Cystic Fibrosis Clinical Trial
Official title:
Effect of Doxycycline on Sputum Biomarkers of Inflammation and Lung Epithelial Repair in Patients With Cystic Fibrosis.
Doxycycline is known to exhibit immune modulatory activities beyond its antibacterial
effects. In particular, doxycycline is a potent inhibitor of matrix metalloproteinase 9,
which is a protease derived largely from neutrophils. Recent studies demonstrate a
significant correlation between pulmonary disease severity and sputum concentrations of
MMP-9 in patients with CF. In addition, sputum MMP-9 levels are associated with airway
remodeling in CF.
The goal of this study is to determine the therapeutic potential of doxycycline in
modulating host airway inflammation in patients with CF. Specifically, the study will
characterize the PK /PD of doxycycline, evaluate the safety of short term therapy, and
explore the concentration effect relationship between doxycycline exposure and sputum
biomarker levels.
This study will consist of a prospective, open-label, randomized, controlled trial conducted
in 24 patients with cystic fibrosis. Twenty subjects will be stratified in a 1:2 ratio based
on baseline FEV1 into mild (> 70%) or moderate (40-70%) pulmonary disease in order to
control for disease severity within each dose level. The subjects will be randomized in
blocks of four to receive no drug, 40mg, 100mg, or 200mg daily for 28 days.
Sputum samples will be obtained in all groups by induction with hypertonic saline at
baseline, 8, 24, and 48 hours following the first dose and then weekly for 4 weeks. Sputum
will also be collected at two follow up visits after the treatment period at weeks 5 and 6.
In the doxycycline group, serial blood samples (5 mL) for determination of doxycycline
concentrations will be obtained before and at 0, 0.5, 1, 2, 4, 12, 24, and 48 hours
following the 1-hr infusion of a single IV dose. Once daily dosing of doxycycline will
resume immediately following the 48-hour blood sample and will continue until day 28.
Additional levels will be obtained pre-dose, and 1, 2, and 3 hours after doses administered
on days 14 and 28. A sample of blood will be obtained at baseline, and at days 28 for
inflammatory marker analyses.
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