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Nintedanib Twice Daily vs Placebo in Patients Diagnosed With Idiopathic Pulmonary Fibrosis (IPF)

Primary Purpose

Idiopathic Pulmonary Fibrosis

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Matching Placebo
Nintedanib
Sponsored by
Boehringer Ingelheim
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Idiopathic Pulmonary Fibrosis

Eligibility Criteria

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

Inclusion criteria:

  1. Written Informed Consent consistent with International Conference on Harmonisation Good Clinical Practice (ICH-GCP) and local laws signed prior to entry into the study
  2. Patient aged >= 40 years at Visit 1.
  3. IPF diagnosed, according to the 2011 American Thoracic Society (ATS) / European Respiratory Society (ERS) / Japanese Respiratory Society(JRS)/ Latin American Thoracic Association (ALAT)/ Latin American Thoracic Association/ Idiopathic Pulmonary Fibrosis (IPF) guidelines for diagnosis and management, within 5 years and reaffirmed applying 2011 Guidelines (P11-07084) if diagnosed >2 years and up to 5 year from Visit 1,. Diagnosis must be confirmed by chest High Resolution Computerized Tomography (HRCT) taken within 24 months of Visit 1. All HRCT results reported to be possible or inconsistent usual interstitial pneumonia (UIP) must have confirmatory pathology.
  4. Carbon monoxide Diffusing capacity or Transfer factor of the lung for carbon monoxide (DLCO) (corrected for Hb): 30%-79% predicted of normal
  5. Forced Vital Capacity (FVC) >= 50% predicted of normal at Visit 1 and Visit 2

Exclusion criteria:

  1. AST, ALT > 1.5 fold ULN
  2. Bilirubin > 1.5 fold ULN
  3. Bleeding risk:

    1. Patients who require fibrinolysis, full-dose therapeutic anticoagulation (e.g. vitamin K antagonists, dabigatran, heparin, hirudin), or high dose antiplatelet therapy. Exceptions: prophylactic low dose heparin or heparin flush as needed for maintenance of an indwelling intravenous device (e.g. enoxaparin 4000 IU s.c. per day) and prophylactic use of antiplatelet therapy (e.g. acetyl salicylic acid up to 325 mg/d, or clopidogrel at 75 mg/d, or equivalent doses of other antiplatelet therapy)
    2. History of hemorrhagic Central Nervous System (CNS) event within 12 months
    3. Any of the following within 3 months:

      • Haemoptysis or haematuria.
      • Active gastro-intestinal bleeding or ulcers.
      • Major injury or surgery.
    4. Coagulation parameters: International normalised ratio (INR) > 2, prothrombin time (PT) and partial thromboplastin time (PTT) > 150% of institutional ULN.
  4. Planned major surgery within the next 3 months, including lung transplantation, major abdominal or major intestinal surgery.
  5. Thrombotic risk

    1. Known inherited predisposition to thrombosis.
    2. History of thrombotic event (including stroke and transient ischemic attacks) within 12 months
  6. Current or planned usage of any investigational drug during the course of this trial
  7. Previous treatment with nintedanib within a clinical trial in the previous 3 months and discontinuation of nintedanib study treatment due to an adverse event
  8. Known hypersensitivity to the trial drug or its component
  9. A disease or condition which in the opinion of investigator may put the patient at risk because of participation in this trial or limit the patient's ability to participate in this trial. Patients will be excluded if they require greater than 12L/min oxygen, are not ambulatory or require use of a walker or cane during the 6 Minute Titration Walk Test. Patients who cannot complete the 6 Minute Titration Walk Test are excluded from participation.
  10. Alcohol or drug abuse which in the opinion of the investigator would interfere with trial participation.
  11. Pregnant women or women who are breast feeding or of child bearing potential not using two effective methods of birth control (one barrier and one highly effective non-barrier) for at least 1 month prior to trial and/or not committing to using it until 3 months after end of treatment.

