Total joint replacements are effective for chronic pain but can lead to Prosthetic Joint Infections (PJI), primarily caused by Staphylococcus aureus and resistant to antibiotics. Standard treatment involves DAIR surgery and antibiotics, but there's a need for better solutions due to rising infections and antibiotic resistance. Bacteriophage therapy, which targets specific bacteria, shows promise. Phaxiam Therapeutics is studying the safety and efficacy of phage therapy in treating Staphylococcus aureus infections in hip or knee PJI patients undergoing DAIR.
Total joint replacement serves as valuable interventions in the management of chronic refractory pain when the other conservative treatments have not worked. They play a vital role in alleviating discomfort and improving the quality of life of subjects battling with joint diseases. However, the joint replacements present the challenge of Prosthetic Joint Infection (PJI). PJI have serious complications and can lead to significant mortality, morbidity, and healthcare expenditure. The leading cause of PJI is gram-positive cocci, specifically Staphylococcus aureus. Bacterial biofilms, mainly formed with Staphylococcus, represent a significant challenge in the treatment of PJIs due to their resistance to antibiotic therapy. Standard of Care (SOC) for these complex infections is characterized primarily by an initial surgery (Debridment Antibiotics and Implant Retention (DAIR) and various regiments and combinations of antibiotics. While the patterns of utilization vary between institutions and geography, DAIR is considered low-invasive procedure, characterized by the possibility of not explanting the prosthetic implant and resecting the bone. The growing demand for joint arthroplasty and current PJI rates, combined with antibacterial resistance, clearly indicate an unmet medical need in treating biofilm-based PJIs. Bacteriophage therapy could potentially improve the treatment paradigm for PJIs. Bacteriophages naturally occur with highly specific bacterial viruses that infiltrate bacterial cells, disrupting their metabolism, and causing bacterial lysis. Initial in vivo studies of phage therapy for bone-related infections have shown promise. Phaxiam Therapeutics, a biotechnology company specializing in the research and development of anti-infective therapies using bacteriophages., has collections of phages against Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. These phages have shown promise in preliminary tests and studies. The objective of GLORIA study Is to assess the safety and efficacy of phage therapy versus placebo in treating Staphylococcus aureus infections in hip or knee PJI patients undergoing DAIR.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
100
Three intra-articular injections during and/or following DAIR procedure
Three intra-articular injections during and/or following DAIR procedure
To assess the safety of phage therapy + DAIR compared with placebo + DAIR
Incidence of serious adverse events
Time frame: From enrollment up to 3 months
To assess the efficacy of phage therapy + DAIR compared with placebo + DAIR
Percentage of patients with clinical cure
Time frame: From enrollment up to 3 months
To assess the safety of phage therapy + DAIR compared with placebo + DAIR
Incidence of all adverse events and all safety parameters
Time frame: From enrollment up to 12 months
To assess the efficacy of phage therapy + DAIR compared with placebo + DAIR
Percentage of Patient with clinical cure from S.aureus's infection up to 6 months and up to 12 months. Percentage of patients with relapse exclusively due to another germ than Staphylococcus aureus up to 3 months, 6 months and 12 months
Time frame: From enrollment up to 12 months
To describe the immunological response in serum and in joint fluid
Titration of anti-Staphylococcus aureus phage antibodies
Time frame: From enrollment up to 3 months
To describe the S. aureus bacterial load (bacteriology) in the joint fluid up to 1 month
Quantitative or Semi-Quantitative analysis of bacterial load
Time frame: From enrollment up to 1 month
To describe Cytology in the joint fluid
Quantification and identification of polynuclear of joint fluid
Time frame: From enrollment up to 1 month
To describe the hospitalization duration
Number of hospitalizations
Time frame: From enrollment up to 3 months and up to 12 months
To describe the hospitalization duration
Total duration of hospitalizations
Time frame: From enrollment up to 3 months and up to 12 months
To describe the quality of life for patients
Results of quality-of-life questionnaires (EQ-5D-5L: EuroQol-5 Dimensions-5 Levels) from 0 (worst health you can imagine) to 100 (best health you can imagine)
Time frame: From enrollment up to 3 months and up to 12 months
To describe joint function rehabilitation
Total score of either KOOS-12 (Knee Injury and Osteoarthritis Outcome Score 12 questions) OR HOOS-12 (Hip Injury and Osteoarthritis Outcome Score-12 questions) Questionnaires, depending on infected joint. The score is calculated in a scale from 0 (extreme symptoms) to 100 (absence of symptoms).
Time frame: From enrollment up to 3 months and up to 12 months
To describe the evolution of the prosthetic joint infection by X Ray image
X Ray image analysis to detect the potential appearance of abnormal loosening (border with shifting of the prosthesis)
Time frame: From screening up to 3 months and up to 12 months
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