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Atorvastatin Effect on Reduction of COPD Exacerbations (Captain)

Primary Purpose

Copd, COPD Exacerbation, Smoking

Status
Recruiting
Phase
Phase 4
Locations
Poland
Study Type
Interventional
Intervention
Atorvastatin 40 Mg Oral Tablet
Placebo
Sponsored by
Medical University of Bialystok
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Copd

Eligibility Criteria

40 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Subject has signed Informed Consent Form and is able to understand the purpose and procedures required for the study and is willing to participate in the study.
  2. Subject [male or female] is aged 40 years and older.
  3. Subject is able to understand and comply with the protocol requirements and instructions and is likely to complete the study as planned.
  4. Patients with stable COPD with persistent airflow limitation (stable COPD (post-bronchodilator FEV1<80% of the predicted normal and post-bronchodilator FEV1/FVC<0,70 at visit 1.) Stage II- IV) and with moderate to very severe airflow limitation according to GOLD guidelines.
  5. At least two moderate/severe COPD exacerbations, or at least one leading to hospitalization or ICU admission within 12 months, preceding screening visit.
  6. Current or ex-smokers who have a smoking history of at least 10 pack years.

Exclusion Criteria:

  1. Contraindication to statin therapy included but not limited to: known poliomyelitis, motor neuron disease, cranial or temporal arteritis, stroke or myopathy.
  2. Statin use within the last 3 months prior to study start.
  3. Prior diagnosis of statin induced myopathy or hypersensitivity reaction to another HMG-CoA-reductase inhibitor.
  4. Using e-cigarettes or I IQOS tobacco heating system.
  5. Pregnant or nursing (lactating) women.
  6. Women of child bearing potential, unless they are using effective method of contraception during dosing of study treatment.
  7. Patient with a clinically significant abnormality at visit 1 in investigator opinion.
  8. Patients with a clinically relevant laboratory abnormality at visit 1 in investigator opinion.
  9. Patients with a history of malignancy of any organ system (including lung cancer).
  10. Patients unable to perform acceptable spirometry and lung volumes procedures.
  11. Patients who had a COPD exacerbations that required treatment with antibiotics and/or oral corticosteroids and/or hospitalization in the 6 weeks prior to visit 1.
  12. Patients who have had a respiratory tract infection within 4 weeks prior to visit1.
  13. Patients requiring oxygen therapy (>15hr/day) on a daily basis for chronic hypoxemia.
  14. Patients with a history of asthma or onset of symptoms prior to age 40 years
  15. Patients with concomitant pulmonary disease (e.g. lung fibrosis, sarcoidosis, interstitial lung disease, pulmonary hypertension, tuberculosis).
  16. Patients with primary bronchiectasis.
  17. Patients with a diagnosis of α-1 antitrypsin deficiency (AATD).
  18. Patients with pulmonary lobectomy or lung volume reduction surgery or lung transplantation.
  19. Active abuse of drugs or alcohol, poor compliance anticipated.
  20. Use concomitant medications that are known to interact with atorvastatin: warfarin and other coumarin (vitamin K antagonists) anticoagulants, cyclosporin, gemfibrozil or other non or selective nonsteroidal anti-inflammatory drugs, proton pump inhibitors (PPIs) used by last 6 months.
  21. Patients participating in or planning to participate in the active phase of a supervised pulmonary rehabilitation program during the study.
  22. Use of other investigational drugs within 30 days or 5 half-lives, whichever is longer, prior to screening visit.
  23. Those unable in the opinion of the Investigator to comply fully with the study requirements.

Sites / Locations

  • Medical University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Statins

Placebo

Arm Description

Atorvastatin 40 mg treatment, p.o., QD

Placebo tablet, p.o., QD

Outcomes

Primary Outcome Measures

COPD exacerbation rate
The exacerbation of the disease (defined as an acute worsening of respiratory symptoms that results in additional therapy) will be measured during the study treatment and follow-up phases, and compared between studied groups.
Time to the COPD exacerbation
The time to the first exacerbation will be compared between the Intervention and Placebo groups.