Sites / Locations

  • Western CT Medical Group, P.C.
  • Clinical Research Center Sarasota Memorial Hosptial
  • Chest Medicine Clinical Services
  • Baptist Health Lexington
  • Minnesota Lung Research
  • Dartmouth-Hitchcock Medical Center
  • Winthrop University Hospital
  • ID Clinical Research, LTD
  • The Oregon Clinic
  • Lowcountry Lung and Crit Care
  • Annette C & Harold C Simmons Transplant Institute
  • University of Alberta Hospital (University of Alberta)
  • Vancouver General Hospital
  • St. Paul's Hospital
  • Concordia Hospital
  • QEII Health Sciences Centre (Dalhousie University)
  • St. Joseph's Healthcare Hamilton
  • CHUS Fleurimont
  • Cukurova Universitesi Tip Fakultesi Gog. Hast. Anabilim Dali
  • Ankara Universitesi Tip Fakultesi
  • Istanbul Universitesi Cerrahpasa Tip Fakultesi
  • Yedikule Gog. Hst. EAH
  • Sureyyapasa Gogus Hast. ve Gogus Cer. Egit. ve Aras. Has.
  • Ege Universitesi T.F.
  • Dr.Suat Seren EAH

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Nintedanib

Placebo

Arm Description

150 mg twice daily

twice daily dosing

Outcomes

Primary Outcome Measures

Relative Change From Baseline in High Resolution Computerized Tomography (HRCT) Quantitative Lung Fibrosis (QLF) Score at 6 Months
Relative change from baseline in HRCT QLF score at 6 months was calculated as the difference of the QLF score at month 6 minus the QLF score at baseline divided by the baseline QLF score. The QLF score itself ranges from 0 to 100%, where greater values represent a greater amount of lung fibrosis and are considered a worse health status. Hence smaller relative changes from baseline (i.e., ratios) were considered favorable. HCRT assessment obtained during screening visit was considered as baseline.

Secondary Outcome Measures

Effect of Six Month Delayed Treatment Onset: Relative Change From Baseline in HRCT QLF Score at 12 Months
Relative change from baseline in HRCT QLF score at 12 months was calculated as the ratio of the QLF score at 12 months to baseline. Greater values of the QLF score represented a worse health status and hence smaller relative changes from baseline (i.e., ratios) were considered favorable. HCRT assessment obtained during screening visit was considered as baseline. Note that due to the change in study design, patients randomized to the placebo group were treated with nintedanib after completion of the first 6-month treatment period. Therefore, this new endpoint was defined to address the effect of a 6-month delayed onset of nintedanib treatment.
Absolute Change in Forced Vital Capacity (FVC) From Baseline at 6 Months
Absolute change in Forced Vital Capacity (FVC) from baseline at 6 months is presented.
Relative Change in FVC From Baseline at 6 Months
Relative change in FVC from baseline at 6 months is presented.
Categorical Change in FVC From Baseline at 6 Months
Percentage of participants reporting categorical change in FVC from baseline at 6 months are presented.
St. George's Respiratory Questionnaire (SGRQ) Total Score Change From Baseline at 6 Months
SGRQ total score change from baseline at 6 months is presented. SGRQ is a health-related quality of life questionnaire divided into 3 components : symptoms, activity and impact. The total score (summed weights) can range from 0 to 100 with a lower score denoting a better health status. Means provided are the adjusted means based on all analyzed patients in the model (not only patients with a baseline and measurement at month 6).
6MWT Total Distance Walked Change From Baseline at 6 Months
Change in total distance covered in 6-minute walk test (6MWT) from baseline at 6 month is presented. The 6-Minutes Walk Test (6-MWT) was conducted according to the American Thoracic Society (ATS) Criteria.
University of California San Diego Shortness of Breath Questionnaire (UCSD-SOBQ) Change From Baseline at 6 Months
University of California San Diego Shortness of Breath Questionnaire (UCSD-SOBQ) change from baseline at 6 months is presented. Shortness of Breath Questionnaire measures the shortness of breath. It comprises of 24 items. Each item is scored on a scale between 0-5 where 5 represents maximal breathlessness. The responses to all items are summed up to provide the overall score that can range from 0 (best outcome) to 120 (worst outcome). Means presented are the adjusted means and are based on all analyzed patients in the model (not only patients with a baseline and measurement at month 6).
All-cause Mortality at 6 Months
Percentage of subjects died from all causes between 0 to 6 months are presented.
Respiratory Hospitalizations at 6 Months
Percentage of subjects hospitalized due to respiratory problems between 0 to 6 months are presented.
Respiratory Mortality at 6 Months
Percentage of subjects who died due to respiratory cause between 0 to 6 months are presented.
Acute Idiopathic Pulmonary Fibrosis (IPF) Exacerbations at 6 Months
Percentage of subjects experienced first acute IPF exacerbations (based on Investigator reported adverse events) between 0 to 6 months are presented.

