Metered Cryospray for the Treatment of Patients With Chronic Obstructive Pulmonary Disease With Chronic Bronchitis
Primary Purpose
COPD, Chronic Bronchitis
Status
Active
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
RejuvenAir System
Sham
Sponsored by
About this trial
This is an interventional treatment trial for COPD
Eligibility Criteria
Inclusion Criteria:
Each Subject must meet the following criteria to be enrolled in the study:
- Males and females ≥40 to <80 years of age.
- Subject is able to read, understand, and sign a written Informed Consent in order to participate in the study.
- Subject has a diagnosis of CB and COPD and has been symptomatic 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).
- Subject is classified as having moderate or severe (GOLD stage 2-3) airflow obstruction defined by a post-bronchodilator of =>30% FEV1 to <80% predicted with a baseline FEV1/FVC of <0.70.
- Subject has a COPD assessment tool (CAT) score of ≥10.
- Subject is being treated according to current medically accepted treatment guidelines without successful resolution of chronic bronchitis and agrees to continue maintenance pulmonary/COPD medications (as defined per GOLD Standard for medications) for the duration of the study (subject must be on a regime of pulmonary medications for a minimum of 2 weeks prior to enrolment into the study).
- Smoking history of at least 10 pack years.
- Non-smoking for a minimum of 2 months prior to consent and agrees to continue not smoking for the duration of the study.
- Subject is able to adhere to and undergo 4 bronchoscopic procedures (5 for control subjects accepting cross over option), in the opinion of the investigator or per hospital guidelines.
- For women of childbearing potential: non-pregnant, non-lactating, and agree to practice an adequate birth control method (abstinence, combination barrier and spermicide, or hormonal) for the duration of the study.
Exclusion Criteria:
A potential subject who meets any of the following criteria will be excluded from participation in this study:
- Subject has had an acute pulmonary infection, exacerbation or pneumonia requiring medical treatment (with antibiotics and/or steroids) within 6 weeks of initially planned study bronchoscopy.
- Diagnosis of asthma with an onset before 30 years of age.
- Subject has Alpha-1 antitrypsin deficiency.
- Subject has other origins of respiratory disease aside from chronic bronchitis and COPD.
- Subject is using e-cigarettes, vaping or taking any oral or inhaled substances not prescribed by a physician.
- Subject has untreatable or life-threatening arrhythmias, or history of inability to adequately oxygenate during a bronchoscopy, or has acute respiratory failure with hypercapnia.
- Subject has bullous emphysema characterized as large bullae >30 millimetres on HRCT; or subject has stenosis in the tracheobronchial system, tracheobronchomegaly, trachea-bronchomalacia, amyloidosis or cystic fibrosis.
- Subject has clinically significant bronchiectasis
- Subject has had a transplant procedure (any).
- Subject has a known mucosal tear, has undergone prior lung surgery such as pneumonectomy, lobectomy, bullectomy, or lung volume reduction surgery, bronchial thermoplasty, rheoplasty or cryotherapy.
- 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, clopidrogel (or equal).
- Subject has a serious medical condition, such as: uncontrolled coagulopathy or bleeding disorder, congestive heart failure, uncontrolled angina, myocardial infarction in the past year, renal failure, liver disease, cerebrovascular accident within the past 6 months, uncontrolled diabetes, uncontrolled hypertension, autoimmune disease or uncontrolled gastric reflux.
- Subject has or is receiving chemotherapy or active radiation therapy 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 enrolment.
- Subject has known sensitivity to medication required to perform bronchoscopy (such as lidocaine, atropine, and benzodiazepines).
