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Management of Progressive Disease in Idiopathic Pulmonary Fibrosis

Study Purpose

Idiopathic pulmonary fibrosis (IPF) is a prototype of chronic, progressive, and fibrotic lung disease. It has been considered rare, with an incidence estimated to 11.5 cases per 100 000 individuals per year. Increasing rates of hospital admissions and deaths due to IPF suggest an increasing burden of disease. The median survival time from diagnosis is 2-4 years. Recently two disease-modifying therapies, pirfenidone and nintedanib, have been approved worldwide. Both drugs reduce the disease progression as measured by progressive decline in forced vital capacity (FVC), with a reduction of overall mortality showed by meta-analysis of phase III pirfenidone trials. However, progression of disease continues to occur despite the currently available drug therapy. Many patients die from progressive, chronic hypoxemic respiratory failure, or less frequently from acute exacerbation of pulmonary fibrosis. In these patients, no data are available to guide management between continuation of the prescribed antifibrotic drug, to switch to the other available antifibrotic drug, or to combine the available drugs. The combination of nintedanib and pirfenidone is not recommended outside clinical trials. However, although both antifibrotic drugs were developed and approved as monotherapy, two recent trials have suggested the feasibility and safety of combining them over a 12-24 weeks period. These results encourage further studies of combination treatment with pirfenidone and nintedanib in patients with IPF. Such study is timely, as there is a risk that clinicians facing the continued worsening of disease in patients receiving one of the available drugs may prescribe both drugs combined outside clinical trials, potentially exposing patients to a currently unknown risk. This study will evaluate the efficacy and tolerance of the combination pirfenidone and nintedanib as compared to a "switch monotherapy": i.e. switching from the current to the other of the two existing drugs prescribed as monotherapy, in patients who present chronic worsening IPF despite receiving either pirfenidone or nintedanib and as to a "control group": i.e.treatment still be on as before randomization (pirfenidone or nintedanib).

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

No
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Interventional
Eligible Ages 50 Years and Over
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

  • - Patient aged ≥ 50 years.
  • - Patient with Idiopathic Pulmonary Fibrosis satisfying the ATS/ERS/JRS/ALAT diagnostic criteria (29) diagnosed.
In the absence of a surgical lung biopsy, high-resolution computed tomography (HRCT) must be "consistent with Usual Interstitial Pneumonia (UIP)" defined as meeting either criteria A, B, and C, or criteria A and C, or criteria B and C below: A. Definite honeycomb lung destruction with basal and peripheral predominance. B. Presence of reticular abnormality and traction bronchiectasis consistent with fibrosis, with basal and peripheral predominance. C. Atypical features are absent, specifically nodules and consolidation. Ground glass opacity, if present, is less extensive than reticular opacity pattern.
  • - - Patient who fulfill at least 1 of the 4 criteria for IPF progression in the 12 months (+/- one six months) before screening, despite antifibrotic treatment in clinical practice (if yes check the option(s)).
These criteria are: 0 Relative decline in FVC ≥10% predicted 0 Relative decline in FVC ≥5-<10% predicted and worsened respiratory symptoms 0 Relative decline in FVC ≥5-<10% predicted and increased extent of fibrotic changes on chest imaging 0 Worsened respiratory symptoms and increased extent of fibrotic changes on chest imaging.
  • - Patient must have been on a stable dose of pirfenidone or nintedanib prescribed as first-line therapy for at least 6 months, with good tolerance of 1602 to 2403 mg per day of pirfenidone or 200 to 300 mg per day of nintedanib.
  • - Patient who has a FVC ≥ 45% of predicted.
  • - Patient who has a forced expiratory volume in 1 second (FEV1)/FVC ratio > 0.70.
  • - Patient who has a life expectancy of at least 9 months.
  • - Patient who has provided his written informed consent to participate in the study.
  • - Patient affiliated to a social insurance regimen.

