- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04682899
A Trial of Procalcitonin in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease
December 19, 2020 updated by: Bin Cao, Capital Medical University
Procalcitonin-guided Initiation of Antibiotics in AECOPD Inpatients: a Multicenter Randomized Controlled Trial
Current antibiotic prescription for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is generally based on the Anthonisen criteria in The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guideline, that has a potential risk of antibiotics overuse.
The dilemma is to identify patients who are most likely to benefit from antibiotics while avoiding unnecessary antibiotic use.
Procalcitonin (PCT), a more sensitive and specific biomarker of bacterial infection than other conventional laboratory tests, has the potential to determine those patients in whom antibiotics would be beneficial.
It is unclear whether PCT-guided antibiotic therapy is safe and effective for inpatients with AECOPD.
The investigators aim to conduct a 2-arm, multicenter randomized controlled trial in China to determine whether PCT-guided antibiotic therapy will reduce the antibiotic prescription rate for AECOPD without negatively impacting the treatment success rate, compared with the GOLD guideline antibiotic recommendations.
Study Overview
Status
Unknown
Intervention / Treatment
Detailed Description
This trial will recruit 500 hopitalized patients with AECOPD.
The eligible participants will be randomly assigned to either PCT group or guideline group.The investigators aim to compare the efficacy and safety between PCT-gudied antibiotic therapy and guideline-guided antibiotic recommendations.
The primary hypothesis is that PCT-guided antibiotic therapy will reduce the antibiotic prescription rate for AECOPD without negatively impacting the treatment success rate, compared with the GOLD guideline antibiotic recommendations.
Study Type
Interventional
Enrollment (Anticipated)
500
Phase
- Phase 3
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:
- Hospitalized patients with AECOPD
- ≥40 years of age
- Able to understand and communicate to ensure the completion of the trial
- Voluntary participation and provide written informed consent
Exclusion Criteria:
- Fever, Axillary temperature≥38°C
- Pneumonia identified by X-Ray or CT of the chest
- Severe respiratory failure requiring admittance to ICU
- Concurrent infection at another site (e.g. urinary tract infection)
- Immunosuppression secondary to chemotherapy, AIDS or malignant tumor of blood system
- Comorbidities requiring corticosteroids (prednisone 30mg/d or equivalent more than 30 days )
- Invasive mechanical ventilation
- Patients with malignant tumors receiving chemotherapy or radiotherapy
- Pregnancy
- Participation in another clinical trial
- Previously enrollment into the study
- Refuse to attend
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
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: PCT-guided antibiotic therapy (PCT group)
Participants in the PCT group will complete a PCT test within 2 hours after randomization and the results will be sent back to the clinician by laboratory through the internal network of the hospital.
The prescribing clinician will use the results of the PCT to help guide their antibiotic prescription decision.
The detailed recommendations are as follows: if PCT<0.1ng/ml,strongly discouraged;if PCT (0.1-0.25ng/ml) and no sputum purulence, discouraged; if PCT (0.1-0.25ng/ml) and sputum purulence, Recommended; PCT>0.25 ng/ml, Strongly recommended.
|
In procalcitonin group, clinican make a decision of antibiotic precription based on the results of procalcitonin.
|
ACTIVE_COMPARATOR: Guideline-guided antibiotic therapy (guideline group)
Participants in the guideline group will also need to complete a PCT test within 2 hours after randomization, however, the laboratory will save the results and do not sent back to the clinician.
The clinician will make an antibiotic prescribing decision on the basis of the recommendations of GOLD guideline.
The guideline recommend the following patients to receive antibiotic therapy.
Patients with exacerbations of COPD who have three cardinal symptoms: increase in dyspnea, sputum volume, and sputum purulence; have two of the cardinal symptoms, if increased purulence of sputum is one of the two symptoms; or require mechanical ventilation (invasive or noninvasive).
|
In guideline group, clinican make a decision of antibiotic precription based on the recommendations of GOLD guideline.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Antibiotic prescription rate
Time Frame: within 30 days post randomization
|
proportion of patients receiving antibiotics for AECOPD
|
within 30 days post randomization
|
Treatment success rate
Time Frame: day 30 post randomization
|
Treatment success is defined as cure (a complete resolution of signs and symptoms associated with the exacerbation) or improvement (a resolution or reduction of the symptoms and signs associated with the exacerbation, without new symptoms or signs).
|
day 30 post randomization
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Antibiotic prescription rate
Time Frame: day 1 post randomization
|
the proportion of patients receiving antibiotics for AECOPD
|
day 1 post randomization
|
Hospital antibiotic exposure
Time Frame: from randomization to hospital discharge, up to 30 days
|
the number of days of antibiotic consumed for AECOPD and the proportion of patients receiving antibiotic for AECOPD between randomization and hospital discharge
|
from randomization to hospital discharge, up to 30 days
|
Length of hospital stay
Time Frame: from randomization to hospital discharge, up to 30 days
|
the number of days of hospitalization through study completion, an average of 30 days
|
from randomization to hospital discharge, up to 30 days
|
Rate of subsequent exacerbation
Time Frame: within 30 days post randomization
|
proportion of patients present with subsequent acute exacerbation after recovery
|
within 30 days post randomization
|
rate of hospital readmission
Time Frame: from the date of discharge to day 30 post randomization
|
proportion of patients admit to hospital due to AECOPD after discharge
|
from the date of discharge to day 30 post randomization
|
overall mortality
Time Frame: within 30 days post randomization
|
death from all cause
|
within 30 days post randomization
|
ICU admission rate
Time Frame: within 30 days post randomization
|
proportion of patients admit to ICU
|
within 30 days post randomization
|
Change in COPD assessment test
Time Frame: from the baseline of hospital admission to day 30 post randomization
|
the difference between the baseline of hospital admission and day 30 post randomization
|
from the baseline of hospital admission to day 30 post randomization
|
Change in modified Medical Research Council (mMRC) score
Time Frame: from the baseline of hospital admission to day 30 post randomization
|
the difference between the baseline of hospital admission and day 30 post randomization
|
from the baseline of hospital admission to day 30 post randomization
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
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 (ANTICIPATED)
February 1, 2021
Primary Completion (ANTICIPATED)
February 1, 2022
Study Completion (ANTICIPATED)
April 1, 2022
Study Registration Dates
First Submitted
December 8, 2020
First Submitted That Met QC Criteria
December 19, 2020
First Posted (ACTUAL)
December 24, 2020
Study Record Updates
Last Update Posted (ACTUAL)
December 24, 2020
Last Update Submitted That Met QC Criteria
December 19, 2020
Last Verified
October 1, 2020
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- CAP-China PCT-AECOPD
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
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.
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