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A Randomized Trial of GM-CSF in Patients With ALI/ARDS

This study has been completed.
Sponsor:
Collaborators:
Emory University
University of Colorado, Denver
Information provided by (Responsible Party):
Robert C. Hyzy, MD, University of Michigan
ClinicalTrials.gov Identifier:
NCT00201409
First received: September 12, 2005
Last updated: October 28, 2011
Last verified: October 2011

September 12, 2005
October 28, 2011
July 2004
May 2009   (final data collection date for primary outcome measure)
Ventilator-free days during Days 1-28 [ Time Frame: Measured at Day 28 ] [ Designated as safety issue: No ]
Not Provided
Complete list of historical versions of study NCT00201409 on ClinicalTrials.gov Archive Site
  • Lung epithelial cell integrity [ Time Frame: Measured at Day 28 ] [ Designated as safety issue: No ]
  • Alveolar macrophage function [ Time Frame: Measured at Day 28 ] [ Designated as safety issue: No ]
  • Changes in severity of physiologic derangements of respiratory gas exchange [ Time Frame: Measured at Day 28 ] [ Designated as safety issue: Yes ]
  • Non-respiratory organ failure [ Time Frame: Measured at Day 28 ] [ Designated as safety issue: Yes ]
  • Incidence of ventilator-associated pneumonia [ Time Frame: Measured at Day 28 ] [ Designated as safety issue: Yes ]
Not Provided
Not Provided
Not Provided
 
A Randomized Trial of GM-CSF in Patients With ALI/ARDS
A Randomized Trial of GM-CSF in Patients With ALI/ARDS

This study will test the hypothesis that administration of granulocyte-macrophage colony stimulating factor (GM-CSF) to patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) will improve the clinical course and outcome by shortening the duration of mechanical ventilation for these patients.

BACKGROUND:

Respiratory failure due to ALI/ARDS remains a major health problem, despite significant progress in intensive care unit care and ventilator management. ALI/ARDS is characterized by unacceptably high mortality despite enormous expenditure of health care resources. Survivors face long-term consequences that may affect their quality of life. New therapies are needed to improve early survival and to decrease long-term sequelae of this syndrome. GM-CSF is a naturally occurring cytokine that is present in the normal lung, with important roles in pulmonary homeostasis. GM-CSF is essential for normal maturation and function of alveolar macrophages (resident inflammatory cells that are responsible for initial defense against pneumonia). Alveolar epithelial cells line the gas exchange surface of the lung. Acute lung injury and subsequent abnormal healing is linked to delayed repair of damage to the epithelium following initial injury. This can then lead to pulmonary fibrosis. GM-CSF has potent effects on alveolar epithelial cells, promoting proliferation and limiting epithelial cell death. Thus, GM-CSF has a distinctive combination of activities that make it an excellent candidate for a therapeutic intervention in ALI/ARDS. Preliminary studies for this project demonstrate that GM-CSF can protect experimental animals against acute lung injury, can decrease susceptibility to pneumonia, and is protective against pulmonary fibrosis following acute lung injury. There is extensive experience with the administration of recombinant human GM-CSF to human patients (this biological is approved by the FDA and has been well-tolerated in trials involving critically ill patients). This project is based on the hypothesis that administration of GM-CSF will improve clinical outcomes for patients with ALI/ARDS.

DESIGN NARRATIVE:

With the assent of the attending physician, informed consent will be obtained from the patient or next of kin as soon as possible after case identification. Physiologic measurements and specimen collection will begin at the time of entry into the study. Three days after the patient has met criteria for ALI/ARDS or at entry into the study (whichever is later), he/she will be randomized to receive recombinant human GM-CSF (250 mcg/M2) or placebo, administered by slow intravenous infusion once daily for 14 days.

