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Trial · Interventional

TerminatedPhase 2/3Results postedRegistry data

Selepressin Evaluation Programme for Sepsis-Induced Shock - Adaptive Clinical Trial

Short name SEPSIS-ACT

NCTNCT02508649 (opens ClinicalTrials.gov in a new tab)Other id000133Other id2014-003973-41Other id2014

Overview

Status
Terminated
Phase
Phase 2/3
Enrollment
868 participants (actual)
Sponsor
Ferring Pharmaceuticals · Industry
Design
Randomized · Double masking
Countries
5 countries

United States, Belgium, Denmark, France, Netherlands

Start
Jul 2015
Primary completion
3 Oct 2017
Completion
26 Feb 2018
First posted
27 Jul 2015 (estimated)
Last update posted
6 Apr 2021
Conditions
Septic Shock

Timeline

1 trial · 1 stopped early · 1 with posted results

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
20152016201720182019
  1. Ph 2/3

    SEPSIS-ACT

    NCT02508649

    Jul 2015 to 26 Feb 2018

    Terminated

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

This is a double-blind, randomised, placebo-controlled, two-part adaptive clinical trial. The trial is designed to investigate the efficacy and safety of multiple dosing regimens of selepressin and to confirm the efficacy and safety of one dosing regimen in treatment of adult patients with septic shock requiring vasopressor.

Interventions

  • selepressinDrug
  • placeboDrug

Arms5

  • Placebo comparator

    Placebo

  • Experimental

    Selepressin 1

    Starting dose 1.7 ng/kg/min

  • Experimental

    Selepressin 2

    Starting dose 2.5 ng/kg/min

  • Experimental

    Selepressin 3

    Starting dose 3.5 ng/kg/min

  • Experimental

    Selepressin 4

    Starting dose 5.0 ng/kg/min The highest dosing regimen of selepressin was not investigated in the trial as the desired primary outcome for selepressin 3 arm was not achieved, and the trial was terminated for futility.

Primary outcomes1

Outcomes the sponsor listed as primary.

  1. Vasopressor- and Mechanical Ventilator-free Days (PVFDs)

    Time frame · Up to Day 30

    Registry description

    Composite endpoint defined as number of days from start of treatment to 30 days thereafter during which subject is: 1. Alive. However, if patient dies within these 30-days then PVFDs will be zero even if there is a period during which subject is alive and free of both vasopressor treatment and mechanical ventilation; 2. Free of treatment with vasopressors: Less than 60 min during any contiguous 24-h period. If a patient requires vasopressors longer than 60 min in total during any 24-h period, the intervening intervals during which they are free of vasopressors will not be included in the determination of PVFDs; 3. Free of any mechanical ventilation: Less than 60 min during any contiguous 24-h period. If a patient requires mechanical ventilation longer than 60 min in total during any 24-h period, the intervening intervals during which they are not receiving mechanical ventilation will not be included in the period free of mechanical ventilation in the determination of PVFDs.

Secondary outcomes(19)
  1. All-cause Mortality

    Time frame · At Day 90

    Registry description

    All-cause mortality defined as the percentage of subjects that have died, regardless of cause.

  2. Renal Replacement Therapy (RRT)-Free Days

    Time frame · Up to Day 30

    Registry description

    RRT-free days was defined as the number of days a subject is free of treatment with any form of RRT (continuous RRT, intermittent hemodialysis or peritoneal dialysis) and the intermittent periods were not included. RRT-free days was analyzed excluding subjects on RRT for chronic renal failure at time of randomization.

  3. Intensive Care Unit (ICU)-Free Days

    Time frame · Up to Day 30

    Registry description

    The ICU free days, as for the PVFDs, reflect the time from last discharge of the ICU to Day 30 with an absolute penalty for mortality, i.e., any subject that died within this 30-day period was assigned zero value).

  4. Vasopressor-free Days up to Day 30

    Time frame · Up to Day 30

    Registry description

    Number of days from start of treatment to 30 days thereafter during which the subject is free of treatment with vasopressors, i.e. less than 60 min during any contiguous 24-h period.

  5. Mechanical Ventilator-free Days up to Day 30

    Time frame · Up to Day 30

    Registry description

    Number of days from start of treatment to 30 days thereafter during which the subject is free of any mechanical ventilation, i.e. less than 60 min during any contiguous 24-h period.

