Clinical trial NCT03639051: Evaluation of the Safety and Efficacy of TLD in Patients with COPD
Official title: A Multicenter, Randomized, Sham-controlled Study to Evaluate Safety and Efficacy After Treatment with the Nuvaira™ Lung Denervation System in Patients with Chronic Obstructive Pulmonary Disease (COPD)
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: COPD
Lead sponsor: Nuvaira, Inc.
Sponsor class: INDUSTRY
First posted: 2018-08-20
Enrollment: 464
Sex: ALL
Minimum age (years): 40
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Subjects will be randomized with equal allocation (1:1) into two arms: TLD therapy plus optimal medical care (Active Treatment) and optimal medical care (Sham Control). Randomization of subjects will be stratified based on investigational site, participation in a pulmonary rehabilitation maintenance program and baseline use of an inhaled corticosteroid at the time of enrollment.
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to confirm the safety and efficacy of the Nuvaira Lung Denervation System (Nuvaira System) in the treatment of COPD.

Detailed description: The primary objective of this study is to demonstrate the superiority of treatment with the Nuvaira Lung Denervation System (Active Treatment arm) compared to a sham procedure (Sham Control arm) to decrease moderate or severe exacerbations in subjects with COPD on optimal medical care.

The secondary objective is to compare long-term safety, and other efficacy assessments between the Active Treatment arm and the Sham Control arm.

Eligibility criteria: Inclusion Criteria:

* Subject ≥40 years of age at the time of consent;
* Women of child bearing potential must not be pregnant, evidenced by a negative pregnancy test (blood or urine) pre-treatment, or lactating and agree not to become pregnant for the duration of the study;
* Smoking history of at least 10 pack years;
* Not smoking or using any other inhaled substance (e.g., cigarettes, vaping, cannabis, pipes) for a minimum of 2 months prior to consent and agrees to not start for the duration of the study;
* Subject has received a flu vaccination within the 12 months prior to the procedure or agrees to obtain vaccination once it becomes available and agrees to annual vaccinations for the duration of the study;
* Resting SpO2 ≥89% on room air at the time of screening;
* CAT score ≥10 at the time of screening;
* Diagnosis of COPD with 25%≤ FEV1 ≤80% of predicted, PaCO2 ˂ 50 (if FEV1 ˂30%) and FEV1/FVC \<70% (post-bronchodilator);
* Documented history of ≥ 2 moderate COPD exacerbations or ≥ 1 severe COPD exacerbation leading to hospitalization in the 12 months prior to consent with at least one exacerbation occurring while the subject was on optimal medical care (taking LAMA and a LABA, or scheduled SABA or SAMA instead of either a LAMA or LABA, not both, as regular respiratory maintenance medication);
* Subject is on optimal medical care at the time of consent;
* If subject has participated in a formal pulmonary rehabilitation program recently, program completion must have occurred ≥3 months prior to consent; if in a maintenance program, subject agrees to continue their current program through their 12-month follow-up visit;
* Subject is a candidate for bronchoscopy in the opinion of the physician or per hospital guidelines and is able to discontinue blood thinning medication peri-procedurally;
* The subject is able and agrees to complete all protocol required baseline and follow-up tests and assessments including taking certain medications (e.g., azithromycin, prednisolone/prednisone);
* Subject has provided written informed consent using a form that has been reviewed and approved by the Institutional Review Board (IRB)/Ethics Committee (EC).

