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A Study to Investigate the Differential Effects of Inhaled Symbicort and Advair on Lung Microbiota (DISARM)

Primary Purpose

Chronic Obstructive Pulmonary Disease

Status
Unknown status
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Fluticasone group
Budesonide group
Formoterol group
Sponsored by
University of British Columbia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Obstructive Pulmonary Disease

Eligibility Criteria

40 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Provision of informed consent prior to any study specific procedures.
  • History of moderate to very severe COPD with a post-bronchodilator forced expiratory volume/forced vital capacity (FEV1/FVC) <0.70 and a post-bronchodilator FEV1>20% and ≤80% of predicted normal value at screening.
  • Current smoker or ex-smoker with a tobacco history of ≥10 pack-years (1 pack year= 20 cigarettes smoked per day for 1 year).

Exclusion Criteria:

  • Clinically important pulmonary disease other than COPD (e.g. active lung infection, clinically significant bronchiectasis, pulmonary fibrosis, cystic fibrosis, hypoventilation syndrome associated with obesity, and primary ciliary dyskinesia) and/ or radiological findings suggestive of a respiratory disease other than COPD that is contributing to the subject's respiratory symptoms.
  • Any disorder, including, but not limited to, cardiovascular, gastrointestinal, hepatic, renal, neurological, musculoskeletal, infectious, endocrine, metabolic, haematological, psychiatric, or major physical impairment that is not stable in the opinion of the Investigator and could:

    1. Affect the safety of the subject throughout the study
    2. Influence the findings of the study or their interpretation
    3. Impede the subject's ability to complete the entire duration of study Subjects who have epilepsy must be on a stable dose of medication for 30 days prior to Visit 4.
  • Unstable ischemic heart disease, or uncontrolled arrhythmia, cardiomyopathy, heart failure, and renal failure, or uncontrolled hypertension as defined by the Investigator, or any other relevant cardiovascular disorder as judged by the Investigator
  • Treatment with systemic corticosteroids and/or antibiotics, and/or hospitalization for a COPD exacerbation within 8 weeks prior to enrolment (Visit 1), based on last dose of steroids or last date of hospitalization whatever occurred later.
  • Acute upper or lower respiratory infection requiring antibiotics or antiviral medication within 2 weeks prior to enrolment (Visit 1).
  • Pneumonia within 8 weeks prior to enrolment (Visit 1), based on the last day of antibiotic treatment or hospitalization date, whatever occurred later.
  • Pregnant, breastfeeding, or lactating women.
  • Any clinically significant abnormal findings in physical examination, vital signs, haematology, clinical chemistry, or urinalysis during screening/run-in period, which, in the opinion of the Investigator, may put the subject at risk because of his/her participation in the study, or may influence the results of the study, or the subject's ability to complete entire duration of the study.
  • Use of immunosuppressive medication, including rectal corticosteroids, high potency topical corticosteroids and systemic steroids within 28 days prior to randomization.
  • Receipt of blood products within 30 days prior to enrollment (Visit 1).
  • Receipt of any investigational non-biologic product within 30 days or 5 half-lives prior to Visit 1.
  • History of alcohol or drug abuse within the past year, which may compromise the study data interpretation as judged by Investigator or Study Physician.
  • Subjects who in the opinion of the investigator or qualified designee have evidence of active tuberculosis (TB), either treated or untreated.
  • Scheduled in-patient hospitalization or surgical procedure during the course of the study.
  • Asthma as a primary or main diagnosis according to the Global Initiative for Asthma (GINA, http://www.ginasthma.org/) guidelines or other accepted guidelines. Subjects with a past medical history of asthma (e.g. childhood or adolescence) may be included.
  • The male partner of someone who may become pregnant during the course of the study

Sites / Locations

  • St. Paul's HospitalRecruiting
  • BC Cancer AgencyRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

Fluticasone group

Budesonide group

Formoterol group

Arm Description

Advair (fluticasone) 250 mcg to be administered twice daily via Diskus for 12 weeks

Symbicort (budesonide) 400 mcg to be administered twice daily via Turbuhaler for 12 weeks

Oxeze (formoterol) 12 microg to be administered twice daily via Turbuhaler for 12 weeks

Outcomes

Primary Outcome Measures

Change in total bacterial population in the bronchoalveolar lavage fluid
Change in bacterial diversity using Shannon Index based on 16S sequencing.

