Improving Patient Outcomes by Selective Implantation of the Zephyr EBV - Study (IMPACT)

A Multicentre, Prospective, Randomized, Controlled, One-way Crossover Investigation of Endobronchial Valve (EBV) Therapy vs. Standard of Care (SoC) in Homogeneous Emphysema

The aim of this prospective, randomized, controlled, one-way crossover study is to assess and compare the efficacy of the Zephyr endobronchial valves vs. Standard of Care (SoC) in patients suffering from COPD with Homogeneous Emphysema. Patients will be followed up for 12 months after randomization. Patients in the SoC arm will crossover to the EBV treatment arm after the 6-month visit and will be followed up for 6 additional months.The primary objective is the variation of FEV1 between baseline and 3-month follow-up visit. The secondary objectives will evaluate quality of life, exercise capacity, dyspnea (including BODE index) changes, target lobe volume reduction, as well as safety outcomes.

Study Overview

• Status: Completed
• Conditions: COPD Patients With Homogeneous Emphysema; Endoscopic Lung Volume Reduction With Endobronchial Valve
• Intervention / Treatment: Device: Endobronchial Valve

• Study Type: Interventional
• Enrollment (Actual): 93
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Austria
  • Vienna, Austria, 1140
    • Ludwig-Boltzmann-Institut für COPD und Pneumologische Epidemiologie
• Germany
  • Berlin, Germany, 13353
    • Charité Campus Virchow-Klinikum
  • Essen, Germany, 45239
    • Ruhrlandklinik, Westdeutsches Lungenzentrum
  • Hamburg, Germany, 21075
    • Lungenabteilung Thoraxzentrum Hamburg
  • Heidelberg, Germany, 69126
    • Thoraxklinik am Universitats klinikum Heidelberg
  • Hemer, Germany, 58675
    • Lungenklinik Hemer
  • Nürnberg, Germany, 90419
    • Klinikum Nürnberg Nord
• Netherlands
  • Groningen, Netherlands, 9700RB
    • Department of pulmonary dieases, University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Homogeneous emphysema
• 15% ≤ FEV1 ≤ 45% predicted
• TLC > 100% predicted
• RV ≥ 200% predicted
• 6MWT ≥ 150 m
• Non-smoker > 8 weeks prior to study entry
• Absence of Collateral Ventilation in the target lobe

Exclusion Criteria:

