Activated Protein C to Treat Acute Lung Injuries

This study has been terminated.
(Per recommendation of the NHLBI DSMB)
Sponsor:
Collaborator:
Information provided by:
University of California, San Francisco
ClinicalTrials.gov Identifier:
NCT00112164
First received: May 27, 2005
Last updated: March 11, 2014
Last verified: March 2014
  Purpose

The purpose of this study is to test the efficacy of activated Protein C (Xigris) for improving clinical outcomes in individuals with acute lung injury (ALI).


Condition Intervention Phase
Respiratory Distress Syndrome, Adult
Drug: Xigris
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: Prospective, Randomized Phase II Clinical Trial of Activated Protein C (Xigris) Versus Placebo for the Treatment of Acute Lung Injury

Resource links provided by NLM:


Further study details as provided by University of California, San Francisco:

Primary Outcome Measures:
  • Number of ventilator-free days (measured at Day 28)

Estimated Enrollment: 90
Study Start Date: January 2005
Study Completion Date: February 2007
Detailed Description:

BACKGROUND:

The hypothesis that procoagulant and inflammatory mechanisms may have a dual role in tissue injury was tested in the phase III clinical trial of recombinant Xigris for severe sepsis (Bernard, 2001). There was a significant reduction in mortality from 30% to 24% in patients treated with Xigris. However, there is no information on the effect of Xigris on patients with sepsis and co-existing ALI. Because Xigris is known to have both anti-coagulant and anti-inflammatory properties, it is plausible that it may be effective at treating patients with ALI from pulmonary and non-pulmonary infectious causes. There is also a good rationale for the hypothesis that Xigris may be effective at treating ALI from non-infectious causes. In experimental lung injury, from a non-infectious cause, such as hyperoxia or a like acid-lung injury, pro-coagulant mechanisms play a role in the pathogenesis of the ALI (Eitzman, 1996; Barazzone, 1996). Furthermore, research has shown that plasma-protein C deficiency occurs in almost all patients with ALI, and reduced Protein C levels are associated with a higher mortality and more non-pulmonary organ system dysfunction, even in patients with non-septic causes of ALI (Ware, 2003). Elevated levels of thrombomodulin, a product of endothelial injury, were measured in the plasma of all patients with ALI regardless of the clinical disorder associated with lung injury. The elevations of thrombomodulin were much higher in edema fluid than in plasma, suggesting that local activation and release of thrombomodulin had occurred, probably from both epithelial and endothelial sources from the lung, again supporting the hypothesis that a common pathway to lung injury may occur in both septic and non-septic causes of ALI. In addition, there is considerable evidence that the normal fibrinolytic mechanisms are impaired in the alveolar compartment in patients with ALI. Elevated levels of plasminogen-activator-inhbitor-1 (PAI-1) in the plasma of pulmonary edema fluid have a predictive value for identifying patients with ALI who are more likely to die than survive, regardless of the clinical risk factors that predisposes the development of ALI (Prabhakaran, 2003). Thus, this supports the rationale for testing Xigris as a treatment for patients with ALI, regardless of the clinical disorder associated with the cause of the lung injury. Since Xigris has both anti-coagulant and anti-inflammatory properties (Esmon, 2000; Grey, 1994), this treatment could reverse both the intravascular and the extravascular lung injuries and allow the lung epithelial and endothelial barriers to recover from a functional breakdown of both barriers. This study will evaluate the effects of the treatment of biochemical markers on alveolar epithelial injury.

DESIGN NARRATIVE:

Participants will be randomly assigned to receive either Xigris or saline placebo, to be administered continuously for 96 hours. Participants will be followed for 28 days, regardless of whether the drug is stopped for an adverse event, if the participant or physician decides to stop the drug, if the participant is discharged from the hospital with unassisted breathing, or until death.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • PaO2/FiO2 levels less than or equal to 300
  • Bilateral infiltrates consistent with pulmonary edema on frontal chest radiograph
  • Positive pressure ventilation through an endotracheal tube or tracheostomy
  • No clinical evidence of left atrial hypertension that would explain the pulmonary infiltrates; if measured, pulmonary arterial wedge pressure less than or equal to 18 mm Hg

Exclusion Criteria:

