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Cystic FibrosisPhase 3COMBATCFNCT01270074

Prevention of Bronchiectasis in Infants With Cystic Fibrosis

A Phase 3 study testing Azithromycin in people with Cystic Fibrosis and Bronchiectasis, run by The University of Queensland at 10 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The general aim of this project is to conduct a randomized, double-blind, placebo-controlled clinical trial of azithromycin to determine whether treatment from infancy is safe and will prevent the onset of bronchiectasis. Read more about this study

Who is it for?
Ages 6 weeks to 6 months
Conditions the study is for
Cystic Fibrosis, Bronchiectasis
What is being tested?
Azithromycin
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
130 participants
Where
10 sitesin 2 countries
Study dates
Apr 2012to Mar 2021
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 weeks to 6 months
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Children of either sex with a diagnosis of CF following detection via New Born Screening (NBS) for cystic fibrosis
  • Participants who, in the opinion of the Investigator, are able to comply with the protocol for its duration
  • Written informed consent signed and dated by parent/legal guardian according to local regulations

Who cannot join

  • Born <30 weeks gestation
  • Prolonged mechanical ventilation in the first 3 months of life
  • Participation in another randomized controlled trial within the 3 months preceding inclusion in this study
  • A significant medical disease or condition other than CF that is likely to interfere with the child's ability to complete the entire protocol
  • Previous major surgery except for meconium ileus
  • Macrolide hypersensitivity

Trial locations and contacts

10 sites in 2 countries.

10 sites in 2 countries

Australia9 sites
  • Women's and Children's Hospital

    Adelaide, South Australia

  • Queensland Children's Hospital

    Brisbane, Queensland, 4101

  • Mater Children's Hospital

    Brisbane, Queensland

  • Royal Children's Hospital

    Brisbane, Queensland

  • Monash Medical Centre

    Melbourne, Victoria

  • Royal Children's Hospital

    Melbourne, Victoria

  • Perth Children's Hospital

    Perth, Western Australia, 6009

  • Sydney Children's Hospital

    Sydney, New South Wales

  • Westmead Children's Hospital

    Sydney, New South Wales

Other trials in Australia

New Zealand1 site
  • Starship Hospital

    Auckland

Other trials in New Zealand

About this study

Official title: A Phase 3 Multi-centre Randomised Placebo-controlled Study of Azithromycin in the Primary Prevention of Radiologically-defined Bronchiectasis in Infants With Cystic Fibrosis.

The general aim of this project is to conduct a randomized, double-blind, placebo-controlled clinical trial of azithromycin to determine whether treatment from infancy is safe and will prevent the onset of bronchiectasis. One hundred and thirty infants will be recruited from CF clinics in Australia and New Zealand and treated from 3 months to three years of age. The primary outcome will be the proportion with radiologically-defined bronchiectasis at 3 years of age. Safety and mechanistic evaluations will also be undertaken.

Read the detailed description

SYNOPSIS OF PROTOCOL

Title Multi-centre randomized placebo-controlled study of azithromycin in the primary prevention of radiologically-defined bronchiectasis in infants with Cystic Fibrosis

Clinical Phase Phase 3

Protocol Number: AZI001

TGA Reference Number:

Protocol Co-Chairs: Peter D. Sly \& Stephen M. Stick Microbiology Consultant: Lisa Saiman CT Consultant: Harm Tiddens Statistical Consultant: Robert S Ware

Study Design Randomized, double-blind parallel groups. Participants will be randomized into one of the following 2 groups on a 1:1 ratio with 65 participants per group;

Group A: 10 mg/kg (as 200mg/5ml) azithromycin three times weekly for three years added to standard CF therapy.

Group B: matched placebo three times weekly for three years added to standard CF therapy.

Accrual Objective 130 children

Accrual Period 24 months

Study Duration 36 months

Countries: Australia and New Zealand

Sites: Brisbane Au, Sydney, Au, Melbourne Au, Adelaide Au, Perth Au,Auckland Nz, Christchurch Nz.