  6. Duration of Septic Shock (i.e. Vasopressor Use) up to Day 30

    Time frame · Up to Day 30

    Registry description

    The duration of septic shock was defined as the cumulative periods (\>1 h), from start of investigational medicinal product (IMP) treatment until Day 30, on IMP or vasopressors.

  7. Duration of Mechanical Ventilation up to Day 30

    Time frame · Up to Day 30

    Registry description

    The duration of mechanical ventilation was defined as the cumulative periods (\>1 h), from start of the IMP treatment until Day 30, on mechanical ventilation.

  8. The Percentage of Subjects With RRT up to Day 30 (Counting Subjects Who Died as on RRT and Excluding Subjects on RRT for Chronic Renal Failure at the Time of Randomization)

    Time frame · Up to Day 30

    Registry description

    Renal replacement therapy is defined as continuous RRT, intermittent hemodialysis, or peritoneal dialysis. In order to ensure that any reduction in the incidence of RRT was not caused by an increase in mortality, all subjects dying within the 30-day period were counted as on RRT.

  9. Duration of RRT up to Day 90 (Excluding Subjects on RRT for Chronic Failure at the Time of Randomization)

    Time frame · Up to Day 90

    Registry description

    The duration of RRT was defined as the cumulative periods (\>1 h) from start of IMP until Day 90 with RRT (continuous renal replacement therapy, intermittent hemodialysis, or peritoneal dialysis). Subjects on RRT for chronic renal failure at time of randomization were not included in the analysis.

  10. Overall and Individual Organ (Cardiovascular, Respiratory, Renal, Hepatic, Coagulation) Scores Using a Modified Version of the SOFA up to Day 7 or Until ICU Discharge

    Time frame · Days 1, 3, and 7 or discharge from ICU

    Registry description

    The presence of 5 organ dysfunctions (cardiovascular, respiratory, renal, hepatic, coagulation) was assessed using a modified Sequential Organ Failure Assessment (SOFA) (i.e. SOFA except the Glasgow Coma Scale). In addition, any dose of vasopressors or positive ionotropes will attribute 3 or 2 points on the cardiovascular scale, respectively. Each organ has a possible dysfunction score of 0 (no organ dysfunction) to 4 (dysfunctional organ), for a total modified SOFA score range of 0 (no organ dysfunction) to 23 (all organs with dysfunction).

  11. Percentage of Subjects With New Organ Dysfunction and New Organ Failure (Based on the SOFA Score) up to Day 7 and Day 30

    Time frame · Up to Day 7 and Day 30

    Registry description

    The presence of 5 organ dysfunctions (cardiovascular, respiratory, renal, hepatic, coagulation) was assessed using a SOFA score. Each organ has a possible dysfunction score of 0 (no organ dysfunction) to 4 (all organs with dysfunction). Incidence of new organ dysfunction is defined as an increase ≥ 1 from baseline to post baseline up until the end of the period (e.g. going from 1-2) in any of the individual SOFA scores. Incidence of new organ failures is defined as a change in any of the individual SOFA scores from (0-2) at baseline to (3-4) post baseline up until the end of the period (Day 7 or 30) (if the SOFA scores goes from (0-2) to (3-4) and back to (0-2) again within the period, that will still count as a new organ failure). Percentage of subjects with new organ dysfunction and new organ failure (based on the SOFA Score) up to Day 7 and Day 30 are reported.

  12. ICU Length of Stay up to Day 30

    Time frame · Up to Day 30

    Registry description

    ICU length of stay is defined as the cumulative periods (\>1 h) spent in ICU from start of IMP to 30 days after.

  13. All-cause Mortality (Defined as the Percentage of Subjects That Have Died, Regardless of Cause) at Day 30 and Day 180

    Time frame · At Day 30 and Day 180

    Registry description

    All-cause mortality defined as the percentage of subjects that have died, regardless of cause.

  14. Daily Fluid Balance Until ICU Discharge (for a Maximum of 7 Days)

    Time frame · Baseline and Days 1-7

    Registry description

    Fluid balance (as a rate of time) calculated for fluid administered during episode of severe sepsis/septic shock will be presented until ICU discharge (for a maximum of 7 days).

