AntiCoagulant Effectiveness in Idiopathic Pulmonary Fibrosis (ACE-IPF)
This study will test the effectiveness of warfarin in patients with IPF. Approximately 256 patients will be randomized 1:1 to either warfarin or placebo. Patients will return at week 1 for a safety review and every 16 weeks for 48 weeks. The primary endpoint in the study is the time to either death, non-bleeding/non-elective hospitalization, or a drop of greater than 10% in forced vital capacity (FVC) from baseline.
|Study Design:||Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||AntiCoagulant Effectiveness in Idiopathic Pulmonary Fibrosis (ACE-IPF)|
- Death, Non-bleeding/Non-elective Hospitalization, or >10% Drop in Forced Vital Capacity [ Time Frame: Events up to 48 weeks ] [ Designated as safety issue: Yes ]Death, non-bleeding/non-elective hospitalization, or >10% drop in forced vital capacity.
- All Cause Mortality [ Time Frame: maximum of 48 weeks ] [ Designated as safety issue: Yes ]
- Change in Forced Vital Capacity (FVC) From Baseline to 16 Weeks [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]Week-16 change from Baseline
- All-cause Hospitalizations [ Time Frame: maximum 48 weeks ] [ Designated as safety issue: No ]
- Bleeding Events [ Time Frame: maximum of 48 weeks ] [ Designated as safety issue: Yes ]
- Acute Exacerbations of Idiopathic Pulmonary Fibrosis (IPF) [ Time Frame: maximum of 48 weeks ] [ Designated as safety issue: No ]
- Respiratory-related Hospitalizations [ Time Frame: maximum 48 weeks ] [ Designated as safety issue: No ]
- Cardiovascular Mortality or Morbidity [ Time Frame: maximum of 48 weeks ] [ Designated as safety issue: No ]Measured at 48 Weeks
- Change in 6-minute Walk Distance (6MWD) [ Time Frame: Change from baseline to last visit (maximum of 48 weeks) ] [ Designated as safety issue: No ]The 6MWD is a measure of exercise tolerance. Change in exercise tolerance is calculated at the latest time point (up to 48 weeks) minus the earliest time point (at baseline).
- Total Score St. George's Respiratory Questionnaire (SGRQ) [ Time Frame: Week 16 Change from Baseline ] [ Designated as safety issue: No ]The SGRQ is a quality of life measurement used to assess respiratory well being with a 0*-100 range (*indicates better health--lower is better).
- Change in Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) From Baseline to 16 Weeks [ Time Frame: Week 48 / Final Visit ] [ Designated as safety issue: No ]The DLCO measures the partial pressure difference between inspired and expired carbon monoxide.
- Fibrin D-dimer Change From Baseline to 16 Weeks [ Time Frame: maximum of 48 weeks ] [ Designated as safety issue: No ]Biomarker that measures biologic activities in patients as opposed to response.
|Study Start Date:||October 2009|
|Study Completion Date:||July 2011|
|Primary Completion Date:||July 2011 (Final data collection date for primary outcome measure)|
Active Comparator: warfarin
Oral warfarin titrated to an international normalization ratio (INR) of 2-3
Oral warfarin (1mg or 2.5mg) titrated to an INR of 2-3.
Other Name: warfarin sodium
Placebo Comparator: placebo
Oral placebo (1mg or 2.5mg)
Oral placebo (1mg or 2.5mg)
ACE-IPF was a double-blind, randomized, placebo-controlled trial of an oral warfarin dose adjusted to an international normalized ratio (INR) response of 2.0 to 3.0, compared with a sham dose-adjusted placebo. The trial was originally designed as an event-driven study with a treatment period of up to 144 weeks. Given the slow rate of recruitment and higher than anticipated event rates seen in another Idiopathic Pulmonary Fibrosis Clinical Research Network (IPFnet) trial, the protocol was modified to have a maximum treatment period of 48 weeks after eleven patients were enrolled in the study. Participants were to be seen at screening, baseline, and at 16, 32, and 48 weeks after enrollment.
