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Helium-3 MRI Imaging Study in COPD

Primary Purpose

Pulmonary Disease, Chronic Obstructive

Status
Completed
Phase
Phase 1
Locations
United Kingdom
Study Type
Interventional
Intervention
He-3 MRI
Salbutamol
Ipratropium
MRI
Sponsored by
GlaxoSmithKline
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Pulmonary Disease, Chronic Obstructive focused on measuring Hyperpolarised helium-3, Lung Imaging, Magnetic Resonance Imaging

Eligibility Criteria

50 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

- Diagnosis of Chronic Obstructive Pulmonary Disease (COPD) diagnosis: an established clinical history of chronic pulmonary disorder in accordance with the following description by the American Thoracic Society / European Respiratory Society [ATS / ETS, 2004]

Chronic obstructive pulmonary disease is a preventable and treatable disease characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Although COPD affects the lungs, it also produces significant systemic consequences.

  • The patient is clinically stable with no change in symptoms or medication, no admissions to hospital, and with neither antibiotic therapy nor systemic steroid use for at least 6 weeks prior to screening. (Screening may be rescheduled after an appropriate period of stability)
  • Male and female patients aged ≥50 years
  • A female patient is eligible to participate if she is of non-childbearing potential defined as pre-menopausal females with a documented tubal ligation or hysterectomy; or postmenopausal defined as 12 months of spontaneous amenorrhea (in questionable cases a blood sample with simultaneous follicle stimulating hormone (FSH) ≥40 M1U/mL and estradiol ≤ 40 pg/mL (≤140 pmol/L) is confirmatory).
  • Subjects have refrained from short-acting bronchodilators for 8 hours, long-acting β2-agonists (including any long-acting β2 agonist containing inhaler) and theophyllines for 24 hours and Tiotropium, phosphodiesterase-4 (PDE4) inhibitors (e.g. Roflumilast) and ultra long-acting beta-adrenoceptor agonists (e.g. Indacaterol) for 48 hours prior to admission to the unit on study days.
  • Subjects with a post-bronchodilator FEV1 to FVC ratio (FEV1/FVC) < 0.7
  • Subjects with a post-bronchodilator FEV1 ≥ 30% and ≤ 80% of predicted normal for height, age and sex at screening.
  • Subjects with a cigarette smoking history of ≥10 pack years (1 pack year = 20 cigarettes smoked per day for 1 year or the equivalent). Both current and former smokers are eligible to be enrolled.
  • Resting SpO2 of >90% on room air
  • QTcB or QTcF < 450 msec; or QTc < 480 msec in subjects with Bundle Branch Block (based on a single ECG value).
  • The patient is able to understand and comply with protocol requirements, instructions and protocol-stated restrictions, and to give informed consent.

Exclusion Criteria:

  • Unstable cardiac disease or history of clinically significant arrhythmia (including established atrial fibrillation).
  • Patients with a primary diagnosis of α-1 antitrypsin deficiency.
  • Patients with other significant respiratory disorders.
  • Patients with any acute infection, exacerbation of COPD or other unstable medical condition.
  • Patients in whom inhaled beta-2 agonists or anticholinergics are contraindicated.
  • Patients who have undergone thoracic surgery including lung volume reduction surgery or have conditions that prevent them from performing spirometry and other physiological testing.
  • Patients who are non Magnetic Resonance Imaging (MRI) compatible (ferro-magnetic metallic implants, pacemakers) as per the MRI questionnaire.
  • Patients with renal complaints relating to potential adverse reactions to Gd-DTPA intravascular MRI contrast agent.
  • Patients who suffer from claustrophobia.
  • The patient has participated in a clinical trial and has received an investigational product within the following time period prior to the first study day in the current study: 30 days, 5 half-lives or twice the duration of the biological effect of the investigational product (whichever is longer) of that study.
  • Exposure to more than four new chemical entities within 12 months prior to the first dosing day.
  • History of sensitivity to any of the study medications, or components thereof or a history of drug or other allergy that, in the opinion of the investigator or GSK Medical Monitor, contraindicates their participation.
  • Subjects must abstain from taking prescription (not related to their COPD) or nonprescription drugs (including vitamins and dietary or herbal supplements), within 7 days (or 14 days if the drug is a potential enzyme inducer) or 5 half-lives (whichever is longer) prior to the first study day until completion of the follow-up visit, unless in the opinion of the Investigator and sponsor the medication will not interfere with the study.
  • Unwillingness or inability to follow the procedures outlined in the protocol.

