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Trial registered on ANZCTR
Registration number
ACTRN12624000333516
Ethics application status
Approved
Date submitted
28/02/2024
Date registered
26/03/2024
Date last updated
26/03/2024
Date data sharing statement initially provided
26/03/2024
Type of registration
Retrospectively registered
Titles & IDs
Public title
SCIP RHD: Subcutaneous injection of benzathine Penicillin G (BPG) in people with rheumatic fever
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Scientific title
Safety, tolerability and acceptability of high dose, subcutaneous injection of benzathine penicillin G (Bicillin® L-A) in children and young adults with rheumatic fever
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Secondary ID [1]
311624
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
This study is linked to ACTRN12622000916741
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Health condition
Health condition(s) or problem(s) studied:
rheumatic fever
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rheumatic heart disease
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Condition category
Condition code
Cardiovascular
329739
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0
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Other cardiovascular diseases
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Infection
329740
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0
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Other infectious diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This is a Phase II trial to test the safety, tolerability, acceptance, and pharmaco-equivalence of high dose subcutaneous Bicillin® L-A in children and young adults living with rheumatic fever and regularly receiving intramuscular benzathine penicillin G (BPG) injections. 70 to 91 days after the participants have taken part in ACTRN12622000916741, they will be offered the opportunity to remain on high dose (11.5mL/13.8MIU-20.7mL/10.8MIU) subcutaneous injection of Bicillin® L-A as an alternative to their regular monthly intramuscular BPG injection. Subcutaneous injection of high dose Bicillin, will be administered by the study nurse every 70-91 days for a period of 18 months. Electronic medical records will be utilised to monitor adherence to the high dose Bicillin.
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Intervention code [1]
328080
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Treatment: Drugs
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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To measure adherence to long-term (18 months) high dose Bicillin® L-A administered by subcutaneous injection.
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Assessment method [1]
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Participants will have one-on-one face-to-face semi-structured interviews designed for this study to understand lived experiences of receiving regular subcutaneous BPG injections, in comparison to their regular intramuscular BPG. Interviews will occur after participants have been on SCIP for at least one-year. Interviews will be audio recorded, hand written notes will also be taken of key discussion points.
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Timepoint [1]
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18 months post-baseline
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Primary outcome [2]
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To measure the time (in days) that penicillin concentrations remain above the minimum inhibitory concentration (0.02mg/mL) for Streptococcus pyogenes following high dose Bicillin® L-A administered by subcutaneous injection.
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Assessment method [2]
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Dried blood samples to ascertain the outcome will be taken at: baseline (prior to dosing) of Bicillin ®L-A infusion, across a one-year period.
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Timepoint [2]
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Every 70-91 days across an 18-month period post baseline.
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Secondary outcome [1]
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To compare prior adherence to intramuscular BPG to adherence to subcutaneous injection of BPG.
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Assessment method [1]
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Regional BPG registers.
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Timepoint [1]
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One year prior to starting subcutaneous injections and one year of being on subcutaneous injections.
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Eligibility
Key inclusion criteria
Aged 6 years of age or older with a prior diagnosis of rheumatic fever or rheumatic heart disease.
Currently on secondary prophylaxis.
No prior documented allergy to penicillin, cephalosporin antibiotics.
Normally reside in New Zealand.
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Minimum age
6
Years
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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
History of adverse drug reaction or hypersensitivity.
Planned absence from their usual place of residence during the study trial.
History within the last 12 months of intramuscular, or subcutaneous injection of the abdominal wall, or history of surgery to the buttocks, abdomen or abdominal wall within the last 12 months.
Pregnancy.
Scarring or superficial changes on the abdomen.
Dermatological conditions that affect the abdomen.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Non-randomised 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
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Phase 2
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
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Actual
1/06/2023
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Date of last participant enrolment
Anticipated
31/08/2025
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Actual
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Date of last data collection
Anticipated
28/02/2027
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Actual
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Sample size
Target
65
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Accrual to date
20
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Final
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
26179
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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Te Niwha
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Address [1]
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Country [1]
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New Zealand
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Primary sponsor type
University
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Name
University of Otago
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Address
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Country
New Zealand
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
318084
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Country [1]
318084
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Southern Health and Disability Ethics Committee
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Ethics committee address [1]
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https://ethics.health.govt.nz/about/southern-health-and-disability-ethics-committee/
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Ethics committee country [1]
314777
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New Zealand
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Date submitted for ethics approval [1]
314777
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08/05/2023
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Approval date [1]
314777
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25/05/2023
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Ethics approval number [1]
314777
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Summary
Brief summary
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) almost exclusively affect Indigenous Maori and Pacific children and young adults living in socio-economically deprived areas of the North Island in Aotearoa, New Zealand. Across the Tasman, the associated morbidity from RHD is the leading driver of cardiovascular inequality for Indigenous Australians. For 70 years, the only proven way to prevent ARF progression has been benzathine penicillin G (BPG), given as a monthly intramuscular (IM) injection. The effectiveness of this approach is limited by pain and the frequency of injection which leads to sub-optimal adherence. There is an urgent need to improve penicillin formulations for all children living with ARF/RHD. Based on previous work we have shown that penicillin can be delivered as an ‘implant’ if given as a high-dose subcutaneous (SC) infusion, which allows for sustained penicillin concentrations (>3 months). This approach fulfils the ideal product characteristics for the next generation of long-acting penicillin. Our Phase I trial (ACTRN12621000135819) showed that SCIP was tolerable and provided sustained penicillin concentrations in healthy adults and our Phase II trial (ACTRN12622000916741) has shown that children and young adults who are currently receiving monthly BPG injections for their ARF/RHD, prefer to have Bicillin ®L-A delivered by subcutaneous injection every 70/91 days (depending on weight). This study will follow a cohort of children and young adults who wish to remain on Bicillin ®L-A delivered by subcutaneous injection across an extended timeframe (minimum one-year).
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Trial website
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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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Dr Julie Bennett
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Address
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University of Otago, 23A Mein Street, Newtown, Wellington 6021
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Country
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New Zealand
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Phone
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+64 21321993
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Julie Bennett
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Address
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University of Otago, 23A Mein Street, Newtown, Wellington 6021
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Country
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New Zealand
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Phone
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+64 21321993
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Julie Bennett
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Address
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University of Otago, 23A Mein Street, Newtown, Wellington 6021
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Country
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New Zealand
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Phone
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+64 21321993
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Fax
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Email
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[email protected]
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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
Individual participant data will not be made publicly available.
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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