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Septic ShockPhase 2/3FLUDROSEPSISNCT05001854

Hemodynamics Effects of Fludrocortisone on the Pressor Response to Noradrenaline Septic Shock Patients

A Phase 2/3 study testing Fludrocortisone in people with Septic Shock, run by Rennes University Hospital at 1 site in France.

Suspended

Paused. Enrolment is on hold for now and may resume.

Official record
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Trial summary

The benefit of low-dose steroids in septic shock is still debated today, especially with mineralocorticoids. Fludrocortisone is a synthetic mineralocorticoid, an analogue of aldosterone, which has shown, in combination with hydrocortisone, a favorable effect on the mortality of septic shock patients with relative… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Septic Shock
What is being tested?
Fludrocortisone
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
40 participants
Where
1 siteFrance
Study dates
31 Mar 2022to Dec 2024
Phase
Phase 2/3
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age > 18 years
  • Patient with septic shock for less than 48 hours, defined by the combination of:
  • Sepsis defined as organ dysfunction caused by an inappropriate host response to infection (increase in SOFA score of at least 2 points secondary to infection),
  • Persistent hypotension requiring vasopressor drugs to maintain mean arterial pressure ≥ 65 mmHg,
  • Hemodynamic stability for >30 min with mean arterial pressure ≥ 65 mmHg and noradrenaline dose ≤ 0.5 μg/kg/min,
  • Consent signed by the patient, family member, or legal representative or inclusion under emergency procedure,
Show all 18Show fewer
  • Negative to a diagnostic test for SARS-CoV2 less than 72 hours old; the test used must be on the the list published on the Ministry of Solidarity and Health website
  • Non-inclusion Criteria:
  • Current treatment with steroids or other treatment that may affect the hypothalamic-pituitary-adrenal axis,
  • Anesthetic induction with etomidate within 6 hours prior to randomization given its selective inhibitory effect on 11 β-hydroxylase,
  • Known hypersensitivity to fludrocortisone (or any of its excipients), or to tetracosactide (Synacthen®),
  • Disturbed gastric emptying (gastric residue > 500 ml) in the absence of an alternative route of administration available (naso-jejunal tube or jejunostomy),
  • Pregnant or nursing woman,
  • Patient participating in another trial, possibly interfering with the study procedures,
  • Person not affiliated to a social security system,
  • Known situation of deprivation of freedom (safeguard of justice), guardianship or curatorship,
  • Patient with a life expectancy of less than 24 hours.
  • Patient with known or suspected SARS-CoV2 pneumonia

Who cannot join

  • Patients under court protection will be excluded as soon as the investigator is aware of their status.
  • Hemodynamic worsening with noradrenaline dose >1.5 μg/kg/min before evaluation of the primary end point.
  • Catecholamine withdrawal before evaluation of the primary end point.

Trial locations and contacts

1 site in 1 country.

France1 site
  • Rennes University Hospital - Intensive Care unit

    Rennes, Brittany Region, 35033

Other trials in France

About this study

Official title: Evaluation of the Hemodynamics Effects of Fludrocortisone on the Pressor Response to Noradrenaline in Septic Shock Patients

The benefit of low-dose steroids in septic shock is still debated today, especially with mineralocorticoids. Fludrocortisone is a synthetic mineralocorticoid, an analogue of aldosterone, which has shown, in combination with hydrocortisone, a favorable effect on the mortality of septic shock patients with relative adrenal insufficiency. In a previous study in healthy volunteers, we showed for the first time that fludrocortisone at a dose of 400 μg per day significantly improved the pressor response to phenylephrine. These results confirm the observations reported in rats with endotoxin shock, where fludrocortisone was shown to significantly increase blood pressure and contractile response to phenylephrine. These encouraging results argue for a potential vascular beneficial effect of fludrocortisone and need to be confirmed in a population of septic shock patients. In this context, we aimed to evaluate the effect of oral administration of 100 μg every 6 hours of fludrocortisone on vascular responsiveness to noradrenaline in septic shock patients.

