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- Klinische proef NCT00985244
Macrolide Maintenance Therapy in Chronic Obstructive Pulmonary Disease (COLUMBUS)
Influence of Macrolide Maintenance Therapy and Bacterial Colonisation on Exacerbation Frequency and Progression of COPD, a Randomized Double-blind Placebo-controlled Trial
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
COPD is characterized by progressive development of airflow limitation that is poorly reversible. Because of a poor understanding of COPD pathogenesis, treatment is mostly symptomatic and new therapeutic strategies are limited. There is a direct relationship between the severity of the disease and the intensity of the inflammatory response.One of the hypothesis for persistent airway inflammation is that the presence of recurrent infections is responsible for this condition.
Macrolide antibiotics have a bacteriostatic as well as anti-inflammatory properties. This clinical trial will investigate whether maintenance treatment with macrolide antibiotics during 1 year in people with 3 or more exacerbations in the preceding year of inclusion can decrease the exacerbation rate in that same year of treatment.
Studietype
Inschrijving (Werkelijk)
Fase
- Niet toepasbaar
Contacten en locaties
Studie Locaties
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Noord-Brabant
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Breda, Noord-Brabant, Nederland, 4818 CK
- Amphia Ziekenhuis
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- Diagnosis of COPD according to GOLD criteria (FEV1/FVC<70%), classification into GOLD I (FEV1 70-100% predicted), GOLD II (FEV1 50-70% predicted), GOLD III (FEV1 30- 50% predicted) or GOLD IV (FEV1 ≤ 30% predicted)
- Age ≥ 18 years
- Three or more exacerbations of COPD in one year for which a course of prednisone and/or antibiotic therapy was started
- Clinically stable during 1 month. Patients have to be free of COPD exacerbation or respiratory tract infection within a month prior to involvement in the study and they should not have received a high dose of systemic glucocorticoids or antibiotics in this period
- Informed consent
Exclusion Criteria:
- Use of antibiotics or high dose of systemic steroids within a month prior to involvement in the study.
- Addition of inhalation steroids to the patient's therapy regimen, shortly before entering the study.
- Pregnant or lactating women.
- Allergy to macrolides.
- Liver disease (alanine transaminase and/or aspartate transaminase levels 2 or more times the upper limit of normal).
- Asthma, defined as episodic symptoms of airflow obstruction which is reversible with bronchodilators, assessed with lung function testing.
- Presence of a malignancy which is clinically active.
- Bronchiectasis.
- Malignancy of any kind for which the subject is under treatment or is being monitored as part of follow up after treatment.
- Heart failure.
- Use of drugs which can adversely interact with macrolides and for which therapeutic monitoring cannot be undertaken.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Preventie
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Verviervoudigen
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Actieve vergelijker: Azithromycin
Subjects in this group will receive 3 times a week 500 mg of the antibiotic azithromycin
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Subjects in this group will receive 3 times a week 500 mg of the antibiotic azithromycin during 1 year.
Andere namen:
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Placebo-vergelijker: Placebo
Subjects in this group will receive 3 times a week placebo
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Persons in this group will receive 3 times a week placebo of azithromycin during 1 year.
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
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Reduction in number of exacerbations
Tijdsspanne: 1 year
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1 year
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Lung function parameters (FEV1 (L), FVC (L), FRC (L), RV (L), TLC(L), IC (L), 6 minute walking distance)
Tijdsspanne: Day 1. Also 3, 6, 9 and 12 months.
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Day 1. Also 3, 6, 9 and 12 months.
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Disease specific health related quality of life measured by St. George's Respiratory Questionnaire (SGRQ)
Tijdsspanne: Day 1. Also 3, 6, 9 and 12 months. In case of an exacerbation.
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Day 1. Also 3, 6, 9 and 12 months. In case of an exacerbation.