Secondary Outcome Measures

Changes in forced expiratory volume in the first second (FEV1)
The differences in absolute value between Placebo and Atorvastatin group will be evaluated in time points [Visit 1 ,Visit 3,Visit 4, Visit 5, Visit 6 and Visit 8], and the relative change between Visit 1 and following time points [Visit 3 - Visit 8] in both arms will be compared.
Changes in health-related quality of life
The St George's Respiratory Questionnaire (SGRQ) score will be used and the differences in absolute value between Placebo and Atorvastatin group will be evaluated in time points [Visit 2 , Visit 5, and Visit 7], as well as the - relative change between Visit 2 and following time points [Visit 5 and Visit 7] in both arms will be compared. Scores range from 0 to 100; higher scores indicating more limitations.
Changes of inflammatory pathway gene expression
The gene expression will be evaluated in the peripheral blood leucocytes (PBL) by RNA-seq analysis, at visit Visit 1, Visit 2, Visit 5 and Visit 7, and the differences between Placebo and Atorvastatin groups will be analyzed, as well as a relative change between visits Visit 1 and Visit 2, Visit 5 and Visit 7 in both arms will be compared.
Changes in peripheral blood leucocyte count
The peripheral blood leucocytes count will be measured and the differences in absolute values between Placebo and Atorvastatin group will be calculated in time points Visit 1 ,Visit 3, Visit 5 and Visit 7, as well as a relative change between visits Visit 1 and Visit 2, Visit 3, Visit 5 , Visit 7 in both arms will be compared.
Changes in the blood fibrinogen concentrations
A blood fibrinogen concentration will be measured and the differences in absolute values between Placebo and Atorvastatin group will be calculated in time points Visit 1 ,Visit 3, Visit 5 and Visit 7, as well as a relative change between visits Visit 1 and Visit 2, Visit 3, Visit 5 , Visit 7 in both arms will be compared.
Changes in the blood Interleukin-6 concentrations
The Interleukin-6 blood concentrations will be measured and the differences in absolute values between Placebo and Atorvastatin group will be calculated in time points Visit 1 ,Visit 3, Visit 5 and Visit 7, as well as a relative change between visits Visit 1 and Visit 2, Visit 3, Visit 5 , Visit 7 in both arms will be compared.
Changes in the blood high sensitivity C - reactive protein concentrations
The blood high sensitivity C - reactive protein concentrations will be measured and the differences in absolute values between Placebo and Atorvastatin group will be calculated in time points Visit 1 ,Visit 3, Visit 5 and Visit 7, as well as a relative change between visits Visit 1 and Visit 2, Visit 3, Visit 5 , Visit 7 in both arms will be compared.

Full Information

First Posted
February 15, 2021
Last Updated
July 22, 2022
Sponsor
Medical University of Bialystok
Collaborators
Medical Research Agency, Poland
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1. Study Identification

Unique Protocol Identification Number
NCT04789057
Brief Title
Atorvastatin Effect on Reduction of COPD Exacerbations
Acronym
Captain
Official Title
Non-commercial Clinical Trial of Statins CAncer Preventive and Pleiotropic TherApy IN Smokers With Chronic Obstructive Pulmonary Disease (COPD)
Study Type
Interventional

2. Study Status

Record Verification Date
July 2022
Overall Recruitment Status
Recruiting
Study Start Date
February 11, 2022 (Actual)
Primary Completion Date
December 31, 2025 (Anticipated)
Study Completion Date
December 31, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Medical University of Bialystok
Collaborators
Medical Research Agency, Poland

