Corticosteroids as Rescue Therapy for the Late Phase of Acute Respiratory Distress Syndrome

Late Steroid Rescue Study (LaSRS): The Efficacy of Corticosteroids as Rescue Therapy for the Late Phase of Acute Respiratory Distress Syndrome

The purpose of this study is to assess innovative treatment methods in patients with adult respiratory distress syndrome (ARDS) as well as those at risk of developing ARDS.

Study Overview

• Status: Completed
• Conditions: Lung Diseases; Acute Respiratory Distress Syndrome
• Intervention / Treatment: Drug: Mythylprednisolone

Detailed Description

BACKGROUND:

ARDS affects approximately 150,000 people in the United States each year. Despite twenty years of research into the mechanisms that cause this syndrome and numerous developments in the technology of mechanical ventilation, the mortality rate has remained greater than 50 percent. In addition to the tragic loss of human life, this condition poses a cost to society because these patients spend an average of two weeks in intensive care units and require multiple high tech procedures. Because of the overwhelming nature of the lung injury once it is established, prevention appears to be the most effective strategy for improving the outlook for those with ARDS.

Basic research has identified numerous inflammatory pathways that are associated with the development of ARDS. Agents that block these mediators prolong survival in animals with lung injury, and a few of them have been tested in human patients. Because of the large number of putative mediators and the variety of ways that their action can be blocked, the possibility for new drug development is almost infinite. This is an exciting prospect, since it envisions the first effective pharmacologic treatment for ARDS. However, preliminary clinical studies have shown conflicting results, and there is an urgent need for a mechanism to efficiently and effectively test new drugs in ARDS. Treatment studies in patients with ARDS are difficult to perform for three reasons. First, the complicated clinical picture makes it difficult to accumulate a large number of comparable patients in any one center. Secondly, there is no agreement on the optimal supportive care of these critically ill patients. Finally, many of the patients meeting study criteria will not be enrolled in study protocols because of the acute nature of the disease process. For these reasons, therapeutic trials in ARDS require multicenter cooperation.

DESIGN NARRATIVE:

This study compared the effect of corticosteroids with placebo in the management of late-phase (greater than seven days) ARDS. The study determined if the administration of the corticosteroid, methylprednisolone sodium succinate, in severe ARDS that was either stable or worsening after seven days, would reduce mortality and morbidity. The primary endpoint was mortality at 60 days. Secondary endpoints included ventilator-free days and organ failure-free days. LaSRS was designed to include 400 patients and began recruiting in the Spring of 1997. In October 1999, the data and safety monitoring board (DSMB) reduced the recruitment target number to 200 patients because the eligible patients were fewer than anticipated.

• Study Type: Interventional
• Enrollment: 200
• Phase: Phase 3

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 13 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosed with ARDS or has risk factors for ARDS; individuals will be considered at risk if they are critically ill and have trauma, sepsis, shock, pneumonia, inhalation injury, drug overdose, pancreatitis, or hypertransfusion
• Onset of ARDS must be between 7 and 28 days prior to study entry
• Since ARDS onset, bilateral infiltrates must have persisted and participants must have required continuous mechanical ventilation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Double

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Mortality rates (measured at time of hospital discharge or 60 days after study entry)

Secondary Outcome Measures

Outcome Measure
Number of ventilator-free days (measured at 28 days following study entry)
Number of organ failure-free days (measured at 28 days following study entry)
Reduction in markers of ongoing inflammation and fibroproliferation (measured at 7 days following study entry)

Collaborators and Investigators

• Sponsor: National Heart, Lung, and Blood Institute (NHLBI)
• Investigators: Principal Investigator: Edward Abraham, University of Colorado, Denver; Principal Investigator: William Fulkerson, Duke University; Principal Investigator: Leonard Hudson, University of Washington; Principal Investigator: Paul Lanken, University of Pennsylvania; Principal Investigator: Michael Matthay, University of California; Principal Investigator: Alan Morris, Latter Day Saints Hospital; Principal Investigator: David Schoenfeld, Massachusetts General Hospital; Principal Investigator: Henry Silverman, University of Maryland; Principal Investigator: Galen Toews, University of Michigan; Principal Investigator: Arthur Wheeler, Vanderbilt University; Principal Investigator: Herbert Wiedemann, The Cleveland Clinic

Publications and helpful links

General Publications

• Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, Thompson BT, Ancukiewicz M; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006 Apr 20;354(16):1671-84. doi: 10.1056/NEJMoa051693.

Helpful Links

• Acute Respiratory Distress Syndrome Clinical Network [ARDSNet]

Study record dates

Study Major Dates

• Study Start: March 1, 1997
• Study Completion: September 1, 2005

Study Registration Dates

• First Submitted: February 21, 2006
• First Submitted That Met QC Criteria: February 21, 2006
• First Posted (Estimate): February 23, 2006

Study Record Updates

• Last Update Posted (Estimate): May 9, 2006
• Last Update Submitted That Met QC Criteria: May 8, 2006
• Last Verified: April 1, 2006

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Respiratory Tract Diseases; Respiration Disorders; Disease; Infant, Newborn, Diseases; Lung Injury; Infant, Premature, Diseases; Syndrome; Lung Diseases; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Acute Lung Injury
• Other Study ID Numbers: 355; N01 HR46054; N01 HR46055; N01 HR46056; N01 HR46057; N01 HR46058; N01 HR46059; N01 HR46060; N01 HR46061; N01 HR46062; N01 HR46063; N01 HR46064