EASE Trial: Exhale Airway Stents for Emphysema

Study Overview
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Brief Summary
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This is an international clinical research study evaluating the safety and effectiveness of a new procedure called airway bypass. The goal of this research is to see if airway bypass can relieve hyperinflation (overfilling) of the lungs, thereby improving lung function and reducing shortness of breath in patients with severe homogeneous (diffuse) emphysema. EASE stands for Exhale Airway Stents for Emphysema.

Detailed Description
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Over 3 million people in the United States and tens of millions more throughout the world live with emphysema, a chronic, progressive, irreversible disease of the lungs. The hallmark of emphysema is hyperinflation of the lungs -- air is trapped in the lungs and cannot escape, causing the lungs to become larger and larger. This makes it difficult to breathe and dyspnea (shortness of breath) is the result. The airway bypass procedure is performed using a bronchoscope with the patient under anesthesia. Very small passageways are created between the damaged lung tissue and the larger breathing passages (airways). Small stents are inserted to keep the new pathways from closing. These pathways could potentially provide a way for the trapped air to escape when the patient exhales. If the amount of air trapped in the lungs is reduced then it should be easier for the person to breathe. The EASE study will compare the effects of Exhale Drug-Eluting Stents in patients to a sham-control group of patients who do not receive the stents. Two out of three (2/3) of the participants in the trial will be in the airway bypass group, or treatment group. Participants in the treatment group will undergo the airway bypass procedure with up to six drug-eluting stents implanted in their lungs, creating the passageways for the trapped air to escape. A smaller group - one out of three (1/3) participants - will be the control group. The control group will have bronchoscopy, but passages will not be made and stents will not be implanted. Participants will need to return to the study center four times during the year for follow-up visits and tests. All participants will be told which group they were in when they come back for a follow-up visit one year after the procedure. Participants in the control group will be finished with the trial after one year. Participants in the treatment group will have a follow-up visit once a year for the next four years to monitor the longer term effects of the airway bypass procedure. This is why the end date of the trial is listed as 2012.

Official Title
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A Randomized, Double-blind Study to Evaluate the Safety and Effectiveness of the Exhale® Drug-Eluting Stent in Homogeneous Emphysema Subjects With Severe Hyperinflation

Conditions
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Emphysema

Intervention / Treatment
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* Device: Exhale® Drug-Eluting Stent
* Device: Sham control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: High resolution computed tomography (CT) scan evidence of homogeneous emphysema. Stopped smoking at least 8 weeks before entering the trial. Post-bronchodilator RV/TLC ≥ 0.65. Post-bronchodilator Forced Expiratory Volume (FEV1) ≤ 50% or FEV1 < 1 liter. Marked dyspnea, scoring ≥ 2 on the modified Medical Research Council scale of 0-4. Patient has undergone supervised pulmonary rehabilitation of 16-20 sessions over 6-10 weeks. Exclusion Criteria: Change in FEV1 > 20% pre- and post- bronchodilator measurements or > 200 ml if post-bronchodilator FEV1 < 1 liter. Respiratory infections requiring 3 or more hospitalizations in past year. Inability to walk > 140 meters (150 yards) in 6 minutes. Previous lung volume reduction surgery (LVRS) or lobectomy.

Ages Eligible for Study
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Minimum Age: 35 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: 2<br>subject receives optimal medical management, supervised pulmonary rehabilitation therapy and undergoes bronchoscopy but no stents are placed | Device: Sham control<br>* 5-10 minute bronchoscopic procedure in which the lungs are examined and a bronchial lavage is performed; the bronchoscope is then retracted to a point above the carina and below the vocal folds for the remained of the time; total procedure time is about 1-2 hours<br>|
| Experimental: 1<br>subject receives optimal medical management, supervised pulmonary rehabilitation therapy and undergoes bronchoscopy during which up to six Exhale drug-eluting stents are placed in the lungs | Device: Exhale® Drug-Eluting Stent<br>* Bronchoscopic procedure in which up to six Exhale Drug-Eluting Stents are placed in the lungs; total procedure time is 1 to 2 hours<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Forced Vital Capacity (FVC) |  | 6 months | 
| modified Medical Research Council (mMRC) score (breathlessness) |  | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Residual Volume/Total Lung Capacity (RV/TLC) |  | 6 months | 
| Forced Vital Capacity (FVC) |  | 6 months | 
| modified Medical Research Council Dyspnea Scale (mMRC) |  | 6 months | 
| Forced Expiratory Volume in 1 second (FEV1) |  | 6 months | 
| St. George's Respiratory Questionnaire (SGRQ) |  | 6 months | 
| 6-minute walk (6MW) |  | 6 months | 
| Cycle Ergometry |  | 6 months | 
| Note: Residual Volume/Total Lung Capacity (RV/TLC) will be analyzed for superiority. All other secondary endpoints will be analyzed for informational purposes. |  | 6 months | 
| Residual Volume (RV) |  | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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COPD (Chronic Obstructive Pulmonary Disease), Emphysema, Hyperinflation, Minimally Invasive