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
It is a randomized, multicenter, prospective, double-blind, placebo controlled, interventional clinical trial that will be conducted in Poland, in about 12 Hospital Pulmonary Departments to evaluate the effectiveness of atorvastatin on the reduction of inflammation process in patients with chronic obstructive pulmonary diseases, and possible biomarkers for personalized treatment of COPD.
Detailed Description
It will be a randomized, double-blind, two arm clinical study to assess effect of atorvastatin 40 mg treatment in patients with stable COPD. The whole study duration will include three phases: pre-study screening and enrollment procedures (4 weeks), clinical assessment at dosing (52 weeks), and post study follow up (4 weeks). During the participation in the study subjects will attend Visit 1 (V1, -4 weeks), visit 2 (V2, day 0), visit 3 (V3, week6), visit 4 (V4, week 12), visit 5 (V5, week 26), visit 6 (V6, week 38), visit 7 (V7, week 52), and follow-up end of study visit (EOS, 56 weeks). The study will begin with a 4-weeks screening phase where patients who fulfill preliminary inclusion/exclusion criteria (prior to entry into study), will be given informed consent and screened. The baseline laboratory tests, clinical and medical evaluation including concomitant medication and drug of abuse will be completed to determine patient continuing eligibility to participate in the study. Upon confirmation of eligibility, the patients will be randomized into two treatment groups receiving one of two medications tested in the study. Each patient enrolled into the clinical study will have to report to the clinic 7 times in order to complete procedures. Blood will be drawn before and during the statin or placebo treatment from patients according to study protocol. This part of the project aims to develop statin response biomarkers for personalized treatment of COPD, based on RNA-sequencing (RNA-seq) information derived from, leukocytes and blood plasma of COPD patients with characterized clinical Atorvastatin response phenotypes.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Copd, COPD Exacerbation, Smoking, Gene Expression, Atorvastatin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
460 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Statins
Arm Type
Experimental
Arm Description
Atorvastatin 40 mg treatment, p.o., QD
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo tablet, p.o., QD
Intervention Type
Drug
Intervention Name(s)
Atorvastatin 40 Mg Oral Tablet
Other Intervention Name(s)
Atorvastatin
Intervention Description
p.o., once daily
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Placebo control group
Intervention Description
p.o., once daily
Primary Outcome Measure Information:
Title
COPD exacerbation rate
Description
The exacerbation of the disease (defined as an acute worsening of respiratory symptoms that results in additional therapy) will be measured during the study treatment and follow-up phases, and compared between studied groups.
Time Frame
56 weeks
Title
Time to the COPD exacerbation
Description
The time to the first exacerbation will be compared between the Intervention and Placebo groups.
Time Frame
56 weeks
Secondary Outcome Measure Information:
Title
Changes in forced expiratory volume in the first second (FEV1)
Description
The differences in absolute value between Placebo and Atorvastatin group will be evaluated in time points [Visit 1 ,Visit 3,Visit 4, Visit 5, Visit 6 and Visit 8], and the relative change between Visit 1 and following time points [Visit 3 - Visit 8] in both arms will be compared.
Time Frame
56 weeks
Title
Changes in health-related quality of life
Description
The St George's Respiratory Questionnaire (SGRQ) score will be used and the differences in absolute value between Placebo and Atorvastatin group will be evaluated in time points [Visit 2 , Visit 5, and Visit 7], as well as the - relative change between Visit 2 and following time points [Visit 5 and Visit 7] in both arms will be compared. Scores range from 0 to 100; higher scores indicating more limitations.
Time Frame
56 weeks
Title
Changes of inflammatory pathway gene expression
Description
The gene expression will be evaluated in the peripheral blood leucocytes (PBL) by RNA-seq analysis, at visit Visit 1, Visit 2, Visit 5 and Visit 7, and the differences between Placebo and Atorvastatin groups will be analyzed, as well as a relative change between visits Visit 1 and Visit 2, Visit 5 and Visit 7 in both arms will be compared.
Time Frame
56 weeks
Title
Changes in peripheral blood leucocyte count
Description