  15. Cumulative Fluid Balance Until ICU Discharge (for a Maximum of 7 Days)

    Time frame · Baseline and Days 1-7

    Registry description

    Cumulative fluid balance (total volume) calculated for fluid administered during episode of severe sepsis/septic shock will be presented until ICU discharge (for a maximum of 7 days).

  16. Daily Urine Output Until ICU Discharge (for a Maximum of 7 Days)

    Time frame · Baseline and Days 1-7

  17. Cumulative Urine Output Until ICU Discharge (for a Maximum of 7 Days)

    Time frame · Baseline and Days 1-7

    Registry description

    Cumulative urinary output (absolute values) will be presented until ICU discharge (for a maximum of 7 Days).

  18. Utility, Based on the EuroQol Group's 5-dimension 5-level (EQ-5D-5L) Questionnaire, up to Day 180

    Time frame · Baseline and Days 30, 60, 90 and 180

    Registry description

    The EuroQoL-5-Dimensions (EQ-5D™) was used to assess the overall health of each subject. EQ-5D™ is a standardised instrument for use as a measure of health outcome. The first part of the instrument includes 5 dimensions where the subject indicates which of the given statements best describes the health state on the day of questionnaire completion. The second part contains a visual analogue scale (VAS) where the subject indicates how good or bad his or her own health is on the day of questionnaire completion. EQ-5D-5L will be analyzed by the index value (Range: 0-1; 0=dead state, 1=full health state), the overall quality-adjusted life year (QALY), and the VAS score (Range: 0-100; 0=worst health state, 100=best health state). The EQ-5D-5L was completed at baseline and at the scheduled follow-up days (i.e. Day 30, Day 60, Day 90, and Day 180). Data for EQ VAS score and EQ-5D-5L index score are reported in this endpoint.

  19. Utility, Based on the EuroQol Group's 5-dimension 5-level (EQ-5D-5L) Questionnaire, up to Day 180

    Time frame · Days 30, 60, 90 and 180

    Registry description

    The EQ-5D™ was used to assess the overall health of each subject. EQ-5D™ is a standardised instrument for use as a measure of health outcome. The first part of the instrument includes 5 dimensions where the subject indicates which of the given statements best describes the health state on the day of questionnaire completion. The second part contains a VAS where the subject indicates how good or bad his or her own health is on the day of questionnaire completion. EQ-5D-5L will be analyzed by the index value (Range: 0-1; 0=dead state, 1=full health state), the overall QALY, and the VAS score (Range: 0-100; 0=worst health state, 100=best health state). The EQ-5D-5L was completed at baseline and at the scheduled follow-up days (i.e. Day 30, Day 60, Day 90, and Day 180). Data for EQ-5D-5L QALY is reported in this endpoint.

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

Primary outcome results

Primary outcomeLeast squares mean· Up to Day 30

Vasopressor- and Mechanical Ventilator-free Days (PVFDs)

GroupValue (days)
Placebo14.45
Selepressin Pooled15.00
Secondary and other outcome results(7)
Secondary outcomeNumber· At Day 90

All-cause Mortality

GroupValue (percentage of subjects)
Placebo39.44
Selepressin Pooled40.59
Secondary outcomeLeast squares mean· Up to Day 30

Renal Replacement Therapy (RRT)-Free Days

GroupValue (days)
Placebo18.21
Selepressin Pooled18.50
Secondary outcomeLeast squares mean· Up to Day 30

Intensive Care Unit (ICU)-Free Days

GroupValue (days)
Placebo12.15
Selepressin Pooled12.64
Secondary outcomeMedian· Up to Day 30

Vasopressor-free Days up to Day 30

GroupValue (days)
Placebo25.30
Selepressin 2.5 ng/kg/Min25.60
Selepressin 3.75 ng/kg/Min23.30
Selepressin 5.25 ng/kg/Min25.30
Selepressin Pooled25.10
Secondary outcomeMedian· Up to Day 30

Mechanical Ventilator-free Days up to Day 30

GroupValue (days)
Placebo19.80
Selepressin 2.5 ng/kg/Min18.90
Selepressin 3.75 ng/kg/Min17.20
Selepressin 5.25 ng/kg/Min17.50
Selepressin Pooled17.50
Secondary outcomeMedian· Up to Day 30