Secondary Outcome Measures

Change in bacterial membership using Beta-diversity
Characterization of bacteria Operational Taxonomic Unit
Change in total cell count in bronchoalveolar lavage fluid
Change in total neutrophil count in bronchoalveolar lavage fluid
Change in total lymphocyte count in bronchoalveolar lavage fluid
Change in total mono-macrophage count in bronchoalveolar lavage fluid
Change in St. George's Respiratory Questionnaire
Change in forced expiratory volume in 1 second
Change in forced vital capacity

Full Information

First Posted
May 26, 2016
Last Updated
March 26, 2020
Sponsor
University of British Columbia
Collaborators
AstraZeneca
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1. Study Identification

Unique Protocol Identification Number
NCT02833480
Brief Title
A Study to Investigate the Differential Effects of Inhaled Symbicort and Advair on Lung Microbiota
Acronym
DISARM
Official Title
A Study to Investigate the Differential Effects of Inhaled Symbicort and Advair on Lung Microbiota
Study Type
Interventional

2. Study Status

Record Verification Date
March 2020
Overall Recruitment Status
Unknown status
Study Start Date
February 2015 (undefined)
Primary Completion Date
January 2021 (Anticipated)
Study Completion Date
June 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of British Columbia
Collaborators
AstraZeneca

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study will evaluate the effects of budesonide (using Symbicort which is budesonide and formoterol) and fluticasone (using Advair which is fluticasone and salmeterol) on the airway microorganisms of patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). This is a randomized, parallel group, two-centered clinical trial study to evaluate the effects of a 12 week treatment with Symbicort 400 mcg BID and Advair 250 mcg BID (via Diskus) on airway microbiota in patients with moderate-to-severe COPD. The control arm of this study will be Oxeze 12 ug BID.
Detailed Description
This is a randomized, non-placebo controlled study to evaluate the effects of Symbicort 400 mcg twice daily (BID) and Advair 250 mcg BID over 12 weeks. As the standard of therapy for COPD is a long-acting muscarinic antagonist (LAMA) treatment, a placebo only group cannot be ethically justified. The control arm of this study will thus be Oxeze 12 ug BID. The study will recruit approximately 69 subjects, from St. Paul's Hospital and British Columbia Cancer Agency, randomized 1:1:1 to the 3 arms in blocks. We anticipate 10 to 15% drop out rate, which will enable approximately 60 subjects for full analysis. After the initial enrolment and confirmation of the entry criteria, subjects will perform spirometry before and following bronchodilation with salbutamol (up to 400 ug). They will then enter a 4-week run-in period during which all subjects will be withdrawn from inhaled corticosteroid containing products. They will then be treated with formoterol via Turbuhaler 12 ug BID and short-acting beta-2 agonists as needed (PRN). Subjects may also have LAMA (either tiotropium 18 ug once daily or glycopyrronium 50 ug once daily) at the discretion of the attending physician. At the end of the run-in phase, eligibility will be confirmed and then subjects will undergo pre and post-spirometry, low-dose thoracic computed tomography (CT) and bronchoscopy. One week post-bronchoscopy, the subjects will be randomized to a 12-week treatment period. Subjects may also have LAMA at the discretion of the attending physician. At the end of the 12 week treatment period, the subjects will undergo pre- and post-spirometry and 2nd bronchoscopy. The subjects will be re-evaluated one week following bronchoscopy and then discharged from the study. All subjects with pulmonary nodule requiring follow-up will be evaluated by the attending physician and the pulmonary nodule will be investigated as per guidelines of the Fleischner Society.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Obstructive Pulmonary Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
69 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Fluticasone group
Arm Type
Experimental
Arm Description
Advair (fluticasone) 250 mcg to be administered twice daily via Diskus for 12 weeks
Arm Title
Budesonide group
Arm Type
Experimental
Arm Description
Symbicort (budesonide) 400 mcg to be administered twice daily via Turbuhaler for 12 weeks
Arm Title
Formoterol group
Arm Type
Active Comparator
Arm Description
Oxeze (formoterol) 12 microg to be administered twice daily via Turbuhaler for 12 weeks
Intervention Type
Drug
Intervention Name(s)
Fluticasone group
Other Intervention Name(s)
Advair
Intervention Type
Drug
Intervention Name(s)
Budesonide group
Other Intervention Name(s)
Symbicort
Intervention Type
Drug
Intervention Name(s)
Formoterol group
Other Intervention Name(s)
Oxeze
Primary Outcome Measure Information:
Title
Change in total bacterial population in the bronchoalveolar lavage fluid
Time Frame
12 weeks
Title
Change in bacterial diversity using Shannon Index based on 16S sequencing.
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Change in bacterial membership using Beta-diversity
Time Frame
12 weeks
Title
Characterization of bacteria Operational Taxonomic Unit
Time Frame
12 weeks
Title
Change in total cell count in bronchoalveolar lavage fluid
Time Frame
12 weeks
Title
Change in total neutrophil count in bronchoalveolar lavage fluid
Time Frame
12 weeks
Title
Change in total lymphocyte count in bronchoalveolar lavage fluid
Time Frame
12 weeks
Title
Change in total mono-macrophage count in bronchoalveolar lavage fluid
Time Frame
12 weeks
Title
Change in St. George's Respiratory Questionnaire
Time Frame
12 weeks
Title
Change in forced expiratory volume in 1 second
Time Frame
12 weeks
Title
Change in forced vital capacity
Time Frame
12 weeks