The peripheral blood leucocytes count will be measured and the differences in absolute values between Placebo and Atorvastatin group will be calculated in time points Visit 1 ,Visit 3, Visit 5 and Visit 7, as well as a relative change between visits Visit 1 and Visit 2, Visit 3, Visit 5 , Visit 7 in both arms will be compared.
Time Frame
56 weeks
Title
Changes in the blood fibrinogen concentrations
Description
A blood fibrinogen concentration will be measured and the differences in absolute values between Placebo and Atorvastatin group will be calculated in time points Visit 1 ,Visit 3, Visit 5 and Visit 7, as well as a relative change between visits Visit 1 and Visit 2, Visit 3, Visit 5 , Visit 7 in both arms will be compared.
Time Frame
56 weeks
Title
Changes in the blood Interleukin-6 concentrations
Description
The Interleukin-6 blood concentrations will be measured and the differences in absolute values between Placebo and Atorvastatin group will be calculated in time points Visit 1 ,Visit 3, Visit 5 and Visit 7, as well as a relative change between visits Visit 1 and Visit 2, Visit 3, Visit 5 , Visit 7 in both arms will be compared.
Time Frame
56 weeks
Title
Changes in the blood high sensitivity C - reactive protein concentrations
Description
The blood high sensitivity C - reactive protein concentrations will be measured and the differences in absolute values between Placebo and Atorvastatin group will be calculated in time points Visit 1 ,Visit 3, Visit 5 and Visit 7, as well as a relative change between visits Visit 1 and Visit 2, Visit 3, Visit 5 , Visit 7 in both arms will be compared.
Time Frame
56 weeks
Other Pre-specified Outcome Measures:
Title
Change from baseline in pre-dose values of plethysmography
Description
The functional residual volume (FRC) will be evaluated at Visit 2, Visit 5 and Visit 7, and changes from Visit 1 will be calculated, as well as compared between studied groups.
Time Frame
56 weeks
Title
Change in Inspiratory capacity (IC)
Description
The Inspiratory capacity (IC) will be evaluated will be evaluated at Visit 2, Visit 5 and Visit 7, and changes from Visit 1 will be calculated, as well as compared between studied groups.
Time Frame
56 weeks
Title
Change in 6 minute walking distance (6MWD) test result
Description
The 6MWD tests will be performed at Visit 2, Visit 5 and Visit 7, and changes from Visit 1 will be calculated, as well as compared between studied groups.
Time Frame
56 weeks
Title
The rate of hospitalizations (pulmonary or MACE)
Description
The number of hospitalizations during the treatment and follow-up phases will be evaluated, and compared between studied groups.
Time Frame
56 weeks
Title
Changes in blood pressure
Description
The changes in blood pressure from Visit 1 will be evaluated at Visit 2, Visit 3, Visit 4, Visit 5, Visit 6 and Visit 7, and changes from Visit 1 will be calculated, as well as compared between studied groups.
Time Frame
56 weeks
Title
Changes in heart rate (HR)
Description
The changes in HR from Visit 1 will be evaluated at Visit 2, Visit 3, Visit 4, Visit 5, Visit 6 and Visit 7, and changes from Visit 1 will be calculated, as well as compared between studied groups.
Time Frame
56 weeks
Title
Changes in hematology results
Description
The changes in hematology results from visit Visit 1 will be evaluated, at Visit 3, Visit 5, and Visit 7, as well as the differences between studied groups will be compared.
Time Frame
56 weeks
Title
Changes in biochemistry results
Description
The changes in biochemistry results from visit Visit 1 will be evaluated, at Visit 3, Visit 5, and Visit 7, as well as the differences between studied groups will be compared.
Time Frame
56 weeks
Title
Changes in lipids profile
Description
The changes in lipids profile results from visit Visit 1 will be evaluated, at Visit 3, Visit 5, and Visit 7, as well as the differences between studied groups will be compared.
Time Frame
56 weeks
Title
Changes in blood glucose levels
Description
The changes in blood glucose concentrations from Visit 1 will be evaluated at Visit 7, and compared between studied groups.
Time Frame
56 weeks
Title
Changes in HbA1c levels
Description
The changes in HbA1c levels from Visit 1 will be evaluated at Visit 7, and compared between studied groups.
Time Frame
56 weeks
Title
Changes in the blood AspAT and ALAT concentrations
Description
The changes in blood AspAT and ALAT concentrations from Visit 1 will be evaluated, at Visit 2, Visit 3, Visit 4, Visit 5, Visit 6 and Visit 7, and compared between studied groups.
Time Frame
56 weeks
Title
Changes in the blood CPK concentrations
Description
