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The primary objective of the trial is to assess the safety and tolerability of inhaled nitric oxide (NO) when administered by nasal cannula over a 44 hour period to clinically stable Cystic Fibrosis (CF) subjects. Toxicity is to be defined as a drop in oxygen saturations, a decline in forced expiratory volume in one second (FEV1), or an increase in methemoglobin.
Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein. A cycle of chronic, persistent infections with CF-related pathogens and an excessive inflammatory response progressively damages the airways and lung parenchyma, resulting in widespread bronchiectasis and ultimately, respiratory failure. Despite tremendous advances in understanding the CF gene and the CFTR protein, it is not known exactly how mutations in the gene and defects in CFTR lead to persistent airway infection and inflammation.
Inhaled nitric oxide (NO) has potential to be an effective treatment in CF lung disease. Inhaled NO has been studied in other airways diseases characterized by infection and /or inflammation such as COPD and idiopathic pulmonary fibrosis.
NO has been shown to activate CFTR and alternative chloride channels, thereby increasing chloride current in epithelial cells. Therefore, NO treatment may be beneficial in individuals with CF.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Low Dose Cohort | Experimental | Subjects in the low dose cohort receive 20 part per million (ppm) of nitric oxide via nasal cannula over a 44 hour period. |
|
| High-Dose Cohort | Experimental | Subjects in the high dose cohort receive 40 ppm of nitric oxide via nasal cannula over a 44 hour period. |
|
| Nitrogen | Placebo Comparator | 100% Nitrogen (placebo) will be administer at 20 ppm or 40 ppm via nasal cannula over a 44 hour period. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Nitric Oxide for Inhalation | Drug | Nitric oxide will be administered at 20 ppm via nasal cannula over a 44 hour period. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Safety and Tolerability of Drug, Assessed by Change in Methemoglobin Levels | Methemoglobin level assessments were measured through blood draws - hematology. This test measures the amount of methemoglobin (a type of hemoglobin that is unable to transport oxygen to tissues) in blood. Normal methemoglobin percentage range 1% - 2%. | Baseline and 48 hours |
| Change in Oxygen Saturation | Safety and tolerability of drug assessed by decreased oxygen saturation was measured through pulse oximeter, which measure the amount of oxygen in the blood. Normal range percentage is 95 - 100% | Baseline and 48 hours |
| Change in Forced Expiratory Volume in 1 Second (FEV1) | Decrease in forced expiratory volume in 1 second was measured through spirometer. Spirometer measures the volume of air inspired and expired by the lungs. | Baseline and 48 hours |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Scott Sagel, MD | The Children's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Children's Hospital | Denver | Colorado | 80218 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Inhaled Nitric Oxide Low Dose | Low dose group received Inhaled Nitric Oxide at 20 parts per million (ppm) via nasal cannula for 44 hours |
| FG001 | Inhaled Nitric Oxide High Dose | High dose group received Inhaled Nitric Oxide at 40 ppm via nasal cannula for 44 hours. |
| FG002 | Nitrogen | Nitrogen (Placebo) administered at 20 ppm or 40 ppm via nasal cannula over a 44 hour period |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Inhaled Nitric Oxide Low Dose | Low dose group received Inhaled Nitric Oxide at 20 parts per million (ppm) via nasal cannula for 44 hours |
| BG001 | Inhaled Nitric Oxide High Dose |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Safety and Tolerability of Drug, Assessed by Change in Methemoglobin Levels | Methemoglobin level assessments were measured through blood draws - hematology. This test measures the amount of methemoglobin (a type of hemoglobin that is unable to transport oxygen to tissues) in blood. Normal methemoglobin percentage range 1% - 2%. | Posted | Sep 2010 | Mean | Standard Deviation | Percent of Methemoglobin Level | Baseline and 48 hours |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Inhaled Nitric Oxide Low Dose | Low dose group received Inhaled Nitric Oxide at 20 parts per million (ppm) via nasal cannula for 44 hours |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Otitis Media | Infections and infestations | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Medical Information Call Center | Mallinckrodt Pharmaceuticals | 800-556-3314 | 5 | clinicaltrials@mnk.com |
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| ID | Term |
|---|---|
| D003550 | Cystic Fibrosis |
| ID | Term |
|---|---|
| D010182 | Pancreatic Diseases |
| D004066 | Digestive System Diseases |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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| ID | Term |
|---|---|
| D009569 | Nitric Oxide |
| D001239 | Inhalation |
| D009584 | Nitrogen |
| ID | Term |
|---|---|
| D026361 | Reactive Nitrogen Species |
| D005609 | Free Radicals |
| D007287 | Inorganic Chemicals |
| D009589 | Nitrogen Oxides |
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| Nitric Oxide for Inhalation | Drug | Nitric oxide will be administered at 40 ppm via nasal cannula over a 44 hours period. |
|
|
| Nitrogen | Drug | 100% nitrogen (placebo) will be administered at 20 ppm or 40 ppm via nasal cannula over a 44 hour period. |
|
|
High dose group received Inhaled Nitric Oxide at 40 ppm via nasal cannula for 44 hours.
| BG002 | Nitrogen | Nitrogen (Placebo) administered at 20 ppm or 40 ppm via nasal cannula over a 44 hour period |
| BG003 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| OG002 | Nitrogen | Nitrogen (Placebo) administered at 20 ppm or 40 ppm via nasal cannula over a 44 hour period |
|
|
| Primary | Change in Oxygen Saturation | Safety and tolerability of drug assessed by decreased oxygen saturation was measured through pulse oximeter, which measure the amount of oxygen in the blood. Normal range percentage is 95 - 100% | Posted | Sep 2010 | Mean | Standard Deviation | Percent of oxygen saturation | Baseline and 48 hours |
|
|
|
| Primary | Change in Forced Expiratory Volume in 1 Second (FEV1) | Decrease in forced expiratory volume in 1 second was measured through spirometer. Spirometer measures the volume of air inspired and expired by the lungs. | Posted | Sep 2010 | Mean | Standard Deviation | Liters | Baseline and 48 hours |
|
|
|
| 0 |
| 6 |
| 2 |
| 6 |
| EG001 | Inhaled Nitric Oxide High Dose | High dose group received Inhaled Nitric Oxide at 40 ppm via nasal cannula for 44 hours. | 0 | 6 | 1 | 6 |
| EG002 | Nitrogen | Nitrogen (Placebo) administered at 20 ppm or 40 ppm via nasal cannula over a 44 hour period | 0 | 6 | 0 | 6 |
| Cough | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Epistaxis | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
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| D030342 |
| Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D007232 | Infant, Newborn, Diseases |
| D017672 |
| Nitrogen Compounds |
| D010087 | Oxides |
| D017601 | Oxygen Compounds |
| D009930 | Organic Chemicals |
| D015656 | Respiratory Mechanics |
| D012119 | Respiration |
| D012143 | Respiratory Physiological Phenomena |
| D002943 | Circulatory and Respiratory Physiological Phenomena |
| D004602 | Elements |
| D005740 | Gases |
|
|