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The Effectiveness of Roflumilast in Improving Mucociliary Clearance in Patients With COPD and Chronic Bronchitis

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Johns Hopkins University
ClinicalTrials.gov Identifier:
NCT03073798
First received: March 2, 2017
Last updated: June 29, 2017
Last verified: June 2017
  Purpose

Specific Aim: To determine the effectiveness of Roflumilast in improving i) whole right lung and ii) peripheral right lung mucociliary clearance (MCC) in patients with COPD and chronic bronchitis.

Hypothesis: Roflumilast increases mucociliary clearance in patients with chronic bronchitis.

Study Design: This will be a double-blinded, cross-over randomized controlled trial with 1:1 randomization of 20 individuals with chronic bronchitis. Subjects will undergo baseline MCC then will be randomized to either roflumilast or placebo x 4 weeks, then there will be a 4 week wash-out phase and a second 4 week period of roflumilast/placebo depending on initial randomization. MCC will be conducted at baseline and at the end of each 4 week medication phase.


Condition Intervention Phase
COPD Chronic Bronchitis Emphysema Drug: Roflumilast Drug: Placebo Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Effectiveness of Roflumilast in Improving Mucociliary Clearance in Patients With COPD and Chronic Bronchitis

Resource links provided by NLM:


Further study details as provided by Johns Hopkins University:

Primary Outcome Measures:
  • Difference in Mucociliary Clearance (MCC) Between Visit 1A and Visit 2A [ Time Frame: Change from 0 to 30 minutes ]

    Measurements of MCC (Mucociliary clearance) will be obtained using a large-field-of-view 2D gamma camera (Siemens Orbiter) following inhalation of a radioaerosol containing a gamma emitting isotope 99mtechnetium (99mTc)-sulfur-colloid. The total exposure to radiation from procedures associated with the MCC studies is similar to that of a chest x-ray and is much less than the 0.3 rem that the average person in the United States gets each year from natural sources like the sun, outer space, air, food, and soil.

    After inhaling (0 time point) an aerosol generated from a saline solution containing the radioisotope 99mtechnetium (99mTc)-sulfur-colloid (radioaerosol), subjects will sit with their back to a gamma camera. The gamma camera will acquire an image of where the isotopic marker initially deposits in the right lung at time 0 and how much remains in the lungs at the specified time point and will be measured in change of %/min from 0 min time point.


  • Difference in Mucociliary Clearance (MCC) Between Visit 1A and Visit 2A [ Time Frame: Change from 0 to 60 minutes ]

    Measurements of MCC (Mucociliary clearance) will be obtained using a large-field-of-view 2D gamma camera (Siemens Orbiter) following inhalation of a radioaerosol containing a gamma emitting isotope 99mtechnetium (99mTc)-sulfur-colloid. The total exposure to radiation from procedures associated with the MCC studies is similar to that of a chest x-ray and is much less than the 0.3 rem that the average person in the United States gets each year from natural sources like the sun, outer space, air, food, and soil.

    After inhaling (0 time point) an aerosol generated from a saline solution containing the radioisotope 99mtechnetium (99mTc)-sulfur-colloid (radioaerosol), subjects will sit with their back to a gamma camera. The gamma camera will acquire an image of where the isotopic marker initially deposits in the right lung at time 0 and how much remains in the lungs at the specified time point and will be measured in change of %/min from 0 min time point.


  • Difference in Mucociliary Clearance (MCC) Between Visit 1A and Visit 2A [ Time Frame: Change from 0 to 90 minutes ]

    Measurements of MCC (Mucociliary clearance) will be obtained using a large-field-of-view 2D gamma camera (Siemens Orbiter) following inhalation of a radioaerosol containing a gamma emitting isotope 99mtechnetium (99mTc)-sulfur-colloid. The total exposure to radiation from procedures associated with the MCC studies is similar to that of a chest x-ray and is much less than the 0.3 rem that the average person in the United States gets each year from natural sources like the sun, outer space, air, food, and soil.

    After inhaling (0 time point) an aerosol generated from a saline solution containing the radioisotope 99mtechnetium (99mTc)-sulfur-colloid (radioaerosol), subjects will sit with their back to a gamma camera. The gamma camera will acquire an image of where the isotopic marker initially deposits in the right lung at time 0 and how much remains in the lungs at the specified time point and will be measured in change of %/min from 0 min time point.


  • Difference in Mucociliary Clearance (MCC) Between Visit 1B and Visit 2B [ Time Frame: Change from 0 min to 24 hours ]

    Measurements of MCC (Mucociliary clearance) will be obtained using a large-field-of-view 2D gamma camera (Siemens Orbiter) following inhalation of a radioaerosol containing a gamma emitting isotope 99mtechnetium (99mTc)-sulfur-colloid. The total exposure to radiation from procedures associated with the MCC studies is similar to that of a chest x-ray and is much less than the 0.3 rem that the average person in the United States gets each year from natural sources like the sun, outer space, air, food, and soil.

    After inhaling (0 time point) an aerosol generated from a saline solution containing the radioisotope 99mtechnetium (99mTc)-sulfur-colloid (radioaerosol), subjects will sit with their back to a gamma camera. The gamma camera will acquire an image of where the isotopic marker initially deposits in the right lung at time 0 and how much remains in the lungs at the specified time point and will be measured in change of %/min from 0 min time point.



