Impact of Discontinuing Hypertonic Saline in People With CF on Highly Effective CFTR Modulators- A SIMPLIFY Sub-Study

Not Applicable

Completed

Conditions: Cystic Fibrosis

Registration Number: NCT06350461

Lead Sponsor: Nicole Hamblett

Brief Summary: Despite the increasingly common use of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies in treating cystic fibrosis (CF), it is still largely unknown whether or not other chronic therapies can be safely stopped. This SIMPLIFY sub-study is being done to test whether or not it is safe to stop taking inhaled hypertonic saline in those people that are also taking elexacaftor/tezacaftor/ivacaftor (ETI).

ETI is a combination CFTR modulator therapy that was approved by the Food and Drug Administration for people with CF who have at least one F508del mutation. The three drugs that make up ETI work together to allow many more chloride ions to move into and out of the cells, improving the balance of salt and water in the lungs. These changes result in better clearance of mucus from the lungs and improvements in lung function.

Inhaled hypertonic saline (HS) also improves clearance of mucus from the lungs to support lung function and has been available to people with CF for many years. HS is considered to be relatively burdensome and it is not known whether HS can improve or maintain lung function above what is already gained through ETI use.

The goal of this SIMPLIFY sub-study is to get information about whether or not it is safe to stop hypertonic saline by testing if there is a change in lung function in participants with cystic fibrosis (CF) who are assigned to stop taking HS as compared to those who are assigned to keep taking HS while continuing to take ETI.

This is a sub study of master protocol SIMPLIFY-IP-19, NCT04378153.

The sub study investigating the impact of discontinuing and continuing dornase alfa is registered under NCTXXXXXXX (will add once available).

Detailed Description: This SIMPLIFY sub-study (Hypertonic Saline (HS) Trial) is designed to evaluate the effects of discontinuing HS in people with cystic fibrosis (CF) age 12 and older currently taking the highly effective modulator elexacaftor/tezacaftor/ivacaftor (ETI). This is an open label two-arm randomized non-inferiority trial consisting of a 2-week screening period, randomization to continue or discontinue hypertonic saline, followed by a 6-week study period. Participants at trial entry will be randomized 1:1 to either continue or discontinue their HS therapy.

Clinical outcomes (forced expiratory volume in 1 second \[FEV1\], antibiotic use, pulmonary exacerbations, and patient reported outcomes), safety (adverse events) and patient reported outcomes to evaluate respiratory symptoms and the participant's perception of how stopping HS would impact their daily life will be evaluated in all subjects. Additionally, a subset of participants at selected study sites will participate in Multiple Breath Washout (MBW) to evaluate changes in lung clearance index (LCI).

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 370

Inclusion Criteria

Diagnosis of CF.
Age ≥ 12 years at the Screening Visit.
Forced expiratory volume in 1 second (FEV1) ≥ 70 % predicted at the Screening Visit if < 18 years old, and ≥ 60 % predicted at Screening Visit if ≥ 18 years old.
Clinically stable with no significant changes in health status within the 7 days prior to and including the Screening Visit.
Current treatment with elexacaftor/tezacaftor/ivacaftor (ETI) for at least the 90 days prior to and including the Screening Visit and willing to continue daily use for the duration of the study.
Currently taking hypertonic saline (at least 3%) for at least the 90 days prior to and including the Screening Visit and willing to continue daily use for the 2-week screening period.

Exclusion Criteria

Active smoking or vaping.
Use of an investigational drug within 28 days prior to and including the Screening Visit.
Changes to chronic therapy (e.g., ibuprofen, azithromycin, inhaled tobramycin, aztreonam lysine) within 28 days prior to and including the Screening Visit. This includes new airway clearance routines.
Acute use of antibiotics (oral, inhaled or IV) or acute use of systemic corticosteroids for respiratory tract symptoms within 7 days prior to and including the Screening Visit.
Chronic use of systemic corticosteroids at a dose equivalent to ≥ 10mg per day of prednisone within 28 days prior to and including the Screening Visit.
Antibiotic treatment for nontuberculous mycobacteria (NTM) within 28 days prior to and including the Screening Visit.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Absolute Change in FEV1 % Predicted From Week 0 to Week 6	Week 0 to Week 6	Difference between study arms (discontinue - continue) in the absolute change in FEV1 % predicted from Week 0 to Week 6.

