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Safety and Feasibility Study of Rejuvenair™ for Treating Chronic Bronchitis Patients (Feasibility)

Primary Purpose

Bronchitis, Chronic, Cryotherapy Effect

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
RejuvenAir
Sponsored by
CSA Medical, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bronchitis, Chronic focused on measuring spray cryotherapy, cryotherapy, chronic bronchitis, airflow restrictions

Eligibility Criteria

40 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Males and females ≥40 to ≤75 years of age.
  • Subject is able to read, understand, and sign a written Informed Consent in order to participate in the study.
  • Subject agrees to continue maintenance pulmonary/COPD medications for the duration of the study.
  • Diagnosis of chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD) for a minimum of two years. (Chronic Bronchitis is defined clinically as chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive cough have been excluded.)
  • Pre-procedure post bronchodilator FEV1 of greater than or equal to 30% and less than or equal to 80% of predicted within 3 months of enrollment.
  • Smoking history of at least 10 pack years.
  • Non-smoking for a minimum of 6 months prior to consent and agrees to continue not smoking for the duration of the study.
  • Subject is able to adhere to and undergo 3 (4 if in Phase A) bronchoscope procedures that includes lung biopsies and multiple MCS treatments in the opinion of the investigator

Exclusion Criteria:

  • Subject has had an acute pulmonary infection or pneumonia within prior 6 weeks of study bronchoscopy.
  • Subject has had a CB and/or COPD exacerbation (requiring steroids and/or antibiotics) within 6 weeks prior to study bronchoscopy, as defined by their treating physician
  • Subject has clinically significant bronchiectasis or other respiratory disease other than chronic bronchitis and COPD.
  • Diagnosis of asthma with an onset before 30 years of age
  • Subject has bullous emphysema characterized as large bullae >30 millimeters on CT.
  • Subject has had a transplant.
  • Subject has the inability to walk >140 meters
  • Subject has PaC02 >8kPa, or a PaO2<7kPa at room air.
  • Subject has a RVSP >45mmHg or a LVEF<45% on 2D-cardiac echo.
  • Subject has undergone lung surgery: pneumonectomy, lobectomy, bullectomy, lung volume reduction surgery
  • Subject has had a prior lung device procedure, including emphysema stent(s) implanted, lung coils, valves, lung denervation or other devices for emphysema.
  • Subject is unable to temporarily discontinue use of anticoagulant therapy:

warfarin, Coumadin, LMWH, heparin, clopidogrel (or equal)

  • Subject is on >10 mg of prednisolone/day.
  • Subject has a serious medical condition, such as: uncontrolled congestive heart failure, uncontrolled angina, myocardial infarction in the past year, renal failure, liver disease, cerebrovascular accident within the past 6 months, uncontrolled diabetes, hypertension, autoimmune disease or uncontrolled gastric reflux
  • Subject is pregnant, nursing, or planning to get pregnant during study duration.
  • Subject has received chemotherapy within the past 6 months or is expected to receive chemotherapy during participation in this study.
  • Subject is or has been in another clinical investigational study within 6 weeks of baseline.
  • Subject has known sensitivity to medication required to perform bronchoscopy (such as lidocaine, atropine, and benzodiazepines).
  • Subject has been in another clinical investigational study within 6 weeks of baseline.

Sites / Locations

  • St. Paul's Hospital
  • University Medical Center Groningen
  • Chelsea and Westminster Hosptial/Royal Brompton Hosptial

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

RejuvenAir

Arm Description

RejuvenAir treatment of the right lower lobe and right main stem bronchus. Each MCS will be tailored to the bronchial area undergoing treatment and the amount of liquid nitrogen delivered will vary depending on the airway diameter.

Outcomes

Primary Outcome Measures

Adverse and Serious Adverse Events
Number of subjects with treatment emergent adverse events. Observed rates and two-sided 95% exact confidence interval will be calculated for AE rates and SAE rates overall and for organ class.
Ability to Complete all 3 MCS Treatments
Number of subjects completing all 3 treatments.
Patient Reported Outcome Instrument: St. George's Respiratory Questionnaire (SGRQ)
Scale is 0-100; a higher score is worse

Secondary Outcome Measures

Spirometry Testing
FEV1, FEV1/FVC, VC, FIV1
6 Minute Walk Test
Number of meters walked in six minutes
Leicester Cough Questionnaire (LCQ)
The total score range is 19-133; a higher score is better.
COPD Assessment Test (CAT)
The total score range is 0-40; a higher score is worse
Visual Analog Scale (VAS)
The total score range is 0-100; a higher score is worse
Modified Medical Research Council (mMRC)
The total score range is 0-4; a higher score is worse