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: Provision of informed consent prior to any study specific procedures. History of moderate to very severe COPD with a post-bronchodilator forced expiratory volume/forced vital capacity (FEV1/FVC) <0.70 and a post-bronchodilator FEV1>20% and ≤80% of predicted normal value at screening. Current smoker or ex-smoker with a tobacco history of ≥10 pack-years (1 pack year= 20 cigarettes smoked per day for 1 year). Exclusion Criteria: Clinically important pulmonary disease other than COPD (e.g. active lung infection, clinically significant bronchiectasis, pulmonary fibrosis, cystic fibrosis, hypoventilation syndrome associated with obesity, and primary ciliary dyskinesia) and/ or radiological findings suggestive of a respiratory disease other than COPD that is contributing to the subject's respiratory symptoms. Any disorder, including, but not limited to, cardiovascular, gastrointestinal, hepatic, renal, neurological, musculoskeletal, infectious, endocrine, metabolic, haematological, psychiatric, or major physical impairment that is not stable in the opinion of the Investigator and could: Affect the safety of the subject throughout the study Influence the findings of the study or their interpretation Impede the subject's ability to complete the entire duration of study Subjects who have epilepsy must be on a stable dose of medication for 30 days prior to Visit 4. Unstable ischemic heart disease, or uncontrolled arrhythmia, cardiomyopathy, heart failure, and renal failure, or uncontrolled hypertension as defined by the Investigator, or any other relevant cardiovascular disorder as judged by the Investigator Treatment with systemic corticosteroids and/or antibiotics, and/or hospitalization for a COPD exacerbation within 8 weeks prior to enrolment (Visit 1), based on last dose of steroids or last date of hospitalization whatever occurred later. Acute upper or lower respiratory infection requiring antibiotics or antiviral medication within 2 weeks prior to enrolment (Visit 1). Pneumonia within 8 weeks prior to enrolment (Visit 1), based on the last day of antibiotic treatment or hospitalization date, whatever occurred later. Pregnant, breastfeeding, or lactating women. Any clinically significant abnormal findings in physical examination, vital signs, haematology, clinical chemistry, or urinalysis during screening/run-in period, which, in the opinion of the Investigator, may put the subject at risk because of his/her participation in the study, or may influence the results of the study, or the subject's ability to complete entire duration of the study. Use of immunosuppressive medication, including rectal corticosteroids, high potency topical corticosteroids and systemic steroids within 28 days prior to randomization. Receipt of blood products within 30 days prior to enrollment (Visit 1). Receipt of any investigational non-biologic product within 30 days or 5 half-lives prior to Visit 1. History of alcohol or drug abuse within the past year, which may compromise the study data interpretation as judged by Investigator or Study Physician. Subjects who in the opinion of the investigator or qualified designee have evidence of active tuberculosis (TB), either treated or untreated. Scheduled in-patient hospitalization or surgical procedure during the course of the study. Asthma as a primary or main diagnosis according to the Global Initiative for Asthma (GINA, http://www.ginasthma.org/) guidelines or other accepted guidelines. Subjects with a past medical history of asthma (e.g. childhood or adolescence) may be included. The male partner of someone who may become pregnant during the course of the study
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Lynda Lazosky
Phone
604-682-2344
Ext
64884
Email
llazosky@providencehealth.bc.ca
First Name & Middle Initial & Last Name or Official Title & Degree
Genevieve Rocheleau
Phone
604-682-2344
Ext
64888
Email
grocheleau@providencehealth.bc.ca
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Don Sin, MD
Organizational Affiliation
St. Paul's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
St. Paul's Hospital
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V6Z1Y6
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lynda Lazosky
Phone
604-682-2344
Ext
64884
Email
llazosky@providencehealth.bc.ca
First Name & Middle Initial & Last Name & Degree
Don Sin, MD
First Name & Middle Initial & Last Name & Degree
Van Eeden Stephanus, MD
First Name & Middle Initial & Last Name & Degree
Leung Janice, MD
First Name & Middle Initial & Last Name & Degree
Shaipanich Tawimas, MD
Facility Name
BC Cancer Agency
City
Vancouver
State/Province
British Columbia
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amy English
Email
aenglish@bccrc.ca
First Name & Middle Initial & Last Name & Degree
Stephen Lam, MD
First Name & Middle Initial & Last Name & Degree
Eve-lea Beaudoin, MD

