E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Parenteral nutrition (PN) when oral or enteral nutrition (ON or EN) is impossible, insufficient, or contraindicated in the early phase of critical illness |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Nutritional and Metabolic Diseases [C18] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10051284 |
E.1.2 | Term | Parenteral nutrition |
E.1.2 | System Organ Class | 10042613 - Surgical and medical procedures |
|
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To explore the efficacy of SmofKabiven extra Nitrogen compared with Olimel N9E in reducing the cumulative protein deficit with the same caloric target during the early phase of acute critical illness in haemodynamically stable adult patients who require PN |
|
E.2.2 | Secondary objectives of the trial |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Patients must fulfil all of the following criteria to be eligible for enrolment into the study:
1. Age ≥18 years and <90 years, male and female
2. Critically ill, medical or surgical ICU patient
3. Admitted to the ICU on the same day or the day before with a
minimum expected ICU stay of ≥3 days
4. Central venous access is available for continuous infusion of the study drugs
5. SOFA score ≥2
6. Contraindication against EN or limited tolerance to EN and it is planned that patient receives ≥80% of the total target caloric intake from PN during the first 3 nutritional treatment days
7. Written informed consent from the patient or the patient’s legal representative or deferred written consent from the patient or patient’s legal representative (deferred proxy consent) |
|
E.4 | Principal exclusion criteria |
1. Contraindication against PN or inability to receive PN via central venous access
2. Received PN within 7 days before randomisation
3. It is planned that patient receives ≥20% of the total target caloric
intake via EN, ON (including ONS) and/or non-nutritional sources
(glucose solution for drug dilution or lipids from propofol/clevidipine or
citrate from CRRT) during the first 3 nutritional treatment days
4. BMI <18.5 kg/m2 or >35 kg/m2 5. Burn injury
6. Any severe, persistent blood coagulation disorder with unIt is planned that patient receives ≥20% of the total target caloric
intake via EN, ON (including ONS) and/or non-nutritional sources
(glucose solution for drug dilution or lipids from propofol/clevidipine or
citrate from CRRT) during the first 3 nutritional treatment dayscontrolled bleeding
7. Any congenital errors of amino acid metabolism
8. Uncontrolled hyperglycaemia despite insulin treatment
9. Known hypersensitivity to fish, egg, soybean proteins, peanut protein, or to any of the active substances or excipients contained in SmofKabiven® extra Nitrogen or Olimel N9E
10. Known hypersensitivity to milk protein or to any other substance contained in
Fresubin® Original
11. Treatment-refractory cardiopulmonary or metabolic instability showing persistent or progressive worsening despite increased interventions, including severe pulmonary oedema, severe cardiac insufficiency, myocardial infarction, acute phase of circulatory shock, severe sepsis, embolism, haemodynamic instability, metabolic or respiratory acidosis, hypotonic dehydration, or hyperosmolar coma
12. Severe renal dysfunction, defined as serum creatinine ≥2.0 times baseline or urine output <0.5 mL/kg/h/ for ≥12 hours (Acute Kidney Injury stage ≥2; (KDIGO 2012)), and BUN exceeding 2 x ULN
13. Severe liver failure with encephalopathy, including intoxication (e.g. paracetamol, death cap, golden chain) and/or liver enzymes (AST, ALT, GGT) or bilirubin exceeding 5 x ULN
14. Oncologic disease with anticancer drug and/or radiation treatment
incl. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) during this
trial up to and including study day 28
15. Preceding transplantation causal for acute critical illness
16. Hemophagocytic syndrome
17. Pregnancy or lactation
18. Receiving end-of-life care
19. Pathologically altered blood pH (arterial pH <7.0), oxygen saturation (SaO2 <80%), or carbon dioxide concentration (PaCO2 ≥80 mm Hg)
20. Hyperlipidaemia or any disorder of lipid metabolism characterised by
hypertriglyceridemia (serum triglyceride levels >4 mmol/L [>350 mg/dL])
21. Treatment-refractory, clinically significant major abnormality in the serum
concentration of any electrolyte (sodium, potassium, magnesium, total calcium,
chloride, inorganic phosphorous)
22. Administration of growth hormone including teduglutide within the
previous 4 weeks before randomization
23. Invasive devices and procedures influencing metabolism and organ
perfusion, e.g. extracorporeal membrane oxygenation (ECMO), CRRT,
molecular absorbent recycling system (MARS), intra-aortic balloon pump
(IABP)