Sites / Locations

  • GSK Investigational Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

Salbutamol + Ipratropium

Ipratropium + Salbutamol

Arm Description

Treatment period 1: Salbutamol 5mg nebulised, single Dose. Treatment period 2: Ipratropium 500mcg nebulised, single dose.

Treatment period 1: Ipratropium 500mcg nebulised, single dose. Treatment period 2: Salbutamol 5mg nebulised, single Dose.

Outcomes

Primary Outcome Measures

Changes in Oxygen Saturation
To correlate changes in oxygen saturation pre- and post- bronchodilator (as a reflection of ventilation/perfusion matching) with changes in distribution of regional ventilation/perfusion (V/Q) demonstrated by hyperpolarized helium ventilation MRI/spatially registered proton perfusion.
Changes in distribution of regional ventilation/perfusion assessed by spatially registered Helium-3 Magnetic Resonance Imaging (MRI) and proton perfusion MRI.
To correlate changes in oxygen saturation pre- and post- bronchodilator (as a reflection of ventilation/perfusion matching) with changes in distribution of regional ventilation/perfusion (V/Q) demonstrated by hyperpolarized helium ventilation MRI/spatially registered proton perfusion.

Secondary Outcome Measures

Changes in lung volumes.
To compare lung volumes assessed by plethysmography with registered Helium-3 ventilation MRI and proton MRI.
Changes in standard lung function parameters.
To compare changes in ventilatory parameters as assessed by pulmonary function tests (spirometry) and Helium-3 MRI.
Number of adverse events
To monitor the safety of Helium-3 MRI through adverse events and clinical lung function.
Reproducibility of Helium-3 MRI
To evaluate reproducibility of Helium-3 MRI (pre-bronchodilator) over a 2 week period.
Symptomatic effects of bronchodilators.
To correlate the symptomatic effects of bronchodilators with measures of lung function derived from physiological measures and from 3He MRI and proton MRI.
Regional lung oxygen uptake (pO2)
To compare regional oxygen uptake (direct V/Q) from 3He MRI pO2 mapping with regional V/Q derived from the ratio of 3He ventilation MRI (V) and spatially registered contrast enhanced proton perfusion MRI (Q).
Change in breathlessness
Change in breathlessness according to the Modified Borg Scale of breathlessness.
Helium-3 apparent diffusion coefficient measurements
Helium-3 apparent diffusion coefficient measurements (sensitivity to emphysematous alveolar destruction and minor airway size).
Distribution of flow velocities in major airways
Distribution of flow velocities in major airways assessed by helium-3 MRI
Changes in dyspnoea
Changes in shortness of breath/air hunger monitored throughout the study.

Full Information

First Posted
January 12, 2012
Last Updated
June 26, 2017
Sponsor
GlaxoSmithKline
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1. Study Identification

Unique Protocol Identification Number
NCT02207452
Brief Title
Helium-3 MRI Imaging Study in COPD
Official Title
A Randomized, Methodology Study to Investigate the Use of 3He-MRI Lung Ventilation and Proton MRI Perfusion Imaging to Detect Changes in Ventilation Perfusion Relationships in Chronic Obstructive Pulmonary Disease (COPD) Patients; a Proof of Concept Study.
Study Type
Interventional

