis after treatment of 100 patients, to clarify unblinding rules and consequences of emergency unblinding, update risks and precautions, to clarify follow-up of AEs and SAEs, to amend inclusion criterion 4, to clarify recording of SOFA score, to specify laboratory parameters and include immunological testing, to clarify monitoring procedures, to amend staff details, and to correct minor errors and inconsistencies.
    11 Sep 2013
    Country-Specific Protocol Amendment for UK only Changes were made to implement a safety follow-up visit after 5 half-lives of trimodulin on study day 43 including safety lab parameters, ECG, physical examination, vital signs and AE reporting

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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