Sites / Locations
- University Medical Center Groningen
- The Royal Brompton Hospital
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Sham Comparator
Arm Label
Treatment
Sham Control
Arm Description
MCS
Sham
Outcomes
Primary Outcome Measures
Goblet cell density
Difference in change relative to baseline in goblet cell density per mm of basement membrane in endobronchial cryobiopsies at 6-months between treatment and sham-control groups
Secondary Outcome Measures
Histopathological examination of endobronchial cryobiopsies to determine Inflammatory cells and subtype density per mm of basement membrane
Proportion of inflammatory cells per mm of basement membrane for Neutrophil and Lymphocyte sequencing (RNA-seq)
Histopathological examination of endobronchial cryobiopsies to determine epithelial cell density and area (including respiratory epithelial, goblet and basal cells) per mm of basement membrane
Proportion of epithelial cells per mm of basement membrane for Ciliary and Goblet cells
Transcriptomics: Epithelial gene expression as measured by global gene expression sequencing (RNA-seq)
Transcriptomics: Epithelial gene expression as measured by global gene expression sequencing (RNA-seq)
Pulmonary function tests including spirometry, body plethysmography and transfer factors KCO and TLCO
Pulmonary function tests including spirometry, body plethysmography and transfer factors KCO and TLCO
Patient reported outcome measures including SGRQ, mMRC, CAT and Cough Questionnaires
Patient reported outcome measures including SGRQ, mMRC, CAT and Cough Questionnaires
Health care utilisation assessments including number of respiratory exacerbations, emergency room visits, hospital and intensive care unit admissions related to respiratory adverse events
Health care utilisation assessments including number of respiratory exacerbations, emergency room visits, hospital and intensive care unit admissions related to respiratory adverse events
The 6-minute walk tests
The 6-minute walk tests
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT03892694
Brief Title
Metered Cryospray for the Treatment of Patients With Chronic Obstructive Pulmonary Disease With Chronic Bronchitis
Official Title
Characterizing the Mechanism of Action of Metered Cryospray for the Treatment of Patients With Chronic Obstructive Pulmonary Disease With Chronic Bronchitis
Study Type
Interventional
2. Study Status
Record Verification Date
February 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
February 14, 2020 (Actual)
Primary Completion Date
July 11, 2022 (Actual)
Study Completion Date
November 15, 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
CSA Medical, Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
To evaluate the relationship between airway structure and function in patients with chronic bronchitis treated with metered cryospray (MCS).
Detailed Description
To identify the molecular and cellular targets of MCS treatment and determine the mechanistic relationship to airways remodelling in patients with chronic bronchitis. Phenotype, characterise and correlate clinical, physiological, histological and molecular parameters in patients with chronic bronchitis.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COPD, Chronic Bronchitis
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
Prospective, multi-centre, randomised, blinded, sham controlled trial with 1:1 randomisation. Sham-control arm subjects are eligible to receive treatment after the 6-month visit.
Masking
ParticipantCare ProviderOutcomes Assessor
Masking Description
Sham controlled.
Allocation
Randomized
Enrollment
32 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Treatment
Arm Type
Active Comparator
Arm Description
MCS
Arm Title
Sham Control
Arm Type
Sham Comparator
Arm Description
Sham
Intervention Type
Device
Intervention Name(s)
RejuvenAir System
Intervention Description
Bronchial metered cryospray using RejuvenAir® System.
Intervention Type
Other
Intervention Name(s)
Sham
Intervention Description
Sham control procedure
Primary Outcome Measure Information:
Title
Goblet cell density
Description
Difference in change relative to baseline in goblet cell density per mm of basement membrane in endobronchial cryobiopsies at 6-months between treatment and sham-control groups
Time Frame
6-months post treatment
Secondary Outcome Measure Information:
Title
Histopathological examination of endobronchial cryobiopsies to determine Inflammatory cells and subtype density per mm of basement membrane
Description
Proportion of inflammatory cells per mm of basement membrane for Neutrophil and Lymphocyte sequencing (RNA-seq)
Time Frame
6-months post treatment
Title
Histopathological examination of endobronchial cryobiopsies to determine epithelial cell density and area (including respiratory epithelial, goblet and basal cells) per mm of basement membrane
Description
Proportion of epithelial cells per mm of basement membrane for Ciliary and Goblet cells
Time Frame
6-months post treatment
Title
Transcriptomics: Epithelial gene expression as measured by global gene expression sequencing (RNA-seq)
Description
Transcriptomics: Epithelial gene expression as measured by global gene expression sequencing (RNA-seq)
Time Frame
6-months post treatment
Title
Pulmonary function tests including spirometry, body plethysmography and transfer factors KCO and TLCO
Description
Pulmonary function tests including spirometry, body plethysmography and transfer factors KCO and TLCO
Time Frame
6-months post treatment
Title
Patient reported outcome measures including SGRQ, mMRC, CAT and Cough Questionnaires
Description
Patient reported outcome measures including SGRQ, mMRC, CAT and Cough Questionnaires
Time Frame
6-months post treatment
Title
Health care utilisation assessments including number of respiratory exacerbations, emergency room visits, hospital and intensive care unit admissions related to respiratory adverse events
Description
Health care utilisation assessments including number of respiratory exacerbations, emergency room visits, hospital and intensive care unit admissions related to respiratory adverse events
Time Frame
6-months post treatment
Title
The 6-minute walk tests
Description
The 6-minute walk tests
Time Frame
6-months post treatment
Other Pre-specified Outcome Measures:
Title
Microvesicle quantification
Description
Microvesicle quantification
Time Frame
6-months post treatment
Title
Lobar volumes and gas trapping as determined by quantitative CT and parametric response mapping
Description
Lobar volumes and gas trapping as determined by quantitative CT and parametric response mapping
Time Frame
6-months post treatment
Title
Small airways function as assessed by Impulse Oscillometry (IOS)
Description
Small airways function as assessed by Impulse Oscillometry (IOS)
Time Frame
6-months post treatment
Title
Composition of epithelial ultrastructure as assessed by transmission electron microscopy
Description
Composition of epithelial ultrastructure as assessed by transmission electron microscopy
Time Frame
6-months post treatment
10. Eligibility
Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
79 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Each Subject must meet the following criteria to be enrolled in the study:
Males and females ≥40 to <80 years of age.