2. Study Status

Record Verification Date
June 2017
Overall Recruitment Status
Completed
Study Start Date
August 5, 2010 (Actual)
Primary Completion Date
July 4, 2011 (Actual)
Study Completion Date
July 4, 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
GlaxoSmithKline

4. Oversight

5. Study Description

Brief Summary
This protocol describes the investigation of the use of hyperpolarised helium magnetic resonance imaging (MRI) in reflecting the regional differences in lung function of moderate to severe Chronic Obstructive Pulmonary Disease (COPD) patients. Since finalisation of the original protocol, new medications for COPD have received Market Authorisation Approvals. Protocol Amendment 02 has been prepared to include these medications in the protocol eligibility criteria and restrictions for the study.
Detailed Description
Chronic Obstructive Pulmonary Disease (COPD) is an important cause of morbidity, mortality, and healthcare costs worldwide. COPD is characterized by progressive airflow limitation that is not fully reversible and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases. It has become clear that simple measures of airflow obstruction are inadequate to relate lung function to exercise capacity or symptoms, and that complex expressions such as dynamic hyper-inflation need to be invoked in seeking to understand overall physiology. In addition to abnormalities of air flow, gas exchange is also deranged. Therefore in considering new treatment approaches, both abnormalities need to be addressed. Techniques to study ventilation variation and perfusion matching across the lung exist but are invasive and exacting, and do not give an indication of the anatomical distribution of changes. There is a clear need for techniques which can provide sensitive, useful and safe repeated measures reflecting regional changes in ventilation and gas exchange in COPD. This study investigates use of hyperpolarised helium magnetic resonance imaging (MRI) in reflecting the regional differences in lung function of moderate to severe COPD patients. A Beta2 bronchodilator - Salbutamol - and a anticholinergic - Ipratropium - will be used in this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pulmonary Disease, Chronic Obstructive
Keywords
Hyperpolarised helium-3, Lung Imaging, Magnetic Resonance Imaging

