Emapalumab Treatment For Anticipated Clinical Benefit In Sepsis Driven By The Interferon-Gamma Endotype (The EMBRACE Trial)

Launched by HELLENIC INSTITUTE FOR THE STUDY OF SEPSIS · Nov 15, 2024

Keywords

ClinConnect Summary

The EMBRACE Trial is a research study looking at a new treatment called emapalumab for patients with sepsis, which is a serious infection that can affect the whole body. This trial will be conducted in several Intensive Care Units across Greece and aims to see if emapalumab, a type of medication that blocks a specific protein linked to inflammation, can help improve the health outcomes of patients suffering from sepsis driven by a certain type of immune response. The study will also explore the best way to give this treatment.

To participate, patients need to be adults aged 18 or older and diagnosed with specific types of infections that have led to sepsis. They must be willing to provide written consent and meet certain health criteria. Participants will receive either the study drug or a placebo (a harmless substance with no active treatment) and will be monitored closely during the trial. It’s important to know that certain individuals, such as those with specific infections or health issues, may not be eligible for this study. Overall, this trial aims to find better treatments for sepsis and help doctors understand how to use emapalumab effectively.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Provide written informed consent
• • Adults (≥18 years) of male or female sex
• • Diagnosis of community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), intrabdominal infection (IAI), acute pyelonephritis (AP), primary bloodstream infection (BSI) and viral respiratory infections.
• • Sepsis defined by the Sepsis-3 definitions. This is defined as any new infection which is accompanied by an increase of the total baseline SOFA score by at least 2 points. The total baseline SOFA score is calculated by the medical comorbidities and by the evaluation of clinical variables before the sepsis episode in the case of hospital-acquired sepsis. In the case of patients with unknown baseline SOFA score, sepsis is defined as any new infection accompanied by total SOFA score 2 or more.
• • Willingness to use effective contraceptive methods during the period from the start of the study drug to 6 months after the administration of the last dose of the study drug, in patients of reproductive age.
• • Serological documentation of IDS defined as detectable blood IFNγ and CXCL9 more than 2,200 pg/ml. IFNγ and CXCL9 are measured in the central study lab by an enzyme immunosorbent assay.
• • Absence of sepsis-induced immunoparalysis (SII). This is defined as ≥8000 of HLA-DR receptors on CD45/CD14-monocytes measured by flow-cytometry in the central lab using the BD™ fluorescence assay9.
• Exclusion Criteria:
• • Body weight more than 104 kg
• • Intake of any other biological during the last 30 days prior screening except for the intake of anakinra or tocilizumab for patients with active infection by SARS-CoV-2
• • Intake of any Janus kinase inhibitors during the last 30 days prior screening except for the intake of baricitinib for patients with active infection by SARS-CoV-2
• • Known active infection by Mycobacterium tuberculosis or other mycobacteria. These patients may be enrolled in the trial if treatment against infection by Mycobacterium tuberculosis or other mycobacteria has been initiated
• • Known active infection by VZV (varicella zoster virus) or by Histoplasma capsulatum or by Leishmania spp. These patients may be enrolled in the trial if treatment against infection by VZV or Histoplasma capsulatum has been initiated
• • Known active infection by the hepatitis B virus, by the hepatitis C virus and by cytomegalovirus
• • Vaccination the last 12 weeks before screening with BCG vaccine
• • Vaccination with any live or attenuated live vaccine (other than BCG) the last 12 weeks before screening
• • Known allergy or hypersensitivity reactions to emapalumab
• • Patients living with the human immunodeficiency virus (HIV)
• • Patients with stage IV solid or hematologic malignancy
• • Patients with neutropenia (less than 1,000 neutrophils/mm3)
• • Patients transplanted for solid organ or stem cells
• • Pregnancy or lactation
• • Participation in any other interventional trial the last 28 days prior to day 1