Read the detailed description

Patients admitted to medical and surgical intensive care units with septic shock who meet the selection criteria may be offered participation in the study. The consent is signed either by the patient or his or her relative/legal representative if he or she is not capable or the patient is included according to the emergency procedure in the absence of a relative. The patient is managed according to the usual procedures for patients in septic shock. After collection of the initial workup and basal measurements, the physician randomizes (=includes) the patient into one of 2 arms : the patient receives either fludrocortisone (400 μg per day), administered in 1 dose of 100 μg every 6 hours, i.e., 2 tablets of 50 μg per dose, or the placebo

Conditions
Septic Shock
Being tested
Fludrocortisone, Placebo
Medical subject headings
Shock, Septic

What participants receive

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

  • FludrocortisoneDrug

    Also called Flucortac

    100 μg every 6 hours of fludrocortisone per os

  • PlaceboDrug

    100 μg every 6 hours of placebo per os

Study groups in NCT05001854
Study groupRoleWhat they receive
FludrocortisoneExperimental100 μg every 6 hours of fludrocortisone per os A pharmacokinetic study is performed in this arm
Receives: Drug: Fludrocortisone
ControlPlacebo comparator100 μg every 6 hours of placebo per os
Receives: Drug: Placebo

What is being measured

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

  1. Mean arterial blood pressure (mmHg)

    Mean arterial blood pressure (mmHg) after a dose escalation of norepinephrine in increments of 0.2 μg/kg/min to a maximum dose of 1.5 μg/kg/min.

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

Secondary outcomes (49)
  1. Heart rate

    Heart rate

    Measured: Baseline, before the first administration of the drug (fludrocortisone/placebo)

  2. Heart rate

    Heart rate

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  3. Heart rate

    Heart rate

    Measured: After the 3rd administration of fludrocortisone or placebo (12 hours)

  4. Heart rate

    Heart rate

    Measured: After the 4th administration of fludrocortisone or placebo (18 hours)

  5. arterial pressure

    Mean arterial pressure, systolic arterial pressure, diasystolic arterial pressure

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  6. arterial pressure

    Mean arterial pressure, systolic arterial pressure, diasystolic arterial pressure

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  7. arterial pressure

    Mean arterial pressure, systolic arterial pressure, diasystolic arterial pressure

    Measured: After the 3rd administration of fludrocortisone or placebo (12 hours)

  8. arterial pressure

    Mean arterial pressure, systolic arterial pressure, diasystolic arterial pressure

    Measured: After the 4th administration of fludrocortisone or placebo (18 hours)

  9. Cardiac output

    Cardiac output

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  10. Cardiac output

    Cardiac output

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  11. Cardiac output

    Cardiac output

    Measured: After the 3rd administration of fludrocortisone or placebo (12 hours)

  12. Cardiac output

    Cardiac output

    Measured: After the 4th administration of fludrocortisone or placebo (18 hours)

  13. Cardiac index

    Cardiac index

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  14. Cardiac index

    Cardiac index

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  15. Cardiac index

    Cardiac index

    Measured: After the 3rd administration of fludrocortisone or placebo (12 hours)

  16. Cardiac index

    Cardiac index

    Measured: After the 4th administration of fludrocortisone or placebo (18 hours)

  17. Indexed Systemic Vascular Resistances (ISVR)

    Indexed Systemic Vascular Resistances (ISVR)

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  18. Indexed Systemic Vascular Resistances (ISVR)

    Indexed Systemic Vascular Resistances (ISVR)

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  19. Indexed Systemic Vascular Resistances (ISVR)

    Indexed Systemic Vascular Resistances (ISVR)

    Measured: After the 3rd administration of fludrocortisone or placebo (12 hours)

  20. Indexed Systemic Vascular Resistances (ISVR)

    Indexed Systemic Vascular Resistances (ISVR)

    Measured: After the 4th administration of fludrocortisone or placebo (18 hours)

  21. Indexed Global Telediastolic Volume (IGVT)

    Indexed Global Telediastolic Volume (IGVT)

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  22. Indexed Global Telediastolic Volume (IGVT)

    Indexed Global Telediastolic Volume (IGVT)

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  23. Indexed Global Telediastolic Volume (IGVT)

    Indexed Global Telediastolic Volume (IGVT)

    Measured: After the 3rd administration of fludrocortisone or placebo (12 hours)

  24. Indexed Global Telediastolic Volume (IGVT)

    Indexed Global Telediastolic Volume (IGVT)

    Measured: After the 4th administration of fludrocortisone or placebo (18 hours)

  25. Ejection Volume Variability (EVV)

    Ejection Volume Variability (EVV)

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  26. Ejection Volume Variability (EVV)

    Ejection Volume Variability (EVV)

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  27. Ejection Volume Variability (EVV)

    Ejection Volume Variability (EVV)

    Measured: After the 3rd administration of fludrocortisone or placebo (12 hours)

  28. Ejection Volume Variability (EVV)

    v

    Measured: After the 4th administration of fludrocortisone or placebo (18 hours)

  29. Extravascular Pulmonary Water (EVW)

    Extravascular Pulmonary Water (EVW)

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  30. Extravascular Pulmonary Water (EVW)

    Extravascular Pulmonary Water (EVW)

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  31. Extravascular Pulmonary Water (EVW)

    Extravascular Pulmonary Water (EVW)

    Measured: After the 3rd administration of fludrocortisone or placebo (12 hours)

  32. Extravascular Pulmonary Water (EVW)

    Extravascular Pulmonary Water (EVW)

    Measured: After the 4th administration of fludrocortisone or placebo (18 hours)

  33. Mortality

    Percentage of deceased patients

    Measured: Day 28

  34. Mortality

    Percentage of deceased patients

    Measured: Day 90

  35. Length of stay in intensive care unit

    Length of stay in intensive care unit

    Measured: Day 90

  36. Length of stay in care unit

    Length of stay in care unit

    Measured: Day 90

  37. Time to wean from catecholamines

    Time to wean from catecholamines

    Measured: Day 90

  38. Duration of mechanical ventilation (MV)

    Duration of mechanical ventilation (MV)

    Measured: Day 90

  39. Inflammation markers

    IFNγ, TNF α, IL1β, IL6, IL10 dosage

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  40. Inflammation markers

    IFNγ, TNF α, IL1β, IL6, IL10 dosage

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  41. natremia dosage

    blood sodium

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  42. natremia dosage

    blood sodium

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  43. urinary sodium dosage

    urinary sodium

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  44. urinary sodium dosage

    urinary sodium

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  45. kalemia dosage

    blood potassium

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  46. kalemia dosage

    blood potassium

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  47. urinary potassium dosage

    urinary potassium

    Measured: Baseline, before the first administration of the experimental drug (fludrocortisone/placebo)

  48. urinary potassium dosage

    urinary potassium

    Measured: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)

  49. pharmacokinetics of fludrocortisone : Area under the plasma concentration-time curve (plasma concentrations of fludrocortisone at 5 times)

    in the experimental group only.

    Measured: After 4th dose of fludrocortisone (18 hours)

Timeline

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

  1. First posted12 Aug 2021
  2. Study start31 Mar 2022
  3. Primary completionJun 2024 (estimated)
  4. Study completionDec 2024 (estimated)

Why it stopped: study suspended until new therapeutic units are available

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 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05001854
Sponsor's protocol ID
35RC19_8860
Other IDs
2020-001430-35
Acronym
FLUDROSEPSIS
Status last verified
Nov 2023
First submitted
8 Jul 2021
Last updated
18 Nov 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Fludrocortisone in people with Septic Shock, run by Rennes University Hospital at 1 site in France.

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 18 inclusion and 3 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: paused, as of the sponsor's last update on 18 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. 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. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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?

Results are not available in the source record.

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?

Mean arterial blood pressure (mmHg) (time frame: 1,5 hours after the second administration of fludrocortisone or placebo (7,5 hours)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 18 Nov 2023.

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