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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04544293
Registration number
NCT04544293
Ethics application status
Date submitted
3/09/2020
Date registered
10/09/2020
Titles & IDs
Public title
Clinical Trial of Inhaled Molgramostim Nebulizer Solution in Autoimmune Pulmonary Alveolar Proteinosis (aPAP)
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Scientific title
A Randomized, Double-blind, Placebo-controlled Clinical Trial of Once-daily Inhaled Molgramostim Nebulizer Solution in Adult Subjects With Autoimmune Pulmonary Alveolar Proteinosis (aPAP)
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Secondary ID [1]
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2020-001263-85
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Secondary ID [2]
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SAV006-05
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Universal Trial Number (UTN)
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Trial acronym
IMPALA-2
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Autoimmune Pulmonary Alveolar Proteinosis
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Condition category
Condition code
Respiratory
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Other respiratory disorders / diseases
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Inflammatory and Immune System
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Autoimmune diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Molgramostim
Treatment: Drugs - Placebo
Experimental: Molgramostim - Double-blind treatment with molgramostim nebulizer solution 300 µg once daily for 48 weeks, followed by open-label treatment with molgramostim nebulizer solution 300 µg once daily for 96 weeks
Placebo comparator: Placebo - Double-blind treatment with placebo nebulizer solution once daily for 48 weeks, followed by open-label treatment with molgramostim nebulizer solution 300 µg once daily for 96 weeks
Treatment: Drugs: Molgramostim
Molgramostim 300 µg nebulizer solution
Treatment: Drugs: Placebo
Matching placebo
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Change from baseline in percentage (%) predicted diffusing capacity of the lung for carbon monoxide (DLCO) to Week 24
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Assessment method [1]
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As a measure of pulmonary gas exchange, a standardized lung function test, DLCO, will be conducted. The single-breath DLCO test will be performed in accordance with American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines for DLCO testing.
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Timepoint [1]
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From Baseline to Week 24
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Secondary outcome [1]
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Change from baseline in percentage (%) predicted DLCO to Week 48
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Assessment method [1]
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As a measure of pulmonary gas exchange, a standardized lung function test, DLCO, will be conducted. The single-breath DLCO test will be performed in accordance with ATS/ERS guidelines for DLCO testing.
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Timepoint [1]
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From Baseline to Week 48
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Secondary outcome [2]
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Change from baseline in St. Georges Respiratory Questionnaire (SGRQ) Total score to Week 24
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Assessment method [2]
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The SGRQ includes questions related to three components: Activity (activities that cause or are limited by breathlessness), Impact (social functioning and psychological disturbances resulting from airway disease), and Symptoms (respiratory symptoms, their frequency and severity). The questionnaire has a recall period of 4 weeks for Symptoms, whereas Activity and Impact components address the subject's current state. The subjects will be asked to grade their current health on a 5-point scale (very poor, poor, fair, good, or very good).
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Timepoint [2]
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From Baseline to Week 24
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Secondary outcome [3]
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Change from baseline in SGRQ Activity component score to Week 24
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Assessment method [3]
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The SGRQ includes questions related to three components: Activity (activities that cause or are limited by breathlessness), Impact (social functioning and psychological disturbances resulting from airway disease), and Symptoms (respiratory symptoms, their frequency and severity). The questionnaire has a recall period of 4 weeks for Symptoms, whereas Activity and Impact components address the subject's current state. The subjects will be asked to grade their current health on a 5-point scale (very poor, poor, fair, good, or very good).
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Timepoint [3]
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Week 24
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Secondary outcome [4]
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Change from baseline in exercise capacity (EC), expressed as peak metabolic equivalents (METs) to Week 24
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Assessment method [4]
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As a functional measure of exertional limitations related to dyspnea, EC will be assessed by an exercise treadmill test. EC will be expressed in peak METs (1 MET=3.5 mL O2/kg/min). The highest treadmill speed and grade achieved will be used to calculate peak METs.
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Timepoint [4]
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From Baseline to Week 24
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Secondary outcome [5]
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Change from baseline in SGRQ Total score to Week 48
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Assessment method [5]
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The SGRQ includes questions related to three components: Activity (activities that cause or are limited by breathlessness), Impact (social functioning and psychological disturbances resulting from airway disease), and Symptoms (respiratory symptoms, their frequency and severity). The questionnaire has a recall period of 4 weeks for Symptoms, whereas Activity and Impact components address the subject's current state. The subjects will be asked to grade their current health on a 5-point scale (very poor, poor, fair, good, or very good).