The primary outcome was a composite endpoint based on the time to all-cause mortality; non-elective, non-bleeding hospitalization; or a decrease in the absolute FVC ≥10% from baseline value. Secondary outcome measures included rates of mortality, hospitalization, respiratory-related hospitalization, acute exacerbation, bleeding, cardiovascular events, and changes over time in FVC, six-minute walk test distance, diffusing capacity of lung for carbon monoxide (DLCO), plasma fibrin D-dimer levels, and quality of life (QOL) assessments.
Data Analysis Continuous variables at baseline were expressed as means (standard deviations) and medians (25th and 75th percentiles). Categorical variables at baseline were expressed as counts and percentages. Unadjusted estimates of event rates for time-to-event variables were computed using the Kaplan-Meier estimator with comparisons based on the log-rank test statistic. The primary hypothesis was tested using a Cox proportional hazards regression model, comparing the treatment effect on the primary composite endpoint. Pre-specified covariates in this model included an indicator variable for the treatment group and the DLCO measurement from the baseline assessment.
Subjects were randomly assigned to study arms in a 1:1 ratio, using a permuted-block design with varying block sizes, to receive either warfarin or matched placebo. Subjects were stratified by clinical center and a DLCO threshold of 35% of predicted. Randomization lists were generated by the study data coordinating center (DCC) and provided to a phone- and web-enabled registration system (Almac Clinical Services, Inc.) that allowed sites to enroll subjects and receive study kits while keeping the study team and subjects blinded to treatment assignment.
INR testing and monitoring:
Study subjects were provided two strengths of warfarin tablets (1 mg and 2.5 mg) or matching placebos. Subjects measured their INR with encrypted meters (INRatio®, Alere, San Diego, CA) at least weekly. Home monitoring was validated by plasma INR measurement at the week 1 and 16 visits. Individual INR meters and test strips were replaced and subjects were reinstructed if meter INR readings varied by more than 30% from the laboratory INR. Efficacy of home INR measures were determined by time-in-target INR range of all patients, calculated on the basis of linear interpolation, 12 after excluding readings taken at baseline, during initial warfarin titration (until INR ≥ 2.0), study drug interruption, or following the discontinuation of study drug.
Show 22 Study Locations
|Study Chair:||Galen Toews, MD||University of Michigan|
|Study Director:||Gail Weinmann, MD||National Heart, Lung, and Blood Institute (NHLBI)|
|Principal Investigator:||Kevin Brown, MD||National Jewish Health|
|Principal Investigator:||Rob Kaner, MD||Weill Medical College at Cornell University|
|Principal Investigator:||Talmadge King, MD||University of California, San Francisco|
|Principal Investigator:||Joe Lasky, MD||Tulane University School of Medicine|
|Principal Investigator:||James Loyd, MD||Vanderbilt University|
|Principal Investigator:||Fernando Martinez, MD||University of Michigan|
|Principal Investigator:||Imre Noth, MD||University of Chicago|
|Principal Investigator:||Ganesh Raghu, MD||University of Washington|
|Principal Investigator:||Jesse Roman, MD||Emory University|
|Principal Investigator:||Jay Ryu, MD||Mayo Clinic|
|Principal Investigator:||Joseph Lynch, MD||University of California, Los Angeles|
|Principal Investigator:||Kevin Anstrom, PhD||Duke University|
|Principal Investigator:||Joao deAndrade, MD||University of Alabama at Birmingham|
|Principal Investigator:||Jeffrey Chapman, MD||The Cleveland Clinic|
|Principal Investigator:||Lake Morrison, MD||Duke University|
|Principal Investigator:||Michael Kallay, MD||Highland Hospital|
|Principal Investigator:||Steven Sahn, MD||Medical University of South Carolina|
|Principal Investigator:||Marilyn Glassberg, MD||University of Miami|
|Principal Investigator:||Milton Rossman, MD||University of Pennsylvania|
|Principal Investigator:||John Fitzgerald, MD||University of Texas|
|Principal Investigator:||Mary Beth Scholand, MD||University of Utah|
|Principal Investigator:||Neil Ettinger, MD||St Luke's Hospital|
|Principal Investigator:||Danielle Antin-Ozerkis, MD||Yale University|