• Active pulmonary infection
• More than 3 exacerbations with hospitalizations over the past 12 months
• Pulmonary hypertension (sPAP > 45 mmHg)
• MI or other relevant CV events in the past 6 months
• Alpha-1 antitrypsin deficiency
• Bronchiectasis
• Prior LVR or LVRS procedure
• > 20% difference in perfusion between right and left lung
• Hypercapnia (paCO2 > 55 mmHg
• Asthma
• Use of more than 25 mg/day prednisolone or equivalent
• Severe bullous emphysema
• Systemic or malignant disease with high death probability within 12 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ELVR with Endobronchial Valves; Endoscopic Lung Volume Reduction with Zephyr Endobronchial Valve	Device: Endobronchial Valve; Endoscopic Lung Volume Reduction with Zephyr Endobronchial Valve
No Intervention: Standard of Care; Patients will receive optimal drug therapy and medical management according to clinical practice.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage Change in Forced Expiratory Volume in 1 s (FEV1) (ITT Population)	Percentage change in FEV1 at 3 months relative to Baseline in the EBV group, compared to the SoC group.	At baseline and after 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Absolute Change in Target Lobe Volume for EBV Group (ITT Population)	Target Lobe Volume Reduction (TLVR) was evaluated by quantitative analysis of HRCT scans at Baseline and at 3-months post-valve placement to measure the target lobe volume.	At baseline and after 3 months
Percent Change in Target Lobe Volume for EBV Group (ITT Population)	Target Lobe Volume Reduction (TLVR) was evaluated by quantitative analysis of HRCT scans at Baseline and at 3-months post-valve placement to measure the target lobe volume.	At baseline and after 3 months
Percent of Subjects in the EBV Group With a Target Lobe Volume Reduction (TLVR) of ≥ 350ml at 3 Months	The threshold of TLVR ≥350 mL was used to determine the proportion of subjects that achieved this amount of TLVR in the EBV group.	At baseline and after 3 months
Absolute Change in FEV1 (L) Post Bronchodilator at 3 Months	The mean absolute change in FEV1(L) relative to Baseline at 3 months between the EBV and SoC groups	At baseline and after 3 months
Absolute Change in FEV1 (% Predicted) Post Bronchodilator at 3 Months	The mean absolute change in FEV1(% Predicted) relative to Baseline at 3 months between the EBV and SoC groups	At baseline and after 3 months
Absolute Change in Residual Volume (RV) at 3 Months	Mean absolute change in Residual Volume relative to Baseline at 3 months between the EBV and SoC groups	At baseline and after 3 months
Percent Change in Residual Volume (RV) at 3 Months	Mean percent change in Residual Volume relative to Baseline at 3 months between the EBV and SoC groups	At baseline and after 3 months
Percent Predicted Change in Residual Volume at 3 Months	Percent predicted change in RV relative to Baseline at 3 months between the EBV and SoC groups	At baseline and after 3 months
Absolute Change in Six-Minute Walk Distance at 3 Months	Mean absolute change in the 6MWD from Baseline to 3 months in the EBV group compared to the SOC	At baseline and after 3 months
Percent Change in Six-Minute Walk Distance at 3 Months	Mean percent change in the 6MWD from Baseline to 3 months in the EBV group compared to the SOC	At baseline and after 3 months
Absolute Change in the SGRQ Total Score From Baseline to 3 Months	Mean absolute change in the St. George's Respiratory Questionnaire Total Score from Baseline to 3 months in the EBV group compared to the SoC group. Scores range from 0 to 100, with higher scores indicating more limitations.	At baseline and after 3 months
Percent Change (%) in the SGRQ Total Score From Baseline to 3 Months	Mean percent change in the SGRQ Total Score from Baseline to 3 months in the EBV group compared to the SoC group	At baseline and after 3 months
Absolute Change in the mMRC Dyspnea Score From Baseline to 3 Months	Mean absolute change in the Modified Medical Research Council (mMRC) Dyspnea Score from Baseline to 3 months in the EBV group compared to the SoC group. The mMRC (Modified Medical Research Council) stratifies severity of dyspnea in respiratory diseases. The severity of dyspnea is rated on a scale of 0 to 4, with higher scores indicating more limitations.	At baseline and after 3 months
Percent Change (%) in the mMRC Dyspnea Score From Baseline to 3 Months	Mean percent change in the mMRC Dyspnea Score from Baseline to 3 months in the EBV group compared to the SoC group. The mMRC (Modified Medical Research Council) stratifies severity of dyspnea in respiratory diseases. The severity of dyspnea is rated on a scale of 0 to 4, with higher scores indicating more limitations.	At baseline and after 3 months
Absolute Change in the CAT Total Score From Baseline to 3 Months	Mean absolute change in the COPD Assessment Test (CAT) Total Score from Baseline to 3 months in the EBV group compared to the SoC group. The COPD Assessment Test (CAT) is an eight-item questionnaire designed to quantify the impact of COPD symptoms on the health status of patients. The CAT provides a score of 0-40 to indicate the impact of disease.	At baseline and after 3 months
Percent Change (%) in CAT Total Score From Baseline to 3 Months	The COPD Assessment Test (CAT) is an eight-item questionnaire designed to quantify the impact of COPD symptoms on the health status of patients. The CAT provides a score of 0-40 to indicate the impact of disease. Higher scores denote a more severe impact of COPD on a patient's life.	At baseline and after 3 months
Absolute Change in EQ-5D Summary Index From Baseline to 3 Months	Mean absolute change in the EQ-5D Summary Index from Baseline to 3 months in the EBV group compared to the SoC group. EQ-5D is a standardized instrument to measure health-related quality of life that can be used in a wide range of health conditions and treatments. The EQ-5D consists of a descriptive system and the EQ VAS. The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The EQ-5D health states may be converted into a single summary index by applying a formula that attaches weights to each of the levels in each dimension. The maximum score of 1 indicates the best health state, while 0 indicates the worst health state.	At baseline and after 3 months
Percent Change (%) in EQ-5D Summary Index From Baseline to 3 Months	Mean percent change in EQ-5D Summary Index from Baseline to 3 months in the EBV group compared to the SoC group.	At baseline and after 3 months
Absolute Change in EQ-5D VAS (Health State Today) Score From Baseline to 3 Months	Mean absolute change in the EQ-5D VAS (Health State Today) Score from Baseline to 3 months in the EBV group compared to the SoC group. Scores range from 0 to 100, with higher scores indicating better outcome.	At baseline and after 3 months

Collaborators and Investigators

• Sponsor: Pulmonx International Sàrl
• Investigators: Principal Investigator: Arschang Valipour, MD, PhD, FCCP, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology Otto-Wagner-Spital 1140 Wien / Austria; Principal Investigator: Felix Herth (co-principal investigator), MD, Heidelberg University; Principal Investigator: Ralf Eberhardt (co-principal investigator), MD, Heidelberg University

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2014
• Primary Completion (Actual): April 1, 2016
• Study Completion (Actual): March 15, 2017

Study Registration Dates

• First Submitted: December 21, 2013
• First Submitted That Met QC Criteria: December 27, 2013
• First Posted (Estimate): December 31, 2013

Study Record Updates

• Last Update Posted (Actual): August 16, 2019
• Last Update Submitted That Met QC Criteria: July 9, 2019
• Last Verified: July 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Emphysema
• Other Study ID Numbers: 630-0014