Exclusion Criteria:

  • - Patients under judicial protection.
  • - Female patient who is pregnant or lactating, or is of child bearing potential (defined as a sexually mature woman not surgically sterilized or not post-menopausal for at least 24 consecutive months if ≤ 55 years or 12 months if > 55 years) and who did not agree to use highly effective methods of birth control throughout the study.
  • - Patient who is currently on both pirfenidone and nintedanib.
  • - Patient who has already received pirfenidone and nintedanib either concomitantly or successively.
  • - Patient who has a contra-indication to pirfenidone or nintedanib.
  • - Patient who has emphysema > 15% on HRCT or the extent of emphysema is greater than the extent of fibrosis according to reported results from the most recent HRCT.
  • - Patient who had acute exacerbation of idiopathic pulmonary fibrosis within the previous 3 months.
  • - Patient who has a history of cigarette smoking within the previous 3 months.
  • - Patient who has received experimental therapy for IPF within 4 weeks before baseline.
  • - Patient who is receiving systemic corticosteroids equivalent to prednisone > 15 mg/day or equivalent within 2 weeks before baseline.
  • - Patient who received Immuno-suppressants (e.g. methotrexate, azathioprine, cyclophosphamide, cyclosporine, sirolimus, everolimus or other immunosuppressants) within 4 weeks before baseline.
  • - Patient who has a history of a malignancy within the previous 5 years, with the exception of basal cell skin neoplasms.
In addition, a malignant diagnosis or condition first occurring prior to 5 years must be considered cured, inactive, and not under current treatment.
  • - Patient who, in the Investigator's opinion, is not able to perform home spirometry in accordance with the protocol.
  • - Patient who has any concurrent condition other than IPF that, in the Investigator's opinion, is unstable and/or would impact the likelihood of survival for the study duration or the subject's ability to complete the study as designed, or may influence any of the safety or efficacy assessments included in the study.
  • - Patient who has baseline resting oxygen saturation of < 88% on room air or supplemental oxygen.
  • - Patient who had lung transplantation or who is on a lung transplant list and the investigator anticipates the patient will not be able to complete the study prior to transplant.

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT03939520
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

Phase 4
Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

Hospices Civils de Lyon
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

Vincent COTTIN, Pr
Principal Investigator Affiliation Hospices Civils de Lyon
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

Other
Overall Status Recruiting
Countries France
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

Progressive Idiopathic Pulmonary Fibrosis
Arms & Interventions

Arms

Experimental: Combined therapy

Active Comparator: Switch monotherapy

Other: Control group

Interventions

Drug: - pirfenidone and nintedanib

The experimental group will receive pirfenidone 2403 mg per day (at least 1602 mg) in combination with nintedanib 300 mg per day (at least 200 mg) during 24 weeks.

Drug: - pirfenidone or nintedanib

The second intervention group will switch from one monotherapy during 24 weeks: with pirfenidone 2403 mg per day (at least 1602 mg) or nintedanib 300 mg per day (at least 200 mg) to the other monotherapy (nintedanib in patients who received pirfenidone as first line therapy before inclusion and conversely).

Drug: - pirfenidone or nintedanib

The control group will keep on the same monotherapy during 24 weeks: with pirfenidone 2403 mg per day (at least 1602 mg) or nintedanib 300 mg per day (at least 200 mg) to the other monotherapy (nintedanib in patients who received pirfenidone as first line therapy before inclusion and conversely).

Contact a Trial Team

If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.

