Effect of Fostair® on Biomarkers of Platelet Adhesion in Idiopathic Pulmonary Fibrosis
Primary Purpose
Idiopathic Pulmonary Fibrosis
Status
Completed
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
fostair
placebo
Sponsored by
About this trial
This is an interventional treatment trial for Idiopathic Pulmonary Fibrosis focused on measuring Platelets adhesion
Eligibility Criteria
Inclusion Criteria:
- Male or female subjects from 40 to 85 years of age
- Diagnosis of definite IPF according to American Thoracic Society / European respiratory symposium (ATS/ERS) Consensus Statement (2011) using either High-resolution computed tomography (HRCT) or surgical lung biopsy (SLB).
- Carbon monoxide transfer factor (TLco) of ≥ 30 % predicted ( historical measure accepted as long as within the last year).
- Able to maintain O2 saturation of ≥ 89% while breathing room air at rest.
- forced vital capacity (FVC) of 50-80% predicted value
- Negative serum pregnancy test at screening and negative urine pregnancy test at randomisation for female subjects of childbearing potential.
- Competency to understand the information given in the Ethics Committee approved Patient Information Sheet and Consent Form; subjects must sign the form prior to the initiation of any study procedures, unless the assessment is performed as standard of care for this disease
Exclusion Criteria:
. Clinically significant respiratory diseases other than IPF, including asbestosis, other pneumoconiosis or hypersensitivity pneumonitis.
- Clinically significant heart disease defined as a myocardial infarction documented by an ST elevation (STEMI) on electrocardiogram (ECG) within 6 months prior to screening, percutaneous coronary intervention or coronary artery bypass surgery within 6 months prior to screening, unstable angina pectoris, congestive heart failure (NYHA class III/IV or known left ventricular ejection fraction < 25%), ischaemic heart disease, right heart failure, significant right ventricular hypertrophy, or uncontrolled arrhythmia.
- Current smokers
- Use of any inhaled long acting beta-agonist or inhaled steroid within the 3 months prior to screening
- Use of any medication to treat or possibly indicated in the treatment of IPF, such as pirfenidone, and oral corticosteroids.
- Use of any Antiplatelet therapy which may alter assessment of study end points e.g. clopidogrel, Prasugrel, Dipyridamole etc.
- History of cancer, precancerous state (eg, familial polyposis, breast cancer 1 (BRCA1),breast cancer 2 (BRCA2), carcinoma in-situ), other than non-melanomatous skin cancer, within 5 years prior to screening.
- History or evidence of a clinically significant disorder, condition, or disease that, in the opinion of the investigator would pose a risk to subject safety or interfere with the study evaluations, procedures, or completion.
- Participation in an investigational drug or device trial < 30 days prior to screening
Sites / Locations
- Respiratory Medicine Clinical trials Unit
Arms of the Study
Arm 1
Arm 2
Arm Type
Placebo Comparator
Experimental
Arm Label
placebo inhaler
fostair
Arm Description
matched placebo inhaler, to be taken 2 puffs, twice a day for 28 days
fostair 100mcg/6mcg 2pufss, twice a day.
Outcomes
Primary Outcome Measures
platelet-monocyte complex formation
Measurements will include platelet-monocyte complex formation measured at baseline, and post investigational treatments at Visit 5 and visit 8.
platelet P-selectin expression
platelet p selectin expression will be measured at baseline, and post investigational treatments at Visit 5 and visit 8.
platelet fibrinogen binding
Platelet fibrinogen binding will be measured at baseline, and post investigational treatments at Visit 5 and visit 8.
Secondary Outcome Measures
forced vital capacity
forced vital capacity will be measured at baseline and then at visit 5 and visit 8 following 1 months treatment of fostair or placebo
sputum eosinophils cells
inflammatory cells will be measured at baseline, and post investigational treatments at Visit 5 and visit 8.
six minute walk distance
six minute walk distance will be measured at baseline, and post investigational treatments at Visit 5 and visit 8.
Full Information
NCT ID
NCT02048644
First Posted
January 23, 2014
Last Updated
July 11, 2019
Sponsor
Hull University Teaching Hospitals NHS Trust
Collaborators
Chiesi Farmaceutici S.p.A.
