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Ig PRx in AECOPD: Pilot Study

Primary Purpose

Chronic Obstructive Pulmonary Disease

Status
Completed
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Intravenous immunoglobulin (IVIG)
Normal Saline
Sponsored by
Ottawa Hospital Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Chronic Obstructive Pulmonary Disease focused on measuring AECOPD, COPD

Eligibility Criteria

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

Inclusion Criteria:

  • Hospitalized adult patient with AECOPD (clinically dominant AECOPD in the case of multiple co-morbidities eg. absence of overt lobar pneumonia or acute congestive heart failure or alternate diagnosis such as acute coronary syndrome or pulmonary embolism)
  • Diagnosis of severe COPD (post bronchodilator FEV1 <50%, FEV1/FVC ratio <0.7) made by standard spirometry within previous 12 months or within three days of admission if previous PFT data is not available
  • Age >40 years
  • >10 pack year smoking history
  • At least one COPD exacerbation in the previous 12 months before enrollment, defined by having had documented inpatient or outpatient treatment by physician with antibiotics and/or prednisone for physician diagnosed COPD exacerbation
  • Expected to live > 12 months

Exclusion Criteria:

  • Known severe hypersensitivity to immunoglobulin or its components (anaphylaxis)
  • Underlying malignancy (including chronic lymphocytic leukemia)
  • History of hematopoietic stem cell transplant or solid organ transplant
  • Current treatment with a biological therapy for other conditions
  • Concomitant significant immunodeficiency or on immunosuppressive treatment other than for COPD
  • Alpha-1 antitrypsin deficiency
  • Significant proteinuria (dipstick proteinuria ≥ 3+ or known urinary protein loss ≥ 2 g/day or nephrotic syndrome) and/or has acute renal failure and/or severe renal impairment (creatinine more than 2.5 times the upper limit of normal and/or on dialysis)
  • IgA deficiency (IgA <0.1 g/L)
  • Immunoglobulin therapy in the last 12 months or on current Ig therapy or have a clinical indication for Ig replacement therapy (www.nacblood.ca/resources/guidelines/IVIG.html)
  • Obesity (BMI ≥35 kg/m²)
  • Pregnancy

Sites / Locations

  • The Ottawa Hospital, General Campus

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Intervention Arm 1: Treatment

Intervention Arm 2: Control

Arm Description

Baseline Ig < 7g/L group - Intravenous immunoglobulin (IVIG) 0.8 g/kg will be given within 12 hours after randomization during hospital admission and then every 4 weeks for 44 weeks (total 48 weeks). Baseline Ig > or = 7 g/L group - Intravenous immunoglobulin (IVIG) 0.5 g/kg will be given within 12 hours after randomization during hospital admission and then every 4 weeks for 44 weeks (total 48 weeks).

Baseline Ig < 7g/L group - Normal Saline (0.9% NaCl) 8 mL/kg will be given within 12 hours after randomization during hospital admission and then every 4 weeks for 44 weeks (total 48 weeks). Baseline Ig > or = 7 g/L group - Normal Saline (0.9% NaCl) 5 mL/kg will be given within 12 hours after randomization during hospital admission and then every 4 weeks for 44 weeks (total 48 weeks).

Outcomes

Primary Outcome Measures

Recruitment
Average number of patients being recruited per month. The study meets primary outcome if at least 4 patients can be recruited per month on average.
Adherence and protocol compliance
Number and percentage of recruited patients adhere to the allocated treatment and protocol. We aim to achieve 80% adherence rate which is defined as at least 80% of patients adhere to 80% of allocated treatment and protocol

