- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02583282
A Study to Compare the Efficacy and Safety of Intrapleural Doxycycline Versus Iodopovidone for Performing Pleurodesis in Malignant Pleural Effusion
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Introduction & Review of literature Malignant pleural effusion (MPE) arises in advanced-stages of malignancies and frequently heralds a poor prognosis. Most patients with MPE are symptomatic. The most common symptom is exertional dyspnea. Most patients undergo chemotherapy or local treatments to palliate symptoms such as dyspnea, cough & chest pain, to improve quality of life. If the underlying malignancy is chemo sensitive (e.g., small-cell carcinoma of lung & lymphoma), systemic chemotherapy may control the pleural effusion.1 However, when pleural effusion persists or reaccumulates after chemotherapy, the management of refractory MPE includes local therapeutic methods such as thoracentesis, pleurodesis, pleurectomy, or pleuroperitoneal shunting. Instilling of sclerosing agents into the pleural cavity (pleurodesis) is a common method for the management of MPE. For several years, various agents such as anti-neoplastics (e.g., nitrogen mustard, bleomycin), tetracycline derivatives, talc, erythromycin, silver nitrate, and povidone-iodine have been injected into the pleural cavity to create pleurodesis.
According to a recent survey, tetracycline or its derivative (doxycycline) is the preferred agent for performing pleurodesis at many centers.7 However, intravenous preparation of doxycycline is not freely available and also induces severe inflammation in the pleura that results in severe chest pain and discomfort to the patient. In a previous study from the investigators' center, the investigators have demonstrated equal efficacy of iodopovidine in comparison to talc in inducing pleural symphysis.8 Also, iodopovidine has been postulated to have anti-neoplastic effects and hence may help in reducing the drain output. Apart from these benefits iodopovidine is easily available and is cost effective. The investigators believe that iodopovidone will have better efficacy than doxycycline in inducing pleurodesis in malignant pleural effusion.
Study hypothesis In patients with malignant pleural effusion, pleurodesis with intrapleural instillation of iodopovidone will have better efficacy in comparison with doxycycline.
Methods
Study design: This will be a randomized double blind study conducted in the Department of Pulmonary Medicine, PGIMER, Chandigarh.
Selection of cases: A total of 100 consecutive patients of malignant pleural effusion will be enrolled in the study. Patients will be equally randomized to undergo pleurodesis, either with intrapleural iodopovidone or intrapleural doxycycline. A written informed consent will be taken from all the patients participating in the present study
Randomization: Patient will be randomized 1:1 to undergo pleurodesis either by instillation of intrapleural iodopovidone or intrapleural doxycycline. The randomization sequence will be computer generated. The sequence generated will be kept in a sealed opaque envelope and will be opened at the time of procedure
Procedure: A chest tube (24-28 F) will be inserted through the fifth intercostal space in the mid-axillary line, to achieve complete drainage of the effusion and/or complete lung expansion. In case of large effusions, drainage will be spread over 24-48 h to prevent re-expansion pulmonary oedema. Pleurodesis will be performed when the daily drainage output will decrease to <150 mL/day and chest radiograph demonstrates apposition of pleural surfaces. In cases of pneumothorax, complete lung expansion and absence of any air leaks will be confirmed before instillation of the chemical agent. A chest radiograph will be performed to confirm complete re-expansion. Normal saline solution (50 mL) containing lignocaine (2 mg/kg ideal body weight) will be infused through the chest tube. Simultaneously, tramadol (100 mg) will be administered intravenously for analgesia. After 15 minutes pleurodesis will be performed either by instillation of doxycycline or by iodopovidone.
Doxycycline: 500 mg of doxycycline will be dissolved in 50 ml of normal saline. The combination will then be instilled through the chest tube in the pleural cavity and the chest tube drain will be clamped for 4 hours.
Iodopovidone: 20 ml of 10% betadine (Microshield, Johnson and Johnson, Solan, India) will be dissolved in 80 mL of normal saline. The combination will then be instilled through the chest tube in the pleural cavity and the chest tube drain will be clamped for 4 hours.
The chest tube will be flushed with 50 mL of normal saline after instillation of study drug (doxycycline or iodopovidone).
Endpoint: The chest tube will be removed if the drainage output is less than 100mL of pleural fluid and there is complete lung re-expansion with no residual pneumothorax on chest radiograph. Pulse, blood pressure, respiratory rate and temperature will be measured before and every 30 minutes after the procedure for 6 hours. Chest pain after pleurodesis will be recorded on a visual analogue scale (VAS) of 0-100 mm. Patients will be given additional intravenous tramadol (50 mg) on an as-needed basis after the procedure. Any complications related to the procedure will be recorded. Complications such as hypotension, fever, acute respiratory failure and empyema will be noted. Patients will be followed up at 1 week, at 1, 3 and 6 months.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
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Chandigarh, India, 160012
- Bronchoscopy suite, PGIMER
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- recurrent symptomatic malignant pleural effusion, with subjective improvement of dyspnea following thoracentesis
Exclusion Criteria:
- history of any allergy to iodine or doxycycline
- history of thyroid disorders
- failure of lung expansion after insertion of intercostal tube (trapped lung)
- presence of air leaks
- advanced malignancy with limited predicted life expectancy (<30 days)
- failure to provide informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Doxycycline
Intrapleural doxycycline
|
500 mg of doxycycline will be dissolved in 50 ml of normal saline.
The combination will then be instilled through the chest tube in the pleural cavity and the chest tube drain will be clamped for 4 hours.
|
Active Comparator: Iodopovidine
Intrapleural iodopovidine
|
20 ml of 10% betadine (Microshield, Johnson and Johnson, Solan, India) will be dissolved in 80 mL of normal saline.
The combination will then be instilled through the chest tube in the pleural cavity and the chest tube drain will be clamped for 4 hours.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Complete success
Time Frame: 30 days
|
long-term relief of symptoms related to the effusion, with absence of re-accumulation of fluid on chest radiograph at 30 days
|
30 days
|
Partial success
Time Frame: 30 days
|
diminution of dyspnea related to the effusion, with only partial reaccumulation of fluid and no requirement for therapeutic thoracentesis
|
30 days
|
Failed pleurodesis
Time Frame: 30 days
|
reaccumulation of pleural fluid requiring therapeutic thoracentesis, persistence of drainage output >250mL/day requiring repeat procedure, lack of success requiring surgical intervention
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30 days
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to pleurodesis
Time Frame: 1 week
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interval between instillation of the agent and removal of the chest tube
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1 week
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Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- INT/IEC/2015/232
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