1. Study Identification
Unique Protocol Identification Number
NCT02048644
Brief Title
Effect of Fostair® on Biomarkers of Platelet Adhesion in Idiopathic Pulmonary Fibrosis
Official Title
A Randomized, Double-blind, Placebo-controlled, Crossover Study to Assess the Effect of 28 Day Treatment With Fostair® Pressurized Metered-dose Inhaler (pMDI) 200/12 on Biomarkers of Platelet Adhesion in Patients With Idiopathic Pulmonary Fibrosis
Study Type
Interventional
2. Study Status
Record Verification Date
July 2019
Overall Recruitment Status
Completed
Study Start Date
March 2014 (undefined)
Primary Completion Date
April 2015 (Actual)
Study Completion Date
May 2015 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hull University Teaching Hospitals NHS Trust
Collaborators
Chiesi Farmaceutici S.p.A.
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
The investigator has recently studied markers of platelet activation in idiopathic pulmonary fibrosis (IPF) and found that in IPF patients there is a significantly increased platelet reactivity when compared with controls which is demonstrated by a concentration dependent increase in platelet-monocyte complex formation, platelet P-selectin expression and platelet fibrinogen binding in the presence of' the platelet agonists Adenosine diphosphate and L- Threonyl- L- phenylalanyl- L- leucyl- L- leucyl- L-argininamide (TFLLR).
During platelet activation the platelets degranulate releasing numerous profibrotic cytokines including Transforming growth factor beta and Platelet derived growth factor that are recognised to be important in the pathogenesis of IPF. It is therefore plausible that the observed increased platelet reactivity in IPF contributes to the fibrotic process through local activation and degranulation with release of proinflammatory and profibrotic mediators within the pulmonary circulation.
There is evidence that corticosteroid treatment may alter platelet adhesion, in a study of spontaneously hypertensive rat (SHR) increased circulating glucocorticoid, suppressed p-selectin expression. p selectin is a transmembrane protein present in the α granules of platelets. P selectin has a crucial role in platelet aggregation and platelet-leukocyte interactions, which are both potentially important mechanisms in the initiation and/or progression of tissue injury and development of thrombosis. In a study of patients with chronic obstructive pulmonary disease (COPD) exacerbation these were treated with either β agonists alone or β agonist and 40mg prednisolone and compared with a control group. At presentation the COPD patients had higher pulmonary artery pressure (PAP) higher p selectin and fibrinogen levels but lower Antithrombin III levels (AT III). The pulmonary artery pressure and fibrinogen levels were found to be significantly decreased in the steroid treated group whilst the p-selectin levels further increased in the non steroidal therapy patients.
Rationale for the Current Study
There is a significant unmet medical need for the treatment of IPF; the only medication approved for treatment of IPF in the United Kingdom (UK) is Pirfenidone and outside the UK there is none. The main goal of the current study is to evaluate the effect of Fostair on the biomarkers of platelet activation in IPF disease which the investigator believes play a pivotal role in the pathogenesis of IPF and whether this translates in to a clinically beneficial effect of Fostair on IPF disease.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Idiopathic Pulmonary Fibrosis
Keywords
Platelets adhesion
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
20 (Actual)
8. Arms, Groups, and Interventions
Arm Title
placebo inhaler
Arm Type
Placebo Comparator
Arm Description
matched placebo inhaler, to be taken 2 puffs, twice a day for 28 days
Arm Title
fostair
Arm Type
Experimental
Arm Description
fostair 100mcg/6mcg 2pufss, twice a day.
Intervention Type
Drug
Intervention Name(s)
fostair
Other Intervention Name(s)
beclometasone dipropionate and formoterol fumarate
Intervention Description
beclometasone dipropionate 200mcg and formoterol 12 mcg delivered by inhaler, twice a day for 28 days
Intervention Type
Drug
Intervention Name(s)
placebo
Intervention Description
placebo matched inhaler 2puffs to be taken twice a day for 28 days
Primary Outcome Measure Information:
Title
platelet-monocyte complex formation
Description
Measurements will include platelet-monocyte complex formation measured at baseline, and post investigational treatments at Visit 5 and visit 8.
