- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02696564
Losartan Effects on Emphysema Progression (LEEP)
May 4, 2022 updated by: JHSPH Center for Clinical Trials
A randomized, parallel, placebo controlled trial to evaluate the effect of 100mg/day losartan on the progression of emphysema as measured by quantitative HRCT compared to placebo
.
Study Overview
Detailed Description
This is a trial designed to test if a treatment, losartan, may decrease the progression of Chronic Obstructive Pulmonary Disease (COPD).
Losartan is an angiotensin receptor blocking agent, commonly used as an antihypertensive agent, which has been shown to alter cardiac remodeling after myocardial infarction and renovascular remodeling in diabetes-mellitus.
In this trial participants with mild to severe COPD, with Computed Tomography (CT) evidence of emphysema (5-35% of voxels with < -950 Hounsfield Units), will be randomly assigned to receive 100mg/day of losartan or placebo for 48 weeks.
The primary outcome measure will be the rate of progression of emphysema, quantified as the percent of lung voxels with a density less than -950 HU as measured by High Resolution CT (HRCT, from baseline to 48 weeks.
Study Type
Interventional
Enrollment (Actual)
220
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Alabama
-
Birmingham, Alabama, United States, 35249
- University of Alabama at Birmingham
-
-
Arizona
-
Tucson, Arizona, United States, 85724
- University of Arizona
-
-
California
-
San Diego, California, United States, 92103
- University of California at San Diego
-
San Francisco, California, United States, 94143
- University of California at San Francisco
-
-
Colorado
-
Denver, Colorado, United States, 80206
- National Jewish Medical and Research Center
-
-
Connecticut
-
Danbury, Connecticut, United States, 06810
- Western Connecticut Health Network
-
-
Florida
-
Jacksonville, Florida, United States, 32209
- University of Florida College of Medicine
-
Tampa, Florida, United States, 33613
- University of South Florida
-
-
Illinois
-
Chicago, Illinois, United States, 60611
- Northwestern University
-
Chicago, Illinois, United States, 60612
- Rush University Medical Center
-
Chicago, Illinois, United States, 60608
- University of Illinois at Chicago
-
Chicago, Illinois, United States, 60637
- University of Chicago Hospitals
-
-
Indiana
-
Indianapolis, Indiana, United States, 46260
- St. Vincent Hospital And Health Care Center, Inc.
-
-
Kansas
-
Kansas City, Kansas, United States, 66160
- University of Kansas Medical Center
-
-
Louisiana
-
New Orleans, Louisiana, United States, 70112
- Louisiana State University
-
-
Michigan
-
Ann Arbor, Michigan, United States, 48109-5360
- University of Michigan
-
-
Missouri
-
Saint Louis, Missouri, United States, 63104
- St. Louis University School of Medicine
-
Saint Louis, Missouri, United States, 63110
- St. Louis Asthma Clinical Research Center - Washington University School of Medicine
-
-
New York
-
New York, New York, United States, 10032
- Columbia University Medical Center
-
New York, New York, United States, 10016
- New York University School of Medicine
-
New York, New York, United States, 10021
- Weill Cornell Medicine
-
New York, New York, United States, 10029
- Mount Sinai National Jewish Health Respiratory Institute; Icahn School of Medicine
-
-
North Carolina
-
Durham, North Carolina, United States, 27710
- Duke University Medical Center
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, United States, 19140
- Temple University
-
Pittsburgh, Pennsylvania, United States, 15213
- University of Pittsburgh Medical Center
-
-
Texas
-
Houston, Texas, United States, 77030
- Baylor College of Medicine
-
-
Vermont
-
Colchester, Vermont, United States, 05466
- Vermont Lung Center at The University of Vermont
-
-
Washington
-
Seattle, Washington, United States, 98108
- Pacific Northwest Airways - VA Puget Sound Healthcare System
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
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:
- Mild to severe COPD: Ratio of forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) less than or equal to 0.70, FEV1 20-80% of predicted
- Current or former smoker
- HRCT scan with 5-35% of voxels with density less than -950 Hounsfield Units (HU)
- Ability to understand and willingness to sign consent documents
Exclusion Criteria:
- Current therapy with angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB)
- Known intolerance to ACE inhibitor or ARB
- History of angioedema
- Conventional indication for ACE inhibitor or ARB (e.g., history of myocardial infarction, known cardiomyopathy)
- Renal insufficiency (GFR <30 mL/min by Cockcroft-Gault calculation)
- Current regular use of NSAIDs defined as daily use 5 or more days of the week for more than one month
- Potassium supplementation or serum potassium level of 5.0 milliequivalents (mEq)/dL or higher at V1
- Current use of a potassium sparing diuretic
- COPD exacerbation requiring treatment within 6 weeks at V1
- Chronic systemic corticosteroid use of more than 10mg/day of prednisone
