Title

Long Term Administration of Inhaled Mannitol in Cystic Fibrosis
Long Term Administration of Inhaled Mannitol in Cystic Fibrosis- A Safety and Efficacy Study
  • Phase

    Phase 3
  • Study Type

    Interventional
  • Study Participants

    318
The purpose of this study is to examine the efficacy and safety of 26 weeks treatment with inhaled mannitol in subjects with cystic fibrosis. Previous studies have demonstrated improvements in lung function, mucociliary clearance, changes in physical properties of mucus, 24 hour sputum weight and quality of life. The results of this study are to further investigate and confirm these findings in addition to examine the effect on antibiotic use and chest infections. It is hypothesised that inhaled mannitol will have beneficial effects compared to a control treatment. An open label phase of 26 weeks duration will follow the blinded 26 week phase. During the open label phase all subjects will receive active treatment.
Study Started
Sep 30
2008
Primary Completion
Apr 30
2010
Study Completion
Nov 30
2010
Results Posted
Oct 09
2020
Last Update
Oct 09
2020

Drug inhaled mannitol

400 mg BD for 26 + 26 weeks

Drug Placebo comparator

BD for 26 weeks followed by 26 weeks of inhaled mannitol in the open label phase

A Experimental

active treatment

B Placebo Comparator

Criteria

Inclusion Criteria:

Have given written informed consent to participate in this study in accordance with local regulations
Have a confirmed diagnosis of cystic fibrosis (positive sweat chloride value ≥ 60 mEq/L) and/or genotype with two identifiable mutations consistent with CF, accompanied by one or more clinical features consistent with the CF phenotype)
Be aged > 6 years old
Have FEV1 >40 % and < 90% predicted
Be able to perform all the techniques necessary to measure lung function

Exclusion Criteria:

Investigators, site personnel directly affiliated with this study, or their immediate families. Immediate family is defined as a spouse, parent, child or sibling, whether biologically or legally adopted.
Be considered "terminally ill" or eligible for lung transplantation
Have had a lung transplant
Be using nebulized hypertonic saline in the 4 weeks prior to visit 1
Have had a significant episode of hemoptysis (>60 mL) in the three months prior to enrolment
Have had a myocardial infarction in the three months prior to enrolment
Have had a cerebral vascular accident in the three months prior to enrolment
Have had major ocular surgery in the three months prior to enrolment
Have had major abdominal, chest or brain surgery in the three months prior to enrolment
Have a known cerebral, aortic or abdominal aneurysm
Be breast feeding or pregnant, or plan to become pregnant while in the study
Be using an unreliable form of contraception (female subjects at risk of pregnancy only)
Be participating in another investigative drug study, parallel to, or within 4 weeks of visit 0
Have a known allergy to mannitol
Be using beta blockers
Have uncontrolled hypertension - systolic BP > 190 and / or diastolic BP > 100
Have a condition or be in a situation which in the Investigator's opinion may put the subject at significant risk, may confound results or may interfere significantly with the patient's participation in the study

Be 'Mannitol Tolerance Test positive'

-

Summary

Mannitol 400mg

Control

All Events

Event Type Organ System Event Term Mannitol 400mg Control

Change in Absolute FEV1 From Baseline Over 26 Weeks

Change from baseline in forced expiratory volume at one second (FEV1) averaged over 26 weeks (measured at 6,14 and 26 weeks) The mean absolute change from baseline FEV1 (mL) over 26 weeks (measured at week 6, 14 and 26) will be compared between the two treatment groups with a REML (restricted maximum likelihood) based repeated measures approach.Least square means presented are for the average change over the 6, 14, and 26 week visits.

Mannitol 400mg

106.53
mL (Least Squares Mean)
95% Confidence Interval: 62.43 to 150.62

Control

52.38
mL (Least Squares Mean)
95% Confidence Interval: 2.09 to 102.68

Change in FEV1 From Baseline Over 26 Weeks - Dornase Users

In the subset of dornase users, the mean absolute change from baseline FEV1 (mL) averaged over 26 weeks (measured at week 6, 14 and 26) will be compared between the two treatment groups with a REML (restricted maximum likelihood) based repeated measures approach. Least square means presented are for the average change over the 6, 14, and 26 week visits. Change from baseline over 26 weeks (measured at 6,14, 26 weeks) in subset of dornase users

Mannitol 400mg

78.6
mL (Least Squares Mean)
95% Confidence Interval: 27.64 to 129.56

Control

35.11
mL (Least Squares Mean)
95% Confidence Interval: -20.99 to 91.21

Rate of Protocol Defined Pulmonary Exacerbations (PDPE)

Exacerbations treated with IV antibiotics and with at least 4 signs and symptoms according to Fuchs criteria (1994). Summary table presents the number with 0, 1,2 and 3 PDPEs during the 26 week treatment period.

Mannitol 400mg

Control

Hospitalisations Associated With Protocol Defined Pulmonary Exacerbations (PDPEs)

The number of hospitalisations is summarised and then the rate per person is analysed.

Mannitol 400mg

Control

Antibiotic Use Associated With PDPEs

Number of courses per person in the 26 week period is summarised and then the rate per person analysed.

Mannitol 400mg

Control

Absolute Change in FEV1 Percent Predicted at 26 Weeks

Change from baseline at 26 weeks in FEV1 percent predicted with BOCF for those with missing values at week 26

Mannitol 400mg

3.14
% of predicted (Least Squares Mean)
95% Confidence Interval: 1.49 to 4.78

Control

0.72
% of predicted (Least Squares Mean)
95% Confidence Interval: -1.18 to 2.62

Change in FVC (mL) Across 26 Weeks

Change from baseline in forced vital capacity (FVC) across 26 weeks (measured at 6,14 and 26 weeks)

Mannitol 400mg

136.33
mL (Least Squares Mean)
95% Confidence Interval: 88.54 to 184.11

Control

64.98
mL (Least Squares Mean)
95% Confidence Interval: 10.58 to 119.37

Change From Baseline FEF25-75 (mL/s) Over 26 Weeks

Change from baseline in forced expiratory flow at 25-75% of forced vital capacity (FEF25-75) (mL/s) averaged over 26 weeks (measured at 6,14 and 26 weeks) The mean absolute change from baseline over 26 weeks (measured at week 6, 14 and 26) was compared between the two treatment groups with a REML (restricted maximum likelihood) based repeated measures approach. Least square means presented are for the average change over the 6, 14, and 26 week visits.

Mannitol 400mg

84.65
mL/s (Least Squares Mean)
95% Confidence Interval: 6.66 to 162.63

Control

50.31
mL/s (Least Squares Mean)
95% Confidence Interval: -38.24 to 138.86

Sputum Weight at Baseline in Response to First Dose of Treatment

Sputum was collected during and for 30 minutes following the administration of the first dose of study treatment.

Mannitol 400mg

4.9
g (Mean)
Standard Deviation: 6.18

Control

3.5
g (Mean)
Standard Deviation: 4.40

Total

305
Participants

Age, Categorical

CF mutation

Hospitalisations in year prior to study participation

Pulmonary exacerbations in year prior to study participation

Race (NIH/OMB)

Region of Enrollment

Sex: Female, Male

Randomisation to First Dose

Mannitol 400mg

Control

Double Blind Treatment Period

Mannitol 400mg

Control

Drop/Withdrawal Reasons

Mannitol 400mg

Control