Time Frame
1 month
Title
platelet P-selectin expression
Description
platelet p selectin expression will be measured at baseline, and post investigational treatments at Visit 5 and visit 8.
Time Frame
1 month
Title
platelet fibrinogen binding
Description
Platelet fibrinogen binding will be measured at baseline, and post investigational treatments at Visit 5 and visit 8.
Time Frame
1 month
Secondary Outcome Measure Information:
Title
forced vital capacity
Description
forced vital capacity will be measured at baseline and then at visit 5 and visit 8 following 1 months treatment of fostair or placebo
Time Frame
visit1, visit 5 and visit 8
Title
sputum eosinophils cells
Description
inflammatory cells will be measured at baseline, and post investigational treatments at Visit 5 and visit 8.
Time Frame
1 month
Title
six minute walk distance
Description
six minute walk distance will be measured at baseline, and post investigational treatments at Visit 5 and visit 8.
Time Frame
1 month
10. Eligibility
Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male or female subjects from 40 to 85 years of age
Diagnosis of definite IPF according to American Thoracic Society / European respiratory symposium (ATS/ERS) Consensus Statement (2011) using either High-resolution computed tomography (HRCT) or surgical lung biopsy (SLB).
Carbon monoxide transfer factor (TLco) of ≥ 30 % predicted ( historical measure accepted as long as within the last year).
Able to maintain O2 saturation of ≥ 89% while breathing room air at rest.
forced vital capacity (FVC) of 50-80% predicted value
Negative serum pregnancy test at screening and negative urine pregnancy test at randomisation for female subjects of childbearing potential.
Competency to understand the information given in the Ethics Committee approved Patient Information Sheet and Consent Form; subjects must sign the form prior to the initiation of any study procedures, unless the assessment is performed as standard of care for this disease
Exclusion Criteria:
. Clinically significant respiratory diseases other than IPF, including asbestosis, other pneumoconiosis or hypersensitivity pneumonitis.
Clinically significant heart disease defined as a myocardial infarction documented by an ST elevation (STEMI) on electrocardiogram (ECG) within 6 months prior to screening, percutaneous coronary intervention or coronary artery bypass surgery within 6 months prior to screening, unstable angina pectoris, congestive heart failure (NYHA class III/IV or known left ventricular ejection fraction < 25%), ischaemic heart disease, right heart failure, significant right ventricular hypertrophy, or uncontrolled arrhythmia.
Current smokers
Use of any inhaled long acting beta-agonist or inhaled steroid within the 3 months prior to screening
Use of any medication to treat or possibly indicated in the treatment of IPF, such as pirfenidone, and oral corticosteroids.
Use of any Antiplatelet therapy which may alter assessment of study end points e.g. clopidogrel, Prasugrel, Dipyridamole etc.
History of cancer, precancerous state (eg, familial polyposis, breast cancer 1 (BRCA1),breast cancer 2 (BRCA2), carcinoma in-situ), other than non-melanomatous skin cancer, within 5 years prior to screening.
History or evidence of a clinically significant disorder, condition, or disease that, in the opinion of the investigator would pose a risk to subject safety or interfere with the study evaluations, procedures, or completion.
Participation in an investigational drug or device trial < 30 days prior to screening
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Simon Hart, MD
Organizational Affiliation
Hull University Teaching Hospitals NHS Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
Respiratory Medicine Clinical trials Unit
City
Cottingham
State/Province
East Yorkshire
ZIP/Postal Code
HU16 5JQ
Country
United Kingdom
12. IPD Sharing Statement
Citations:
Citation
Wright C, Arnell K, Fraser S, et al. S46 An RCT of 28 day treatment with Fostair® pMDI 200/12 BD on platelet biomarkers in patients with Idiopathic Pulmonary Fibrosis. Thorax 2015;70:A29-A30.
Results Reference
result
Links:
URL
https://thorax.bmj.com/content/70/Suppl_3/A29.2
Description
Publication Link
Learn more about this trial
Effect of Fostair® on Biomarkers of Platelet Adhesion in Idiopathic Pulmonary Fibrosis
We'll reach out to this number within 24 hrs