Study to Evaluate the Efficacy & Safety of the INTERCEPT Blood System for RBCs in Complex Cardiac Surgery Patients

Summary

Participation Requirements

Description

This is a prospective, multicenter, randomized, double-blinded, active controlled, parallel-design, non-inferiority study. Screening/Recruitment In order to minimize the number of patients who enroll in the study but do not require RBC transfusion, only patients with a relatively high likelihood to ...

This is a prospective, multicenter, randomized, double-blinded, active controlled, parallel-design, non-inferiority study. Screening/Recruitment In order to minimize the number of patients who enroll in the study but do not require RBC transfusion, only patients with a relatively high likelihood to receive a RBC transfusion as determined by the Investigator (e.g., patients receiving aspirin, clopidogrel (or analogs) and/or GPIIb/IIIa inhibitors), or patients with a TRUST Score of ?3 will be eligible for enrollment. Patients ? 11 years of age undergoing complex cardiac surgery may be identified through pre-operative scheduling procedures in advance of their operations. All potentially eligible patients will be approached for study consent prior to their surgical procedure. Subjects who consent to the study will be assigned a study ID number and undergo screening. Screening data collection and procedures will include: Demographics (age, sex), vital signs, height, weight, EKG, type of scheduled surgery, need for irradiated RBCs, medical and surgical history, transfusion history, physical examination, concomitant medications, complete blood count, blood type, blood chemistry, DAT, IAT, specific immune reactivity to IBS RBCs, and pregnancy test (when applicable). A blood sample for HLA antibodies will also be obtained and sent to a central lab. Screening will include documentation of the patient's pre-surgical exposure to radiographic contrast media and number of prior pregnancies (females). Screening data may be derived from the medical record when performed within 7 days of screening. Eligibility status and other study data including all TRUST components will be entered into the clinical database via an electronic data capture (EDC) system using electronic case report forms (eCRFs). Patients who fail eligibility for any or multiple inclusion/exclusion criteria may be rescreened for eligibility closer to the time of surgery. Randomization and Blinding Eligible subjects will be randomized up to 7 days before or on the day of scheduled surgery (Day 0). An Interactive Web Response System (IWRS) will be used for electronic randomization of eligible patients. Randomization (in 1:1 ratio for Test:Control) stratified by site, pre-existing renal impairment (baseline sCr ?1.2mg/dL), and cardiac surgery group (more at risk for renal complication vs. less) will be employed. Screened subjects who receive a red cell transfusion prior to randomization will no longer be considered for randomization, and their participation in the study will end. Randomized subjects who do not receive any study RBC transfusions following randomization to within the first 48 hours after completion of surgery will be discontinued from the study and replaced. Only delegated blood bank staff will have access to subjects' treatment arm assignment. RBC unit labels will be identical for Test and Control products. Operating room staff, surgical staff, ICU staff, and others caring for participating patients, as well as the sponsor (and delegates), will be blinded to treatment assignment. Unblinded CRAs will monitor the production of the RBC components. Treatment Once a subject is randomized, only study RBCs (Test or Control, per the subject's randomization) should be dispensed and transfused during the acute transfusion support period (Day 0 to Day 7 post surgery, hospital discharge, or death, whichever is first), as clinically indicated and determined by the treating physician. In rare exceptions where study RBCs are unavailable or patient's need for RBC transfusions exceeds the quantity of study RBCs in inventory at the hospital blood bank (e.g. during a Massive Transfusion Protocol), a transfusion using non-study RBC (conventional) may be given to provide the patient with an appropriate and necessary treatment. In this case, a protocol deviation should be documented. If a study RBC transfusion is given after randomization before surgery commences, a protocol deviation should also be documented. Treatment assessments will be divided into an acute transfusion support period starting the day of surgery during which study RBC (Test or Control) are administered, a post-surgical follow-up period of a minimum of 28 days after the last study transfusion to collect additional safety data, a clinical assessment at day 30 after surgery specifically for mortality and RRT status, and a visit at day 75 (±15) after the last study transfusion to assess mortality and RRT status, and collect samples for serological screening for antibodies specific to INTERCEPT RBCs. In all patients, anesthesia and surgical procedures will be performed according to the local standards of care. Following the acute transfusion support period (Day 0 to Day 7), subjects may receive conventional RBC components if additional transfusions are needed, as indicated by their treating physician. Study Assessments: Monitoring and Follow-up Baseline through Acute Transfusion Support Period (Pre-Op Day -1 to Post-Op Day 7) Hemodynamic and laboratory measures