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
35740433
Citation
Ho CG, Milne S, Li X, Yang CX, Leitao Filho FS, Cheung CY, Yang JSW, Hernandez Cordero AI, Yang CWT, Shaipanich T, van Eeden SF, Leung JM, Lam S, Sin DD. Airway Eosinophilia on Bronchoalveolar Lavage and the Risk of Exacerbations in COPD. Biomedicines. 2022 Jun 15;10(6):1412. doi: 10.3390/biomedicines10061412.
Results Reference
derived
PubMed Identifier
34610114
Citation
Akata K, Leung JM, Yamasaki K, Leitao Filho FS, Yang J, Xi Yang C, Takiguchi H, Shaipanich T, Sahin B, Whalen BA, Yang CWT, Sin DD, van Eeden SF. Altered Polarization and Impaired Phagocytic Activity of Lung Macrophages in People With Human Immunodeficiency Virus and Chronic Obstructive Pulmonary Disease. J Infect Dis. 2022 Mar 2;225(5):862-867. doi: 10.1093/infdis/jiab506.
Results Reference
derived
PubMed Identifier
34464242
Citation
Leitao Filho FS, Takiguchi H, Akata K, Ra SW, Moon JY, Kim HK, Cho Y, Yamasaki K, Milne S, Yang J, Yang CWT, Li X, Nislow C, van Eeden SF, Shaipanich T, Lam S, Leung JM, Sin DD. Effects of Inhaled Corticosteroid/Long-Acting beta2-Agonist Combination on the Airway Microbiome of Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Clinical Trial (DISARM). Am J Respir Crit Care Med. 2021 Nov 15;204(10):1143-1152. doi: 10.1164/rccm.202102-0289OC.
Results Reference
derived

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A Study to Investigate the Differential Effects of Inhaled Symbicort and Advair on Lung Microbiota

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