Evaluation of the Safety and Efficacy of TLD in Patients with COPD

NCT ID: NCT03639051

Last Updated: 2024-11-14

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 464 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-05-23
• Study Completion Date: 2028-09-30

Brief Summary

The purpose of this study is to confirm the safety and efficacy of the Nuvaira Lung Denervation System (Nuvaira System) in the treatment of COPD.

Detailed Description

The primary objective of this study is to demonstrate the superiority of treatment with the Nuvaira Lung Denervation System (Active Treatment arm) compared to a sham procedure (Sham Control arm) to decrease moderate or severe exacerbations in subjects with COPD on optimal medical care.

The secondary objective is to compare long-term safety, and other efficacy assessments between the Active Treatment arm and the Sham Control arm.

Conditions

COPD

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

Active Treatment

Target Lung Denervation (TLD) with the Nuvaira Lung Denervation System (RF energy delivered) and optimal medical care for COPD.

Group Type: EXPERIMENTAL

Targeted Lung Denervation (TLD)

Intervention Type: DEVICE

Targeted Lung Denervation (TLD) Therapy is a bronchoscopically guided, minimally invasive procedure using the Nuvaira™ Lung Denervation System.

Optimal Medical Care

Intervention Type: OTHER

Taking regular maintenance medication that minimally includes a long-acting muscarinic antagonist (LAMA) and a long-acting beta2-agonist (LABA).

Sham Control

Sham Targeted Lung Denervation (TLD) procedure with the Nuvaira Lung Denervation System (catheter placement and balloon deployment in all treatment locations, no RF energy delivered) and optimal medical care for COPD.

Group Type: SHAM_COMPARATOR

Optimal Medical Care

Intervention Type: OTHER

Taking regular maintenance medication that minimally includes a long-acting muscarinic antagonist (LAMA) and a long-acting beta2-agonist (LABA).

Interventions

Targeted Lung Denervation (TLD)

Targeted Lung Denervation (TLD) Therapy is a bronchoscopically guided, minimally invasive procedure using the Nuvaira™ Lung Denervation System.

Intervention Type: DEVICE

Optimal Medical Care

Taking regular maintenance medication that minimally includes a long-acting muscarinic antagonist (LAMA) and a long-acting beta2-agonist (LABA).

Intervention Type: OTHER

Other Intervention Names

TLD, TLD Therapy

Eligibility Criteria

Inclusion Criteria

• Subject ≥40 years of age at the time of consent;
• Women of child bearing potential must not be pregnant, evidenced by a negative pregnancy test (blood or urine) pre-treatment, or lactating and agree not to become pregnant for the duration of the study;
• Smoking history of at least 10 pack years;
• Not smoking or using any other inhaled substance (e.g., cigarettes, vaping, cannabis, pipes) for a minimum of 2 months prior to consent and agrees to not start for the duration of the study;
• Subject has received a flu vaccination within the 12 months prior to the procedure or agrees to obtain vaccination once it becomes available and agrees to annual vaccinations for the duration of the study;
• Resting SpO2 ≥89% on room air at the time of screening;
• CAT score ≥10 at the time of screening;
• Diagnosis of COPD with 25%≤ FEV1 ≤80% of predicted, PaCO2 ˂ 50 (if FEV1 ˂30%) and FEV1/FVC <70% (post-bronchodilator);
• Documented history of ≥ 2 moderate COPD exacerbations or ≥ 1 severe COPD exacerbation leading to hospitalization in the 12 months prior to consent with at least one exacerbation occurring while the subject was on optimal medical care (taking LAMA and a LABA, or scheduled SABA or SAMA instead of either a LAMA or LABA, not both, as regular respiratory maintenance medication);
• Subject is on optimal medical care at the time of consent;
• If subject has participated in a formal pulmonary rehabilitation program recently, program completion must have occurred ≥3 months prior to consent; if in a maintenance program, subject agrees to continue their current program through their 12-month follow-up visit;
• Subject is a candidate for bronchoscopy in the opinion of the physician or per hospital guidelines and is able to discontinue blood thinning medication peri-procedurally;
• The subject is able and agrees to complete all protocol required baseline and follow-up tests and assessments including taking certain medications (e.g., azithromycin, prednisolone/prednisone);
• Subject has provided written informed consent using a form that has been reviewed and approved by the Institutional Review Board (IRB)/Ethics Committee (EC).

