Clinical Trial Results:
A multi-centre randomised placebo-controlled trial of prophylactic enteral lactoferrin supplementation to prevent late-onset invasive infection in very preterm infants.
Summary
|
|
EudraCT number |
2012-004260-22 |
Trial protocol |
GB |
Global end of trial date |
03 May 2018
|
Results information
|
|
Results version number |
v1(current) |
This version publication date |
26 Aug 2018
|
First version publication date |
26 Aug 2018
|
Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
|
|||
Trial identification
|
|||
Sponsor protocol code |
ELFIN01
|
||
Additional study identifiers
|
|||
ISRCTN number |
ISRCTN88261002 | ||
US NCT number |
- | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
|
|||
Sponsor organisation name |
University of Oxford
|
||
Sponsor organisation address |
Wellington Square, Oxford, United Kingdom,
|
||
Public contact |
Ursula Bowler, National Perinatal Epidemiology Unit, 0044 01865289749, ursula.bowler@npeu.ox.ac.uk
|
||
Scientific contact |
Ursula Bowler, National Perinatal Epidemiology Unit, 0044 01865289749, ursula.bowler@npeu.ox.ac.uk
|
||
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 |
03 May 2018
|
||
Is this the analysis of the primary completion data? |
Yes
|
||
Primary completion date |
03 May 2018
|
||
Global end of trial reached? |
Yes
|
||
Global end of trial date |
03 May 2018
|
||
Was the trial ended prematurely? |
No
|
||
General information about the trial
|
|||
Main objective of the trial |
To test the efficacy of the enteral administration of 150 mg/kg/day of bovine lactoferrin in reducing the incidence of microbiologically-confirmed or clinically suspected late-onset invasive infection (defined as more than 72 hours after birth) from trial entry until hospital discharge in a population of very preterm infants.
|
||
Protection of trial subjects |
None
|
||
Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
01 Dec 2013
|
||
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 |
United Kingdom: 2203
|
||
Worldwide total number of subjects |
2203
|
||
EEA total number of subjects |
2203
|
||
Number of subjects enrolled per age group |
|||
In utero |
0
|
||
Preterm newborn - gestational age < 37 wk |
2203
|
||
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) |
0
|
||
From 65 to 84 years |
0
|
||
85 years and over |
0
|
|
|||||||||||||||||||
Recruitment
|
|||||||||||||||||||
Recruitment details |
The trial was conducted in 37 neonatal units in the UK between 7th May 2014 and 28th September 2017. | ||||||||||||||||||
Pre-assignment
|
|||||||||||||||||||
Screening details |
Eligible participants were very preterm infants (gestational age at birth <32 weeks) who were <72 hours old at randomisation. Exclusion criteria were presence of a severe congenital anomaly, anticipated enteral fasting for longer than 14 days, and no realistic prospect of survival. | ||||||||||||||||||
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, Carer, Assessor | ||||||||||||||||||
Blinding implementation details |
The lactoferrin powder had similar granularity to sucrose so that when the dry IMP was shaken within the opaque, sealed pots it was not possible to distinguish lactoferrin from sucrose by the sound generated. The opaque containers did not allow the dry IMP to be seen unless the sealed stopper was removed.
|
||||||||||||||||||
Arms
|
|||||||||||||||||||
Are arms mutually exclusive |
Yes
|
||||||||||||||||||
Arm title
|
Lactoferrin | ||||||||||||||||||
Arm description |
Bovine lactoferrin | ||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||
Investigational medicinal product name |
Bovine lactoferrin
|
||||||||||||||||||
Investigational medicinal product code |
|||||||||||||||||||
Other name |
|||||||||||||||||||
Pharmaceutical forms |
Powder for solution for injection/infusion
|
||||||||||||||||||
Routes of administration |
Nasogastric use
|
||||||||||||||||||
Dosage and administration details |
The IMP was prescribed at a dose of 150 mg/kg body weight per day (up to a maximum of 300 mg/day). The IMP was prepared for administration by addition by syringe of sterile water (4 mL) plus expressed breast or formula (1 mL). The pot was shaken vigorously by hand for 30 seconds to generate a mixture containing 75mg/mL of IMP. The mixture was allowed to stand for 30 minutes before removal for administration using an enteral feeding syringe. The IMP was administered once daily by naso- or oro-gastric tube once the infant’s enteral feed volume was >12 mL/kg/day and continued until 34 weeks’ postmenstrual age.
