Clinical trial NCT03851991: The Efficacy and Safety of Arbidol in Reducing the Frequency of AECOPD.
Official title: A 52-week Multicenter, Randomized, Double-blind, Placebo-controlled, Prospective Study to Evaluate the Efficacy and Safety of Arbidol in Reducing the Frequency of AECOPD.
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE4
Conditions: COPD Patients
Keywords: AECOPD
Arbidol
Lead sponsor: Shengjing Hospital
Sponsor class: OTHER
First posted: 2019-02-22
Enrollment: 990
Sex: ALL
Minimum age (years): 40
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause of death in the world. Acute exacerbations of COPD (AECOPD) are the most important events in the course of the disease because they negatively impact health status, life quality, disease progression, patients survival and economic and social burden. Reducing frequency of AECOPD is the key goal of management for COPD. Since respiratory viral infections are the mainly trigger of AECOPD, anti-viral therapy would be the affective method to prevent the exacerbation or reduce the attack severity. However, there are no positive study results of treating or preventing AECOPD used by current anti-viral drugs approved by FDA so far.

Arbidol is a non-nucleoside antiviral drug. It inhibits viral DNA and RNA synthesis by inhibiting fusion of viral lipid vesicle membrane with host cell membranes. Arbidol has broad-spectrum antiviral activity. In addition to inhibition of influenza virus, it against a variety of viruses including respiratory syncytial disease (RSV), parainfluenza virus, human rhinovirus, coxsackie virus (CV), adenovirus (ADV) and so on. In recent years, some fundamental and clinical researches have shown that arbidol has a significant role in prevention and treatment of influenza virus and other acute respiratory viral infections. Therefore, the investigators speculate that Arbidol will effectively control COPD combined with upper respiratory virus infection, thereby reducing acute exacerbations of COPD.

This is a prospective, multicenter, randomized, double-blind, placebo-controlled, 52-week study. The purpose of this study is to evaluate the efficacy and safety of arbidol in improving the frequency and extent of moderate or severe acute exacerbations in patients with COPD. Eligible subjects will be randomly assigned to treatment group or placebo group at a 2:1 ratio. Subjects of treatment group receive an on-demand arbidol 200 mg three times per day while placebo group receives matched placebo. When the subject has a new respiratory infection, original respiratory symptoms worsen, or fever (the lower body temperature is greater than 37.3℃), oral medication is given immediately. The subjects are required to receive the first dose of drug within 8 hours after the symptoms of upper respiratory tract infection.


Eligibility criteria: Inclusion Criteria:

1. Patients from Outpatient clinic.
2. Informed consent and assent must be obtained before any study assessment is performed.
3. Aged ≥40 years.
4. Continuous respiratory symptoms, such as chronic cough, sputum or shortness of breath etc.
5. Exposure to risk factors: Host factors, Tobacco, Occupation, Indoor/outdoor pollution
6. FEV1/FVC less than 0.70 after withholding bronchodilator.
7. 2 or more acute exacerbations of COPD within the 12 months prior to visit 0. Or more than 1 hospitalizations due to AECOPD within the 12 months prior to visit 0.
8. Good compliance.

Exclusion Criteria:

1. Patients with any chronic diseases except COPD which in the opinion of the investigator may interfere with study evaluation or optimal participation in the study.
2. Patients with a history of chronic lung disease other than COPD, including (but not limited to) active tuberculosis, lung cancer, clinically significant bronchiectasis, primary pulmonary hypertension, sarcoidosis, interstitial lung disease, asthma (other than asthma COPD overlap), severe cor pulmonale.
3. Patients with acute coronary syndrome(ACS) or acute left heart failure within the 6 months prior to visit 0. Patients accepted Coronary interventional therapy or coronary artery bypass grafting due to ACS within the 3 months prior to visit 0.
4. Patients with uncontrolled hypertension.
5. Patients who started oral \>10mg prednisolone or Equivalent systemic corticosteroids within 4 weeks prior to Visit 1. Or patients who received antibiotics within 4 weeks prior to Visit 1. Or patients who received standard treatment for COPD within 4 weeks prior to Visit 1. Or use of other investigational drugs within 5 half-lives of enrollment, or within 30 days, whichever is longer.
6. Patients who received influenza vaccine or other viral vaccine within the 12 months prior to visit 0.
7. The end of AECOPD therapy was within the 4 weeks prior to visit 0. Or Occurrence of AECOPD within the 6 weeks prior to visit 0.
8. History of arbidol sensitivity.
9. No person directly associated with the administration of the study is allowed to participate as a study subject.
10. Use of other investigational intervention within within 30 days.
11. Patients with obviously abnormal liver function, AST or ALT\>2 times the upper limit of normal value or total bilirubin\>1.3 times the upper limit of normal value.

Primary outcomes:
measure: Frequency of moderate or severe acute exacerbation in patients with chronic obstructive pulmonary disease
timeFrame: 52 weeks
Secondary outcomes:
measure: The frequency of Acute exacerbation of patients leads to hospitalization
timeFrame: 52 weeks
measure: The intervals to the next acute exacerbation after the first use of the study drug
timeFrame: 52 weeks
measure: To assess the change of FEV1 from baseline
timeFrame: 52 weeks
measure: Mean duration of moderate or severe acute exacerbation in chronic obstructive pulmonary disease
timeFrame: 52 weeks
measure: Throat swab and virus separation experiment to detect the composition of respiratory viruses in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring hospitalization
timeFrame: 52 weeks
measure: Number of unscheduled visits to a clinic for COPD exacerbation
timeFrame: 52 weeks
measure: Number of emergency room visits for AECOPD
timeFrame: 52 weeks
measure: Number of hospitalizations due to AECOPD
timeFrame: 52 weeks
Other outcomes:
Locations:
city: Shenyang
country: China
facility: Shenjing Hospital
state: Liaoning
Study officials:
affiliation: Shengjing Hospital
name: Li Zhao, Doctor
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ko FW, Chan KP, Hui DS, Goddard JR, Shaw JG, Reid DW, Yang IA. Acute exacerbation of COPD. Respirology. 2016 Oct;21(7):1152-65. doi: 10.1111/resp.12780. Epub 2016 Mar 30.
citation: Zwaans WA, Mallia P, van Winden ME, Rohde GG. The relevance of respiratory viral infections in the exacerbations of chronic obstructive pulmonary disease-a systematic review. J Clin Virol. 2014 Oct;61(2):181-8. doi: 10.1016/j.jcv.2014.06.025. Epub 2014 Jul 4.
citation: Brooks MJ, Burtseva EI, Ellery PJ, Marsh GA, Lew AM, Slepushkin AN, Crowe SM, Tannock GA. Antiviral activity of arbidol, a broad-spectrum drug for use against respiratory viruses, varies according to test conditions. J Med Virol. 2012 Jan;84(1):170-81. doi: 10.1002/jmv.22234. Epub 2011 Oct 25.