Secondary Outcome Measures

Number of participants with treatment-related adverse events as assessed by CTCAE
This will be assessed by documentation of adverse events in patients treated with Ig treatment versus control
Tolerability of treatment
The proportion of patients able to complete the treatment in the experimental arm during the study period versus in the control arm
Efficacy trend: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) rates
AECOPD will be ascertained by monthly follow-up phone calls as well as questionnaires during study visits to detect inpatient/outpatient treatment for exacerbations.
Efficacy trend: Health status
measured by the validated St. George Respiratory Questionnaire
Efficacy trend: Quality of life
validated quality of life measurement tool - EuroWol EQ-5D-5L
Efficacy trend: % predicted FEV1
FEV1 value will be measured using a hand held spirometer. FEV1 value will be recorded in Litres (L) and reported as a percent of their predicted value (using the NHANES III reference standards for predicted values
Efficacy trend: FEV1/FVC
FVC will be measured using a hand held spirometer, and will be recorded in Litres (L). Ratio of FEV1 and FVC will be reported.
Efficacy trend: Health services use
Number of non-study physician visits, emergency department (ED) and hospital admissions over the twelve-month study period.
Efficacy trend: Health care system cost
we will take the perspective of healthcare system and will measure the cost of health services use and an intervention. Intervention cost includes medication, staff, and equipment cost.

Full Information

First Posted
February 10, 2016
Last Updated
November 25, 2019
Sponsor
Ottawa Hospital Research Institute
Collaborators
CSL Behring, Grifols Biologicals, LLC
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1. Study Identification

Unique Protocol Identification Number
NCT02690038
Brief Title
Ig PRx in AECOPD: Pilot Study
Official Title
Feasibility and Safety of Immunoglobulin (Ig) Prophylactic Treatment in COPD Patients With Frequent Exacerbations: A Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
November 2019
Overall Recruitment Status
Completed
Study Start Date
September 2016 (undefined)
Primary Completion Date
November 20, 2019 (Actual)
Study Completion Date
November 20, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ottawa Hospital Research Institute
Collaborators
CSL Behring, Grifols Biologicals, LLC