Full Information

First Posted
June 25, 2015
Last Updated
February 22, 2023
Sponsor
CSA Medical, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02483637
Brief Title
Safety and Feasibility Study of Rejuvenair™ for Treating Chronic Bronchitis Patients
Acronym
Feasibility
Official Title
A Prospective Safety and Feasibility Study of the RejuvenAir™ System Metered Cryospray Therapy for Chronic Bronchitis Patients
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Completed
Study Start Date
February 2016 (undefined)
Primary Completion Date
May 2019 (Actual)
Study Completion Date
May 20, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
CSA Medical, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study evaluates the safety of RejuvenAir Cryospray therapy to treat symptomatic chronic bronchitis patients with airflow restrictions.
Detailed Description
Prospective, open label, single arm study with sequential accrual of subjects with known chronic bronchitis. There are two phases to this study. Phase A will enroll up to 12 subjects and will treat a single lobe to assess safety, feasibility and histology/immunology. After review of the data by the Data Safety Monitoring Board, Phase B of the study would begin. In Phase B of the study, Phase A subjects would have their remaining two lobes treated. In addition up to 24 subjects will be enrolled and will have all upper and lower lobes treated to assess safety, feasibility and immunology.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bronchitis, Chronic, Cryotherapy Effect
Keywords
spray cryotherapy, cryotherapy, chronic bronchitis, airflow restrictions

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
RejuvenAir
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
RejuvenAir
Arm Type
Experimental
Arm Description
RejuvenAir treatment of the right lower lobe and right main stem bronchus. Each MCS will be tailored to the bronchial area undergoing treatment and the amount of liquid nitrogen delivered will vary depending on the airway diameter.
Intervention Type
Device
Intervention Name(s)
RejuvenAir
Intervention Description
Device: RejuvenAir
Primary Outcome Measure Information:
Title
Adverse and Serious Adverse Events
Description
Number of subjects with treatment emergent adverse events. Observed rates and two-sided 95% exact confidence interval will be calculated for AE rates and SAE rates overall and for organ class.
Time Frame
Change from Baseline to 3-Months Following Completion of Treatments
Title
Ability to Complete all 3 MCS Treatments
Description
Number of subjects completing all 3 treatments.
Time Frame
Change from Baseline to 3-Months Following Completion of Treatments
Title
Patient Reported Outcome Instrument: St. George's Respiratory Questionnaire (SGRQ)
Description
Scale is 0-100; a higher score is worse
Time Frame
Change from Baseline to 3-Months Following Completion of Treatments
Secondary Outcome Measure Information:
Title
Spirometry Testing
Description
FEV1, FEV1/FVC, VC, FIV1
Time Frame
Change from Baseline to 3-Months, 1 year, 2 year and 3 year Following Completion of Treatments
Title
6 Minute Walk Test
Description
Number of meters walked in six minutes
Time Frame
Change from Baseline to 3-Months, 1 year, 2 year and 3 year Following Completion of Treatments
Title
Leicester Cough Questionnaire (LCQ)
Description
The total score range is 19-133; a higher score is better.
Time Frame
Change from Baseline to 3-Months, 1 year, 2 year and 3 year Following Completion of Treatments
Title
COPD Assessment Test (CAT)
Description
The total score range is 0-40; a higher score is worse
Time Frame
Change from Baseline to 3-Months, 1 year, 2 year and 3 year Following Completion of Treatments
Title
Visual Analog Scale (VAS)
Description
The total score range is 0-100; a higher score is worse
Time Frame
Change from Baseline to 3-Months, 1 year, 2 year and 3 year Following Completion of Treatments
Title
Modified Medical Research Council (mMRC)
Description
The total score range is 0-4; a higher score is worse
Time Frame
Change from Baseline to 3-Months, 1 year, 2 year and 3 year Following Completion of Treatments
Other Pre-specified Outcome Measures:
Title
Exacerbation Rate
Description
Annualized exacerbation rates
Time Frame
Change from Baseline to 3-Months, 1 year, 2 year and 3 year Following Completion of Treatments
Title
Airway Wall Thickness Using HRCT
Description
Lumen radius in mm.
Time Frame
Change from Baseline to 3-Months, 1 year, 2 year and 3 year Following Completion of Treatments
Title
Plasma Fibrinogen
Description
150-400mg/dL
Time Frame
Change from Baseline to 3-Months, 1 year, 2 year and 3 year Following Completion of Treatments

