Last updated on January 2020

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

Brief description of study

The objective of this study is to evaluate the efficacy and safety of RBC transfusion for support of acute anemia in cardiovascular surgery patients based on the clinical outcome of renal impairment following transfusion of red blood cells (RBCs) treated with the INTERCEPT Blood System (IBS) for Red Blood Cells compared to patients transfused with conventional RBCs.

Detailed Study 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 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 will 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 blood products, medical and surgical history, transfusion history, physical examination, concomitant medications, complete blood count, blood type, blood chemistry, coagulation panel, troponin, DAT test, immune reactivity to IBS RBCs, and pregnancy test (when applicable). All TRUST components will be collected on the CRF.

Randomization and Blinding Potentially eligible subjects will be screened and will be considered for randomization. If a subject is screened and receives a red cell transfusion prior to randomization, that subject will no longer be considered for randomization, and their participation in the study will end. An Interactive Web Response System 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 type will be employed. Randomized subjects who do not receive any study RBC transfusions during surgery or within the first 48 hours after completion of surgery, hospital discharge, or death, whichever occurs first, will be replaced.

Screening will include documentation of the patients' pre-surgical exposure to radiographic contrast media, number of prior pregnancies (females), complete blood count, blood chemistries, blood type, DAT, IAT, RBC antibody screen, and the presence of antibodies to INTERCEPT RBC. Data may be derived from the medical record where performed within 7 days of screening.

At screening, the subject's eligibility status will be entered into the electronic data capture system (EDC). On the day before or day of scheduled surgery, eligible subjects will be enrolled and randomized with a 1:1 ratio for Test: Control within each randomization stratum. Only appropriate blood bank staff will be able to access the 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 monitors will monitor the production of the RBC components.

Treatment Randomized subjects will be transfused with Test or Control RBCs during surgery (Day 0) through Day 7 post surgery, hospital discharge, or death, whichever is first, as clinically indicated and determined by the treating physician. Treatment assessments will be divided into an acute surgical care period starting the day of surgery until Day 7, hospital discharge, or death, whichever is first, 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, clinical assessment at day 30 and day 75 (15) after the last study transfusion for mortality and RRT status, and collection of samples for serological screening for antibodies specific to IBS at end of study (75 (15) days).

In all patients anesthesia and surgical procedures will be performed according to the local standards of the institution. Study RBC components will be ordered and administered to study subjects by their treating physicians, also according to the local standards of care. Following the study treatment period, subjects may receive conventional RBC components if additional transfusions are needed, as indicated by their treating physician.

Study Assessments: Monitoring and Follow-up Acute Surgical Care Period (Pre-operative to Post-operative Day 7) Hemodynamic and laboratory measures will be assessed pre-operatively (Day -1) and daily from post-operative Day 1 through post-operative 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 standard care on Day 7, attempts will be made to perform phlebotomy on that day for a complete blood count and sCr determination. Randomized subjects who do not receive an RBC transfusion either during surgery or within the first 48 hours after surgery, hospital discharge, or death, whichever occurs first, will not be followed any longer and will be replaced.

Hemodynamic parameters that will be monitored include heart rate, blood pressure, mean arterial pressure, central venous pressure (CVP), peripheral oxygen saturation via pulse oximetry probe, arterial PO2, FiO2 and arterial oxygen saturation (as available in the medical records).

Laboratory parameters that will be monitored include BUN, creatinine, ALT, fibrinogen, bilirubin, troponin-I, lactic acid, 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 surgical care period up to 7 days post-surgery. Other parameters will be collected on a daily basis as available in the medical record. 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 documented on a daily basis from the time of randomization through post-operative and as available through day 28 after the last study transfusion.

Blood samples for detection of antibody to IBS RBC will be collected at Day 28 ( 3 days window) and Day 75 (15 day window) following 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 as available following the 7-day treatment 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 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 studies including sCr ,DAT/ IAT and RBC allo-antibodies; a sample for HLA antibodies and antibodies specific to IBS RBC 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. Mortality and the need for RRT through Day 30 post-surgery will also be documented.

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.

End of Study (7515 Days After last Study Transfusion) On 7515 days after the last study transfusion (End of Study), serum samples for antibodies specific for IBS RBC 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, intensive care and/or cardiac surgery experts, and a statistician. DSMB members will be independent of the Sponsor.

Interim Analysis and Early Stopping Rule Aside from the interim sample size re-estimation, no 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.

Clinical Study Identifier: NCT03459287

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