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Alpha-1-Antitrypsin (AAT) To Treat Emphysema In AAT-Deficient Patients (EXACTLE)

This study has been completed.
Information provided by (Responsible Party):
Grifols Therapeutics Inc. Identifier:
First received: September 12, 2005
Last updated: August 5, 2014
Last verified: August 2014
The goal of this trial was to explore the utility of evaluating emphysema progression through CT scans measuring lung density during a 2 year period of weekly infusions of either placebo or human alpha-1-antitrypsin (AAT; Prolastin®). Exacerbation data recorded in patient diaries were also collected. All efficacy data were analyzed for potential use in evaluating Prolastin efficacy in this and other clinical trials.

Condition Intervention Phase
Alpha 1-Antitrypsin Deficiency Drug: Alpha1-Proteinase Inhibitor (Human) Drug: Albumin (Human) 20%, United States Pharmacopeia (USP) Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Multi-center, Randomized Trial With I.V. Prolastin® to Evaluate Frequency of Exacerbations and Progression of Emphysema by Means of Multi-slice CT Scans in Patients With Congenital Alpha-1-antitrypsin Deficiency.

Resource links provided by NLM:

Further study details as provided by Grifols Therapeutics Inc.:

Primary Outcome Measures:
  • The Progression Rate of Emphysema Determined by Change in 15th Percentile of Lung Density Measured by Annual CT Scan of the Whole Lung [ Time Frame: 24 or 30 months ]

Secondary Outcome Measures:
  • Change in Lung Density at Each Visit as Measured by Computed Tomography [ Time Frame: 24 or 30 months ]
  • The Frequency of Exacerbations as Determined by Patient Diary. [ Time Frame: 24 or 30 months ]
  • The Deterioration of the Lung Function Will be Assessed by Measurement of the Change in Forced Expiratory Volume at One Second (FEV1) and Transfer Factor of Carbon Monoxide (KCO) [ Time Frame: 24 or 30 months ]
  • Duration and Severity of the Exacerbations [ Time Frame: 24 or 30 months ]
  • Mortality [ Time Frame: 24 or 30 months ]
  • Quality of Life With a Disease Specific Instrument, the St. George's Respiratory Questionnaire [ Time Frame: 24 or 30 months ]

Enrollment: 77
Study Start Date: December 2003
Study Completion Date: January 2007
Primary Completion Date: January 2007 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Group 1
Drug: Alpha1-Proteinase Inhibitor (Human)
Weekly infusion of 60 mg/kg body weight for 2 years
Other Names:
  • Prolastin
  • alpha-1 antitrypsin (AAT)
  • BAY x 5747
  • BAY 10-5233
  • TAL-05-00007
  • NDC 13533-601-30
  • NDC 13533-601-35
Placebo Comparator: Group 2 Drug: Albumin (Human) 20%, United States Pharmacopeia (USP)
Weekly infusion for 2 years. Albumin (Human) 20% will be diluted with 5% glucose to a final concentration of 2.0%.
Other Names:
  • Plasbumin®-20
  • Plasbumin®-20 (Low Aluminum)
  • Albumin (Human) 20%
  • TAL-05-00008
  • TAL-05-00024
  • BAY 34-9255
  • NDC 3533-683-20
  • NDC 1533-683-71
  • NDC 13533-691-20
  • NDC 13533-691-71

Detailed Description:

This is a one to one randomized, placebo-controlled, clinical, exploratory study with the aim of collecting information on possible clinical endpoints i.e., the progression of emphysema by lung density measurements with CT scan and frequency of exacerbations that could be used for a subsequent placebo controlled clinical trial. Progression of disease will be investigated in 80 patients with alpha-1-antitrypsin deficiency, who will be treated with human alpha-1-antitrypsin (AAT; Prolastin®) or placebo weekly for two years to analyze the effect of treatment on lung density and exacerbations. Targeted augmentation therapy with weekly infusions of Prolastin® will be a dose of 60 mg/kg body weight (range of 51.72 to 71.43 mg per kg body weight).

Therefore, this study focuses on several questions:

  • Is the 15th percentile point calculated by analysis of CT lung histograms a useful endpoint for clinical trials in AAT deficiency?
  • Is quantitation of exacerbations in AAT-deficient patients a useful endpoint for clinical trials in AAT deficiency?
  • Are there significant differences between the treatments in favor of Prolastin®?

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patient with pulmonary emphysema due to severe congenital AAT deficiency of phenotype protease inhibitor Z (PiZ) or other rare genotypes (not MS, MZ or SZ) and AAT serum level < 11 microns (µM) or < 80 mg/dL (status to be confirmed by phenotyping and genotyping)
  • Inspiratory capacity (VC - ERV) > 1.2 L and forced expiratory volume at one second (FEV1) < 80% of predicted value post bronchodilator
  • FEV1/VC < 70% of predicted value post-bronchodilator or transfer factor of carbon monoxide (KCO) < 80% of predicted value post-bronchodilator
  • History of at least one exacerbation in the past 2 years
  • Written informed consent

Exclusion Criteria:

  • FEV1 < 25% of predicted value post-bronchodilator
  • Augmentation therapy for more than one month with plasma-derived human alpha 1-antitrypsin (AAT) within the last 2 years
  • History of lung transplant
  • Any lung surgery within the past 2 years
  • On any thoracic surgery waiting list
  • Diagnosis of liver cirrhosis
  • Severe concomitant disease
  • Active pulmonary infection/exacerbations within the last month
  • Active smoking during the last 6 months or plasma positive for cotinine
  • Body weight < 42 kg or > 92 kg
  • Pregnancy or lactation
  • Women of child-bearing potential without adequate contraception
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00263887

Gentofte Hospital Department of Respiratory Medicine
Hellerup, Denmark, 2900
Department of Pulmonary Medicine, Malmö University Hospital
Malmö, Sweden
United Kingdom
Queen Elizabeth Hospital
Birmingham, England, United Kingdom, B15 2TH
Sponsors and Collaborators
Grifols Therapeutics Inc.
Principal Investigator: Asger Dirksen, MD PHD University of Copenhagen
  More Information

Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Grifols Therapeutics Inc. Identifier: NCT00263887     History of Changes
Other Study ID Numbers: 100533
Study First Received: September 12, 2005
Results First Received: September 24, 2009
Last Updated: August 5, 2014

Keywords provided by Grifols Therapeutics Inc.:
alpha 1 proteinase inhibitor
alpha1 proteinase inhibitor
congenital emphysema
replacement therapy

Additional relevant MeSH terms:
Pulmonary Emphysema
Subcutaneous Emphysema
Alpha 1-Antitrypsin Deficiency
Pathologic Processes
Pulmonary Disease, Chronic Obstructive
Lung Diseases, Obstructive
Lung Diseases
Respiratory Tract Diseases
Liver Diseases
Digestive System Diseases
Genetic Diseases, Inborn
Alpha 1-Antitrypsin
Protein C Inhibitor
Protease Inhibitors
Trypsin Inhibitors
Serine Proteinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action processed this record on September 20, 2017