will be assessed pre-operatively (Day -1, Baseline) and daily as available in the medical record from post operative Day 1 through Day 7, hospital discharge or death, whichever occurs first. If a subject is discharged prior to Day 7 but returns to the study site for a standard of care visit on Day 7, blood samples should be obtained on that day for a complete blood count and sCr determination. Randomized subjects who do not receive an RBC transfusion following randomization to within the first 48 hours after surgery will be discontinued from the study and replaced. Hemodynamic parameters that will be monitored include heart rate, blood pressure, mean arterial pressure, central venous pressure (CVP), and peripheral oxygen saturation via pulse oximetry probe. Laboratory parameters that will be monitored include BUN, creatinine (sCr), AST, ALT, fibrinogen, bilirubin, troponin, hemoglobin, and platelet counts. A blood sample for sCr will be taken at 48 (±4 hours) after completion of surgery, and sCr will be determined on a daily basis during the acute transfusion support period up to 7 days post-surgery. Other parameters will be collected on eCRFs only when available in the medical record, i.e., it is not mandatory to order or obtain other labs daily if not performed as a standard of care. Laboratory parameters will be measured by a CLIA accredited local laboratory. The use of radiographic contrast media will be documented starting 7 days prior to surgery, as will details related to the specific surgical procedure (type of procedure, start and end times, RBC components transfused, all other blood components transfused, estimated blood loss from the surgical procedure, concomitant medications, intraoperative cell recovery and reinfusion, hemodilution procedures, and nadir temperature. Additionally, daily estimated blood loss from chest tube(s) and from other sources, and day of chest tube removal will be recorded. Transfusion reactions, AEs and SAEs will be assessed on a daily basis and documented in the eCRF from the start of the first study transfusion through post-operative Day 7 and as available through day 28 after the last study transfusion. Post-operative Day 8 to 28 Days After Last Study Transfusion Subjects will be monitored for transfusion reactions, AEs and SAEs following the 7-day acute transfusion support period, through 28 days after the last study transfusion or death, whichever occurs first, according to the local standard of care. In an outpatient setting, weekly telephone surveillance calls to the subject will be performed in order to collect safety events until the next follow-up visit. 28 (±3) Days After Last Study Transfusion or Premature Discontinuation from study. Subjects who have been discharged should be scheduled for the follow up visit 28 (±3) days after the last study transfusion to obtain additional safety information, including patient-reported AEs/ SAEs; laboratory results including sCr, DAT/ IAT; a sample for HLA antibodies and antibodies specific to INTERCEPT RBCs will be obtained, either in hospital or at clinic visit. All randomized subjects who receive any study RBC transfusion must have their vital status documented at this visit, or earlier if the subject dies prior to the visit. If a subject has been discharged, other safety information (e.g., AEs and SAEs) may be obtained through medical records, the subject's physician, or a telephone interview with either the subject or a family member. 30 Days After Surgery All randomized subjects who receive a study RBC transfusion must have their vital status and need for RRT documented at Day 30 after surgery. RRT that is provided prophylactically during surgery while patient is on a bypass machine (the pump), does not meet this endpoint. The vital status and RRT assessment on Day 30 can be performed either from the medical records, from a phone call to the subject or family, or during the visit 28±3 days after the last study transfusion (only if the last study transfusion was given at day 2 or later in the acute transfusion support period). End of Study: 75 (±15 Days) After last Study Transfusion 75 (±15) days after the last study transfusion (End of Study), serum samples for antibodies specific for INTERCEPT RBCs will be obtained, either in hospital, at a clinic visitor or offsite. Mortality and the need for RRT will be assessed. Data and Safety Monitoring Board (DSMB) The study data and safety will be monitored by an independent Data and Safety Monitoring Board (DSMB). The primary mission of the DSMB is to ensure patient safety and protocol compliance for data collection. The DSMB will be assembled by the Sponsor and composed of transfusion medicine and other experts as per the DSMB charter. DSMB members will be independent of the Sponsor. Interim Analysis and Early Stopping Rule Aside from the blinded interim analysis for sample size re-estimation*, no other interim analysis is planned for this study to compare treatment differences with respect to efficacy or safety at any time prior to the completion of the study. Specific stopping rules, defined for safety considerations, are defined in Section 4.6 of the protocol. *A blinded interim analysis of the primary efficacy endpoint will be performed after approximately 300 patients have been treated in both treatment groups combined. The sample size will be reassessed and may be adjusted to ensure adequate power in consultation with the FDA at that time.

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