International Sites

CHU d'Angers, Angers, France

Status

Recruiting

Address

CHU d'Angers

Angers, ,

Site Contact

Frédéric GAGNADOUX

vincent.cottin@chu-lyon.fr

4 27 85 77 00

Centre Hospitalier de la côte Basque, Bayonne, France

Status

Not yet recruiting

Address

Centre Hospitalier de la côte Basque

Bayonne, ,

Site Contact

Pierre RIGAUD

vincent.cottin@chu-lyon.fr

4 27 85 77 00

CHRU de Besançon - Hôpital Jean Minjoz, Besançon, France

Status

Not yet recruiting

Address

CHRU de Besançon - Hôpital Jean Minjoz

Besançon, ,

Site Contact

Mathilde DUPREZ

vincent.cottin@chu-lyon.fr

4 27 85 77 00

AP - HP - Hôpital Avicenne, Bobigny, France

Status

Recruiting

Address

AP - HP - Hôpital Avicenne

Bobigny, ,

Site Contact

Hilario NUNES

vincent.cottin@chu-lyon.fr

4 27 85 77 00

CHRU Hôpital Cavale Blanche, Brest, France

Status

Recruiting

Address

CHRU Hôpital Cavale Blanche

Brest, ,

Site Contact

Aude BARNIER

vincent.cottin@chu-lyon.fr

4 27 85 77 00

Bron, France

Status

Recruiting

Address

Hôpital Pneumologique et Cardiovasculaire Louis Pradel

Bron, ,

Site Contact

Vincent Cottin, Pr

vincent.cottin@chu-lyon.fr

4 27 85 77 00

Caen, France

Status

Recruiting

Address

CHU de Caen - Hôpital de la Côte de Nacre

Caen, ,

Site Contact

Emmanuel BERGOT

vincent.cottin@chu-lyon.fr

4 27 85 77 00

Dijon, France

Status

Recruiting

Address

CHU Dijon Bourgogne - Hôpital François Mitterrand

Dijon, ,

Site Contact

Philippe BONNIAUD

vincent.cottin@chu-lyon.fr

4 27 85 77 00

CHRU de Lille - Hôpital Albert Calmette, Lille, France

Status

Recruiting

Address

CHRU de Lille - Hôpital Albert Calmette

Lille, ,

Site Contact

Lidwine WEMEAU-STERVINOU

vincent.cottin@chu-lyon.fr

4 27 85 77 00

CHU de Marseille - Hôpital Nord, Marseille, France

Status

Recruiting

Address

CHU de Marseille - Hôpital Nord

Marseille, ,

Site Contact

Martine REYNAUD-GAUBERT

vincent.cottin@chu-lyon.fr

4 27 85 77 00

Montpellier, France

Status

Recruiting

Address

CHRU de Montpellier - Hôpital Arnaud de Villeneuve

Montpellier, ,

Site Contact

Anne-Sophie GAMEZ

vincent.cottin@chu-lyon.fr

4 27 85 77 00

CHU - Hôpital G.R. Laennec, Nantes, France

Status

Recruiting

Address

CHU - Hôpital G.R. Laennec

Nantes, ,

Site Contact

Stéphanie DIROU

vincent.cottin@chu-lyon.fr

4 27 85 77 00

CHU de Nice, Hôpital Pasteur, Nice, France

Status

Recruiting

Address

CHU de Nice, Hôpital Pasteur

Nice, ,

Site Contact

Charles-Hugo MARQUETTE

vincent.cottin@chu-lyon.fr

4 27 85 77 00

Paris, France

Status

Recruiting

Address

APHP - Hôpital Xavier Bichat-Claude Bernard

Paris, ,

Site Contact

Bruno CRESTANI

vincent.cottin@chu-lyon.fr

4 27 85 77 00

Groupe Hospitalier Paris Saint Joseph, Paris, France

Status

Recruiting

Address

Groupe Hospitalier Paris Saint Joseph

Paris, ,

Site Contact

Jean-Marc NACCACHE

vincent.cottin@chu-lyon.fr

4 27 85 77 00

Ch de Cornouaille, Quimper, France

Status

Not yet recruiting

Address

Ch de Cornouaille

Quimper, ,

Site Contact

Nicolas BIZIEN, Dr

vincent.cottin@chu-lyon.fr

4 27 85 77 00

CHU Rennes - Hôpital Pontchaillou, Rennes, France

Status

Recruiting

Address

CHU Rennes - Hôpital Pontchaillou

Rennes, ,

Site Contact

Stéphane JOUNEAU

vincent.cottin@chu-lyon.fr

4 27 85 77 00

CHU de Toulouse - Hôpital Larrey, Toulouse, France

Status

Recruiting

Address

CHU de Toulouse - Hôpital Larrey

Toulouse, ,

Site Contact

Grégoire PRÉVOT

vincent.cottin@chu-lyon.fr

4 27 85 77 00

CHRU, Tours - Hôpital Bretonneau, Tours, France

Status

Recruiting

Address

CHRU, Tours - Hôpital Bretonneau

Tours, ,

Site Contact

Laurent PLANTIER

vincent.cottin@chu-lyon.fr

4 27 85 77 00

CHU Nancy - Hôpital Brabois, Vandœuvre-lès-Nancy, France

Status

Recruiting

Address

CHU Nancy - Hôpital Brabois

Vandœuvre-lès-Nancy, ,

Site Contact

Anne GUILLAUMOT

vincent.cottin@chu-lyon.fr

4 27 85 77 00

Hôpital Robert Schuman, Vantoux, France

Status

Recruiting

Address

Hôpital Robert Schuman

Vantoux, ,

Site Contact

Benoit GODBERT

vincent.cottin@chu-lyon.fr

4 27 85 77 00