The changes in blood CPK concentrations from Visit 1 will be evaluated, at Visit 2, Visit 3, Visit 4, Visit 5, Visit 6 and Visit 7, and compared between studied groups.
Time Frame
56 weeks
Title
Change in a transfer factor of the lung for carbon monoxide (DLCO)
Description
The DLCO will be evaluated at Visit 2, Visit 5 and Visit 7, and the changes from Visit 1 will be calculated, as well as compared between studied groups.
Time Frame
56 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject has signed Informed Consent Form and is able to understand the purpose and procedures required for the study and is willing to participate in the study. Subject [male or female] is aged 40 years and older. Subject is able to understand and comply with the protocol requirements and instructions and is likely to complete the study as planned. Patients with stable COPD with persistent airflow limitation (stable COPD (post-bronchodilator FEV1<80% of the predicted normal and post-bronchodilator FEV1/FVC<0,70 at visit 1.) Stage II- IV) and with moderate to very severe airflow limitation according to GOLD guidelines. At least two moderate/severe COPD exacerbations, or at least one leading to hospitalization or ICU admission within 12 months, preceding screening visit. Current or ex-smokers who have a smoking history of at least 10 pack years. Exclusion Criteria: Contraindication to statin therapy included but not limited to: known poliomyelitis, motor neuron disease, cranial or temporal arteritis, stroke or myopathy. Statin use within the last 3 months prior to study start. Prior diagnosis of statin induced myopathy or hypersensitivity reaction to another HMG-CoA-reductase inhibitor. Using e-cigarettes or I IQOS tobacco heating system. Pregnant or nursing (lactating) women. Women of child bearing potential, unless they are using effective method of contraception during dosing of study treatment. Patient with a clinically significant abnormality at visit 1 in investigator opinion. Patients with a clinically relevant laboratory abnormality at visit 1 in investigator opinion. Patients with a history of malignancy of any organ system (including lung cancer). Patients unable to perform acceptable spirometry and lung volumes procedures. Patients who had a COPD exacerbations that required treatment with antibiotics and/or oral corticosteroids and/or hospitalization in the 6 weeks prior to visit 1. Patients who have had a respiratory tract infection within 4 weeks prior to visit1. Patients requiring oxygen therapy (>15hr/day) on a daily basis for chronic hypoxemia. Patients with a history of asthma or onset of symptoms prior to age 40 years Patients with concomitant pulmonary disease (e.g. lung fibrosis, sarcoidosis, interstitial lung disease, pulmonary hypertension, tuberculosis). Patients with primary bronchiectasis. Patients with a diagnosis of α-1 antitrypsin deficiency (AATD). Patients with pulmonary lobectomy or lung volume reduction surgery or lung transplantation. Active abuse of drugs or alcohol, poor compliance anticipated. Use concomitant medications that are known to interact with atorvastatin: warfarin and other coumarin (vitamin K antagonists) anticoagulants, cyclosporin, gemfibrozil or other non or selective nonsteroidal anti-inflammatory drugs, proton pump inhibitors (PPIs) used by last 6 months. Patients participating in or planning to participate in the active phase of a supervised pulmonary rehabilitation program during the study. Use of other investigational drugs within 30 days or 5 half-lives, whichever is longer, prior to screening visit. Those unable in the opinion of the Investigator to comply fully with the study requirements.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Robert Mróz, Prof. MD
Phone
+48 85 74095 22
Email
robert.mroz@umb.edu.pl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Mróz, Prof. MD
Organizational Affiliation
Medical University of Bialystok
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medical University Hospital
City
Bialystok
ZIP/Postal Code
15-540
Country
Poland
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Robert Mróz, Prof. MD
Phone
+48 85 740 95 22
Email
robert.mroz@umb.edu.pl
First Name & Middle Initial & Last Name & Degree
Robert Mróz, Professor

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
According to the agreement with the funding institution (Medical Research Agency), the sponsor and research centers must obtain the consent of the funding institution to disclose the clinical trial data.

Learn more about this trial

Atorvastatin Effect on Reduction of COPD Exacerbations

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