Exclusion Criteria:

* Body Mass Index \<18 or \>35;
* Subject has an implantable electronic device and has not received appropriate medical clearance;
* Uncontrolled diabetes in the opinion of the investigator;
* Malignancy treated with radiation or chemotherapy within 1 year of consent;
* Asthma as defined by the current Global Initiative for Asthma (GINA) guidelines;
* Subject diagnosed with a dominant non-COPD lung disease or condition affecting the lungs, which is the main driver of the subjects clinical symptoms (e.g., cystic fibrosis, paradoxical vocal cord motion, eosinophilic granulomatosis with polyangiitis (EGPA), allergic bronchopulmonary aspergillosis, interstitial lung disease or active tuberculosis) or has a documented medical history of pneumothorax within 1 year of consent;
* Clinically relevant bronchiectasis, defined as severe single lobe or multilobar broncial wall thickening associated with airway dilation on CT scan leading to cough and tenacious sputum on most days;
* Pre-existing diagnosis of pulmonary hypertension, clinical evidence of pulmonary hypertension (e.g., cardiovascular function impairment including peripheral edema) and mPAP ≥25 mmHg at rest by right heart catheterization (or estimated right ventricular systolic pressure \>50 mmHg by echocardiogram if no previous right heart catheterization);
* Myocardial infarction within last 6 months, EKG with evidence of life threatening arrhythmias or acute ischemia, pre-existing documented evidence of an LVEF \<40%, stage C or D (ACC/AHA) or Class III or IV (NYHA) congestive heart failure, or any other past or present cardiac findings that make the subject an unacceptable candidate for a bronchoscopic procedure utilizing general anesthesia;
* Surgical procedure(s) on the stomach, esophagus or pancreas performed ≤2 years of consent or ongoing related symptoms within the past year;
* Symptomatic gastric motility disorder(s) (e.g., gastroparesis) as evidenced by a GCSI score ≥18.0, severe uncontrolled GERD (e.g., refractory heartburn, endoscopic esophagitis) or severe dysphagia (e.g., esophageal stricture, achalasia, esophageal spasm);
* Any disease or condition that might interfere with completion of a procedure or this study (e.g., structural esophageal disorder, life expectancy \<3 years);
* Prior lung or chest procedure (e.g., lung transplant, LVRS, BLVR, lung implant, metal stent, valves, median sternotomy, bullectomy, lobectomy, segmentectomy or other interventional lung or chest procedure) performed ≤1 year of consent; NOTE: Any metal in the chest must be ≥5 cm away from the anticipated treatment location(s). Subjects with explanted lung valve(s) allowed if explant occurred ≥3 months prior to treatment.
* Daily use of \>10 mg of prednisone or its equivalent at the time of consent;
* Chronic use of \>40 mg MEDD opioid only medication per day;
* Known contraindication or allergy to medications required for bronchoscopy or general anesthesia (e.g., lidocaine, atropine, propofol, sevoflurane) that cannot be medically controlled;
* Baseline chest CT scan reveals bronchi anatomy cannot be fully treated with available catheter sizes, presence of severe emphysema \>50%, lobar attenuation area or severe bullous disease (\>1/3 hemithorax) (as determined by the CT core lab using a single density mask threshold of -950 HU) or discovery of a mass that requires treatment;
* Subject is currently enrolled in another interventional clinical trial that has not completed follow-up.

