E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients hospitalized in intensive care units, under mechanical ventilation |
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E.1.1.1 | Medical condition in easily understood language |
Patients hospitalized in intensive care units, under mechanical ventilation |
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E.1.1.2 | Therapeutic area | Diseases [C] - Respiratory Tract Diseases [C08] |
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 | 10022519 |
E.1.2 | Term | Intensive care |
E.1.2 | System Organ Class | 10042613 - Surgical and medical procedures |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10076918 |
E.1.2 | Term | Hospital acquired pneumonia |
E.1.2 | System Organ Class | 100000004862 |
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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 determine whether rHu-IFN-γ as compared with placebo, could reduce the rate of hospital-acquired pneumonia and improve outcomes in patients admitted to intensive care unit and requiring mechanical ventilation. |
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E.2.2 | Secondary objectives of the trial |
• to demonstrate the efficiency of rHuIFN-γ, on pneumonia-associated morbidity and mortality reduction • to demonstrate the efficiency of rHuIFN-γ on antimicrobial therapy utilization reduction • To describe the safety and tolerability of rHu-IFN-γ • To assess the suitability, acceptability, and adaptability of rHu-IFN-γ • To assess the economic efficiency of rHuIFN-γ for the prevention of pneumonia • To develop biomarkers for the stratification of patients into responders and non-responders of rHuIFN-γ • To develop a biobank of blood and respiratory samples collected in humans at risk of hospital-acquired pneumonia
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
At Day 90 an ancillary study will concern 20 patients included in Nantes and their relatives (they could be the legal representative who have signed the consent for the inclusion of their relative, or another relative ; the aim being that it should be the person closest to the patient emotionally, and that it is the same person who answers the questionnaires at M1 and M3), if they consent to. Semi-structured interviews will be conducted by a researcher in psychology with patients and relatives (dyads) to gain more insight into the understanding and the interpretation of quantitative data, as recommended by literature on human sciences. |
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E.3 | Principal 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). If it 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.
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E.4 | Principal 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) • Immunodepression (hematologic cancer, aplasia, chemotherapy/radiotherapy for cancer within 3 months prior to the inclusion, known infection Human immunodeficiency virus or 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. |
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E.5 End points |
E.5.1 | Primary end point(s) |
To demonstrate the efficiency of rHuIFN-γ for the prevention of hospital-acquired pneumonia, the primary endpoint is the composite outcome of all-cause mortality at day 28 and/or the occurrence of hospital-acquired pneumonia within 28 days after randomization. Hospital acquired-pneumonia is diagnosed after the 48th hour of hospitalization according to European and French guidelines (Torres et al. Eur Respir J 2017; Leone et al. ACCPM 2018) : - at least two of the following criteria: body temperature >38°C; leucocytosis>12000 cells per mL, leucopenia <4000 cells per mL, or purulent pulmonary secretions - appearance of a new infiltrate or change in an existing infiltrate on chest radiography, - positive culture of a respiratory tract samples from mechanically ventilated patients with quantitative culture (for patients with antibiotics < 48h) (thresholds of 104 colony-forming units (CFU) per mL for a bronchoalveolar lavage, 105 CFU/mL for a blind BAL (mini BAL) sample, and ≥105 CFU/mL for a tracheal sample). A semi-quantitative is acceptable, notably for patients with antibiotics >48h. Respiratory samples are obtained before starting any new antibiotic treatment. An adjudication committee, composed of 1 investigator by country who will be blinded to the trial-group assignments, will review the medical charts of patients with respiratory tract infections of the 2 other participating countries, in order to review the diagnosis. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
The secondary outcomes to determine the efficiency of rHu-IFN-γ, on pneumonia-associated morbidity and mortality reduction are: -All-cause mortality at D28 and 90. -Hospital acquired Pneumonia at D28 -Bacterial ecology of the 1st episode of HAP (respiratory fluids). -Rate of ventilator-associated tracheobronchitis at D28 defined as at least two of the following criteria : body temperature >38°C; leukocytosis>12000 cells per mL, leucopenia <4000 cells per 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 (Martin-Loeches et al. Lancet Respir Med 2015) -Acute Respiratory Distress Syndrome within 28d after randomization -Duration of antimicrobial therapy at D28, antibiotic free days at D28 (the number of antibiotic free days is defined as the number of days between D1 and D28 for which living patients don’t receive antibiotics. Dead patients will be ascribed 0 antibiotic free days). -Duration of mechanical ventilation at D90, mechanical ventilation free days at D90. -Duration of ICU hospitalization at D90, Duration of hospitalization at D90, hospital free days at D90.
The secondary outcomes to determine the tolerance of rHu-IFN-γ are: -Rate of serious adverse effects and suspected unexpected serious adverse reaction (SUSAR) at D15. -Rate of leukocytosis, neutropenia, lymphopenia, thrombopenia at D15. -Rate of liver cytolysis (Increases in AST and/or ALT) at D15. -Rate of pancreatitis (Increase in Lipase) at D15. -Fever,headache,nausea at D15. -Allergic reaction at D15. -Injection site reaction at D15. -Myalgia, arthralgia, back pain at D15.
The secondary outcomes to determine the economic efficiency of rHu-IFN-γ in the prevention of pneumonia are: Economic endpoints at M3:Incremental cost effectiveness ratio (ICER). We will assess the economic efficiency of the various interventions compared by performing a cost-effectiveness analysis (CEA) using QALYs (Quality-Adjusted Life-Years) as a measure of effectiveness.
The secondary outcomes to determine the suitability and acceptability of rHu-IFN-γ from the patients’ and relatives’ perspectives are :
Suitability 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 Changes in anxiety and depression from M1 to M3 measured with the HADS scale validated in French, Greek, and Spanish Changes in subjective well-being from M1 to M3 measured with the Satisfaction With Life Scale (SWLS) validated in French, Greek, and Spanish At M1 and M3, these questionnaires will be filled in by the patient (patient’s perspective) and by one relative (relative’s perspective). The relatives could be the legal representative who have signed the consent for the inclusion of their relative, or another relative ; the aim being that it should be the person closest to the patient emotionally, and that it is the same person who answers the questionnaires at M1 and M3, if they consent to.
Acceptability 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.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | Yes |
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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
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 | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
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.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 18 |
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 | Yes |
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
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Date of collection of all biomarker analyses. |
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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 | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial months | 27 |