- Resting SpO2 <89% on 2 L nasal cannula continuous flow; unless at altitude > 4,000 feet, then resting oxygen saturation (SpO2) <89% on 4 L N C continuous flow
- Untreated arterial hypertension (systolic blood pressure greater than140 mm Hg, diastolic blood pressure greater than 90 mm Hg)
- Blood pressure less than 90 mm Hg systolic or 60 mm Hg diastolic while standing or sitting
- Known unilateral or bilateral renal artery stenosis higher than 70%
- Previous lung resection surgery
- Evidence of interstitial, occupational or chronic infectious lung disease
- Changes to chest that preclude adequate HRCT imaging (e.g. Metallic objects in the chest such as shrapnel or pacemaker leads)
- For women of child bearing potential, positive pregnancy test or unwillingness to use two methods of birth control or abstinence for the duration of the study
- Major chronic illnesses which in the judgment of the study physician would interfere with participation in the study e.g. including but not limited to: cardiac, renal, hepatic (LFTs more than 2.5x normal upper limit), neurological, psychiatric, endocrine or neoplastic diseases, uncontrolled diabetes, uncontrolled HIV infection or other immune system disorder, hyperthyroidism, seizure disorders, non-skin cancer, rheumatic diseases
- Failure to keep screening appointments or other indicators of non-adherence
- Inability to be contacted by telephone
- Intention to leave area within 12 months
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Losartan
At randomization participants will start with a dose of 50mg (one capsule) once a day for 2 weeks.
If this dose is well tolerated and systolic BP is >90 mm Hg and diastolic BP is > 60 mm Hg, the dose will be increased to 100 mg (2 capsules) once a day for the remaining 46 weeks.
|
50mg once per day for two weeks,followed by 100mg once per day for 46 weeks if increased dose tolerated
|
Placebo Comparator: placebo
At randomization participants will start with a dose of one capsule (inactive) once a day for 2 weeks.
After two weeks, if systolic BP is >90 mm Hg and diastolic BP is > 60 mm Hg, the dose will be increased to 2 capsules once a day for the remaining 46 weeks.
|
one capsule per day for two weeks, followed by two capsules per day for 46 weeks
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Mean pct950
Time Frame: 48 weeks
|
change in percentage of voxels with density less than -950 Hounsfield Units
|
48 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change From Baseline in Pre-bronchodilator FEV1 Percent Predicted
Time Frame: 48 weeks
|
Change from the first visit to the final visit in a spirometry (breathing test) measure: forced expiratory volume in one second (FEV1).
The test is administered without the participant taking any bronchodilator medication.
The FEV1 is compared to standard predicted values in the US population for each individual based on their height, gender, and ethnic group; the result is given as percent of predicted value.
|
48 weeks
|
Change From Baseline in Post-bronchodilator FEV1 Percent Predicted
Time Frame: 48 weeks
|
Change from the first visit to the final visit in a spirometry (breathing test) measure: forced expiratory volume in one second (FEV1).
This test is performed after the participant is given bronchodilator medications.
The FEV1 is compared to standard predicted values in the US population for each individual based on their height, gender, and ethnic group; the result is given as percent of predicted value.
|
48 weeks
|
Change From Baseline in CAT Score
Time Frame: 48 weeks
|
Change from the first visit to the final visit in the participant's COPD Assessment Test (CAT) score.
The CAT is an 8-item questionnaire assessing the impact of COPD on health status.
CAT scores range from 0 to 40, with higher scores indicating a more severe impact of COPD on a patient's life.
|
48 weeks
|
Change From Baseline in SGRQ Score: Total
Time Frame: 48 weeks
|
Change from the first visit to the final visit in participants' score on the St George's Respiratory Questionnaire - COPD.
The St George's Respiratory Questionnaire for COPD patients (SGRQ-C) is a 40-item questionnaire designed to measure impact on overall health, daily life, and perceived well-being in patients with COPD.
The SGRQ-C includes three categories: Symptoms (frequency and severity), Activities caused or limited by breathlessness, and Impacts on social and psychological functioning caused by airways disease.
The total score and scores for each category range from 0 to 100, with higher scores indicating more limitations.
|
48 weeks
|
Change From Baseline in SGRQ Score: Symptoms
Time Frame: 48 weeks
|
Change from the first visit to the final visit in participants' scores on the symptom-related questions on the St Georges Respiratory Questionnaire-COPD.
The St George's Respiratory Questionnaire for COPD patients (SGRQ-C) is a 40-item questionnaire designed to measure impact on overall health, daily life, and perceived well-being in patients with COPD.
The SGRQ-C includes three categories: Symptoms (frequency and severity), Activities caused or limited by breathlessness, and Impacts on social and psychological functioning caused by airways disease.