|
||||||||||||||||||
Arm title
|
Placebo | ||||||||||||||||||
Arm description |
Sucrose | ||||||||||||||||||
Arm type |
Placebo | ||||||||||||||||||
Investigational medicinal product name |
Sucrose
|
||||||||||||||||||
Investigational medicinal product code |
|||||||||||||||||||
Other name |
|||||||||||||||||||
Pharmaceutical forms |
Powder for solution for injection/infusion
|
||||||||||||||||||
Routes of administration |
Nasogastric use
|
||||||||||||||||||
Dosage and administration details |
The IMP was prescribed at a dose of 150 mg/kg body weight per day (up to a maximum of 300 mg/day). The IMP was prepared for administration by addition by syringe of sterile water (4 mL) plus expressed breast or formula (1 mL). The pot was shaken vigorously by hand for 30 seconds to generate a mixture containing 75mg/mL of IMP. The mixture was allowed to stand for 30 minutes before removal for administration using an enteral feeding syringe. The IMP was administered once daily by naso- or oro-gastric tube once the infant’s enteral feed volume was >12 mL/kg/day and continued until 34 weeks’ postmenstrual age.
|
||||||||||||||||||
|
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Baseline characteristics reporting groups
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Lactoferrin
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group description |
Bovine lactoferrin | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group description |
Sucrose | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||
End points reporting groups
|
|||
Reporting group title |
Lactoferrin
|
||
Reporting group description |
Bovine lactoferrin | ||
Reporting group title |
Placebo
|
||
Reporting group description |
Sucrose |
|
||||||||||||||||
End point title |
Microbiologically-confirmed or clinically suspected late-onset infection | |||||||||||||||
End point description |
||||||||||||||||
End point type |
Primary
|
|||||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
|||||||||||||||
|
||||||||||||||||
Statistical analysis title |
Adjusted risk ratio | |||||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
|||||||||||||||
Number of subjects included in analysis |
2182
|
|||||||||||||||
Analysis specification |
Pre-specified
|
|||||||||||||||
Analysis type |
superiority | |||||||||||||||
P-value |
= 0.233 | |||||||||||||||
Method |
Mixed models analysis | |||||||||||||||
Parameter type |
Risk ratio (RR) | |||||||||||||||
Point estimate |
0.95
|
|||||||||||||||
Confidence interval |
||||||||||||||||
level |
99% | |||||||||||||||
sides |
2-sided
|
|||||||||||||||
lower limit |
0.86 | |||||||||||||||
upper limit |
1.04 |
|
||||||||||||||||
End point title |
Microbiologically-confirmed late-onset infection | |||||||||||||||
End point description |
||||||||||||||||
End point type |
Secondary
|
|||||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
|||||||||||||||
|
||||||||||||||||
Statistical analysis title |
Adjusted risk ratio | |||||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
|||||||||||||||
Number of subjects included in analysis |
2182
|
|||||||||||||||
Analysis specification |
Pre-specified
|
|||||||||||||||
Analysis type |
superiority | |||||||||||||||
P-value |
= 0.49 | |||||||||||||||
Method |
Mixed models analysis | |||||||||||||||
Parameter type |
Risk ratio (RR) | |||||||||||||||
Point estimate |
1.05
|
|||||||||||||||
Confidence interval |
||||||||||||||||
level |
99% | |||||||||||||||
sides |
2-sided
|
|||||||||||||||
lower limit |
0.87 | |||||||||||||||
upper limit |
1.26 |
|
||||||||||||||||
End point title |
All-cause mortality | |||||||||||||||
End point description |
||||||||||||||||
End point type |
Secondary
|
|||||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
|||||||||||||||
|
||||||||||||||||
Statistical analysis title |
Adjusted risk ratio | |||||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
|||||||||||||||
Number of subjects included in analysis |
2152
|
|||||||||||||||
Analysis specification |
Pre-specified
|
|||||||||||||||
Analysis type |
superiority | |||||||||||||||
P-value |
= 0.782 | |||||||||||||||
Method |
Mixed models analysis | |||||||||||||||
Parameter type |
Risk ratio (RR) | |||||||||||||||
Point estimate |
1.05
|
|||||||||||||||
Confidence interval |
||||||||||||||||
level |
99% | |||||||||||||||
sides |
2-sided
|
|||||||||||||||
lower limit |
0.66 | |||||||||||||||
upper limit |
1.68 |
|
||||||||||||||||
End point title |
Necrotising enterocolitis Bell stage II and above | |||||||||||||||
End point description |
||||||||||||||||
End point type |
Secondary
|
|||||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
