Randomized, Single Blind, Controlled Trial of Inhaled Glutathione Versus Placebo in Patients With Cystic Fibrosis
Trial Snapshot
- Phase
- Phase 3
- Sponsor
- Enrollment
- 150
- Locations
- 1
- Primary Endpoint
- Forced expiratory volume in one second (FEV1) percent
Study Overview
Brief Summary
Cystic fibrosis (CF) is the most common inherited disease among the Caucasian population with considerable morbidity and reduced life expectancy.
Excessive oxidants released by activated inflammatory cells and persisting infections are considered the main mechanism of damage of respiratory epithelium in CF.Glutathione (GSH) represents the first-line defence of the lung against oxidative stress-induced cell injury; however, a depletion of its levels has been observed in the airways of patients affected by CF. In vitro studies have showed that CFTR protein plays a pivotal role in transmembrane glutathione transport. Therapeutic approaches with inhaled GSH could improve the reduced lung antioxidant capacity in order to counterbalance the oxidant stress linked to the chronic airway inflammation and bacterial infection.
Primary objective of the study is to investigate whether a 12 months treatment with inhaled GSH can improve airway obstruction in CF patients. Secondary objectives include the effects of GSH therapy on exercise capacity, body mass index (BMI), respiratory symptoms, quality of life, frequency of pulmonary exacerbations, hospital admissions, and antibiotic administration. Moreover the study will evaluate the effect of GSH therapy on markers of oxidative stress in exhaled breath condensate (EBC) and in serum, and on inflammatory markers on brushed nasal epithelial cells.
Detailed Description
150 eligible patients will be enrolled on the basis of inclusion criteria. Patients will be divided in two groups: 1) Group 1 age between 6 and 18 years; 2) Group 2 older than 18 years. Patients will be randomly assigned to the treatment or placebo arm.Patients randomized in the GSH arm will receive a dosage of 10 mg/kg bid over a 12 months period.
Clinical visits will take place at the beginning (visit 0, enrolment visit) and after one month (visit 1), three months (visit 2), six months (visit 3) nine months (visit 4), and twelve months (visit 5, end of treatments).
Follow-up clinical visits will take place one month (visit 6), three months (visit 7), six months (visit 8) after the end of treatments.
At visit 0, all eligible patients will inhale GSH (10 mg/Kg) and a dynamic spirometry will be performed before, 10 and 60 minutes after inhalation. Patients showing a decrease in FEV1 greater than 15% after GSH inhalation will be excluded from the study.
At visit 0 and at each following visits (visit 1, 2, 3, 4, 5, 6, 7 and 8) will be performed and evaluated:
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Participant)
Eligibility Criteria
- Ages
- 6 Years to 45 Years (Child, Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •a confirmed diagnosis of cystic fibrosis documented by sweat chloride test over 60 mmol/L and/or genotype analysis;
- •male and female aged older than 6 years;
- •stable clinical condition;
- •written informed consent.
Exclusion Criteria
- •pregnancy and fertile women taking oral contraceptives;
- •cigarette smoking;
- •positive culture for Burkholderia Cepacia;
- •history of haemoptysis or pneumothorax;
- •FEV1<= 40% of the predicted value;
- •hyperresponsiveness to GSH inhalation test.
Arms & Interventions
Physiological solution
Intervention: Physiological solution (Drug)
Reduced Inhaled Glutathione
Intervention: Inhaled Reduced Glutathione (Drug)
Outcomes
Primary Outcomes
Forced expiratory volume in one second (FEV1) percent
Time Frame: 12 months
Increase of at least 15% of the percent of forced expiratory volume in one second (FEV1) after GSH therapy compared to placebo
Secondary Outcomes
- Small airway function(12 months)
- Exercise Capacity(12 months)
- BMI(12 months)
- Dyspnoea(12 months)
- Cough(12 months)
- Quality of life(12 months)
- Pulmonary exacerbations(12 months)
- Markers of oxidative stress (H2O2)in serum and in exhaled breath condensate (EBC)(12 months)
- Epithelial inflammatory markers on brushed nasal epithelial cells(12 months)
Investigators
Serafino A. Marsico
Professor of Respiratory Diseases
University of Campania "Luigi Vanvitelli"