Duration of Septic Shock (i.e. Vasopressor Use) up to Day 30

GroupValue (days)
Placebo2.220
Selepressin 2.5 ng/kg/Min1.660
Selepressin 3.75 ng/kg/Min1.790
Selepressin 5.25 ng/kg/Min1.465
Selepressin Pooled1.635
Secondary outcomeMedian· Up to Day 30

Duration of Mechanical Ventilation up to Day 30

GroupValue (days)
Placebo2.255
Selepressin 2.5 ng/kg/Min1.690
Selepressin 3.75 ng/kg/Min2.800
Selepressin 5.25 ng/kg/Min1.910
Selepressin Pooled1.990

Adverse events, as posted

Adverse events as posted: participants affected out of participants at risk, by group
GroupDeathsSerious eventsOther events
PlaceboSterile 0.9% sodium chloride solution given as an infusion, was used as the placebo.116 / 26685 / 26694 / 266
Selepressin 2.5 ng/kg/MinStarting dose: 1.7 ng/kg/min selepressin; Maximum dose: 2.5 ng/kg/min selepressin, given as an infusion.80 / 19157 / 19154 / 191
Selepressin 3.75 ng/kg/MinStarting dose: 2.5 ng/kg/min selepressin; Maximum dose: 3.75 ng/kg/min selepressin, given as an infusion.76 / 17765 / 17763 / 177
Selepressin 5.25 ng/kg/MinStarting dose: 3.5 ng/kg/min selepressin; Maximum dose: 5.25 ng/kg/min selepressin, given as an infusion.85 / 19457 / 19460 / 194
Selepressin PooledAll selepressin arms pooled together and treated as a single arm.241 / 562179 / 562177 / 562

Each cell reads participants affected / participants at risk, as the registry posted them.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies2

Studies that cite this trial.

More studies

2 studies on this page

PubMed tag: none · 2019

Corrected

Effect of Selepressin vs Placebo on Ventilator- and Vasopressor-Free Days in Patients With Septic Shock: The SEPSIS-ACT Randomized Clinical Trial.

Laterre et al. 2019JAMAcited by 111

PMID 31577035PMC6802260DOI 10.1001/jama.2019.14607PUB-31577035

Rights unknown

Indexing hint: Clinical trial · 2018

Rationale and Design of an Adaptive Phase 2b/3 Clinical Trial of Selepressin for Adults in Septic Shock. Selepressin Evaluation Programme for Sepsis-induced Shock-Adaptive Clinical Trial.

Lewis et al. 2018Annals of the American Thoracic Societycited by 29

PMID 29388815DOI 10.1513/annalsats.201708-669sdPUB-29388815

Full text at the publisher
Publisher page

Eligibility

Who could join, as posted.

Sex
All
Age
from 18 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Inclusion Criteria: * 18 years of age or older * Proven or suspected infection * Septic shock defined as hypotension requiring vasopressor treatment despite adequate fluid resuscitation * Informed consent obtained in accordance with local regulations Exclusion Criteria: * Not possible to initiate trial drug treatment within 12 hours from onset of vasopressor treatment for septic shock * Primary cause of hypotension not due to sepsis * Previous severe sepsis with intensive care unit admission within this hospital stay * Known/suspected acute mesenteric ischaemia * Suspicion of concomitant acute coronary syndrome based on clinical symptoms and/or ECG during this episode of septic shock * Chronic mechanical ventilation for any reason OR severe chronic obstructive pulmonary disease (COPD) requiring either continuous daily oxygen use during the preceding 30 days or mechanical ventilation (for acute exacerbation of COPD) during the preceding 30 days * Received bone marrow transplant during the preceding 6 months or chemotherapy during the preceding 30 days for lymphoma or leukemia * Known to be pregnant * Decision to limit full care taken before obtaining informed consent * Use of vasopressin in the past 12 hours prior to start of trial drug treatment or use of terlipressin within 7 days prior to start of trial drug treatment * Prior enrolment in the trial * Prior use of an investigational medicinal product within the last month OR planned or concurrent participation in a clinical trial for any investigational drug or investigational device

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