Subject is able to read, understand, and sign a written Informed Consent in order to participate in the study.
Subject has a diagnosis of CB and COPD and has been symptomatic 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).
Subject is classified as having moderate or severe (GOLD stage 2-3) airflow obstruction defined by a post-bronchodilator of =>30% FEV1 to <80% predicted with a baseline FEV1/FVC of <0.70.
Subject has a COPD assessment tool (CAT) score of ≥10.
Subject is being treated according to current medically accepted treatment guidelines without successful resolution of chronic bronchitis and agrees to continue maintenance pulmonary/COPD medications (as defined per GOLD Standard for medications) for the duration of the study (subject must be on a regime of pulmonary medications for a minimum of 2 weeks prior to enrolment into the study).
Smoking history of at least 10 pack years.
Non-smoking for a minimum of 2 months prior to consent and agrees to continue not smoking for the duration of the study.
Subject is able to adhere to and undergo 4 bronchoscopic procedures (5 for control subjects accepting cross over option), in the opinion of the investigator or per hospital guidelines.
For women of childbearing potential: non-pregnant, non-lactating, and agree to practice an adequate birth control method (abstinence, combination barrier and spermicide, or hormonal) for the duration of the study.
Exclusion Criteria:
A potential subject who meets any of the following criteria will be excluded from participation in this study:
Subject has had an acute pulmonary infection, exacerbation or pneumonia requiring medical treatment (with antibiotics and/or steroids) within 6 weeks of initially planned study bronchoscopy.
Diagnosis of asthma with an onset before 30 years of age.
Subject has Alpha-1 antitrypsin deficiency.
Subject has other origins of respiratory disease aside from chronic bronchitis and COPD.
Subject is using e-cigarettes, vaping or taking any oral or inhaled substances not prescribed by a physician.
Subject has untreatable or life-threatening arrhythmias, or history of inability to adequately oxygenate during a bronchoscopy, or has acute respiratory failure with hypercapnia.
Subject has bullous emphysema characterized as large bullae >30 millimetres on HRCT; or subject has stenosis in the tracheobronchial system, tracheobronchomegaly, trachea-bronchomalacia, amyloidosis or cystic fibrosis.
Subject has clinically significant bronchiectasis
Subject has had a transplant procedure (any).
Subject has a known mucosal tear, has undergone prior lung surgery such as pneumonectomy, lobectomy, bullectomy, or lung volume reduction surgery, bronchial thermoplasty, rheoplasty or cryotherapy.
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, clopidrogel (or equal).
Subject has a serious medical condition, such as: uncontrolled coagulopathy or bleeding disorder, congestive heart failure, uncontrolled angina, myocardial infarction in the past year, renal failure, liver disease, cerebrovascular accident within the past 6 months, uncontrolled diabetes, uncontrolled hypertension, autoimmune disease or uncontrolled gastric reflux.
Subject has or is receiving chemotherapy or active radiation therapy 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 enrolment.
Subject has known sensitivity to medication required to perform bronchoscopy (such as lidocaine, atropine, and benzodiazepines).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Pallav Shah, MD
Organizational Affiliation
The Royal Brompton Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Medical Center Groningen
City
Groningen
Country
Netherlands
Facility Name
The Royal Brompton Hospital
City
London
ZIP/Postal Code
SW3 6NP
Country
United Kingdom
12. IPD Sharing Statement
Learn more about this trial
Metered Cryospray for the Treatment of Patients With Chronic Obstructive Pulmonary Disease With Chronic Bronchitis
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