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males and females ≥40 to ≤75 years of age. Subject is able to read, understand, and sign a written Informed Consent in order to participate in the study. Subject agrees to continue maintenance pulmonary/COPD medications for the duration of the study. Diagnosis of chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD) for a minimum of two years. (Chronic Bronchitis is defined clinically as chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive cough have been excluded.) Pre-procedure post bronchodilator FEV1 of greater than or equal to 30% and less than or equal to 80% of predicted within 3 months of enrollment. Smoking history of at least 10 pack years. Non-smoking for a minimum of 6 months prior to consent and agrees to continue not smoking for the duration of the study. Subject is able to adhere to and undergo 3 (4 if in Phase A) bronchoscope procedures that includes lung biopsies and multiple MCS treatments in the opinion of the investigator Exclusion Criteria: Subject has had an acute pulmonary infection or pneumonia within prior 6 weeks of study bronchoscopy. Subject has had a CB and/or COPD exacerbation (requiring steroids and/or antibiotics) within 6 weeks prior to study bronchoscopy, as defined by their treating physician Subject has clinically significant bronchiectasis or other respiratory disease other than chronic bronchitis and COPD. Diagnosis of asthma with an onset before 30 years of age Subject has bullous emphysema characterized as large bullae >30 millimeters on CT. Subject has had a transplant. Subject has the inability to walk >140 meters Subject has PaC02 >8kPa, or a PaO2<7kPa at room air. Subject has a RVSP >45mmHg or a LVEF<45% on 2D-cardiac echo. Subject has undergone lung surgery: pneumonectomy, lobectomy, bullectomy, lung volume reduction surgery Subject has had a prior lung device procedure, including emphysema stent(s) implanted, lung coils, valves, lung denervation or other devices for emphysema. Subject is unable to temporarily discontinue use of anticoagulant therapy: warfarin, Coumadin, LMWH, heparin, clopidogrel (or equal) Subject is on >10 mg of prednisolone/day. Subject has a serious medical condition, such as: uncontrolled congestive heart failure, uncontrolled angina, myocardial infarction in the past year, renal failure, liver disease, cerebrovascular accident within the past 6 months, uncontrolled diabetes, hypertension, autoimmune disease or uncontrolled gastric reflux Subject is pregnant, nursing, or planning to get pregnant during study duration. Subject has received chemotherapy within the past 6 months or is expected to receive chemotherapy during participation in this study. Subject is or has been in another clinical investigational study within 6 weeks of baseline. Subject has known sensitivity to medication required to perform bronchoscopy (such as lidocaine, atropine, and benzodiazepines). Subject has been in another clinical investigational study within 6 weeks of baseline.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Heather Nigro
Organizational Affiliation
CSA Medical
Official's Role
Study Director
Facility Information:
Facility Name
St. Paul's Hospital
City
Vancouver
State/Province
British Columbia
Country
Canada
Facility Name
University Medical Center Groningen
City
Groningen
Country
Netherlands
Facility Name
Chelsea and Westminster Hosptial/Royal Brompton Hosptial
City
London
ZIP/Postal Code
SW10 9NH
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
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2604284
Citation
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Results Reference
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17035444
Citation
Innes AL, Woodruff PG, Ferrando RE, Donnelly S, Dolganov GM, Lazarus SC, Fahy JV. Epithelial mucin stores are increased in the large airways of smokers with airflow obstruction. Chest. 2006 Oct;130(4):1102-8. doi: 10.1378/chest.130.4.1102.
Results Reference
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PubMed Identifier
24493923
Citation
Ramos FL, Krahnke JS, Kim V. Clinical issues of mucus accumulation in COPD. Int J Chron Obstruct Pulmon Dis. 2014 Jan 24;9:139-50. doi: 10.2147/COPD.S38938. eCollection 2014.
Results Reference
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Godwin BL, Coad JE, "Healing responses following cryothermic and hyperthermic tissue ablation. " SPIE Proceedings 2009: Volume 7181, p1-9
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20860505
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Sciurba FC, Ernst A, Herth FJ, Strange C, Criner GJ, Marquette CH, Kovitz KL, Chiacchierini RP, Goldin J, McLennan G; VENT Study Research Group. A randomized study of endobronchial valves for advanced emphysema. N Engl J Med. 2010 Sep 23;363(13):1233-44. doi: 10.1056/NEJMoa0900928.
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PubMed Identifier
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Shah PL, Zoumot Z, Singh S, Bicknell SR, Ross ET, Quiring J, Hopkinson NS, Kemp SV; RESET trial Study Group. Endobronchial coils for the treatment of severe emphysema with hyperinflation (RESET): a randomised controlled trial. Lancet Respir Med. 2013 May;1(3):233-40. doi: 10.1016/S2213-2600(13)70047-X. Epub 2013 Apr 23.
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PubMed Identifier
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Citation
Gibson PG. Cough is an airway itch? Am J Respir Crit Care Med. 2004 Jan 1;169(1):1-2. doi: 10.1164/rccm.2310009. No abstract available.
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Jeffery P, Holgate S, Wenzel S; Endobronchial Biopsy Workshop. Methods for the assessment of endobronchial biopsies in clinical research: application to studies of pathogenesis and the effects of treatment. Am J Respir Crit Care Med. 2003 Sep 15;168(6 Pt 2):S1-17. doi: 10.1164/rccm.200202-150WS. No abstract available.
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Smith BM, Hoffman EA, Rabinowitz D, Bleecker E, Christenson S, Couper D, Donohue KM, Han MK, Hansel NN, Kanner RE, Kleerup E, Rennard S, Barr RG. Comparison of spatially matched airways reveals thinner airway walls in COPD. The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study and the Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS). Thorax. 2014 Nov;69(11):987-96. doi: 10.1136/thoraxjnl-2014-205160. Epub 2014 Jun 13.
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derived

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Safety and Feasibility Study of Rejuvenair™ for Treating Chronic Bronchitis Patients

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