|||||||||||||||
|
||||||||||||||||
Statistical analysis title |
Adjusted risk ratio | |||||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
|||||||||||||||
Number of subjects included in analysis |
2169
|
|||||||||||||||
Analysis specification |
Pre-specified
|
|||||||||||||||
Analysis type |
superiority | |||||||||||||||
P-value |
= 0.538 | |||||||||||||||
Method |
Mixed models analysis | |||||||||||||||
Parameter type |
Risk ratio (RR) | |||||||||||||||
Point estimate |
1.13
|
|||||||||||||||
Confidence interval |
||||||||||||||||
level |
99% | |||||||||||||||
sides |
2-sided
|
|||||||||||||||
lower limit |
0.67 | |||||||||||||||
upper limit |
1.89 |
|
||||||||||||||||
End point title |
Severe retinopathy of prematurity treated medically or surgically | |||||||||||||||
End point description |
||||||||||||||||
End point type |
Secondary
|
|||||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
|||||||||||||||
|
||||||||||||||||
Statistical analysis title |
Adjusted risk ratio | |||||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
|||||||||||||||
Number of subjects included in analysis |
2160
|
|||||||||||||||
Analysis specification |
Pre-specified
|
|||||||||||||||
Analysis type |
superiority | |||||||||||||||
P-value |
= 0.42 | |||||||||||||||
Method |
Mixed models analysis | |||||||||||||||
Parameter type |
Risk ratio (RR) | |||||||||||||||
Point estimate |
0.89
|
|||||||||||||||
Confidence interval |
||||||||||||||||
level |
99% | |||||||||||||||
sides |
2-sided
|
|||||||||||||||
lower limit |
0.62 | |||||||||||||||
upper limit |
1.28 |
|
||||||||||||||||
End point title |
Bronchopulmonary dysplasia at 36 week postmentrual age | |||||||||||||||
End point description |
||||||||||||||||
End point type |
Secondary
|
|||||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
|||||||||||||||
|
||||||||||||||||
Statistical analysis title |
Adjusted risk ratio | |||||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
|||||||||||||||
Number of subjects included in analysis |
2050
|
|||||||||||||||
Analysis specification |
Pre-specified
|
|||||||||||||||
Analysis type |
superiority | |||||||||||||||
P-value |
= 0.867 | |||||||||||||||
Method |
Mixed models analysis | |||||||||||||||
Parameter type |
Risk ratio (RR) | |||||||||||||||
Point estimate |
1.01
|
|||||||||||||||
Confidence interval |
||||||||||||||||
level |
99% | |||||||||||||||
sides |
2-sided
|
|||||||||||||||
lower limit |
0.9 | |||||||||||||||
upper limit |
1.13 |
|
||||||||||||||||
End point title |
Late-onset infection, NEC, ROP, BPD or mortality | |||||||||||||||
End point description |
||||||||||||||||
End point type |
Secondary
|
|||||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
|||||||||||||||
|
||||||||||||||||
Statistical analysis title |
Adjusted risk ratio | |||||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
|||||||||||||||
Number of subjects included in analysis |
2186
|
|||||||||||||||
Analysis specification |
Pre-specified
|
|||||||||||||||
Analysis type |
superiority | |||||||||||||||
P-value |
= 0.743 | |||||||||||||||
Method |
Mixed models analysis | |||||||||||||||
Parameter type |
Risk ratio (RR) | |||||||||||||||
Point estimate |
1.01
|
|||||||||||||||
Confidence interval |
||||||||||||||||
level |
99% | |||||||||||||||
sides |
2-sided
|
|||||||||||||||
lower limit |
0.94 | |||||||||||||||
upper limit |
1.08 |
|
|||||||||||||
End point title |
Administration of antimicrobials | ||||||||||||
End point description |
|||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
From commencment of IMP until 34 weeks postmenstrual age
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Median difference | ||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
||||||||||||
Number of subjects included in analysis |
2116
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
P-value |
= 0.625 | ||||||||||||
Method |
Quantile regression | ||||||||||||
Parameter type |
Median difference (final values) | ||||||||||||
Point estimate |
0
|
||||||||||||
Confidence interval |
|||||||||||||
level |
99% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
-1 | ||||||||||||
upper limit |
1 |
|
|||||||||||||
End point title |
Length of hospital stay | ||||||||||||
End point description |
|||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Median difference | ||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
||||||||||||
Number of subjects included in analysis |
2007
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
P-value |
= 0.446 | ||||||||||||
Method |
Quantile regression | ||||||||||||
Parameter type |
Median difference (final values) | ||||||||||||
Point estimate |
