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COPDEarly Phase 1NCT03135860

Effect iNO on Functional Respiratory Imaging in Subjects With WHO Group 3 Pulmonary Hypertension With COPD on Oxygen

A Early Phase 1 study testing Inhaled Nitric Oxide 30mcg/kg IBW/hr in people with COPD and Pulmonary Hypertension, run by Bellerophon at 1 site in Belgium.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The objective of this exploratory study is to examine the utility of high resolution computed tomography (HRCT) to measure changes in functional pulmonary imaging parameters as a function of long term iNO administrationusing the device INOpulse for 4 weeks in relation to Patient Reported Outcome (PRO) and exercise… Read more about this study

Who is it for?
Ages 40 to 85 years
What is being tested?
Inhaled Nitric Oxide 30mcg/kg IBW/hr
Could I receive a placebo?
No, everyone receives an active treatment
How many people
7 participants
Where
1 siteBelgium
Study dates
Oct 2016to 21 Aug 2017
Phase
Early Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 1. Male or female patient 2. A confirmed diagnosis of COPD by the Global initiative for chronic Obstructive Lung Disease (GOLD) criteria 3. Pulmonary hypertension will be defined as sPAP ≥ 38 mmHg as determined by echocardiogram (not obtained within ± 7 days of an exacerbation) within the past 12 months.
  • 4. Current or former smokers with at least 10 pack-years of tobacco cigarette smoking before study entry 5. Age ≥ 40 years, ≤ 85 years 6. A post-bronchodilatory FEV1/FVC < 0.7 and a FEV1 < 60% predicted (values obtained within 6 months prior to screening can be used unless obtained within ± 7 days of an exacerbation; otherwise, the test must be performed during screening) 7. Receiving LTOT for ≥ 3 months and ≥ 10 hours per day as determined by history 8. Females of childbearing potential must have a negative pre-scan urine pregnancy test 9. Signed informed consent prior to the initiation of any study mandated procedures or Assessments

Who cannot join

  • 1. Males who have the intention to father a child during the study. 2. A diagnosis of asthma or other non-COPD respiratory disease, in the opinion of the Investigator 3. Lack of patency of nares upon physical examination 4. Experienced during the last month an exacerbation requiring:
  • start of or increase in systemic oral corticosteroid therapy and/or
  • hospitalization 5. Left ventricular dysfunction as measured by:
  • <!-- -->
  • Screening echocardiographic evidence of left ventricular systolic dysfunction (left ventricular ejection fraction [LVEF] < 40%), or
  • Screening echocardiographic evidence of left ventricular diastolic dysfunction >moderate (i.e., > Grade 3), or
Show all 12Show fewer
  • Any history of pulmonary capillary wedge pressure (PCWP), left atrial pressure (LAP) or left ventricular end diastolic pressure (LVEDP) > 18 mmHg as measured during cardiac catheterization within the past 6 months unless documented to have resolved by a subsequent cardiac catheterization 6. Renal impairment (i.e., an estimated GFR CKD-EPI < 30 ml/min/1.73 m2) or history of renal failure using the equation:
  • Men:
  • crs< 0.9 mg/dL: eGFRCKD-EPI = 141 × (crs /0.9)-0.411 × 0.993Age crs≥ 0.9 mg/dL: eGFRCKD-EPI = 141 × (crs /0.9)-1.209 × 0.993Age
  • Woman:
  • crs< 0.7 mg/dL: eGFRCKD-EPI = 144 × (crs /0.7)-0.329 × 0.993Age crs≥ 0.7 mg/dL: eGFRCKD-EPI = 144 × (crs /0.7)-1.209 × 0.993Age where crs= Normal and elevated serum creatinine Subjects with possible compromised kidney function (i.e., Glomerular Filtration Rate estimated using the Modification of Diet in Renal Disease equation [eGFR CKD-EPI] between 30 and 60 ml/min/1.73 m2) may be enrolled provided the Radiology Department and Principal Investigator review the medical records of subjects with an eGFR CKD-EPI between 30 and 60 ml/min/1.73 m2 in order to confirm the contrast agent can be safely administered to these subjects and approval by both the Radiology Department and Principal Investigator must be obtained before enrolling these subjects.
  • 7. Known allergy to contrast media. 8. Clinically significant valvular heart disease that may contribute to PH, including mild or greater aortic valvular disease (aortic stenosis or regurgitation) and/or moderate or greater mitral valve disease (mitral stenosis or regurgitation), or status post mitral valve replacement 9. Use within 30 days of screening or current use of approved PH medications such as sildenafil or bosentan (use of Cialis® or Viagra® for erectile dysfunction is permitted) 10. Use of investigational drugs or devices within 30 days prior to enrollment into the study 11. Any underlying medical or psychiatric condition that, in the opinion of the Investigator, makes the subject an unsuitable candidate for the study

