Study on the Impact of Decolonization Treatment of Pneumocystis Jirovecii on the Frequency of Acute Exacerbation in COPD
A Multicenter, Prospective, Double-blind, Randomized Controlled Study on the Impact of Decolonization Treatment on the Frequency of Acute Exacerbation in Patients With Chronic Obstructive Pulmonary Disease Colonized With Pneumocystis Jirovecii
Previous researches have found the common colonization of Pneumocystis jirovecii (Pj) in the airways of people with chronic obstructive pulmonary disease (COPD). And this colonization may exacerbate airway inflammation and increase the frequency of acute exacerbation in people with COPD.
The goal of this clinical trial is to study if "decolonization treatment" (that is, removing these colonizing Pj) works to improve the prognosis of COPD colonized by Pj in adults. The main question it aims to answer is:
- Does the Trimethoprim-Sulfamethoxazole (TMP-SMX, an antibiotics) decolonization treatment reduce the frequency of acute exacerbation in participants with COPD colonized by Pj who have a high risk of acute exacerbation.
Researchers will compare TMP-SMX to a placebo (a look-alike substance that contains no drug) to see if TMP-SMX works to reduce the frequency of acute exacerbation of COPD.
Participants will:
- Take drug TMP-SMX or a placebo 2 tablet every day for 4 weeks.
- Visit the clinic after 2 weeks, 1 month, 3 months, 6 months and 12 months for survey questions, checkups and tests.
- Keep a diary of their symptoms and the number of times they experience acute exacerbations
Studieoversikt
Status
Status
Forhold
Forhold
Intervensjon / Behandling
Intervensjon / Behandling
Studietype
Studietype
Registrering (Antatt)
Registrering
Fase
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiekontakt
Studiekontakt
- Navn: Hua Zhou, Doctor
- Telefonnummer: +86 571 8723 6876
- E-post: zhouhua1@zju.edu.cn
Studiesteder
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Guangdong
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Guangzhou, Guangdong, Kina
- The First Affiliated Hospital of Guangzhou Medical University
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Ta kontakt med:
- Zhengtu Li
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Hubei
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Wuhan, Hubei, Kina
- Tongji Hospital
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Ta kontakt med:
- Yuanzhou He
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Jiangxi
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Nanchang, Jiangxi, Kina
- Second Affiliated Hospital of Nanchang University
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Ta kontakt med:
- Xinyi Zhang
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Shanghai Municipality
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Shanghai, Shanghai Municipality, Kina
- Shanghai Pulmonary Hospital, Shanghai, China
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Ta kontakt med:
- Shuyi Gu
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Shanghai, Shanghai Municipality, Kina
- Shanghai Tongji Hospital, Tongji University School of Medicine
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Ta kontakt med:
- Yingzhou Xie
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Sichuan
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Chengdu, Sichuan, Kina
- West China Hospital
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Ta kontakt med:
- Chengdi Wang
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Zhejiang
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Hangzhou, Zhejiang, Kina
- Sir Run Run Shaw Hospital
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Ta kontakt med:
- Hequan Li
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Hangzhou, Zhejiang, Kina
- Zhejiang Hospital
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Ta kontakt med:
- Jian Ye
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Hangzhou, Zhejiang, Kina
- First affiliated Hospital of Zhejiang University
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Ta kontakt med:
- Yinan Yao
- E-post: yaoyinan@zju.edu.cn
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Hangzhou, Zhejiang, Kina
- Red Cross Hospital, Hangzhou, China
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Ta kontakt med:
- Chuhui Ru
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Huzhou, Zhejiang, Kina
- Huzhou Central Hospital
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Ta kontakt med:
- Bin Wang
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Jiaxing, Zhejiang, Kina
- Affiliated Hospital of Jiaxing University
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Ta kontakt med:
- Wenyu Chen
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Jiaxing, Zhejiang, Kina
- Zhejiang Rongjun Hospital
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Ta kontakt med:
- Lixin Wu
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Lishui, Zhejiang, Kina
- Lishui hospital of Zhejiang University
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Ta kontakt med:
- Youyi Du
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Lishui, Zhejiang, Kina
- The Sixth Affiliated Hospital of Wenzhou Medical University
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Ta kontakt med:
- Jinwei Huang
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Quzhou, Zhejiang, Kina
- Zhejiang Quhua Hospital
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Ta kontakt med:
- Kai Fang
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Shaoxing, Zhejiang, Kina
- Shaoxing people's Hospital
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Ta kontakt med:
- Xing Chen
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Taizhou, Zhejiang, Kina
- Taizhou Hospital
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Ta kontakt med:
- Junfei Zhu
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Taizhou, Zhejiang, Kina
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University
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Ta kontakt med:
- Xiaomai Wu
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Wenzhou, Zhejiang, Kina
- First Affiliated Hospital of Wenzhou Medical University
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Ta kontakt med:
- Yuping Li
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Deltakelseskriterier
Kvalifikasjonskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Voksen
- Eldre voksen
Tar imot friske frivillige
Beskrivelse
Inclusion Criteria:
- Age 40 and above,male or female;
