Bronchoscopic lung volume reduction for severe emphysema using thermoablation

Bronchoscopic Lung Volume Reduction in Severe Emphysema Using Thermoablation

This study is testing a new lung treatment using heat to see if it helps people with severe emphysema breathe better compared to standard care.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 224 (estimated)
• Ages: 40 Years to 75 Years
• Sex: All
• Sponsor: IHF GmbH - Institut für Herzinfarktforschung (Academic / other)
• Locations: 12 sites (Berlin and 11 other locations)
• Trial ID: NCT05717192 on ClinicalTrials.gov

What this trial studies

This clinical trial is a prospective, multicentre, open-label study that aims to evaluate the effectiveness of bronchoscopic lung volume reduction using thermoablation in patients with severe emphysema. Participants will be randomly assigned to receive either the interventional treatment or standard conservative therapy as per GOLD guidelines. The study seeks to provide evidence on the safety and efficacy of this innovative approach compared to traditional methods, potentially offering a new treatment option for patients suffering from severe emphysema.

Who should consider this trial

Good fit: Ideal candidates for this study are adults aged 40 to 75 with severe emphysema who have not benefited from standard treatments.

Not a fit: Patients with mild to moderate emphysema or those who are current smokers may not receive benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly improve lung function and quality of life for patients with severe emphysema.

How similar studies have performed: Previous studies have suggested that bronchoscopic lung volume reduction techniques may be effective, but this specific approach using thermoablation is relatively novel.

Eligibility criteria

Inclusion Criteria:

* Age: ≥ 40 years and ≤ 75 years
* Written informed consent obtained from the patient
* Severe emphysema with indication for BTVA:
* bilateral heterogeneous emphysema of the upper lobes in GOLD stage 3/4 and
* evidence of severe emphysema in high-resolution computed tomography (not older than 6 months prior to inclusion) and
* functional evidence of severe pulmonary hyperinflation and
* FEV1 post lysis between 20% and \< 45% (calculated) and
* Total lung capacity (TLC) ≥ 100% (calculated) and
* Residual volume (RV) \> 175% (calculated) and
* arterial blood gas values of: PaCO2 ≤ 50 mmHg; PaO2 \> 50 mmHg on room air and
* marked dyspnoea with a score ≥ 2 on the Medical Research Council modified scale (mMRC) and
* 6-minute walk test \> 140 metres
* Patient-specific, pre-interventional exhaustion of conservative treatment options
* optimised medical therapy (according to the GOLD guidelines) and
* Non-smoker for 6 months prior to inclusion
* Evidence of completed pulmonary and geriatric rehabilitation in the last 4 years
* ≥ 6 weeks outpatient or
* ≥ 3 weeks inpatient or
* Individual Participation in regular physical activities that go beyond the activities of daily living (e.g. a walking programme)
* According to the investigator's assessment mentally and physically able to participate in the study procedures and visits
* Indication within the framework of an interdisciplinary case conference with specialists in pneumology, radiology and thoracic surgery in accordance with §3 of the guideline on quality assurance measures in accordance with § 136 Paragraph 1 Sentence 1 Number 2 SGB V for inpatient care with bronchoscopic lung volume reduction procedures for severe emphysema (QS-RL BLVR).

Exclusion Criteria:

* Any condition that would interfere with the conduct of the clinical trial follow-up or bronchoscopy or affect the outcome of the clinical trial
* DLCO \< 20% (calculated)
* Body mass index (BMI) \< 18 kg/m2 or \> 32 kg/m2
* Pulmonary hypertension
* Peak systolic PAP \> 45 mmHg or mean PAP \> 25 mmHg
* Right heart catheter measurements are considered authoritative over echocardiogram measurements
* Clinically significant bronchiectasis
* Pneumothorax or pleural effusions within the last 6 months
* Heart and/or lung transplantation, surgical lung volume reduction (LVRS), bullectomy, lobectomy or pneumonectomy, pleurodesis or any surgery in the target lobes (upper lobes).
* Recent respiratory infection or COPD exacerbation in the last 6 weeks
* Unstable COPD (any of the following conditions):
* \>3 COPD-related hospitalisations requiring antibiotics in the last 12 months
* COPD-related hospital stay in the last 3 months
* daily use of systemic steroids, \> 5 mg prednisolone
* Single large bulla (defined as \> 1/3 of the volume of the lobe) in the upper lobe or paraseptal emphysema distribution in the lobe being treated
* Coagulopathy or current use of anticoagulants
* Patients with current endobronchial valves or with valves explanted less than 6 months ago in the target lobe in a segment to be treated with InterVapor®.
* Patients with implanted, endobronchial coils (coils)
* Patients with previous endobronchial polymer/adhesive treatment
* Patients with immune system disorders or concomitant diseases that necessitate the use of immunosuppressants of clinical relevance
* History of any of the following conditions:
* Myocardial infarction or acute coronary syndrome in the previous year
* Hospitalisation for left heart failure in the last year
* clinically leading asthma disease or alpha-1-antitrypsin deficiency
* Known sensitivity to medications required to perform bronchoscopy
* Life expectancy \< 12 months
* Newly prescribed morphine derivatives within the last 4 weeks
* Pregnancy at the time of inclusion

Where this trial is running

Berlin and 11 other locations

• Charité Campus Benjamin Franklin — Berlin, Germany (Recruiting)
• Gemeinschaftskrankenhaus Havelhöhe gGmbH Klinik für Anthroposophische Medizin — Berlin, Germany (Recruiting)
• Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II — Bonn, Germany (Not_yet_recruiting)
• Pneumologische Universitätsklinik Ruhrlandklinik — Essen, Germany (Recruiting)
• Universitätsklinikum Halle (Saale) — Halle, Germany (Recruiting)
• Thoraxklinik University of Heidelberg — Heidelberg, Germany (Recruiting)
• Lungenklinik Hemer — Hemer, Germany (Recruiting)
• Lungenfachklinik Immenhausen — Immenhausen, Germany (Recruiting)
• Asklepios Klinik Langen, Klinik für Innere Medizin III — Langen, Germany (Not_yet_recruiting)
• KlinKlinikuim Lüdenscheid, Klinik für Pneumologie, internistische Intensivmedizin, Infektiologie und Schlafmedizin — Lüdenscheid, Germany (Recruiting)
• Thoraxzentrum Bezirk Unterfranken — Münnerstadt, Germany (Recruiting)
• Helios Hanseklinikum Stralsund — Stralsund, Germany (Recruiting)

Study contacts

• Study coordinator: Felix Herth, MD

Conditions Emphysema or Chronic Obstructive Pulmonary Disease