Enhancement of in−Vitro GC Function in Patients With COPD

This study has been completed.
Sponsor:
Collaborators:
Mitsubishi Tanabe Pharma Corporation
Medical Research Council
Information provided by:
Imperial College London
ClinicalTrials.gov Identifier:
NCT00241631
First received: October 18, 2005
Last updated: September 17, 2007
Last verified: September 2007
  Purpose

The global burden of COPD − a common and debilitating chronic inflammatory disease that is characterised by the progressive development of airflow limitation (shortness of breath − SOB) and is poorly reversible with currently available drugs −is increasing. Cigarette smoking is strongly linked with the ongoing inflammation; inflammation that can continue even when the patient has stopped smoking. The severity of airflow limitation (SOB) is correlated with the degree of pulmonary (lung) inflammation.

Histone deacetylases (HDACs)are important molecules in suppressing this pulmonary inflammation. We have recently shown that patients with COPD have a reduction in total HDAC which correlates with the severity of their lung disease.

Corticosteroids (anti−inflammatory treatment) act, at least in part, by recruitment of these HDACs to the site of active inflammatory gene transcription (which reduces the production of inflammatory molecules) and are widely used in COPD in patients with severe disease. Unfortunately, in COPD, inhaled corticosteroids seem to have little effect on the underlying inflammation (though in a selective group of patients with COPD they do reduce the number of infections a patient may have by a small amount). Theophylline has been used in the treatment of asthma and COPD for over 70 years, but its use has recently declined. Data so far obtained in primary cells (cells from patients used in the laboratory) from COPD patients suggests that low dose theophylline (~5mg/l) should be effective in restoring steroid sensitivity in patients with COPD (and hence reduce inflammation thus improving SOB). We wish therefore to continue these studies on theophylline principally by conducting a small clinical pilot study on 20−30 COPD patients in a randomised, double−blind, placebo−controlled, parallel−group study.


Condition Intervention Phase
COPD
Drug: fluticasone
Drug: placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Enhancement of in-Vitro GC Function in Patients With COPD. A Randomised, Double Blind, Placebo Controlled, Parallel-Group Study to Investigate the Effect of Theophylline and Fluticasone on Induced Sputum Cells Obtained Form COPD Patients

Resource links provided by NLM:


Further study details as provided by Imperial College London:

Primary Outcome Measures:
  • sputum inflammatory cell counts [ Time Frame: 4 weeks ]

Enrollment: 31
Study Start Date: April 2006
Study Completion Date: August 2007
Arms Assigned Interventions
Active Comparator: 1 Drug: fluticasone
500 mg b.d.
Placebo Comparator: 2 Drug: placebo

Detailed Description:

as above

  Eligibility

Ages Eligible for Study:   40 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:Participants with COPD with an FEV1 of 80−30% predicted. This will incorporate the majority of participants with COPD seen within the chest clinic. Patients with an FEV1 > 80% predicted are not generally severe enough to warrant hospital follow up. These patients are also unlikely to have severe enough disease (and therefore airway inflammation) which may be modified by the therapeutic agents we are studying.

Patients with an FEV1 < 30% tend to have more severe symptom limitation and generally (though not always) find participation in a clinical trial involving 4 visits to the clinic difficult. Their airway disease is also generally less responsive to therapeutic intervention and as a consequence finding measurements which show changes to these therapeutic interventions is more difficult.

COPD patients

  • All participants will be classified to Stage 2−3 of the GOLD (Global initiative for Obstructive Lung Disease) guidelines
  • Male or female, aged 45-80 years (according to GOLD guidelines)
  • 30% < FEV1 < 80% predicted
  • FEV1/FVC < 70%
  • Cigarette exposure of >10 pack−years#
  • With or without chronic symptoms (cough, sputum production, dyspnea).
  • Steroid therapy will be stopped before run−in, but long acting bronchodilators are acceptable.
  • The participants are able to give informed consent # The smoking history should include both the number smoked, for how long, and an estimate of total pack−years of smoking. One pack of 20 cigarettes smoked per day for 1 year = one pack year. Total pack years = No. cigarettes smoked per day/20 x no. years of smoking

Exclusion Criteria:

Any history or evidence of asthma

  • Pregnancy, breast−feeding or planned pregnancy during the study. Fertile women not using acceptable contraceptive measures, as judged by the investigator
  • Hospital admission with respiratory infection within the last 6 months
  • Upper respiratory infection within the last 4 weeks
  • Participants who have received research medication within the previous one month
  • Participants unable to give informed consent
  • Any mental condition rendering the participant unable to understand the nature, scope and possible consequences of the study
  • Known or suspected hypersensitivity to study therapy or excipients
  • Participants with significant or unstable ischemic heart disease, arrhythmia, cardiomyopathy, heart failure, uncontrolled hypertension as defined by the investigator, or any other relevant cardiovascular disorder as judged by the investigator
  • Any current respiratory tract disorders other than COPD, which is considered by the investigator to be clinically significant
  • Any significant disease or disorder (e.g. gastrointestinal, liver, renal, neurological, musculoskeletal, endocrine, metabolic, malignant, psychiatric, major physical impairment) or abnormality laboratory tests which, in the opinion of the investigator, may either put the participant at risk because of inclusion in the study, or may influence the results of the study, or the participants ability to take part in the study
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00241631

Locations
United Kingdom
Windsor chest clinic KEVII Hospital
Windsor, Berks, United Kingdom, SL4 3DP
Sponsors and Collaborators
Imperial College London
Mitsubishi Tanabe Pharma Corporation
Medical Research Council
Investigators
Principal Investigator: ian adcock, PhD Imperial College London
  More Information

Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
ClinicalTrials.gov Identifier: NCT00241631     History of Changes
Other Study ID Numbers: mitHDAC#1
Study First Received: October 18, 2005
Last Updated: September 17, 2007
Health Authority: United Kingdom: Research Ethics Committee

Additional relevant MeSH terms:
Fluticasone
Anti-Inflammatory Agents
Therapeutic Uses
Pharmacologic Actions
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Asthmatic Agents
Respiratory System Agents
Dermatologic Agents
Anti-Allergic Agents

ClinicalTrials.gov processed this record on September 16, 2014