Clinical Trial Details
— Status: Active, not recruiting
Administrative data
NCT number |
NCT05011656 |
Other study ID # |
PURIFY Multi-center RCT |
Secondary ID |
|
Status |
Active, not recruiting |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
December 21, 2021 |
Est. completion date |
April 30, 2023 |
Study information
Verified date |
December 2022 |
Source |
Henry M. Jackson Foundation for the Advancement of Military Medicine |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
This study is a multi-center, randomized controlled feasibility trial to evaluate the initial
safety and efficacy of a novel extracorporeal blood purification (EBP) therapy in critically
ill patients with pathogen associated shock across 15 U.S. sites. Adults (18 years old and
older) admitted to the ICU with all of the following:
• Pathogen associated shock defined as:
- The need for vasopressors to maintain mean arterial pressure (MAP) ≥ 65 mmHg despite
adequate fluid resuscitation
- Presence of a pathogen detected in the bloodstream within 72 hours of screening using
commercially available in-vitro diagnostic testing
Description:
Patients meeting the eligibility criteria will be randomized to receive either treatment with
the investigational device (Seraph 100) + 'State of the Art' care versus 'State of the Art'
care alone. This study is a multi-center, un-blinded, randomized controlled feasibility trial
to evaluate the initial safety and efficacy of Seraph 100 in critically ill patients with
pathogen associated shock across 15 US sites. This study will not be done in a blinded
fashion from either the patient or caregiver perspective given: 1) the need for invasive,
central line placement, and 2) to ensure that limited hospital resources (e.g., hemodialysis
machines) are available for patients that require therapy. While the study trial will not be
conducted in a blinded fashion, the members of the study team that do the data analysis will
be blinded.
The target population is adults (18 years old and older) admitted to the ICU with all of the
following:
- Pathogen associated shock AND
- The need for vasopressors at any dose to maintain mean arterial pressure (MAP) ≥ 65 mm
Hg despite adequate fluid resuscitation.
Study Arms: Patients will be randomized to receive either Arm 1: Seraph 100 treatment plus
'State of the Art' or Arm 2: 'State of the Art' care alone. "State of the Art care" will be
defined as the treatment algorithms outlined in the Surviving Sepsis Campaign for the
treatment of septic shock, available at https://www.sccm.org/SurvivingSepsisCampaign/Home.
Study Randomization and stratification: Patients who qualify will be immediately randomized.
The study will randomize patients 2:1 to investigational product plus 'State of the Art' care
and 'State of the Art' alone, respectively. Upon randomization, patients will be stratified
by age (≥65 and <65). While ideally, the research team would stratify by other variables (to
include demographics, causative pathogen, GCS, SOFA, associated organ failure, and
pre-existing conditions), given the small number of patients in this trial (particularly in
the control group) this is not possible.
The Seraph 100 Microbind® Affinity Blood Filter (Seraph 100) manufactured by ExThera Medical
Corporation in Martinez, CA.
Investigational Treatment Duration for Seraph 100: A sufficient blood flow rate and exposure
of the patient's blood to the Seraph 100 adsorption media will optimize the treatment success
with a target total filtered blood volume of 100L per day. Based on the target total filtered
blood volume of 100L, the average treatment duration and blood flow rates are captured below:
Average Blood Flow Rate Treatment Duration 350 ml/min 5 hours 300 ml/min 6 hours 250 ml/min 7
hours 200 ml/min 8 hours
- At an average blood flow of 350mL/min, this would translate to almost 5 hours of
treatment time; an average of 200mL/min would mean a treatment time of 8 hours.
- Treatments will occur daily for up to 4 consecutive days or until all of the following
criteria are met:
- Vasopressor-free for >24h
- MAP≥65
- Treatments will be held if subjects are unable to tolerate extra-corporeal therapy
(defined as MAP<65 despite fluids and vasopressors)
Patients will be assessed daily while hospitalized as part of routine, standard of care in
the ICU. All patients enrolled in this study will undergo clinical efficacy, safety, and
laboratory assessments. Blood, urine, and respiratory samples will be obtained at baseline,
Day 1 (pre/post treatment) through Day 4, Day 7, and Day 28. Demographic and baseline
clinical parameters will be recorded at the time of randomization. Pertinent clinical
parameters will be recorded hourly for the first 96 hours, once on day 7, and once on day 28.
SOFA scores will be recorded daily for the first 7 days. Outcomes data will be recorded on
day 28 and at the time of hospital discharge or death. Patient status will be assessed at 30,
60, and 90 days to include vital signs, physical examination, adverse event evaluation, and a
targeted medication review. Survival status will be assessed 90 days after enrollment (if the
patient is no longer hospitalized).
The first 10 patients randomized to interventional therapy, as well as the first 5 patients
randomized to the control group, will undergo additional pharmacokinetic (PK) evaluation of
antimicrobial removal by the filter treatment. These first 15 total patients enrolled must
also meet all requirements for the main portion of the study.
As part of the initial PK study, the Data Safety Monitoring Board (DSMB) will also review
safety data after the first 5 device patients consented and treated. Safety and PK data will
also be reviewed after the first 10 device patients are consented and treated. If there are
significant safety concerns after DSMB review, the sponsor will immediately pause the trial
and communicate the information with the FDA.
The PK results of the first 10 treatment patients will be reported to FDA for review to
confirm the proposed dosing prior to commencing enrollment of the remaining subjects for a
total of 60 patients.