Primary Endpoint The primary endpoints are the proportion of children with radiologically-defined bronchiectasis at age 3 years, and the proportion of lung tissue affected by disease at age 3 years.

Secondary Endpoints

  • The extent and severity of bronchiectasis at age 3 years
  • The volume of trapped gas at age 3 years
  • CF-related quality of life
  • Time to first pulmonary exacerbation
  • Proportion of participants experiencing a pulmonary exacerbation
  • Number of courses of inhaled or oral antibiotics
  • Number of days of inhaled antibiotics
  • Incidence of hospitalizations/Accident and Emergency department (A\&E) visits for an acute respiratory exacerbation
  • Number of days hospitalized for an acute respiratory exacerbation
  • Number of days if intravenous antibiotics
  • Body mass index at 3 years of age.

Exploratory Endpoints

  • Markers of neutrophilic inflammation
  • Markers of oxidative stress
  • Composition of airway flora

Safety Endpoints

  • Proportion of participants growing P. aeruginosa in BAL
  • Age of acquisition of P. aeruginosa in BAL
  • Emergence of macrolide-resistant S. aureus, small colony variant S. aureus and non-tuberculous mycobacteria (NTM)
  • Treatment-related adverse events
  • Haematology and clinical chemistry

Inclusion Criteria Participants who meet all of the following criteria are eligible for enrolment as study participants:

  1. Children of either sex with a diagnosis of CF following detection via New Born Screening (NBS) for cystic fibrosis
  2. Participants who, in the opinion of the Investigator, are able to comply with the protocol for its duration
  3. Written informed consent signed and dated by parent/legal guardian according to local regulations

Exclusion Criteria Participants who meet any of these criteria are not eligible for enrolment as trial participants:

  1. Born <30 weeks gestation
  2. Prolonged mechanical ventilation in the first 3 months of life
  3. Participation in another randomized controlled trial within the 3 months preceding inclusion in this study
  4. A significant medical disease or condition other than CF that is likely to interfere with the child's ability to complete the entire protocol
  5. Previous major surgery except for meconium ileus
  6. Macrolide hypersensitivity

Treatment Description ZITHROMAX® (azithromycin)

Study Procedures The study participants will be stratified by investigational site and randomly assigned to either azithromycin or placebo for three years.

Statistical Considerations Participants will be randomized in blocks to the treatment group or the placebo group using a one-to-one ratio. Randomization will be stratified by study site. This will ensure an approximately equal allocation to each group within each site.

Interim Analyses Interim analyses will occur when the first 50% of children (n=33 per group have completed the 12 month CT and when all subjects have completed the 12 month CT. Interim analyses will determine safety or success (unethical to continue).

Stopping Rules Study enrolment may be stopped if any of the following events occur:

  • Death of a participant that is related to study treatment.
  • The trial meets the definition of futility or success at either of the planned interim analyses
Being tested
Azithromycin, Placebo control
Keywords
double blind placebo controlled randomised clinical trial, azithromycin, infant, pediatric, cystic fibrosis, bronchiectasis
Medical subject headings
Cystic Fibrosis, Bronchiectasis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AzithromycinDrug

    Also called Zithromax

    azithromycin will be given as a liquid preparation at a dose of 10 mg/kg three times per week from three months of age until three years of age

  • Placebo controlDrug

    inert liquid preparation will be given three times per week from three months of age to three years of age

Study groups in NCT01270074
Study groupRoleWhat they receive
azithromycin liquid preparationExperimentalazithromycin will be given at a dose of 10mg/kg given three times per week from three months of age to three years of age
Receives: Drug: Azithromycin
inert liquid preparationActive comparatorinert liquid preparation will be given three times per week from three months of age to three years of age
Receives: Drug: Placebo control

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of children with radiologically-defined bronchiectasis

    bronchiectasis will be determined from a low dose volumetric chest computed tomography scan performed at 3 years of age

    Measured: at three years of age

  2. The proportion of lung tissue affected by disease

    Percentage of diseased lung will be determined from a low dose volumetric chest computed tomography scan performed at 3 years of age