Trial locations and contacts

1 site in 1 country.

Belgium1 site
  • Antwerp University Hospital

    Edegem, 2650

Other trials in Belgium

About this study

Official title: Exploratory Study to Assess the Effect of Pulsed Inhaled Nitric Oxide on Functional Respiratory Imaging Parameters in Subjects With WHO Group 3 Pulmonary Hypertension Associated With Chronic Obstructive Pulmonary Disease (COPD) on Long Term Oxygen Therapy (LTOT).

The objective of this exploratory study is to examine the utility of high resolution computed tomography (HRCT) to measure changes in functional pulmonary imaging parameters as a function of long term iNO administrationusing the device INOpulse for 4 weeks in relation to Patient Reported Outcome (PRO) and exercise tolerance in subjects with WHO Group 3 PH associated with COPD on LTOT.

Changes from baseline to 4 weeks of pulsed iNO and after 2 weeks of withdrawal from pulsed iNO will be evaluated.

Read the detailed description

In this study, pulmonary hypertension (PH) is defined as systolic pulmonary arterial pressure (sPAP) ≥ 38 mmHg by 2-D echocardiogram with Doppler.

NO cylinder concentrations (4880 ppm) at a dose of 30 mcg/kg Ideal Body Weight (IBW)/hr (INOpulse setting of 30 mcg/kg IBW/hr) will be administered.