Full Information

First Posted
November 4, 2013
Last Updated
March 19, 2018
Sponsor
Boehringer Ingelheim
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1. Study Identification

Unique Protocol Identification Number
NCT01979952
Brief Title
Nintedanib Twice Daily vs Placebo in Patients Diagnosed With Idiopathic Pulmonary Fibrosis (IPF)
Official Title
A Six Month Double Blind Randomized Placebo Controlled Trial Followed by Each Arm Being Converted to Oral Nintedanib 150 mg Twice Daily Comparing the Effect on High Resolution Computerized Tomography Quantitative Lung Fibrosis Score, Lung Function, Six Minute Walk Test Distance and St. George's Respiratory Questionnaire After Six Months of Treatment in Patients With Idiopathic Pulmonary Fibrosis With Continued Evaluations Over a Period of up to Eighteen Months
Study Type
Interventional

2. Study Status

Record Verification Date
March 2018
Overall Recruitment Status
Completed
Study Start Date
November 26, 2013 (Actual)
Primary Completion Date
October 27, 2016 (Actual)
Study Completion Date
October 27, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Boehringer Ingelheim

4. Oversight

5. Study Description

Brief Summary
This is an 6 month multi-centre, prospective, randomized, placebo controlled, double blind clinical trial followed by conversion of each arm to active nintedanib for an additional 6 months comparing the effect of nintedanib 150mg bis in die (BID twice daily) on the progression of IPF measured by using High Resolution Computerized Tomography(HRCT), lung function, functional component (6MWT), biomarkers, and PRO component (PROs) with continued treatment and assessments for up to 18 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Idiopathic Pulmonary Fibrosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
Double
Allocation
Randomized
Enrollment
113 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Nintedanib
Arm Type
Experimental
Arm Description
150 mg twice daily
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
twice daily dosing
Intervention Type
Drug
Intervention Name(s)
Matching Placebo
Intervention Description
twice daily dosing
Intervention Type
Drug
Intervention Name(s)
Nintedanib
Intervention Description
gelating capsule
Primary Outcome Measure Information:
Title
Relative Change From Baseline in High Resolution Computerized Tomography (HRCT) Quantitative Lung Fibrosis (QLF) Score at 6 Months
Description
Relative change from baseline in HRCT QLF score at 6 months was calculated as the difference of the QLF score at month 6 minus the QLF score at baseline divided by the baseline QLF score. The QLF score itself ranges from 0 to 100%, where greater values represent a greater amount of lung fibrosis and are considered a worse health status. Hence smaller relative changes from baseline (i.e., ratios) were considered favorable. HCRT assessment obtained during screening visit was considered as baseline.
Time Frame
Baseline and 6 Months
Secondary Outcome Measure Information:
Title
Effect of Six Month Delayed Treatment Onset: Relative Change From Baseline in HRCT QLF Score at 12 Months
Description
Relative change from baseline in HRCT QLF score at 12 months was calculated as the ratio of the QLF score at 12 months to baseline. Greater values of the QLF score represented a worse health status and hence smaller relative changes from baseline (i.e., ratios) were considered favorable. HCRT assessment obtained during screening visit was considered as baseline. Note that due to the change in study design, patients randomized to the placebo group were treated with nintedanib after completion of the first 6-month treatment period. Therefore, this new endpoint was defined to address the effect of a 6-month delayed onset of nintedanib treatment.
Time Frame
Baseline and 12 Months
Title
Absolute Change in Forced Vital Capacity (FVC) From Baseline at 6 Months
Description
Absolute change in Forced Vital Capacity (FVC) from baseline at 6 months is presented.
Time Frame
Baseline and 6 Months
Title
Relative Change in FVC From Baseline at 6 Months
Description
Relative change in FVC from baseline at 6 months is presented.
Time Frame
Baseline and 6 Months
Title
Categorical Change in FVC From Baseline at 6 Months
Description
Percentage of participants reporting categorical change in FVC from baseline at 6 months are presented.
Time Frame
Baseline and 6 Months
Title
St. George's Respiratory Questionnaire (SGRQ) Total Score Change From Baseline at 6 Months
Description
