TY - JOUR
T1 - A Phase II Clinical Trial of Low-Dose Inhaled Carbon Monoxide in Idiopathic Pulmonary Fibrosis
AU - Rosas, Ivan O.
AU - Goldberg, Hilary J.
AU - Collard, Harold R.
AU - El-Chemaly, Souheil
AU - Flaherty, Kevin
AU - Hunninghake, Gary M.
AU - Lasky, Joseph A.
AU - Lederer, David J.
AU - Machado, Roberto
AU - Martinez, Fernando J.
AU - Maurer, Rie
AU - Teller, Danielle
AU - Noth, Imre
AU - Peters, Elizabeth
AU - Raghu, Ganesh
AU - Garcia, Joe G.N.
AU - Choi, Augustine M.K.
N1 - Publisher Copyright:
© 2017
PY - 2018/1
Y1 - 2018/1
N2 - Background Preclinical studies have demonstrated that low-dose carbon monoxide (CO) can abrogate experimental lung fibrosis. To test the therapeutic role of inhaled CO, we designed a clinical study in patients with idiopathic pulmonary fibrosis (IPF). Methods We conducted a multicenter, phase IIa, double-blinded, sham-controlled, clinical trial. Patients with IPF were randomized to treatment with inhaled CO at 100 to 200 parts per million or to inhaled 21% oxygen for 2 h daily, twice weekly, for 12 weeks. The primary study end point was the difference in change in matrix metalloproteinase-7 (MMP7) serum concentration after 12 weeks of treatment. Secondary end points included pulmonary function test measures, 6-min walk distance, rates of adverse events, acute exacerbation, hospitalization and death, and quality of life measures. Results Fifty-eight subjects were randomized to treatment with inhaled CO (n = 29) or placebo (n = 29). Despite modest increases in CO blood levels, the change in MMP7 concentrations after 12 weeks of treatment did not significantly differ between the study arms (MMP7 difference at week 12, −0.90 ng/mL; 95% CI, −4.18 to 2.38 ng/mL). No differences were observed in physiologic measures, incidence of acute exacerbations, hospitalization, death, or patient-reported outcomes. Importantly, no differences in distribution of adverse events were noted between the treatment arms. Conclusions Inhaled CO is well tolerated and can be safely administered to patients with IPF in the ambulatory setting; however, inhaled CO did not result in significant changes in study end points. Our findings support testing the efficacy of inhaled therapies in future IPF clinical trials. Trial Registry ClinicalTrials.gov; No.: NCT01214187; URL: www.clinicaltrials.gov.
AB - Background Preclinical studies have demonstrated that low-dose carbon monoxide (CO) can abrogate experimental lung fibrosis. To test the therapeutic role of inhaled CO, we designed a clinical study in patients with idiopathic pulmonary fibrosis (IPF). Methods We conducted a multicenter, phase IIa, double-blinded, sham-controlled, clinical trial. Patients with IPF were randomized to treatment with inhaled CO at 100 to 200 parts per million or to inhaled 21% oxygen for 2 h daily, twice weekly, for 12 weeks. The primary study end point was the difference in change in matrix metalloproteinase-7 (MMP7) serum concentration after 12 weeks of treatment. Secondary end points included pulmonary function test measures, 6-min walk distance, rates of adverse events, acute exacerbation, hospitalization and death, and quality of life measures. Results Fifty-eight subjects were randomized to treatment with inhaled CO (n = 29) or placebo (n = 29). Despite modest increases in CO blood levels, the change in MMP7 concentrations after 12 weeks of treatment did not significantly differ between the study arms (MMP7 difference at week 12, −0.90 ng/mL; 95% CI, −4.18 to 2.38 ng/mL). No differences were observed in physiologic measures, incidence of acute exacerbations, hospitalization, death, or patient-reported outcomes. Importantly, no differences in distribution of adverse events were noted between the treatment arms. Conclusions Inhaled CO is well tolerated and can be safely administered to patients with IPF in the ambulatory setting; however, inhaled CO did not result in significant changes in study end points. Our findings support testing the efficacy of inhaled therapies in future IPF clinical trials. Trial Registry ClinicalTrials.gov; No.: NCT01214187; URL: www.clinicaltrials.gov.
KW - IPF
KW - MMP7
KW - carbon monoxide
KW - idiopathic pulmonary fibrosis
KW - inhaled therapy
UR - http://www.scopus.com/inward/record.url?scp=85040202384&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040202384&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2017.09.052
DO - 10.1016/j.chest.2017.09.052
M3 - Article
C2 - 29100885
AN - SCOPUS:85040202384
SN - 0012-3692
VL - 153
SP - 94
EP - 104
JO - CHEST
JF - CHEST
IS - 1
ER -