During the screening visit all the inclusion and exclusion criteria will be checked. Eligible patients will return to the site for visit 1. During visit 1 baseline HRCT scans with contrast agent will be obtained at Functional Residual Capacity (FRC) and Total Lung Capacity (TLC). Before the scans are taken a urine pregnancy test will be obtained in female patients with childbearing potential. A retest of the eGFR CKD-EPI value should also be performed before administering the contrast agent, if there is a clinical indication according to the investigator. The treatment will be started after all baseline assessments (physical examination, patency of nares, eGFR CKD-EPI determination, urine pregnancy test, HRCT scans, vital signs including oxygen saturation measurement, Electrocardiogram (ECG), Arterial Blood Gas (ABG), MetHb, 6-minutes walking distance (6MWD) (before and after the 6 MWD a Borg Category Ratio (Borg CR10) leg fatigue and dyspnea scale will be executed and during the 6MWD the oxygen saturation will be measured), PRO, spirometry). A second TLC and FRC scan with contrast agent during the iNO treatment will be taken. The scans will be taken whilst the patient is under iNO treatment for at least 20 minutes on the iNOpulse specific cannula. After the scans taken during the iNO treatment are performed some of the baseline assessments will be repeated whilst the patient is on iNO treatment (vital signs including oxygen saturation measurement, ABG, MetHb, 6MWD (before and after the 6 MWD a Borg CR10 leg fatigue and dyspnea scale will be executed and during the 6MWD the oxygen saturation will be measured), PRO, spirometry). During visit 1 the investigator will discontinue iNO to assess if rebound pulmonary hypertension occurs. In the first 2 patients, iNO therapy will be discontinued while 2D echo is performed to assess sPAP. Furthermore, NIBP, HR, SpO2 will be measured. In the remaining patients the following additional safety assessments (NIBP, HR, SpO2) will be performed while the patient is discontinued at least 20 minutes of iNO. If the investigator considers it is safe to restart the iNO-therapy, the patient will start chronic iNO treatment. After the results of the safety assessments of the 2 first patients are collected a safety meeting will be held to evaluate the results. Depending on the results, the additional 2D echo may be performed in additional patients. Subjects will be contacted via telephone or e-mail ± 24 hours after visit 1, for assessment of vital status, concomitant medications and the occurrence of new AEs or worsening of previously existing recorded AEs and PRO (= visit 2). After 2 weeks of treatment of iNO with a dosage of 30 mcg/kg IBW/hr during at least 12 hours a day patients will be asked to return to the site for visit 3. During that visit following measurements will be performed: patency of nares will be checked, vital signs including oxygen saturation measurement, MetHb, 6MWD (with Borg CR10 leg fatigue and dyspnea scale and oxygen saturation measurement), PRO and AE assessment. After 4 weeks treatment visit 4 will be conducted. 2D - echocardiogram with Doppler (immediately after the 2D - echocardiogram with Doppler NIBP, HR, SpO2 will be measured) and HRCT scans with contrast agent under iNO pulse will be taken. Before the scans are taken an urine pregnancy test will be obtained, if applicable. A retest of the eGFR CKD-EPI value should also be performed before administering the contrast agent, if there is a clinical indication according to the investigator. Spirometry assessments will be performed, patency of nares, ECG, ABG, MetHb, 6MWD (with Borg CR10 fatigue and dyspnea scale and oxygen saturation measurement), PRO will be assessed. After all assessments are completed, iNO will be discontinued. Twenty minutes after discontinuation of iNO-therapy, spirometry, PRO, MetHb, 6MWD (before and after the 6 MWD a Borg CR10 leg fatigue and dyspnea scale will be executed and during the 6MWD the oxygen saturation will be measured) and 2D-echocardiogram with Doppler measurements measurement will be repeated. Vital signs with oxygen saturation will be measured immediately after the 2D-echocardiogram with Doppler. After all the assessments the patient is placed back on his/her prescribed dose of LTOT using their usual cannula. The patient will be assessed for any signs of acute withdrawal. Therefore vital signs including oxygen saturation will be measured.

At visit 5, two weeks after discontinuation of iNO treatment repeat vital signs with oxygen saturation measurement, physical examination, patency of nares, spirometry, 2D-echocardiogram with Doppler (immediately after the 2D - echocardiogram with Doppler NIBP, HR, SpO2 will be measured), ABG, MetHb, 6MWD(with Borg CR10 leg fatigue and dyspnea scale and oxygen saturation measurement), and PRO will be performed. If applicable a last urine pregnancy test will be executed to make sure no pregnancy occurred during the study. If there are no follow-up actions for a patient at this visit, it will be considered as a completion of study participation / end of study for that particular patient.

Being tested
Inhaled Nitric Oxide 30mcg/kg IBW/hr
Keywords
Inhaled Nitric Oxide, COPD, Chronic Obstructive Pulmonary Disease, Idopathic Pulmonary Fibrosis, Long Term Oxygen Therapy (LTOT)
Medical subject headings
Pulmonary Disease, Chronic Obstructive, Hypertension, Pulmonary

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Inhaled Nitric Oxide 30mcg/kg IBW/hrDrug

    Also called iNO, NO,

    Inhaled Nitric Oxide 30 mcg/kg IBW/hr will be administered through the INOPulse Device open label for 4 weeks

Study groups in NCT03135860
Study groupRoleWhat they receive
Inhaled Nitric Oxide 30mcg/kg/IBW/hrExperimentalInhaled nitric oxide 30 mcg/kg IBW/hr NO will be administered through the InoPulse Device open label for 4 weeks
Receives: Drug: Inhaled Nitric Oxide 30mcg/kg IBW/hr

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. change in lobar blood volume at total lung capacity with iNO and the change in lobar blood volume with iNO after 4 weeks of treatment with iNO as measured by HRCT.

    The primary endpoint in this exploratory study is the change in lobar blood volume at total lung capacity with iNO and the change in lobar blood volume with iNO after 4 weeks of treatment with iNO as measured by HRCT.