The total score and scores for each category range from 0 to 100, with higher scores indicating more limitations.
|
48 weeks
|
Change From Baseline in SGRQ Score: Activity
Time Frame: 48 weeks
|
Change from the first visit to the final visit in participants' scores on the activity-related questions on the St Georges Respiratory Questionnaire-COPD.
The St George's Respiratory Questionnaire for COPD patients (SGRQ-C) is a 40-item questionnaire designed to measure impact on overall health, daily life, and perceived well-being in patients with COPD.
The SGRQ-C includes three categories: Symptoms (frequency and severity), Activities caused or limited by breathlessness, and Impacts on social and psychological functioning caused by airways disease.
The total score and scores for each category range from 0 to 100, with higher scores indicating more limitations.
|
48 weeks
|
Change in SGRQ Score: Impact
Time Frame: 48 weeks
|
Change from the first visit to the final visit in participants' scores on the impact-related questions on the St Georges Respiratory Questionnaire-COPD.
The St George's Respiratory Questionnaire for COPD patients (SGRQ-C) is a 40-item questionnaire designed to measure impact on overall health, daily life, and perceived well-being in patients with COPD.
The SGRQ-C includes three categories: Symptoms (frequency and severity), Activities caused or limited by breathlessness, and Impacts on social and psychological functioning caused by airways disease.
The total score and scores for each category range from 0 to 100, with higher scores indicating more limitations.
|
48 weeks
|
Change From Baseline in mMRC Dyspnea Scale
Time Frame: 48 weeks
|
Change from the first visit to the final visit in participants' scores on the modified Medical Research Council dyspnea scale.
The modified Medical Research Council dyspnea scale (mMRC) is a self-rating tool to measure how much breathlessness affects someone's day to day activities.
Scores are between 0 and 4, with higher scores indicating more severe breathlessness.
|
48 weeks
|
Change From Baseline in PROMIS-20a T-score
Time Frame: 48 weeks
|
Change from the first visit to the final visit in participants' scores on the Patient-Reported Outcome Measures Information System (PROMIS) Physical Function assessment.
The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 20a is a 20-item questionnaire used to indicate a patient's ability to perform activities of daily living, such as bathing, dressing, and commuting.
Raw scores from this questionnaire are compared to a reference population to create a "T-score".
The general US population is the reference population.
In this T-score metric, 50 indicates the population mean with a standard deviation of 10.
Higher scores mean better outcomes (more ability to do activities of daily living)
|
48 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 23, 2017
Primary Completion (Actual)
March 31, 2021
Study Completion (Actual)
June 30, 2021
Study Registration Dates
First Submitted
February 25, 2016
First Submitted That Met QC Criteria
February 25, 2016
First Posted (Estimate)
March 2, 2016
Study Record Updates
Last Update Posted (Actual)
June 1, 2022
Last Update Submitted That Met QC Criteria
May 4, 2022
Last Verified
May 1, 2022
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
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Antihypertensive Agents
- Angiotensin II Type 1 Receptor Blockers
- Angiotensin Receptor Antagonists
- Losartan
Other Study ID Numbers
- U01HL128951 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Yes
IPD Plan Description
NHLBI Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Emphysema
-
Pulmonx CorporationRecruitingEmphysema or COPD | Emphysema, PulmonarySpain, Germany, Italy, Australia
-
Pulmonx CorporationActive, not recruiting
-
Heidelberg UniversityUnknown
-
Royal Brompton & Harefield NHS Foundation TrustCompletedHeterogeneous EmphysemaUnited Kingdom
-
Aeris TherapeuticsCompleted
-
Pulmonx CorporationCompleted
-
University Medical Center GroningenCompletedEmphysema or COPDNetherlands
-
University Medical Center GroningenRecruitingEmphysema or COPDNetherlands
-
Aeris TherapeuticsCompleted
-
Rabin Medical CenterUnknownPatients With Advanced Homogeneous EmphysemaIsrael
Clinical Trials on Losartan
-
Baker Heart and Diabetes InstituteWithdrawn
-
National Institute of Diabetes and Digestive and...Johns Hopkins UniversityTerminatedNAFLD - Nonalcoholic Fatty Liver DiseaseUnited States
-
Chinese PLA General HospitalTianjin TongRenTang Group Co., Ltd.UnknownProteinuria | GlomerulonephritisChina
-
University of South FloridaNational Cancer Institute (NCI)CompletedPrecancerous ConditionUnited States
-
Organon and CoTerminated
-
Vifor PharmaCompleted
-
Dong Wha Pharmaceutical Co. Ltd.Completed
-
EMSSuspended
-
University of MiamiNational Heart, Lung, and Blood Institute (NHLBI); Flight Attendant Medical...TerminatedCOPD | Chronic BronchitisUnited States