Secondary Outcome Measures

Name	Time	Method
Number and Percent of Participants Experiencing Adverse Events (AEs) From Week 0 to Week 6	Week 0 to Week 6	Difference between study arms (discontinue - continue) in the percent of participants with at least one AE from Week 0 to Week 6. Includes serious and non-serious AEs.
Rate of Adverse Events (AEs) From Week 0 to Week 6 Therapy Arms	Week 0 to Week 6	Comparison of study arms (discontinue/continue) in the rate of AE occurrence (number of events divided by total follow-up weeks in each arm) from Week 0 to Week 6. Includes serious and non-serious AEs.
Number and Percent of Participants With Temporary or Permanent Changes From Assigned Therapy Regimen Due to Adverse Event From Week 0 to Week 6	Week 0 to Week 6	Difference between study arms (discontinue - continue) in the percent of subjects temporarily or permanently changing their assigned therapy regimen due to an adverse event Week 0 to Week 6
Absolute Change in LCI 2.5 From Baseline to Week 6	Baseline (Week 0 or Week -2) to Week 6	Difference between study arms (discontinue - continue) in the absolute change in LCI 2.5 (Lung Clearance Index) from Baseline (Week 0, if available, or else Week -2) to Week 6. LCI 2.5 is the number of times the volume in the lungs needs to turn over to expel an inert gas. A higher value of LCI 2.5 indicates poorer lung function.
Absolute Change in Respiratory Symptoms, as Measured by the CF Respiratory Symptoms Diary-Chronic Respiratory Infection Symptom Severity Score (CRISS) From Week 0 to Week 6	Week 0 to Week 6	Difference between study arms (discontinue - continue) in the absolute change in respiratory symptoms, as measured by the CF Respiratory Symptoms Diary-Chronic Respiratory Infection Symptom Severity Score (CRISS) from Week 0 to Week 6. The Cystic Fibrosis Respiratory Symptoms Daily Diary (CFRSD) asks a participant to state the extent of their 8 respiratory symptoms: difficulty breathing, feverishness, tiredness, chills or sweats, coughing, coughing up mucus, tightness in the chest and wheezing. Each respiratory symptom is assigned a score from 0-4 based on the response, with zero corresponding to the absence of the symptom and four corresponding to symptom being present 'a great deal' or 'extremely'. A summed score (range from 0-24) is calculated for each participant and converted to a final score with a range of 0 to 100, where the lowest scores indicate improvement of symptoms. Calculation of a score requires responses for at least 7 out of 8 symptoms.
Absolute Change in Respiratory Symptoms, as Measured by CFQ-R Respiratory Domain From Week 0 to Week 6	Week 0 to Week 6	Difference between study arms (discontinue - continue) in the absolute change in respiratory symptoms, as measured by the Cystic Fibrosis Questionnaire-Revised Respiratory Domain Score from Week 0 to Week 6. The Cystic Fibrosis Questionnaire - Revised asks participants 6 questions related to respiratory symptoms which are each assigned a score 1-4. The Respiratory Domain Scaled Score is calculated as follows: 100\*\[{sum of responses}/{number of responses}-1\]/3 only if number of responses ≥ 3; otherwise the score is set to missing. The scaled score ranges from 0 to 100 where higher scores indicate improvement of symptoms.
Absolute Change in FEV1 % Predicted From Week -2 to Week 0	Week -2 to Week 0	Difference between study arms (discontinue - continue) in the absolute change in FEV1 % predicted from Week -2 to Week 0.
Absolute Change in FEV1 % Predicted From Week 0 to Week 2	Week 0 to Week 2	Difference between study arms (discontinue - continue) in the absolute change in FEV1 % predicted from Week 0 to Week 2.
Number and Percent of Participants Initiating Acute Antibiotics From Week 0 to Week 6	Week 0 to Week 6	Difference between study arms (discontinue - continue) in the percent of subjects initiating acute oral, inhaled or intravenous antibiotics from Week 0 to Week 6. Includes antibiotics initiated for respiratory indications; excludes those taken as part of a chronic cycled regimen or for a UTI, skin infection, etc.
Number and Percent of Participants Hospitalized From Week 0 to Week 6	Week 0 to Week 6	Difference between study arms (discontinue - continue) in the percent of subjects hospitalized from Week 0 to Week 6.
Number and Percent of Participants Experiencing Pulmonary Exacerbations From Week 0 to Week 6	Week 0 to Week 6	Difference between study arms (discontinue - continue) in the percent of subjects experiencing a pulmonary exacerbation from Week 0 to Week 6. Pulmonary exacerbations defined using Fuchs criteria.

Trial Locations

Locations (81): University of Alabama at Birmingham
🇺🇸
Birmingham, Alabama, United States
Providence Alaska Medical Center
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Anchorage, Alaska, United States
Tucson Cystic Fibrosis Center
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Tucson, Arizona, United States
Arkansas Children's Hospital
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Little Rock, Arkansas, United States
Miller Children's and Women's Hospital Long Beach
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Long Beach, California, United States
CHOC Children's Hospital
🇺🇸
Orange, California, United States
Stanford University Medical Center
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Palo Alto, California, United States
Rady Children's Hospital and Health Center at the University of California San Diego
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San Diego, California, United States
University of California, San Francisco - Adult Center
🇺🇸
San Francisco, California, United States
University of California, San Francisco - Peds Center
🇺🇸
San Francisco, California, United States
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University of Alabama at Birmingham
🇺🇸Birmingham, Alabama, United States