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Indication of anxiety and depression by Hospital Anxiety Depression Scale (HADS)
Tijdsspanne: Day 1. Also 3, 6, 9 and 12 months.
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Day 1. Also 3, 6, 9 and 12 months.
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Microbiology of sputum (culture and PCR).
Tijdsspanne: Day 1. Also 3, 6, 9 and 12 months. In case of an exacerbation of COPD.
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Day 1. Also 3, 6, 9 and 12 months. In case of an exacerbation of COPD.
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Measurement of inflammatory markers in sputum and serum.
Tijdsspanne: Day 1. Also 3, 6, 9 and 12 months. In case of an exacerbation of COPD.
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Day 1. Also 3, 6, 9 and 12 months. In case of an exacerbation of COPD.
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Adverse events of treatment.
Tijdsspanne: Day 1. Also 3, 6, 9 and 12 months. Whenever adverse events occur.
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Day 1. Also 3, 6, 9 and 12 months. Whenever adverse events occur.
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Length of hospital stay.
Tijdsspanne: Whenever admission to hospital is required for an exacerbation of COPD.
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Whenever admission to hospital is required for an exacerbation of COPD.
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Time till next exacerbation.
Tijdsspanne: Whenever an exacerbation of COPD occurs.
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Whenever an exacerbation of COPD occurs.
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Assess type D personality by DS-14 questionnaire.
Tijdsspanne: Day 1 and month 12.
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Day 1 and month 12.
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Generic health status measured by 12-Item Short Form Health Survey (SF-12).
Tijdsspanne: Day 1, month 3, 6, 9 and 12. In case of an exacerbation.
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Day 1, month 3, 6, 9 and 12. In case of an exacerbation.
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Decrease in percentage of clinical versus outdoor department exacerbations.
Tijdsspanne: Month 12.
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Month 12.
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Effect of maintenance macrolides on intestinal bacterial restistancy patterns
Tijdsspanne: Day 1, month 6 and month 12
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Day 1, month 6 and month 12
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Serology and PCR for atypical microorganisms in serum
Tijdsspanne: day 1. In case of an exacerbation.
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day 1. In case of an exacerbation.
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Intestinal bacterial resistance patterns
Tijdsspanne: Day 1, month 6 and month 12
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Rectal swabs will be tested for bacterial resistance patterns and change in rectal flora as a result of maintenance azithromycin.
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Day 1, month 6 and month 12
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Studie directeur: Joachim Aerts, MD, PhD, Amphia Ziekenhuis
- Studie directeur: Menno van der Eerdem, MD, PhD, Erasmus Medical Center
Publicaties en nuttige links
Algemene publicaties
- Djamin RS, Talman S, Schrauwen EJA, von Wintersdorff CJH, Wolffs PF, Savelkoul PHM, Uzun S, Kerstens R, van der Eerden MM, Kluytmans JAJW. Prevalence and abundance of selected genes conferring macrolide resistance genes in COPD patients during maintenance treatment with azithromycin. Antimicrob Resist Infect Control. 2020 Jul 28;9(1):116. doi: 10.1186/s13756-020-00783-w.
- Uzun S, Djamin RS, Kluytmans JA, Mulder PG, van't Veer NE, Ermens AA, Pelle AJ, Hoogsteden HC, Aerts JG, van der Eerden MM. Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2014 May;2(5):361-8. doi: 10.1016/S2213-2600(14)70019-0. Epub 2014 Apr 15.
- Uzun S, Djamin RS, Kluytmans J, Van't Veer NE, Ermens AA, Pelle AJ, Mulder P, van der Eerden MM, Aerts J. Influence of macrolide maintenance therapy and bacterial colonisation on exacerbation frequency and progression of COPD (COLUMBUS): study protocol for a randomised controlled trial. Trials. 2012 Jun 9;13:82. doi: 10.1186/1745-6215-13-82.
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
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Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- Amphia-ABR29500
- 2009-015857-19 (EudraCT-nummer)
Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .
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