Primary outcomes:
measure: Moderate or severe COPD exacerbations
timeFrame: Randomization to 12 Months
Secondary outcomes:
measure: Time to first severe COPD exacerbation
timeFrame: Randomization to 12 Months
measure: Time to first severe COPD exacerbation (Subgroup)
timeFrame: Randomization to 12 months
measure: Change in St. George's Respiratory Questionnaire COPD Version (SGRQ-C) Total score
timeFrame: Randomization to 12 months
measure: Change in FVC
timeFrame: Randomization to 12 Months
measure: Change in FEV1
timeFrame: Randomization to 12 months
measure: Transition Dyspnea Index (TDI)
timeFrame: Randomization to 12 months
measure: Change in RV
timeFrame: Randomization to 12 months
measure: Time to first respiratory-related hospitalization
timeFrame: Randomization to 12 Months
measure: Change in Short Form Health Survey (SF-36) total score
timeFrame: Randomization to 12 Months
measure: CAT responders
timeFrame: Randomization to 12 Months
Other outcomes:
measure: Changes in quality of life
timeFrame: Randomization to 6, 12 Months
measure: Adverse event rates
timeFrame: Randomization to 12 Months, 3 to 12 Months
measure: Time to first event
timeFrame: 3 to 12 Months
measure: Changes in lung function
timeFrame: Randomization to 12 Months
measure: Changes in dyspnea
timeFrame: Randomization to 12 Months
measure: Healthcare utilization
timeFrame: Randomization to 12 Months
Locations:
city: Birmingham
country: United States
facility: University of Alabama at Birmingham (UAB) Lung Health Center
state: Alabama
city: Phoenix
country: United States
facility: HonorHealth
state: Arizona
city: Sacramento
country: United States
facility: UC Davis
state: California
city: Torrance
country: United States
facility: Harbor UCLA
state: California
city: Jacksonville
country: United States
facility: Ascension St. Vincent's
state: Florida
city: Chicago
country: United States
facility: University of Chicago
state: Illinois
city: Elk Grove Village
country: United States
facility: Suburban Lung Associates
state: Illinois
city: Louisville
country: United States
facility: University of Louisville
state: Kentucky
city: Burlington
country: United States
facility: Lahey Hospital & Medical Center
state: Massachusetts
city: Ann Arbor
country: United States
facility: University of Michigan
state: Michigan
city: Grand Rapids
country: United States
facility: Spectrum Health Medical Group
state: Michigan
city: St. Louis
country: United States
facility: Washington University
state: Missouri
city: Durham
country: United States
facility: Duke University
state: North Carolina
city: Pinehurst
country: United States
facility: First Health of the Carolinas
state: North Carolina
city: Columbus
country: United States
facility: Ohio State University Wexner Medical Center
state: Ohio
city: Philadelphia
country: United States
facility: Temple Lung Center
state: Pennsylvania
city: Pittsburgh
country: United States
facility: University of Pittsburgh Medical Center (UPMC)
state: Pennsylvania
city: Charleston
country: United States
facility: Medical University of South Carolina (MUSC)
state: South Carolina
city: Georgetown
country: United States
facility: St. Davids HealthCare
state: Texas
city: Houston
country: United States
facility: Houston Methodist Hospital
state: Texas
city: Vienna
country: Austria
facility: Krankenhaus Nord - Klinik Floridsdorf
city: Grenoble
country: France
facility: CHU de Grenoble
state: Cedex 9
city: Toulouse
country: France
facility: Hopital Larrey
state: Cedex 9
city: Brest
country: France
facility: Hopital de la Cavale Blanche
city: Montpellier
country: France
facility: Arnaud de Villeneuve Hospital
city: Nice
country: France
facility: Hopital Pasteur
city: Paris
country: France
facility: Bichat-Claude Bernard Hospital
city: Reims
country: France
facility: CHU de Reims
city: Strasbourg
country: France
facility: CHU de Strasbourg
city: Heidelberg
country: Germany
facility: Thorax Klinik Heidelberg
city: Amsterdam
country: Netherlands
facility: UMC
city: Groningen
country: Netherlands
facility: University Medical Center Groningen (UMCG)
city: London
country: United Kingdom
facility: Royal Brompton Harefield Trust
Study officials:
affiliation: University of Pittsburgh Medical Center
name: Frank Sciurba, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: University Medical Center Groningen
name: Dirk-Jan Slebos, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Agrawal A. Interventional Pulmonology: Diagnostic and Therapeutic Advances in Bronchoscopy. Am J Ther. 2021 Feb 9;28(2):e204-e216. doi: 10.1097/MJT.0000000000001344.
citation: Slebos DJ, Degano B, Valipour A, Shah PL, Deslee G, Sciurba FC; AIRFLOW-3 Trial Study Group. Design for a multicenter, randomized, sham-controlled study to evaluate safety and efficacy after treatment with the Nuvaira(R) lung denervation system in subjects with chronic obstructive pulmonary disease (AIRFLOW-3). BMC Pulm Med. 2020 Feb 13;20(1):41. doi: 10.1186/s12890-020-1058-5.