- COPD who meet the diagnostic criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 ( post-bronchodilator FEV1/forced vital capacity [FVC] ratio < 0.7 and post-bronchodilator FEV1% predicted ≥ 30%), and have documented history of high exacerbation risk (Group E, defined as exacerbation history of ≥ 1 moderate or severe acute exacerbation within 12 months prior to inclusion);
- Background triple therapy (ICS + LABA + LAMA) for 3 months prior to randomization with a stable dose of medication for ≥1 month prior to inclusion; Double therapy (LABA + LAMA) allowed if ICS is contraindicated;
- PCR detection of Pneumocystis jirovecii in induced sputum is positive;
- Informed consent
Exclusion Criteria:
- Allergic to TMP, SMX or sulfonamide drugs;
- There are pneumonia or other infections that require long-term use of antibacterial drugs (such as tuberculosis, NTM, other fungi, etc.);
- Having used antibiotics within the previous 4 weeks prior to screening;
- Experience of AECOPD events within the previous 4 weeks prior to screening;
- Having a definite immunodeficiency disorder or receiving immunosuppressive therapy (such as HIV, agranulocytosis, solid organ or hematopoietic stem cell transplantation, malignant tumors, using long-term high-dose hormones > 20mg/day prednisone equivalent for more than 4 weeks);
- Severe liver and kidney dysfunction (ALT/AST > 3 times the upper limit of normal value, eGFR < 60 mL/min/1.73m²);
- Pregnant, lactating women or those planning to become pregnant;
- Folic acid deficiency-induced microcytic anemia;
- Currently using coumarin, phenytoin, pioglitazone, repaglinide, rosiglitazone, glipizide or glibenclamide;
- Currently participating in other interventional clinical studies;
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Dobbelt
Antall våpen
Våpen og intervensjoner
Deltakergruppe / ArmDeltakergruppe / Arm |
Intervensjon / BehandlingIntervensjon / Behandling |
|---|---|
|
Eksperimentell: TMP-SMX
Tablet with the equivalent of one DS TMP-SMX per day by mouth for 4 weeks
|
Receipt of tablet with the equivalent of one double-strength (DS) TMP-SMX(TMP 160mg + SMZ 800mg) per day by mouth for 4 weeks
Andre navn:
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Placebo komparator: placebo
Tablet with placebo by mouth every day for 4 weeks
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Receipt of tablet with placebo by mouth every day for 4 weeks
|
Hva måler studien?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
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Annualized rate of moderate or severe acute exacerbations of chronic obstructive pulmonary disease (COPD) over one year
Tidsramme: Baseline (Day 1) to 12 months
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Baseline (Day 1) to 12 months
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
The clearance rate of TMP-SMX in eliminating Pneumocystis jirovecii in the lower respiratory tract
Tidsramme: 1month
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1month
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The duration of clearance of Pneumocystis jirovecii in the lower respiratory tract
Tidsramme: 3 months,12 months
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3 months,12 months
|
|
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Change from baseline in COPD Assessment Test (CAT) total score
Tidsramme: 1month,3 months,6 months and 12 months
|
The test has a score of 0 (minimum) - 40 (maximum); a lower score means a better outcomes and a higher score means a worse outcome.Negative numbers indicate improvement of condition.
Positive numbers indicate worsening of condition.
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1month,3 months,6 months and 12 months
|
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Change from baseline in modified Medical Research Council dyspnea scale (mMRC)
Tidsramme: 1month,3 months,6 months and 12 months
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The mMRC scale consists of 5 grades (0-4), based on how much breathlessness limits physical activity.
Higher mMRC scores mean a worse outcome.
|
1month,3 months,6 months and 12 months
|
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All-cause mortality rate
Tidsramme: Baseline to 12 months
|
Baseline to 12 months
|
|
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Airway microbiota analysis
Tidsramme: Baseline to 1month and 12 months
|
The microbiome of qualified sputum will be measurable by metagenomic next-generation sequencing (mNGS) technologies.
Its characteristic parameters include the alpha diversity and beta diversity of the microbiome.
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Baseline to 1month and 12 months
|
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Change From Baseline in Post-Bronchodilator Forced Expiratory Volume in 1 Second (FEV1)
Tidsramme: Baseline to 3 months,6 months and 12 months
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Baseline to 3 months,6 months and 12 months
|
|
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Incidence rate of adverse events
Tidsramme: 2 weeks and 1 month
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2 weeks and 1 month
|
Samarbeidspartnere og etterforskere
Sponsor
Sponsor
Samarbeidspartnere
Samarbeidspartnere
Studierekorddatoer
Studer hoveddatoer
Studiestart (Antatt)
Studiestart
Primær fullføring (Antatt)
Primær fullføring
Studiet fullført (Antatt)
Studiet fullført
Datoer for studieregistrering
Først innsendt
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Først lagt ut
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Sist oppdatering lagt ut
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
- Patologiske prosesser
- Kronisk sykdom
- Sykdomsattributter
- Sykdommer i luftveiene
- Lungesykdommer
- Lungesykdommer, obstruktiv
- Patologiske tilstander, tegn og symptomer
- Lungesykdom, kronisk obstruktiv
- Svovelforbindelser
- Organiske kjemikalier
- Heterocykliske forbindelser, 1-ring
- Heterocykliske forbindelser
- Farmasøytiske preparater
- Hydrokarboner
- Hydrokarboner, syklisk
- Hydrokarboner, aromatisk
- Amides
- Anilinforbindelser
- Aminer
- Pyrimidiner
- Benzenderivater
- Medikamentkombinasjoner
- Sulfametoksazol
- Benzenesulfonamider
- Sulfonamider
- Sulfanilamider
- Sulfoner
- Trimethoprim
- Trimetoprim, Sulfamethoxazole medikamentkombinasjon
Andre studie-ID-numre
Andre studie-ID-numre
- 2026-0378
Plan for individuelle deltakerdata (IPD)
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