SGRQ total score change from baseline at 6 months is presented. SGRQ is a health-related quality of life questionnaire divided into 3 components : symptoms, activity and impact. The total score (summed weights) can range from 0 to 100 with a lower score denoting a better health status. Means provided are the adjusted means based on all analyzed patients in the model (not only patients with a baseline and measurement at month 6).
Time Frame
Baseline and 6 Months
Title
6MWT Total Distance Walked Change From Baseline at 6 Months
Description
Change in total distance covered in 6-minute walk test (6MWT) from baseline at 6 month is presented. The 6-Minutes Walk Test (6-MWT) was conducted according to the American Thoracic Society (ATS) Criteria.
Time Frame
Baseline and 6 Months
Title
University of California San Diego Shortness of Breath Questionnaire (UCSD-SOBQ) Change From Baseline at 6 Months
Description
University of California San Diego Shortness of Breath Questionnaire (UCSD-SOBQ) change from baseline at 6 months is presented. Shortness of Breath Questionnaire measures the shortness of breath. It comprises of 24 items. Each item is scored on a scale between 0-5 where 5 represents maximal breathlessness. The responses to all items are summed up to provide the overall score that can range from 0 (best outcome) to 120 (worst outcome). Means presented are the adjusted means and are based on all analyzed patients in the model (not only patients with a baseline and measurement at month 6).
Time Frame
Baseline and 6 Months
Title
All-cause Mortality at 6 Months
Description
Percentage of subjects died from all causes between 0 to 6 months are presented.
Time Frame
6 Months
Title
Respiratory Hospitalizations at 6 Months
Description
Percentage of subjects hospitalized due to respiratory problems between 0 to 6 months are presented.
Time Frame
6 Months
Title
Respiratory Mortality at 6 Months
Description
Percentage of subjects who died due to respiratory cause between 0 to 6 months are presented.
Time Frame
6 Months
Title
Acute Idiopathic Pulmonary Fibrosis (IPF) Exacerbations at 6 Months
Description
Percentage of subjects experienced first acute IPF exacerbations (based on Investigator reported adverse events) between 0 to 6 months are presented.
Time Frame
6 Months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Written Informed Consent consistent with International Conference on Harmonisation Good Clinical Practice (ICH-GCP) and local laws signed prior to entry into the study Patient aged >= 40 years at Visit 1. IPF diagnosed, according to the 2011 American Thoracic Society (ATS) / European Respiratory Society (ERS) / Japanese Respiratory Society(JRS)/ Latin American Thoracic Association (ALAT)/ Latin American Thoracic Association/ Idiopathic Pulmonary Fibrosis (IPF) guidelines for diagnosis and management, within 5 years and reaffirmed applying 2011 Guidelines (P11-07084) if diagnosed >2 years and up to 5 year from Visit 1,. Diagnosis must be confirmed by chest High Resolution Computerized Tomography (HRCT) taken within 24 months of Visit 1. All HRCT results reported to be possible or inconsistent usual interstitial pneumonia (UIP) must have confirmatory pathology. Carbon monoxide Diffusing capacity or Transfer factor of the lung for carbon monoxide (DLCO) (corrected for Hb): 30%-79% predicted of normal Forced Vital Capacity (FVC) >= 50% predicted of normal at Visit 1 and Visit 2 Exclusion criteria: AST, ALT > 1.5 fold ULN Bilirubin > 1.5 fold ULN Bleeding risk: Patients who require fibrinolysis, full-dose therapeutic anticoagulation (e.g. vitamin K antagonists, dabigatran, heparin, hirudin), or high dose antiplatelet therapy. Exceptions: prophylactic low dose heparin or heparin flush as needed for maintenance of an indwelling intravenous device (e.g. enoxaparin 4000 IU s.c. per day) and prophylactic use of antiplatelet therapy (e.g. acetyl salicylic acid up to 325 mg/d, or clopidogrel at 75 mg/d, or equivalent doses of other antiplatelet therapy) History of hemorrhagic Central Nervous System (CNS) event within 12 months Any of the following within 3 months: Haemoptysis or haematuria. Active gastro-intestinal bleeding or ulcers. Major injury or surgery. Coagulation parameters: International normalised ratio (INR) > 2, prothrombin time (PT) and partial thromboplastin time (PTT) > 150% of institutional ULN. Planned major surgery within the next 3 months, including lung transplantation, major abdominal or major intestinal surgery. Thrombotic risk Known inherited predisposition to thrombosis. History of thrombotic event (including stroke and transient ischemic attacks) within 12 months Current or planned usage of any investigational drug during the course of this trial Previous treatment with nintedanib within a clinical trial in the previous 3 months and discontinuation of nintedanib study treatment due