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will look at immunoglobulin (Ig) treatment in hospitalized chronic obstructive lung disease (COPD) patients with frequent exacerbations. This is a Phase II, pilot randomized double blind control study, meaning this study will help assess if this research can be expanded to evaluate Ig treatment in patients with COPD. Ig treatment is a sterile solution of human immunoglobulin proteins given intravenously (in the vein). Immunoglobulins are part of the immune system and help the body fight infections. Participants will be assigned to either receiving the Ig treatment or normal saline as a control product every 4 weeks for 12 months. Participants will continue on current standard therapy as determined by their treating physician.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Other
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
48 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intervention Arm 1: Treatment
Arm Type
Experimental
Arm Description
Baseline Ig < 7g/L group - Intravenous immunoglobulin (IVIG) 0.8 g/kg will be given within 12 hours after randomization during hospital admission and then every 4 weeks for 44 weeks (total 48 weeks). Baseline Ig > or = 7 g/L group - Intravenous immunoglobulin (IVIG) 0.5 g/kg will be given within 12 hours after randomization during hospital admission and then every 4 weeks for 44 weeks (total 48 weeks).
Arm Title
Intervention Arm 2: Control
Arm Type
Active Comparator
Arm Description
Baseline Ig < 7g/L group - Normal Saline (0.9% NaCl) 8 mL/kg will be given within 12 hours after randomization during hospital admission and then every 4 weeks for 44 weeks (total 48 weeks). Baseline Ig > or = 7 g/L group - Normal Saline (0.9% NaCl) 5 mL/kg will be given within 12 hours after randomization during hospital admission and then every 4 weeks for 44 weeks (total 48 weeks).
Intervention Type
Drug
Intervention Name(s)
Intravenous immunoglobulin (IVIG)
Other Intervention Name(s)
Gamunex, CBS IGIV-nex, Privigen, Octagam
Intervention Description
Baseline Ig < 7g/L group - Intravenous immunoglobulin (IVIG) 0.8 g/kg will be given within 12 hours after randomization. Baseline Ig > or = 7 g/L group - Intravenous immunoglobulin (IVIG) 0.5 g/kg will be given within 12 hours after randomization
Intervention Type
Drug
Intervention Name(s)
Normal Saline
Other Intervention Name(s)
Saline, Sodium Chloride
Intervention Description
Baseline Ig < 7g/L group - Normal Saline (0.9% NaCl) 8 mL/kg will be given within 12 hours after randomization. Baseline Ig > or = 7 g/L group - Normal Saline (0.9% NaCl) 5 mL/kg will be given within 12 hours after randomization
Primary Outcome Measure Information:
Title
Recruitment
Description
Average number of patients being recruited per month. The study meets primary outcome if at least 4 patients can be recruited per month on average.
Time Frame
52 weeks
Title
Adherence and protocol compliance
Description
Number and percentage of recruited patients adhere to the allocated treatment and protocol. We aim to achieve 80% adherence rate which is defined as at least 80% of patients adhere to 80% of allocated treatment and protocol
Time Frame
104 weeks
Secondary Outcome Measure Information:
Title
Number of participants with treatment-related adverse events as assessed by CTCAE
Description
This will be assessed by documentation of adverse events in patients treated with Ig treatment versus control
Time Frame
104 weeks
Title
Tolerability of treatment
Description
The proportion of patients able to complete the treatment in the experimental arm during the study period versus in the control arm
Time Frame
104 weeks
Title
Efficacy trend: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) rates
Description
AECOPD will be ascertained by monthly follow-up phone calls as well as questionnaires during study visits to detect inpatient/outpatient treatment for exacerbations.
Time Frame
104 weeks
Title
Efficacy trend: Health status
Description
measured by the validated St. George Respiratory Questionnaire
Time Frame
104 weeks
Title
Efficacy trend: Quality of life
Description
validated quality of life measurement tool - EuroWol EQ-5D-5L
Time Frame
104 weeks
Title
Efficacy trend: % predicted FEV1
Description
FEV1 value will be measured using a hand held spirometer. FEV1 value will be recorded in Litres (L) and reported as a percent of their predicted value (using the NHANES III reference standards for predicted values
Time Frame
104 weeks
Title
Efficacy trend: FEV1/FVC
Description
FVC will be measured using a hand held spirometer, and will be recorded in Litres (L). Ratio of FEV1 and FVC will be reported.
Time Frame
104 weeks
Title
Efficacy trend: Health services use
Description
Number of non-study physician visits, emergency department (ED) and hospital admissions over the twelve-month study period.
Time Frame
104 weeks
Title
Efficacy trend: Health care system cost
Description
we will take the perspective of healthcare system and will measure the cost of health services use and an intervention. Intervention cost includes medication, staff, and equipment cost.
Time Frame
104 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Hospitalized adult patient with AECOPD (clinically dominant AECOPD in the case of multiple co-morbidities eg. absence of overt lobar pneumonia or acute congestive heart failure or alternate diagnosis such as acute coronary syndrome or pulmonary embolism) Diagnosis of severe COPD (post bronchodilator FEV1 <50%, FEV1/FVC ratio <0.7) made by standard spirometry within previous 12 months or within three days of admission if previous PFT data is not available Age >40 years >10 pack year smoking history At least one COPD exacerbation in the previous 12 months before enrollment, defined by having had documented inpatient or outpatient treatment by physician with antibiotics and/or prednisone for physician diagnosed COPD exacerbation Expected to live > 12 months Exclusion Criteria: Known severe hypersensitivity to immunoglobulin or its components (anaphylaxis) Underlying malignancy (including chronic lymphocytic leukemia) History of hematopoietic stem cell transplant or solid organ transplant Current treatment with a biological therapy for other conditions Concomitant significant immunodeficiency or on immunosuppressive treatment other than for COPD Alpha-1 antitrypsin deficiency Significant proteinuria (dipstick proteinuria ≥ 3+ or known urinary protein loss ≥ 2 g/day or nephrotic syndrome) and/or has acute renal failure and/or severe renal impairment (creatinine more than 2.5 times the upper limit of normal and/or on dialysis) IgA deficiency (IgA <0.1 g/L) Immunoglobulin therapy in the last 12 months or on current Ig therapy or have a clinical indication for Ig replacement therapy (www.nacblood.ca/resources/guidelines/IVIG.html) Obesity (BMI ≥35 kg/m²) Pregnancy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Juthaporn Cowan, MD, PhD, FRCPC
Organizational Affiliation
Associate Scientist
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Ottawa Hospital, General Campus
City
Ottawa
State/Province
Ontario
ZIP/Postal Code
K1H 8L6
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
Undecided
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https://lungontario.ca/
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Description
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Description
Intravenous immunoglobulin enhances the killing activity and autophagy of neutrophils isolated from immunocompromised patients against multidrug-re...

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Ig PRx in AECOPD: Pilot Study

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