    Measured: After 4 weeks of treatment

Secondary outcomes (11)
  1. Blood vessel % and density on lobar level

    are the changes from baseline measured by HRCT with pulsed iNO and after dosing with pulsed iNO in Blood vessel % and density on lobar level

    Measured: after 4 weeks of treatment

  2. • Blood vessel % and density on lobal level compared among patients with emphysema, chronic bronchitis or combined emphysema and chronic bronchitis as assessed by HRCT

    are the changes from baseline measured by HRCT with pulsed iNO and after dosing with pulsed iNO in Blood vessel % and density on lobal level compared among patients with emphysema, chronic bronchitis or combined emphysema and chronic bronchitis as assessed by HRCT

    Measured: after 4 week of treatment

  3. Total lung volume at TLC

    the changes from baseline measured by HRCT with pulsed iNO and after dosing with pulsed iNO in Total lung Volume at TLC

    Measured: after 4 week of treatment

  4. Lobar volumes at TLC

    the changes from baseline measured by HRCT with pulsed iNO and after dosing with pulsed iNO in Lobar volumes at TLC

    Measured: after 4 weeks of treatment

  5. Internal airflow distribution based on lobar expansion

    the changes from baseline measured by HRCT with pulsed iNO and after dosing with pulsed iNO in Internal airflow distribution based on lobar expansion

    Measured: after 4 weeks of treatment

  6. Airway volume down to generation 8-10 at TLC

    the change in lobar blood volume at total lung capacity with iNO and the change in lobar blood volume with iNO in Airway volume down to generation 8-10 at TLC

    Measured: After 4 weeks of treatment

  7. Computational Fluid Dynamics (CFD)-based resistance on lobar level

    change in lobar blood volume at total lung capacity with iNO and the change in lobar blood volume with iNO in Computational Fluid Dynamics (CFD)-based resistance on lobar level

    Measured: after 4 weeks of treatment

  8. Ventilation/perfusion (V/Q) matching

    the change in lobar blood volume at total lung capacity with iNO and the change in lobar blood volume with iNO in Ventilation/perfusion (V/Q) matching

    Measured: after 4 weeks of treatment

  9. Spirometry

    the changes from baseline measured by HRCT with pulsed iNO and after dosing with pulsed iNO in Spirometry

    Measured: after 4 weeks of treatment

  10. Change from baseline 6MWD; Borg CR10 Dyspnea and Leg Fatigue Score ; PRO

    Change in baseline to 4 weeks of pulsed iNO and after 2 weeks of withdrawal from pulsed iNO in:6MWD; Borg CR10 Dyspnea and Leg Fatigue Score ; PRO

    Measured: after 4 weeks of treatment two weeks of withdrawal

  11. Change from baseline to 4 weeks of treatment and two weeks of withdrawal

    • Right Ventricular (RV) and Left Ventricular (LV) size and function, PAP as measured by 2D-echocardiogram with Doppler

    Measured: after 4 weeks of treatment two weeks of withdrawal

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 May 2017
  2. Study startOct 2016
  3. Primary completion21 Aug 2017
  4. Study completion21 Aug 2017

Why it stopped: This was an exploratory open-label study and has met its initial objectives

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Early Phase 1
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Exploratory Single Arm Study
Masking
None (open label)
Enrolment
7 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03135860
Sponsor's protocol ID
PULSE-COPD-007
Status last verified
Sep 2017
First submitted
26 Apr 2017
Last updated
21 Feb 2023
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Early Phase 1 study testing Inhaled Nitric Oxide 30mcg/kg IBW/hr in people with COPD and Pulmonary Hypertension, run by Bellerophon at 1 site in Belgium.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 21 Feb 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Early Phase 1 (sometimes called Phase 0) studies give a very small amount of a treatment to a few people, mainly to see how the body handles it.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was stopped early (reason given: This was an exploratory open-label study and has met its initial objectives). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

change in lobar blood volume at total lung capacity with iNO and the change in lobar blood volume with iNO after 4 weeks of treatment with iNO as measured by HRCT. (time frame: After 4 weeks of treatment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Feb 2023.

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