1
|
||||||||||||
Confidence interval |
|||||||||||||
level |
99% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
-1 | ||||||||||||
upper limit |
3 |
|
|||||||||||||
End point title |
Length of stay in intensive care | ||||||||||||
End point description |
|||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Median difference | ||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
||||||||||||
Number of subjects included in analysis |
2046
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
P-value |
= 0.963 | ||||||||||||
Method |
Quantile regression | ||||||||||||
Parameter type |
Median difference (final values) | ||||||||||||
Point estimate |
0
|
||||||||||||
Confidence interval |
|||||||||||||
level |
99% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
-1 | ||||||||||||
upper limit |
1 |
|
|||||||||||||
End point title |
Length of stay in high dependency care | ||||||||||||
End point description |
|||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Median difference | ||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
||||||||||||
Number of subjects included in analysis |
2056
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
P-value |
= 0.42 | ||||||||||||
Method |
Quantile regression | ||||||||||||
Parameter type |
Median difference (final values) | ||||||||||||
Point estimate |
1
|
||||||||||||
Confidence interval |
|||||||||||||
level |
99% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
-1 | ||||||||||||
upper limit |
3 |
|
|||||||||||||
End point title |
Length of stay in special care | ||||||||||||
End point description |
|||||||||||||
End point type |
Secondary
|
||||||||||||
End point timeframe |
From trial entry to hospital discharge home
|
||||||||||||
|
|||||||||||||
Statistical analysis title |
Median difference | ||||||||||||
Comparison groups |
Lactoferrin v Placebo
|
||||||||||||
Number of subjects included in analysis |
2069
|
||||||||||||
Analysis specification |
Pre-specified
|
||||||||||||
Analysis type |
superiority | ||||||||||||
P-value |
= 0.216 | ||||||||||||
Method |
Quantile regression | ||||||||||||
Parameter type |
Median difference (final values) | ||||||||||||
Point estimate |
-1
|
||||||||||||
Confidence interval |
|||||||||||||
level |
99% | ||||||||||||
sides |
2-sided
|
||||||||||||
lower limit |
-3 | ||||||||||||
upper limit |
1 |
|
|||
Adverse events information [1]
|
|||
Timeframe for reporting adverse events |
From trial entry to hospital discharge home
|
||
Assessment type |
Systematic | ||
Dictionary used for adverse event reporting
|
|||
Dictionary name |
MedDRA | ||
Dictionary version |
10
|
||
Frequency threshold for reporting non-serious adverse events: 0% | |||
Notes [1] - There are no non-serious adverse events recorded for these results. It is expected that there will be at least one non-serious adverse event reported. Justification: Not collected as there are multiple non-serious adverse events in this population of very preterm babies. |
|
|||||||
Substantial protocol amendments (globally) |
|||||||
Were there any global substantial amendments to the protocol? Yes | |||||||
Date |
Amendment |
||||||
14 Oct 2013 |
Text amendments to protocol. IMP Dossier amended. Consent form amended. Parent information leaflet amended. ELFIN Statement of Responsibilities introduced. |
||||||
17 Jan 2014 |
IMP Dossier amended. |
||||||
27 May 2014 |
ELFIN/SIFT Summary Leaflet added. |
||||||
21 Jul 2014 |
Notification of temporary halt to trial. |
||||||
29 Oct 2014 |
Two parent posters introduced. |
||||||
03 Nov 2014 |
IMP Dossier amended. Storage requirements of IMP changed. |
||||||
23 Apr 2015 |
Addition of extra recruiting sites in England. |
||||||
31 Jul 2015 |
Parent information leaflet and consent form amended. |
||||||
10 Sep 2015 |
Some continuing care sites converted to recruiting sites. |
||||||
16 Dec 2015 |
Removed requirement for temperature monitoring of IMP at continuing care sites. |
||||||
31 Dec 2015 |
Amendment to text in protocol. |
||||||
21 Jan 2016 |
Conversion of additional continuing care sites to recruiting sites. |
||||||
04 Mar 2016 |
Amendments to text in protocol. |
||||||
09 Aug 2016 |
Additional recruiting sites and change in PIs at existing sites. |
||||||
21 Nov 2016 |
Added continuing care sites in Wales and adapted PIL for Wales. |
||||||
06 Sep 2017 |
Change of existing PI at a a site. |
||||||
15 Mar 2018 |
Amendment to text in protocol. |
||||||
Interruptions (globally) |
|||||||
Were there any global interruptions to the trial? Yes | |||||||
|
|||||||
Limitations and caveats |
|||||||
Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||||||
None reported |