Enrollment: 12
Actual Study Start Date: March 18, 2013
Study Completion Date: May 14, 2015
Primary Completion Date: May 14, 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Medication
Roflumilast. 500 mcg of Roflumilast daily for 4 weeks, then there will be a 4 week wash-out phase (no medication) and a second 4 week period of placebo.
Drug: Roflumilast
500 mcg of Roflumilast which is a prescription medicine used in adults with severe COPD to decrease the number of flare-ups or the worsening of COPD symptoms
Other Name: Daliresp
Drug: Placebo
500 mcg of placebo is used
Other Name: Sugar Pill
Placebo Comparator: Placebo
Placebo. 500 mcg of Placebo daily for 4 weeks, then there will be a 4 week wash-out phase (no medication) and a second 4 week period of Roflumilast
Drug: Roflumilast
500 mcg of Roflumilast which is a prescription medicine used in adults with severe COPD to decrease the number of flare-ups or the worsening of COPD symptoms
Other Name: Daliresp
Drug: Placebo
500 mcg of placebo is used
Other Name: Sugar Pill

Detailed Description:

The purpose of this study is to investigate how well Roflumilast improves mucociliary clearance in people with chronic bronchitis. Several studies show that roflumilast may modulate (change) mucociliary function. This study is designed to determine if these favorable effects lead to improved mucociliary clearance (MCC) in people with chronic bronchitis, thereby, reducing the potential for acute infections and hospitalizations. Daliresp® (roflumilast) is a drug currently marketed (approved by the U.S. Food and Drug Administration (FDA) for use in humans) in the U.S. and is indicated (used) for treatment of people with severe COPD to treat the symptoms of cough and excess mucous linked to chronic bronchitis. Roflumilast is used to reduce the risk (chance) of COPD exacerbations (increase in symptoms such as cough, mucus secretions, and shortness of breath, that can be life threatening and reduces the ability to breathe) linked to chronic bronchitis (swelling of the airways in the lungs). Roflumilast is FDA approved to decrease the number of flare-ups of chronic obstructive pulmonary disease (COPD) in patients with severe COPD with chronic bronchitis and a history of flare-ups. The exact way Roflumilast does this is not known. Although Roflumilast is an FDA approved drug, in this study the drug is not being used for its FDA-approved indication.

If you agree to be in this study, you will receive no new COPD treatment other than the drugs provided for the study. You will also be given a tablet to take once a day, which will be placebo for at least part of the study. A placebo is a substance that looks like the study drug but that contains no active ingredients.

The study is a double-blind study. Double-blind means that neither you nor the study doctor will know which study regimen (roflumilast or placebo) you are receiving throughout the study. However, this information can be made available if medically necessary and as determined by the participant's study. You will undergo baseline mucociliary Clearance (MCC) Measurements then will be randomized (by chance, like the flip of a coin) to receive either roflumilast or placebo for 4 weeks, then there will be a 4 week wash-out phase, and a second 4 week period of roflumilast/placebo depending on initial randomization. Mucociliary Clearance (MCC) Measurements will be conducted at the beginning and at the end of each 4 week study regimen phase. You will be in the study for about 12 weeks and there will be up to 12 visits. At baseline, and prior to each MCC Procedure, you will have health assessments which may include Physical Examination, Health and Demographic Interview, Exhaled Carbon Monoxide (eCO) Testing, Spirometry (Breathing Test), Expectorated Sputum Collection, Pregnancy Testing and Mucociliary Clearance (MCC) Measurements.

  Eligibility

Ages Eligible for Study:   40 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Physician diagnosis of COPD
  • Forced Expiratory Volume in 1 second (FEV1) / Forced Vital Capacity (FVC) ≤70%
  • FEV1 (% predicted) ≥40 % AND ≤ 70%,
  • Tobacco exposure ≥ 10 pack-years,
  • Chronic cough and sputum production
  • At least one COPD exacerbation requiring systemic glucocorticosteroids or treatment in hospital, or both, in the previous year
  • Not suffering from any concomitant disease that might interfere with study procedures or evaluations.

Exclusion Criteria:

  • COPD exacerbation indicated by a treatment with systemic glucocorticosteroids and/or antibiotics not stopped at least 4 weeks prior to the baseline visit V0
  • Lower respiratory tract infection not resolved 4 weeks prior to the baseline visit V0
  • Diagnosis of asthma and/or other relevant lung disease (e.g. history of bronchiectasis, cystic fibrosis, bronchiolitis, lung resection, lung cancer, interstitial lung disease [e.g. fibrosis, silicosis, sarcoidosis], and active tuberculosis
  • Known alpha-1-antitrypsin deficiency
  • Known infection with HIV and/or active hepatitis
  • Pregnancy or women of childbearing potential not using or willing to continue using a medically reliable method of contraception for the entire study period
  • Suspected hypersensitivity to the study medication (roflumilast).
  • Use of mucolytics within the last 4 weeks.
  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 ClinicalTrials.gov identifier: NCT03073798

Sponsors and Collaborators
Johns Hopkins University
Investigators
Principal Investigator: Nadia Hansel, MD MPH Jonhs Hopkins University
Principal Investigator: Beth Laube, PhD Jonhs Hopkins University
  More Information

Responsible Party: Johns Hopkins University
ClinicalTrials.gov Identifier: NCT03073798     History of Changes
Other Study ID Numbers: NA_00078710
Study First Received: March 2, 2017
Results First Received: June 29, 2017
Last Updated: June 29, 2017

Keywords provided by Johns Hopkins University:
Lung Disease
Breathing Difficulty
Smoking
Mucociliary

Additional relevant MeSH terms:
Emphysema
Bronchitis
Acute Disease
Bronchitis, Chronic
Pathologic Processes
Bronchial Diseases
Respiratory Tract Diseases
Lung Diseases, Obstructive
Lung Diseases
Respiratory Tract Infections
Disease Attributes
Pulmonary Disease, Chronic Obstructive

ClinicalTrials.gov processed this record on August 18, 2017