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 1
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
11 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Salbutamol + Ipratropium
Arm Type
Other
Arm Description
Treatment period 1: Salbutamol 5mg nebulised, single Dose. Treatment period 2: Ipratropium 500mcg nebulised, single dose.
Arm Title
Ipratropium + Salbutamol
Arm Type
Other
Arm Description
Treatment period 1: Ipratropium 500mcg nebulised, single dose. Treatment period 2: Salbutamol 5mg nebulised, single Dose.
Intervention Type
Device
Intervention Name(s)
He-3 MRI
Other Intervention Name(s)
Hyperpolarised Helium-3 MRI, He-3 Magnetic Resonance Imaging
Intervention Description
Hyperpolarised helium-3 Magnetic Resonance Imaging (MRI) scan pre-bronchodilator and 1 hour post-bronchodilator (after 1 hour post-bronchodilator assessments/procedures completed).
Intervention Type
Drug
Intervention Name(s)
Salbutamol
Intervention Description
Salbutamol 5mg nebulised single dose
Intervention Type
Drug
Intervention Name(s)
Ipratropium
Intervention Description
Ipratropium 500mcg nebulised single dose
Intervention Type
Device
Intervention Name(s)
MRI
Other Intervention Name(s)
1H MRI
Intervention Description
Proton Magnetic Resonance Imaging (MRI) scan pre-bronchodilator and 1 hour post-bronchodilator (after 1 hour post-bronchodilator assessments/procedures completed).
Primary Outcome Measure Information:
Title
Changes in Oxygen Saturation
Description
To correlate changes in oxygen saturation pre- and post- bronchodilator (as a reflection of ventilation/perfusion matching) with changes in distribution of regional ventilation/perfusion (V/Q) demonstrated by hyperpolarized helium ventilation MRI/spatially registered proton perfusion.
Time Frame
Baseline measurement at screening visit (up to 30 days prior to first dose). Pre-treatment Day 1 (0.5-2 hours pre-dose) and post-dose Day 1 (1 hour post dose), for both treatment periods.
Title
Changes in distribution of regional ventilation/perfusion assessed by spatially registered Helium-3 Magnetic Resonance Imaging (MRI) and proton perfusion MRI.
Description
To correlate changes in oxygen saturation pre- and post- bronchodilator (as a reflection of ventilation/perfusion matching) with changes in distribution of regional ventilation/perfusion (V/Q) demonstrated by hyperpolarized helium ventilation MRI/spatially registered proton perfusion.
Time Frame
Pre-treatment Day 1 (0.5-2 hours pre-dose) and post-dose Day 1 (1 hour post-dose), for both treatment periods.
Secondary Outcome Measure Information:
Title
Changes in lung volumes.
Description
To compare lung volumes assessed by plethysmography with registered Helium-3 ventilation MRI and proton MRI.
Time Frame
Pre-treatment Day 1 (0.5-2 hours pre-dose) and post-dose Day 1 (1 hour post-dose), for both treatment periods.
Title
Changes in standard lung function parameters.
Description
To compare changes in ventilatory parameters as assessed by pulmonary function tests (spirometry) and Helium-3 MRI.
Time Frame
Baseline measurement at screening visit (up to 30 days prior to first dose). Pre-treatment Day 1 (0.5-2 hours pre-dose) and post-dose Day 1 (1 hour post dose), for both treatment periods.
Title
Number of adverse events
Description
To monitor the safety of Helium-3 MRI through adverse events and clinical lung function.
Time Frame
From screening (up to 30 days prior to Day 1) to follow-up (7-14 days after last dose).
Title
Reproducibility of Helium-3 MRI
Description
To evaluate reproducibility of Helium-3 MRI (pre-bronchodilator) over a 2 week period.
Time Frame
Pre-treatment Day 1 (0.5-2 hours pre-dose) for both treatment periods.
Title
Symptomatic effects of bronchodilators.
Description
To correlate the symptomatic effects of bronchodilators with measures of lung function derived from physiological measures and from 3He MRI and proton MRI.
Time Frame
Pre-treatment Day 1 (0.5-2 hours pre-dose) and post-dose Day 1 (1 hour post-dose), for both treatment periods.
Title
Regional lung oxygen uptake (pO2)
Description
To compare regional oxygen uptake (direct V/Q) from 3He MRI pO2 mapping with regional V/Q derived from the ratio of 3He ventilation MRI (V) and spatially registered contrast enhanced proton perfusion MRI (Q).
Time Frame
Pre-treatment Day 1 (0.5-2 hours pre-dose) and post-dose Day 1 (1 hour post-dose), for both treatment periods.
Title
Change in breathlessness
Description
Change in breathlessness according to the Modified Borg Scale of breathlessness.
Time Frame
From screening (up to 30 days prior to Day 1) to follow-up (7-14 days after last dose).
Title
Helium-3 apparent diffusion coefficient measurements
Description
Helium-3 apparent diffusion coefficient measurements (sensitivity to emphysematous alveolar destruction and minor airway size).
Time Frame
Pre-treatment Day 1 (0.5-2 hours pre-dose) and post-dose Day 1 (1 hour post-dose), for both treatment periods.
Title
Distribution of flow velocities in major airways
Description
Distribution of flow velocities in major airways assessed by helium-3 MRI
Time Frame
Pre-treatment Day 1 (0.5-2 hours pre-dose) and post-dose Day 1 (1 hour post-dose), for both treatment periods.
Title
Changes in dyspnoea
Description
Changes in shortness of breath/air hunger monitored throughout the study.
Time Frame
From screening (up to 30 days prior to first dose) to follow-up (7-14 days after last dose).