Exclusion Criteria

• Body Mass Index <18 or >35;
• Subject has an implantable electronic device and has not received appropriate medical clearance;
• Uncontrolled diabetes in the opinion of the investigator;
• Malignancy treated with radiation or chemotherapy within 1 year of consent;
• Asthma as defined by the current Global Initiative for Asthma (GINA) guidelines;
• Subject diagnosed with a dominant non-COPD lung disease or condition affecting the lungs, which is the main driver of the subjects clinical symptoms (e.g., cystic fibrosis, paradoxical vocal cord motion, eosinophilic granulomatosis with polyangiitis (EGPA), allergic bronchopulmonary aspergillosis, interstitial lung disease or active tuberculosis) or has a documented medical history of pneumothorax within 1 year of consent;
• Clinically relevant bronchiectasis, defined as severe single lobe or multilobar broncial wall thickening associated with airway dilation on CT scan leading to cough and tenacious sputum on most days;
• Pre-existing diagnosis of pulmonary hypertension, clinical evidence of pulmonary hypertension (e.g., cardiovascular function impairment including peripheral edema) and mPAP ≥25 mmHg at rest by right heart catheterization (or estimated right ventricular systolic pressure >50 mmHg by echocardiogram if no previous right heart catheterization);
• Myocardial infarction within last 6 months, EKG with evidence of life threatening arrhythmias or acute ischemia, pre-existing documented evidence of an LVEF <40%, stage C or D (ACC/AHA) or Class III or IV (NYHA) congestive heart failure, or any other past or present cardiac findings that make the subject an unacceptable candidate for a bronchoscopic procedure utilizing general anesthesia;
• Surgical procedure(s) on the stomach, esophagus or pancreas performed ≤2 years of consent or ongoing related symptoms within the past year;
• Symptomatic gastric motility disorder(s) (e.g., gastroparesis) as evidenced by a GCSI score ≥18.0, severe uncontrolled GERD (e.g., refractory heartburn, endoscopic esophagitis) or severe dysphagia (e.g., esophageal stricture, achalasia, esophageal spasm);
• Any disease or condition that might interfere with completion of a procedure or this study (e.g., structural esophageal disorder, life expectancy <3 years);
• Prior lung or chest procedure (e.g., lung transplant, LVRS, BLVR, lung implant, metal stent, valves, median sternotomy, bullectomy, lobectomy, segmentectomy or other interventional lung or chest procedure) performed ≤1 year of consent; NOTE: Any metal in the chest must be ≥5 cm away from the anticipated treatment location(s). Subjects with explanted lung valve(s) allowed if explant occurred ≥3 months prior to treatment.
• Daily use of >10 mg of prednisone or its equivalent at the time of consent;
• Chronic use of >40 mg MEDD opioid only medication per day;
• Known contraindication or allergy to medications required for bronchoscopy or general anesthesia (e.g., lidocaine, atropine, propofol, sevoflurane) that cannot be medically controlled;
• Baseline chest CT scan reveals bronchi anatomy cannot be fully treated with available catheter sizes, presence of severe emphysema >50%, lobar attenuation area or severe bullous disease (>1/3 hemithorax) (as determined by the CT core lab using a single density mask threshold of -950 HU) or discovery of a mass that requires treatment;
• Subject is currently enrolled in another interventional clinical trial that has not completed follow-up.

• Minimum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Nuvaira, Inc.

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Frank Sciurba, MD

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh Medical Center

Dirk-Jan Slebos, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University Medical Center Groningen

Locations

University of Alabama at Birmingham (UAB) Lung Health Center

Birmingham, Alabama, United States

HonorHealth

Phoenix, Arizona, United States

UC Davis

Sacramento, California, United States

Harbor UCLA

Torrance, California, United States

Ascension St. Vincent's

Jacksonville, Florida, United States

University of Chicago

Chicago, Illinois, United States

Suburban Lung Associates

Elk Grove Village, Illinois, United States

University of Louisville

Louisville, Kentucky, United States

Lahey Hospital & Medical Center

Burlington, Massachusetts, United States

University of Michigan

Ann Arbor, Michigan, United States

Spectrum Health Medical Group

Grand Rapids, Michigan, United States

Washington University

St Louis, Missouri, United States

Duke University

Durham, North Carolina, United States

First Health of the Carolinas

Pinehurst, North Carolina, United States

Ohio State University Wexner Medical Center

Columbus, Ohio, United States

Temple Lung Center

Philadelphia, Pennsylvania, United States

University of Pittsburgh Medical Center (UPMC)

Pittsburgh, Pennsylvania, United States

Medical University of South Carolina (MUSC)

Charleston, South Carolina, United States

St. Davids HealthCare

Georgetown, Texas, United States

Houston Methodist Hospital

Houston, Texas, United States

Krankenhaus Nord - Klinik Floridsdorf

Vienna, , Austria

CHU de Grenoble

Grenoble, Cedex 9, France

Hopital Larrey

Toulouse, Cedex 9, France

Hopital de la Cavale Blanche

Brest, , France

Arnaud de Villeneuve Hospital

Montpellier, , France

Hopital Pasteur

Nice, , France

Bichat-Claude Bernard Hospital

Paris, , France

CHU de Reims

Reims, , France

CHU de Strasbourg

Strasbourg, , France

Thorax Klinik Heidelberg

Heidelberg, , Germany

UMC

Amsterdam, , Netherlands

University Medical Center Groningen (UMCG)

Groningen, , Netherlands

Royal Brompton Harefield Trust

London, , United Kingdom

Countries

United States; Austria; France; Germany; Netherlands; United Kingdom

References

Agrawal A. Interventional Pulmonology: Diagnostic and Therapeutic Advances in Bronchoscopy. Am J Ther. 2021 Feb 9;28(2):e204-e216. doi: 10.1097/MJT.0000000000001344.

Reference Type: DERIVED

PMID: 33590989 (View on PubMed)

Slebos DJ, Degano B, Valipour A, Shah PL, Deslee G, Sciurba FC; AIRFLOW-3 Trial Study Group. Design for a multicenter, randomized, sham-controlled study to evaluate safety and efficacy after treatment with the Nuvaira(R) lung denervation system in subjects with chronic obstructive pulmonary disease (AIRFLOW-3). BMC Pulm Med. 2020 Feb 13;20(1):41. doi: 10.1186/s12890-020-1058-5.

Reference Type: DERIVED

PMID: 32054473 (View on PubMed)

Other Identifiers

D0543

Identifier Type: -

Identifier Source: org_study_id