This study will allow entry of patients who have fulfilled criteria for ALI/ARDS for up to 7 days. Treatment will be initiated after patients have met criteria for at least 3 days. Treatment with GM-CSF may prove both safe and effective within the first 1-2 days of lung injury. However, the present study will not address that question. It is unlikely that the opportunity for improved outcome will be lost by delaying therapy for up to 3 days (based on the proposed mechanisms by which GM-CSF might benefit this patient population). Similarly, the decision to treat for 14 days will allow for improved outcome in patients with non-resolving ARDS by reducing the incidence of ventilator-associated pneumonia and by decreasing pathologic fibroproliferation.

The primary endpoint for this study will be the duration of mechanical ventilation. Additional important endpoints will include changes in the severity of physiologic derangements of respiratory gas exchange, non-respiratory organ failure, and incidence of ventilator-associated pneumonia. Additional assessments designed to determine the mechanism of benefit of GM-CSF treatment will include measures of lung epithelial cell integrity and measures of alveolar macrophage (lung inflammatory cell) function.

Interventional
Phase 2
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Respiratory Distress Syndrome, Adult
  • Drug: Placebo
    Placebo will be administered by slow intravenous infusion once daily for 14 days.
  • Drug: GM-CSF
    Recombinant human GM-CSF (250 mcg/M2) will be administered by slow intravenous infusion once daily for 14 days.
  • Experimental: 1
    Participants will be randomized to receive recombinant human GM-CSF (250 mcg/M2).
    Intervention: Drug: GM-CSF
  • Placebo Comparator: 2
    Participants will be randomized to receive placebo.
    Intervention: Drug: Placebo

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
132
June 2009
May 2009   (final data collection date for primary outcome measure)

Inclusion Criteria:

Acute onset of illness with:

  • PaO2/FiO2 ratio of less than 300 (ALI) or PaO2/FiO2 ratio of less than 200 (ARDS)
  • Bilateral infiltrates consistent with pulmonary edema on frontal chest radiograph (infiltrates may be patchy, diffuse, homogeneous, or asymmetric)
  • Requirement for positive pressure ventilation via an endotracheal tube
  • No clinical evidence of left atrial hypertension (pulmonary arterial wedge pressure measure up to 18 mm Hg)
  • First three criteria must occur together within a 24-hour interval

Exclusion criteria:

  • Greater than 7 days elapsed following institution of mechanical ventilation
  • Pregnancy
  • Chronic respiratory failure as defined by any of the following: 1) FEV1 less than 20 ml/kg of PBW; or 2) FEV1/FVC less than 50%
  • Chronic hypercapnia or hypoxemia
  • Hospitalization within the past 6 months for acute respiratory failure
  • Chronic home use of oxygen or mechanical ventilation
  • Left ventricular failure as defined by New York Heart Association (NYHA) class IV status
  • Neutropenia (absolute neutrophil count less than 1000 cells/mm3)
  • History of hematological malignancy or bone marrow transplant
  • Entry into other intervention clinical trials
  • Decision of the patient or attending physician to forego aggressive care
  • Expected survival rate of less than 6 months (based solely on pre-existing medical problems [i.e., poorly controlled neoplasm or other end-stage disease])
  • AIDS or known history of HIV infection
  • Prednisone (or equivalent) therapy greater than or equal to 20 mg/day for a period of not less than 2 months with treatment continuing within 3 weeks prior to screening
  • Cytotoxic therapy within 3 weeks of screening
  • Morbid obesity defined as greater than 1 kg/c, body weight
  • At risk for increased intracranial pressure that may result from permissive hypercapnia or in whom permissive hypercapnia may be otherwise contraindicated
  • Neuromuscular disease that would potentially impact ability to wean from mechanical ventilation
  • Receiving extracorporeal membrane oxygenation when meeting screening criteria
Both
18 Years to 90 Years
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00201409
258, P50HL074024, P50 HL074024
Yes
Robert C. Hyzy, MD, University of Michigan
University of Michigan
  • National Heart, Lung, and Blood Institute (NHLBI)
  • Emory University
  • University of Colorado, Denver
Study Director: Robert Paine, MD University of Utah and University of Michigan
Principal Investigator: Robert C. Hyzy, M.D. University of Michigan
University of Michigan
October 2011

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP