Chronic Pulmonary Aspergillosis and Ambisome Aerosol with Itraconazole

Poitiers University Hospital

Status and phase: Enrolling; Phase 3

Conditions: Chronic Pulmonary Aspergillosis

Treatments: Drug: Itraconazole; Drug: inhaled placebo; Drug: inhaled Ambisome®

Study type: Interventional

Funder types: Other

Identifiers

NCT03656081

CPAAARI

Details and patient eligibility

About

This study compares the therapeutic (clinical and radiological) efficacy of a six-month treatment by itraconazole and nebulised Ambisome® (liposomal amphotericin B = LAmB) versus treatment by itraconazole alone, in non - or mildly - immunocompromised patients affected by Chronic Pulmonary Aspergillosis (single aspergilloma excluded).

• Control arm: Itraconazole 200 mg x 2/day associated with inactive nebulised treatment twice a week during 24 weeks.

• Experimental arm: Itraconazole 200 mg x 2/day associated with nebulised LAmB, at 25 mg twice a week during 24 weeks.

Follow up duration for the patients will be 24 months (12 months minimum) after discontinuation of the treatment being studied.

Enrollment: 224 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

All adult patients affected with Chronic Pulmonary Aspergillosis (CPA) "de novo" or in relapse (without any history of resistance to itraconazole) combining the following criteria are eligible:

1. Patient with an Aspergillus bronchopulmonary infection, be it cavitary, fibrotic, necrotizing (SIA/Semi Invasive Aspergillosis) or nodular and documented by compatible thoracic CT-scan images ;

2. Associated with one of the following criteria:

   • positive detection of anti-Aspergillus IgG and/or precipitating anti-aspergillus antibodies, according to the positivity threshold of the laboratory performing the technique,
   • positive direct examination of Aspergillus or positive culture, from bronchopulmonary samples (expectoration or endoscopic aspiration),
   • revealing aspergillar hyphae/filaments on histological samples

3. Men or women age ≥ 18 years;

4. For the women of childbearing age: women having a negative serum pregnancy test, having a contraception highly effective and accepting to pursue it during at least the first 12 months of the study;

5. Patient legally free and not subject to any custody, guardianship, tutelage or subordination measures;

6. Participants must be affiliated to France's Health Care Regime (" Sécurité Sociale ");

7. Free and informed consent signed by each participating patient.

Exclusion criteria

1. • Patient affected with single aspergilloma
2. • Patient presenting a contraindication to itraconazole (including all contraindicated co-administrated medications as listed in the itraconazole SmPc, including notably medications with potential to prolong theQT interval)
3. • Patient presenting a contraindication to voriconazole and posaconazole (including all contraindicated coadministrated medications as listed in the SmPc)
4. • Intolerance to beta2-agonists
5. • Notion of relapse with isolation of an Aspergillus resistant to itraconazole
6. • History of hypersensitivity reaction to liposomal amphotericin B or to itraconazole or to any other constituent
7. • Patient having presented complications related to a previous treatment by nebulised LAmB
8. • Patient received an oral (excepted oral Amphotericin B), parenteral or intra-cavity antifungal treatment within the last 2 months
9. • Severe renal failure (clearance <30 ml / min).
10. • Hepatic failure with transaminase and alkaline phosphatase values > 5 times normal
11. • Significant abnormality of the blood cell and platelet counts (at the discretion of the investigator)
12. • Concomitant use of one or several of treatments contra-indicated with the experimental or non-experimental treatment
13. • Ventricular dysfunction such as congestive cardiac failure or history of congestive cardiac failure or patients with risk(s) factors of cardiac arrhythmia or symptomatic arrhythmia with a prolongation of the corrected QT interval > 450 msec in men and 470 msec in women or treated by medication known to prolong QT interval, or prolongation of the corrected QT interval > 450 msec in men and 470 msec in women.
14. • Invasive pulmonary Aspergillosis, Allergic Bronchopulmonary Aspergillosis
15. • Chronic Pulmonary Aspergillosis with indication for surgical intervention within 6 months from the start
16. • Patients with Cystic Fibrosis
17. • Immunocompromised patients
18. • Threatening hemoptysis, with impossibility to defer surgical procedures (but patients contraindicated to surgery may be included after resolution of the hemoptysis)
19. • Tuberculosis or progressive non-tuberculous mycobacteria
20. • Respiratory infection aggravating the underlying CPA (patient may be included after eradication of infection)
21. • Patient refusing to participate
22. • Protected majors in the meaning of the law, non affiliated persons or with no social security scheme, persons deprived of liberty by a judicial or administrative decision, persons staying in a health or social institution, adults under legal protection, and finally patients in emergencies.
23. • Patient in exclusion period following participation in another interventional study evaluating antifungals or medicines
24. • Women at age to procreate and not using highly effective contraception, pregnant or breastfeeding women

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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224 participants in 2 patient groups, including a placebo group

Itraconazole & inhaled placebo

Placebo Comparator group

Description:

Itraconazole 200 mg x 2/day associated with inactive nebulised treatment (isotonic saline) twice a week during 24 weeks.

Treatment:

Drug: inhaled placebo

Drug: Itraconazole

Itraconazole & inhaled Ambisome®

Experimental group

Description:

Itraconazole 200 mg x 2/day associated with inhaled liposomal amphotericin B (Ambisome®) at 25 mg twice a week during 24 weeks

Treatment:

Drug: inhaled Ambisome®

Drug: Itraconazole