    Measured: at three years of age

Secondary outcomes (9)
  1. extent and severity of bronchiectasis

    bronchiectasis will be determined from a low dose volumetric chest computed tomography scan performed at 3 years of age

    Measured: at three years of age

  2. CF-related quality of life

    Quality of life questionnaire to be measured at 3 years

    Measured: at three years of age

  3. time to first pulmonary exacerbation

    pulmonary exacerbation will be defined using a standardized instrument

    Measured: over the first three years of life

  4. proportion of participants experiencing a pulmonary exacerbation

    pulmonary exacerbation will be defined using a standardized instrument

    Measured: over the first three years of life

  5. body mass index

    body mass index will be calcualted from hieight and weight measurements taken at 3 years of age.

    Measured: at three years of age

  6. Proportion of participants growing Pseudomonas aeruginosa in bronchoalveolar lavage

    bronchoalveolar lavage will be performed at 3 months, 1 year and 3 years of age

    Measured: over the first three years of life

  7. age of acquisition of Pseudomonas aeruginosa

    Measured: over the first three years of life

  8. Emergence of macrolide-resistant Staphylococcus aureus, small colony variant Staphylococcal aureus and non-tuberculous mycobacterium

    Measured: over the first three years of life

  9. Volume of trapped gas at age 3 years

    air trapping will be determined from a low dose volumetric chest computed tomography scan performed at 3 years of age

    Measured: at 3 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Jan 2011 (estimated)
  2. Study startApr 2012
  3. Primary completionMar 2020
  4. Study completionMar 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
130 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01270074
Sponsor's protocol ID
AZI001
Other IDs
STICK10K0
Acronym
COMBATCF
Status last verified
Nov 2019
First submitted
23 Dec 2010
Last updated
16 Sep 2021
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Yes

Publications

  • Douglas TA, Brennan S, Gard S, Berry L, Gangell C, Stick SM, Clements BS, Sly PD. Acquisition and eradication of P. aeruginosa in young children with cystic fibrosis. Eur Respir J. 2009 Feb;33(2):305-11. doi: 10.1183/09031936.00043108. Epub 2008 Nov 14.

    PubMed 19010992
  • Sly PD, Brennan S, Gangell C, de Klerk N, Murray C, Mott L, Stick SM, Robinson PJ, Robertson CF, Ranganathan SC; Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST-CF). Lung disease at diagnosis in infants with cystic fibrosis detected by newborn screening. Am J Respir Crit Care Med. 2009 Jul 15;180(2):146-52. doi: 10.1164/rccm.200901-0069OC. Epub 2009 Apr 16.

    PubMed 19372250
  • Stick SM, Brennan S, Murray C, Douglas T, von Ungern-Sternberg BS, Garratt LW, Gangell CL, De Klerk N, Linnane B, Ranganathan S, Robinson P, Robertson C, Sly PD; Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF). Bronchiectasis in infants and preschool children diagnosed with cystic fibrosis after newborn screening. J Pediatr. 2009 Nov;155(5):623-8.e1. doi: 10.1016/j.jpeds.2009.05.005. Epub 2009 Jul 19.

    PubMed 19616787
  • Stick SM, Foti A, Ware RS, Tiddens HAWM, Clements BS, Armstrong DS, Selvadurai H, Tai A, Cooper PJ, Byrnes CA, Belessis Y, Wainwright C, Jaffe A, Robinson P, Saiman L, Sly PD; COMBAT CF Study Group. The effect of azithromycin on structural lung disease in infants with cystic fibrosis (COMBAT CF): a phase 3, randomised, double-blind, placebo-controlled clinical trial. Lancet Respir Med. 2022 Aug;10(8):776-784. doi: 10.1016/S2213-2600(22)00165-5. Epub 2022 Jun 2.

    PubMed 35662406

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Azithromycin in people with Cystic Fibrosis and Bronchiectasis, run by The University of Queensland at 10 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Sep 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in Australia, New Zealand. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of children with radiologically-defined bronchiectasis (time frame: at three years of age). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01270074, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Sep 2021.

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