to an adverse event Known hypersensitivity to the trial drug or its component A disease or condition which in the opinion of investigator may put the patient at risk because of participation in this trial or limit the patient's ability to participate in this trial. Patients will be excluded if they require greater than 12L/min oxygen, are not ambulatory or require use of a walker or cane during the 6 Minute Titration Walk Test. Patients who cannot complete the 6 Minute Titration Walk Test are excluded from participation. Alcohol or drug abuse which in the opinion of the investigator would interfere with trial participation. Pregnant women or women who are breast feeding or of child bearing potential not using two effective methods of birth control (one barrier and one highly effective non-barrier) for at least 1 month prior to trial and/or not committing to using it until 3 months after end of treatment.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Boehringer Ingelheim
Organizational Affiliation
Boehringer Ingelheim
Official's Role
Study Chair
Facility Information:
Facility Name
Western CT Medical Group, P.C.
City
Danbury
State/Province
Connecticut
ZIP/Postal Code
06810
Country
United States
Facility Name
Clinical Research Center Sarasota Memorial Hosptial
City
Sarasota
State/Province
Florida
ZIP/Postal Code
34239
Country
United States
Facility Name
Chest Medicine Clinical Services
City
Skokie
State/Province
Illinois
ZIP/Postal Code
60076
Country
United States
Facility Name
Baptist Health Lexington
City
Lexington
State/Province
Kentucky
ZIP/Postal Code
40503
Country
United States
Facility Name
Minnesota Lung Research
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55407
Country
United States
Facility Name
Dartmouth-Hitchcock Medical Center
City
Lebanon
State/Province
New Hampshire
ZIP/Postal Code
03756
Country
United States
Facility Name
Winthrop University Hospital
City
Mineola
State/Province
New York
ZIP/Postal Code
11501
Country
United States
Facility Name
ID Clinical Research, LTD
City
Toledo
State/Province
Ohio
ZIP/Postal Code
43608
Country
United States
Facility Name
The Oregon Clinic
City
Portland
State/Province
Oregon
ZIP/Postal Code
97220
Country
United States
Facility Name
Lowcountry Lung and Crit Care
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29406
Country
United States
Facility Name
Annette C & Harold C Simmons Transplant Institute
City
Dallas
State/Province
Texas
ZIP/Postal Code
75246
Country
United States
Facility Name
University of Alberta Hospital (University of Alberta)
City
Edmonton
State/Province
Alberta
ZIP/Postal Code
T6G 2G3
Country
Canada
Facility Name
Vancouver General Hospital
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V5Z 1M9
Country
Canada
Facility Name
St. Paul's Hospital
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V6Z 1Y6
Country
Canada
Facility Name
Concordia Hospital
City
Winnipeg
State/Province
Manitoba
ZIP/Postal Code
R2K 3S8
Country
Canada
Facility Name
QEII Health Sciences Centre (Dalhousie University)
City
Halifax
State/Province
Nova Scotia
ZIP/Postal Code
B3H 3A7
Country
Canada
Facility Name
St. Joseph's Healthcare Hamilton
City
Hamilton
State/Province
Ontario
ZIP/Postal Code
L8N 4A6
Country
Canada
Facility Name
CHUS Fleurimont
City
Sherbrooke
State/Province
Quebec
ZIP/Postal Code
J1H 5N4
Country
Canada
Facility Name
Cukurova Universitesi Tip Fakultesi Gog. Hast. Anabilim Dali
City
Adana
ZIP/Postal Code
01330
Country
Turkey
Facility Name
Ankara Universitesi Tip Fakultesi
City
Ankara
ZIP/Postal Code
06100
Country
Turkey
Facility Name
Istanbul Universitesi Cerrahpasa Tip Fakultesi
City
Istanbul
ZIP/Postal Code
34098
Country
Turkey
Facility Name
Yedikule Gog. Hst. EAH
City
Istanbul
ZIP/Postal Code
34760
Country
Turkey
Facility Name
Sureyyapasa Gogus Hast. ve Gogus Cer. Egit. ve Aras. Has.
City
Istanbul
ZIP/Postal Code
34844
Country
Turkey
Facility Name
Ege Universitesi T.F.
City
Izmir
ZIP/Postal Code
35100
Country
Turkey
Facility Name
Dr.Suat Seren EAH
City
Izmir
ZIP/Postal Code
35110
Country
Turkey

12. IPD Sharing Statement

Citations:
PubMed Identifier
33902584
Citation
Glaspole I, Bonella F, Bargagli E, Glassberg MK, Caro F, Stansen W, Quaresma M, Orsatti L, Bendstrup E. Efficacy and safety of nintedanib in patients with idiopathic pulmonary fibrosis who are elderly or have comorbidities. Respir Res. 2021 Apr 26;22(1):125. doi: 10.1186/s12931-021-01695-y.
Results Reference
derived
Links:
URL
http://trials.boehringer-ingelheim.com/
Description
Synopsis Link

Learn more about this trial

Nintedanib Twice Daily vs Placebo in Patients Diagnosed With Idiopathic Pulmonary Fibrosis (IPF)

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