  • Family / patient refuses
  • Patient / surrogate unavailable
  • Attending refuses
  • Age younger than 18 years
  • Severe sepsis and Acute Physiology and Chronic Health Evaluation (APACHE) II scores greater than 25 within 48 hours of onset of severe sepsis
  • Greater than 72 hours since all inclusion criteria are met
  • Neuromuscular disease that impairs ability to ventilate without assistance, such as C5 or higher spinal cord injury, amyotrophic lateral sclerosis, Guillain-Barré syndrome, myasthenia gravis, or kyphoscoliosis
  • Pregnant
  • Severe chronic respiratory disease
  • Weighs more than 160 kg
  • Burns to more than 70% of total body surface area
  • Cancer or other irreversible disease or condition for which 6-month mortality is estimated to be greater than 50%
  • Bone marrow transplant in the 5 years prior to study entry
  • Not committed to full support
  • Severe chronic liver disease, as determined by a Child-Pugh Score of 11 to 15
  • Diffuse alveolar hemorrhage from vasculitis
  • Participation in another experimental medication study within 30 days of study entry
  • Patients who have already received APC therapy
  • Active internal bleeding
  • Hemorrhagic or ischemic stroke within 3 months of study entry
  • Intracranial or intraspinal surgery or severe head trauma within 2 months of study entry
  • Trauma with an increased risk of life-threatening bleeding
  • Presence of an epidural catheter
  • Intracranial neoplasm mass lesion or evidence of cerebral herniation
  • High risk of intracranial hemorrhage, as determined by 1 of the following: 1) intracranial or spinal pathology which places individuals at risk for intracranial hemorrhage (e.g., arterio-venous malformation or previous intracranial bleeding events, not including meningitis); 2) acute change in neurological status with focal neurological findings; 3) documented intracranial hypertension by lumbar puncture or imaging; or 4) seizures in which there is a clinical suspicion of intracranial hemorrhage
  • Known bleeding diathesis
  • Concurrent therapeutic heparin (greater than 14 units/kg/hr)
  • Platelet count less than 30,000 x 106/L, even if the platelet count is increased after transfusions
  • Prothrombin time greater than 3.0 INR
  • Gastrointestinal bleeding within 6 weeks of study entry
  • Concurrent need for systemic anticoagulation with therapeutic unfractionated heparin or low molecular weight heparin during the study drug infusion
  • Concurrent administration of an anticoagulant (other than subcutaneous heparin for prophylaxis)
  • Concurrent need for platelet glycoprotein Iib/IIIa antagonists or any other antiplatelet agents (patients taking aspirin or other antiplatelet agents at study entry are eligible if medication can be discontinued during study drug infusion)
  • Surgery within 30 days of study entry and single organ failure
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00112164

Locations
United States, California
University of California San Francisco at Fresno
Fresno, California, United States, 93702
University of Southern California
Los Angeles, California, United States, 97239-3098
San Francisco General Hospital
San Francisco, California, United States, 94110
University of California San Francisco
San Francisco, California, United States, 94143-0130
Stanford University, Department of Pulmonary and Critical Care
Stanford, California, United States, 94305
United States, Connecticut
Yale School of Medicine, Section of Pulmonary & Critical Care Medicine
New Haven, Connecticut, United States, 06520-8057
United States, Georgia
Joseph M. Still Burn Center
Augusta, Georgia, United States, 97239-3098
United States, Massachusetts
Bay State Medical Center
Springfield, Massachusetts, United States, 01199
United States, Oregon
Oregon Health Sciences University
Portland, Oregon, United States, 97239-3098
Sponsors and Collaborators
University of California, San Francisco
Investigators
Study Chair: Michael Matthay University of California, San Francisco
  More Information

Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
ClinicalTrials.gov Identifier: NCT00112164     History of Changes
Other Study ID Numbers: 175, P50HL074005
Study First Received: May 27, 2005
Last Updated: March 11, 2014
Health Authority: United States: Federal Government

Keywords provided by University of California, San Francisco:
Acute Respiratory Distress Syndrome

Additional relevant MeSH terms:
Acute Lung Injury
Lung Injury
Respiratory Distress Syndrome, Adult
Respiratory Distress Syndrome, Newborn
Syndrome
Disease
Infant, Newborn, Diseases
Infant, Premature, Diseases
Lung Diseases
Pathologic Processes
Respiration Disorders
Respiratory Tract Diseases
Thoracic Injuries
Wounds and Injuries

ClinicalTrials.gov processed this record on October 20, 2014