24. Receipt of the last dose of study drug in another interventional
clinical trial within the previous 4 weeks before randomisation into this
clinical trial
25. Previous inclusion in the present study
26. Any other known reason that may prevent a patient to take part in
the study in accordance with local requirements |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Protein intake during the 5-day treatment period:
• Proportion of patients reaching ≥70% of the cumulative target for
protein delivery from Study Day 2 through Study Day 6
- The cumulative target for protein delivery is 6.75 g/kg/5d (based on a
daily target of 0.75 g/kg on Study Day 2 and 1.5 g/kg/d on Study Days 3
through 6); 70% of the cumulative target for protein delivery = 4.73
g/kg/5d
- The cumulative protein delivery is calculated as the cumulative intake
of amino acids from study drug and protein from EN or ON (including
ONS) on Study Day 2 through 6 |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
Protein intake during the 5-day treatment period: from Study Day 2 to Day 6 |
|
E.5.2 | Secondary end point(s) |
Protein intake during the 5-day treatment period:
• Percentage of the cumulative target for protein delivery reached from
Study Day 2 through Study Day 6
- Actual cumulative protein delivery (g/kg/5d) divided by 6.75
(g/kg/5d) multiplied by 100
• Mean cumulative protein delivery by PN, EN and ON (including ONS)
from Study Day 2 through Study Day 6
• Calculated mean cumulative protein deficit during the period from
Study Day 2 through Study Day 6
- The cumulative protein deficit is calculated as the cumulative target for
protein delivery (6.75 g/kg/5d) minus the actual administered dose
(g/kg/5d amino acids from study drug + g/kg/5d protein from EN and
ON (including ONS))
Energy intake during the 5-day treatment period:
• Mean total cumulative energy intake from PN, EN, ON (including ONS)
and non-nutritional sources during the 5-day treatment period
(calculated for each day from Study Day 2 through Study Day 6)
• Time to increase of daily EN and ON (including ONS) intake above 20%
of total energy target of 20 kcal/kg/d during the 5-day treatment period
Insulin dose during the 5-day treatment period:
• Mean daily insulin dose during the 5-day treatment period
• Mean cumulative insulin dose for the 5-day treatment period
• Mean change from baseline in daily insulin dose (Study Day 2 through
Study Day 6)
• Maximum single insulin dose during the 5-day treatment period
Blood glucose profile during the 5-day treatment period:
• Mean maximum daily blood glucose value during the 5-day treatment
period
• Mean minimum daily blood glucose value during the 5-day treatment
period
• Mean blood glucose value during the 5-day treatment period
• Mean change from baseline in mean daily blood glucose value (Study
Day 2 through Study Day 6)
Clinical outcome parameters (up to Study Day 28):
• Change from baseline in SOFA score, calculated daily from Study Day 3
through Study Day 7
• Overall survival time up to Study Day 28
• All-cause mortality up to Study Day 28
• Length of stay in the ICU up to Study Day 28
• Re-admission to ICU up to Study Day 28
• ICU mortality up to Study Day 28
• Length of stay in the hospital up to Study Day 28
• Re-admission to hospital up to Study Day 28
• Hospital mortality up to Study Day 28
• Therapeutic Intervention Scoring System (TISS)-28 score (including
individual item score, category score, and total score) on Study Day 7
(documenting 0 -24 h on Study day 6)
Functional Outcome Parameters (up to Study Day 28):
• Duration of mechanical ventilation up to Study Day 28
• Change from baseline in Medical Research Council (MRC) sum score to
Study Day 7, and to day of ICU discharge or on Study Day 28, whatever
occurs first
• Change from baseline of ICU Mobility Scale to Study Days 7, 14, and 28 |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
Protein intake during the 5-day treatment period: from Study Day 2 to Day 6
Energy intake during the 5-day treatment period: from Study Day 2 to Day 6
Insulin dose during the 5-day treatment period: from Study Day 2 to Day 6
Blood glucose profile during the 5-day treatment period: from Study Day 2 to Day 6
Clinical outcome parameters (up to Study Day 28)
Functional Outcome Parameters (up to Study Day 28)
|
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | No |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | Yes |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
|
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 12 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
End of trial is defined as the last visit of the last patient. |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | |
E.8.9.1 | In the Member State concerned months | 12 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial months | 12 |