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: - Diagnosis of Chronic Obstructive Pulmonary Disease (COPD) diagnosis: an established clinical history of chronic pulmonary disorder in accordance with the following description by the American Thoracic Society / European Respiratory Society [ATS / ETS, 2004] Chronic obstructive pulmonary disease is a preventable and treatable disease characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Although COPD affects the lungs, it also produces significant systemic consequences. The patient is clinically stable with no change in symptoms or medication, no admissions to hospital, and with neither antibiotic therapy nor systemic steroid use for at least 6 weeks prior to screening. (Screening may be rescheduled after an appropriate period of stability) Male and female patients aged ≥50 years A female patient is eligible to participate if she is of non-childbearing potential defined as pre-menopausal females with a documented tubal ligation or hysterectomy; or postmenopausal defined as 12 months of spontaneous amenorrhea (in questionable cases a blood sample with simultaneous follicle stimulating hormone (FSH) ≥40 M1U/mL and estradiol ≤ 40 pg/mL (≤140 pmol/L) is confirmatory). Subjects have refrained from short-acting bronchodilators for 8 hours, long-acting β2-agonists (including any long-acting β2 agonist containing inhaler) and theophyllines for 24 hours and Tiotropium, phosphodiesterase-4 (PDE4) inhibitors (e.g. Roflumilast) and ultra long-acting beta-adrenoceptor agonists (e.g. Indacaterol) for 48 hours prior to admission to the unit on study days. Subjects with a post-bronchodilator FEV1 to FVC ratio (FEV1/FVC) < 0.7 Subjects with a post-bronchodilator FEV1 ≥ 30% and ≤ 80% of predicted normal for height, age and sex at screening. Subjects with a cigarette smoking history of ≥10 pack years (1 pack year = 20 cigarettes smoked per day for 1 year or the equivalent). Both current and former smokers are eligible to be enrolled. Resting SpO2 of >90% on room air QTcB or QTcF < 450 msec; or QTc < 480 msec in subjects with Bundle Branch Block (based on a single ECG value). The patient is able to understand and comply with protocol requirements, instructions and protocol-stated restrictions, and to give informed consent. Exclusion Criteria: Unstable cardiac disease or history of clinically significant arrhythmia (including established atrial fibrillation). Patients with a primary diagnosis of α-1 antitrypsin deficiency. Patients with other significant respiratory disorders. Patients with any acute infection, exacerbation of COPD or other unstable medical condition. Patients in whom inhaled beta-2 agonists or anticholinergics are contraindicated. Patients who have undergone thoracic surgery including lung volume reduction surgery or have conditions that prevent them from performing spirometry and other physiological testing. Patients who are non Magnetic Resonance Imaging (MRI) compatible (ferro-magnetic metallic implants, pacemakers) as per the MRI questionnaire. Patients with renal complaints relating to potential adverse reactions to Gd-DTPA intravascular MRI contrast agent. Patients who suffer from claustrophobia. The patient has participated in a clinical trial and has received an investigational product within the following time period prior to the first study day in the current study: 30 days, 5 half-lives or twice the duration of the biological effect of the investigational product (whichever is longer) of that study. Exposure to more than four new chemical entities within 12 months prior to the first dosing day. History of sensitivity to any of the study medications, or components thereof or a history of drug or other allergy that, in the opinion of the investigator or GSK Medical Monitor, contraindicates their participation. Subjects must abstain from taking prescription (not related to their COPD) or nonprescription drugs (including vitamins and dietary or herbal supplements), within 7 days (or 14 days if the drug is a potential enzyme inducer) or 5 half-lives (whichever is longer) prior to the first study day until completion of the follow-up visit, unless in the opinion of the Investigator and sponsor the medication will not interfere with the study. Unwillingness or inability to follow the procedures outlined in the protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
GSK Clinical Trials
Organizational Affiliation
GlaxoSmithKline
Official's Role
Study Director
Facility Information:
Facility Name
GSK Investigational Site
City
Sheffield
ZIP/Postal Code
S10 2JF
Country
United Kingdom

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Helium-3 MRI Imaging Study in COPD

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