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Timepoint [5]
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Week 48
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Secondary outcome [6]
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Change from baseline in SGRQ Activity from baseline to Week 48
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Assessment method [6]
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The SGRQ includes questions related to three components: Activity (activities that cause or are limited by breathlessness), Impact (social functioning and psychological disturbances resulting from airway disease), and Symptoms (respiratory symptoms, their frequency and severity). The questionnaire has a recall period of 4 weeks for Symptoms, whereas Activity and Impact components address the subject's current state. The subjects will be asked to grade their current health on a 5-point scale (very poor, poor, fair, good, or very good).
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Timepoint [6]
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From Baseline to Week 48
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Secondary outcome [7]
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Change from baseline in EC, expressed as peak METs to Week 48
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Assessment method [7]
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As a functional measure of exertional limitations related to dyspnea, EC will be assessed by an exercise treadmill test. EC will be expressed in peak METs (1 MET=3.5 mL O2/kg/min). The highest treadmill speed and grade achieved will be used to calculate peak METs.
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Timepoint [7]
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From Baseline to Week 48
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Secondary outcome [8]
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Change from baseline in alveolar-arterial oxygen difference (A-aDO2) to Week 24 (Specifically for Japan and South Korea)
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Assessment method [8]
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A-aDO2 will be used as an additional measure of gas exchange.
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Timepoint [8]
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From Baseline to Week 24
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Secondary outcome [9]
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Number of subjects with serious and non-serious adverse events
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Assessment method [9]
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Assessment of the safety of MOL compared to placebo
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Timepoint [9]
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From screening (6-week) until Follow-up visit (Week 100)
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Secondary outcome [10]
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Number of subjects with positive treatment-boosted anti Granulocyte macrophage colony stimulating factor (GM-CSF) antibody titers during 24 weeks' treatment and during 48 weeks' treatment
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Assessment method [10]
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Assessment of the safety of MOL compared to placebo
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Timepoint [10]
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From screening (6-week) until Follow-up visit (Week 100)
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Secondary outcome [11]
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Changes in Forced vital capacity (FVC)
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Assessment method [11]
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Assessment of the safety of MOL compared to placebo
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Timepoint [11]
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From Baseline to Weeks 24 and 48
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Secondary outcome [12]
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Changes in Forced expiratory volume in one second (FEV1)
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Assessment method [12]
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Assessment of the safety of MOL compared to placebo
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Timepoint [12]
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From Baseline to Weeks 24 and 48
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Secondary outcome [13]
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Change in QT interval corrected by Fridericia (QTcF)
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Assessment method [13]
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Assessment of the safety of MOL compared to placebo
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Timepoint [13]
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From Baseline to Weeks 4 and 24
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Eligibility
Key inclusion criteria
1. Subject must be =18 years of age, at the time of signing the informed consent (=20 in Japan).
2. A serum anti-GM-CSF autoantibody test result confirming autoimmune PAP.
3. History of PAP, based on examination of a lung biopsy, bronchoalveolar lavage (BAL) cytology, or a high-resolution computed tomogram (HRCT) of the chest.
4. DLCO 70% predicted or lower at the screening and baseline visits.
5. Change in % predicted DLCO of <15% points during the screening period.
6. Demonstrated functional impairment in the treadmill exercise test (defined as a peak MET =8).
7. Willing and able to come off supplemental oxygen use prior to and during the treadmill exercise test, the DLCO assessment, and the arterial blood gas sampling.
8. Resting SpO2 >85% during 15 minutes without use of supplemental oxygen at the screening visits.
9. Male or female
10. Contraceptive use by men or women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
1. Male subjects: Males agreeing to use condoms during and until 30 days after last dose of trial treatment, or males having a female partner who is using adequate contraception as described below.
2. Female subjects: Females who have been post-menopausal for >1 year, or females of childbearing potential after a confirmed menstrual period using a highly efficient method of contraception (i.e. a method with <1% failure rate such as combined hormonal contraception, progesterone-only hormonal contraception, intrauterine device, intrauterine hormone-releasing system, bilateral tubal occlusion, vasectomized partner, sexual abstinence*), during and until 30 days after last dose of trial treatment. Females of childbearing potential must have a negative serum pregnancy test at the screening visits, and a negative urine pregnancy test at Baseline visit (Visit 3) and must not be lactating.
11. Capable of giving signed informed consent as described in Appendix 1 which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.
12. Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other trial procedures specified in the protocol as judged by the Investigator.
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Minimum age
18
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Diagnosis of hereditary or secondary PAP, or a metabolic disorder of surfactant production.
2. WLL performed within 3 months prior to baseline.
3. Requirement for WLL at screening or baseline.
4. GM-CSF treatment within 6 months prior to baseline.
5. Treatment with rituximab within 6 months prior to baseline.
6. Treatment with plasmapheresis within 6 weeks prior to baseline.
7. Treatment with any investigational medicinal product within 5 half-lives or 3 months (whichever is longer) prior to baseline.
8. Previously randomized in this trial.
9. History of allergic reactions to GM-CSF or any of the excipients in the nebulizer solution.
10. Inflammatory or autoimmune disease of a severity that necessitates significant (e.g. more than 10 mg/day systemic prednisolone) immunosuppression.
11. Previous experience of severe and unexplained side-effects during aerosol delivery of any kind of medicinal product.
12. History of, or present, myeloproliferative disease or leukemia.
13. Apparent pre-existing concurrent pulmonary fibrosis.
14. Acute or unstable cardiac or pulmonary disease that may be aggravated by exercise.
15. Known active infection (viral, bacterial, fungal, or mycobacterial) that may affect the efficacy evaluation in the trial.
16. Physical disability or other condition that precludes safe and adequate exercise testing.
17. Any other serious medical condition which in the opinion of the Investigator would make the subject unsuitable for the trial.
18. Pregnant, planning to become pregnant during the trial, or breastfeeding woman. For France only: including as further defined by French Health Code L-1121-5.
19. For France only: Any subject considered to be "vulnerable" on account of, e.g., mental or physical disability, socio-economic situation, or subjects deprived of their liberty. For France only: including as further defined by French Health Code L1121-8-1.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Active, not recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
10/05/2021
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/06/2025
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Actual
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Sample size
Target
160
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
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Royal Prince Alfred Hospital - Camperdown
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Recruitment hospital [2]
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Westmead Hospital - Westmead
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Recruitment postcode(s) [1]
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2050 - Camperdown
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Recruitment postcode(s) [2]
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2145 - Westmead
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Recruitment outside Australia
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United States of America
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Arkansas
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California
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United States of America
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Colorado
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Connecticut
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Florida
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United States of America
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Georgia
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Illinois
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Maryland
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Missouri
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North Carolina
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Ohio
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Pennsylvania
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Texas
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Belgium
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Région De Bruxelles-Capitale
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Belgium
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Vlaams Brabant
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Canada
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Alberta
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Canada
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Ontario
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Canada
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Québec
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France
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State/province [19]
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Auvergne-Rhône-Alpes
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France
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Bretagne
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Germany
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Germany
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Germany
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Nordrhein-Westfalen
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Greece
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Athens
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Ireland
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Dublin
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Italy
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Lombardia
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Japan
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Hokkaidô
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Japan
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Kanagawa
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Japan
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Miyagi
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Japan
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Osaka
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Japan
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Tokyo
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Japan
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Chiba
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Japan
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Kumamoto
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Japan
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Nagakute
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Japan
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Saitama
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Korea, Republic of
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Seoul
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Netherlands
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Utrecht
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Poland
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Mazowieckie
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Portugal
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Lisboa
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Portugal
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Porto
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Romania
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Bucuresti
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Spain
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Cataluña
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Turkey
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Izmir
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Turkey
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Ankara
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Turkey
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Istanbul
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United Kingdom
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London
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Funding & Sponsors
Primary sponsor type
Commercial sector/industry
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Name
Savara Inc.
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Address
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Ethics approval
Ethics application status
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Summary
Brief summary
160 subjects with autoimmune pulmonary alveolar proteinosis (aPAP) will be randomized to receive once daily treatment with inhaled molgramostim or placebo for 48 weeks. Subjects completing the 48 week placebo-controlled period will receive open-label treatment with once daily inhaled molgramostim for 96 weeks.
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Trial website
https://clinicaltrials.gov/study/NCT04544293
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Bruce Trapnell, MD
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Address
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Children's Hospital Medical Center, Cincinnati
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT04544293