Bronchoscopic lung-volume reduction with Exhale airway stents for emphysema (EASE trial): Randomised, sham-controlled, multicentre trial

EASE trial study group

Research output: Contribution to journalArticle

146 Citations (Scopus)

Abstract

Airway bypass is a bronchoscopic lung-volume reduction procedure for emphysema whereby transbronchial passages into the lung are created to release trapped air, supported with paclitaxel-coated stents to ease the mechanics of breathing. The aim of the EASE (Exhale airway stents for emphysema) trial was to evaluate safety and efficacy of airway bypass in people with severe homogeneous emphysema. We undertook a randomised, double-blind, sham-controlled study in 38 specialist respiratory centres worldwide. We recruited 315 patients who had severe hyperinflation (ratio of residual volume [RV] to total lung capacity of ≥0·65). By computer using a random number generator, we randomly allocated participants (in a 2:1 ratio) to either airway bypass (n=208) or sham control (107). We divided investigators into team A (masked), who completed pre-procedure and post-procedure assessments, and team B (unmasked), who only did bronchoscopies without further interaction with patients. Participants were followed up for 12 months. The 6-month co-primary efficacy endpoint required 12 or greater improvement in forced vital capacity (FVC) and 1 point or greater decrease in the modified Medical Research Council dyspnoea score from baseline. The composite primary safety endpoint incorporated five severe adverse events. We did Bayesian analysis to show the posterior probability that airway bypass was superior to sham control (success threshold, 0·965). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00391612. All recruited patients were included in the analysis. At 6 months, no difference between treatment arms was noted with respect to the co-primary efficacy endpoint (30 of 208 for airway bypass vs 12 of 107 for sham control; posterior probability 0·749, below the Bayesian success threshold of 0·965). The 6-month composite primary safety endpoint was 14·4 (30 of 208) for airway bypass versus 11·2 (12 of 107) for sham control (judged non-inferior, with a posterior probability of 1·00 [Bayesian success threshold >0·95]). Although our findings showed safety and transient improvements, no sustainable benefit was recorded with airway bypass in patients with severe homogeneous emphysema. Broncus Technologies.

Original languageEnglish (US)
Pages (from-to)997-1005
Number of pages9
JournalThe Lancet
Volume378
Issue number9795
DOIs
StatePublished - Sep 1 2011
Externally publishedYes

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Pneumonectomy
Emphysema
Multicenter Studies
Stents
Randomized Controlled Trials
Safety
Respiratory Center
Respiratory Mechanics
Total Lung Capacity
Intention to Treat Analysis
Residual Volume
Bayes Theorem
Vital Capacity
Bronchoscopy
Paclitaxel
Dyspnea
Biomedical Research
Air
Research Personnel
Technology

ASJC Scopus subject areas

  • Medicine(all)

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Bronchoscopic lung-volume reduction with Exhale airway stents for emphysema (EASE trial) : Randomised, sham-controlled, multicentre trial. / EASE trial study group.

In: The Lancet, Vol. 378, No. 9795, 01.09.2011, p. 997-1005.

Research output: Contribution to journalArticle

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T1 - Bronchoscopic lung-volume reduction with Exhale airway stents for emphysema (EASE trial)

T2 - Randomised, sham-controlled, multicentre trial

AU - EASE trial study group

AU - Shah, P. L.

AU - Slebos, D. J.

AU - Cardoso, P. F.G.

AU - Cetti, E.

AU - Voelker, K.

AU - Levine, B.

AU - Russell, M. E.

AU - Goldin, J.

AU - Brown, M.

AU - Cooper, J. D.

AU - Sybrecht, G. W.

AU - Alexander, D.

AU - Cuerden, E.

AU - Dusmet, M.

AU - Hind, M.

AU - Hopkinson, N. S.

AU - Kemp, S.

AU - Kon, O. M.

AU - Polkey, M. I.

AU - Douma, R.

AU - Kerstjens, H.

AU - Vennik, P.

AU - Klooster, K.

AU - Smidt, A.

AU - Snijders, S.

AU - Rubin, A.

AU - Berto, P.

AU - Cavalcanti, M.

AU - Spilimbergo, F. B.

AU - Frosi, F.

AU - Schmitt, M.

AU - Soares, P. R.

AU - Ferreira, G.

AU - Horiuchi, T.

AU - Morgan, K.

AU - Bradley, M.

AU - Clapp, N.

AU - Gormley, K.

AU - Miller, A.

AU - Pope-Nix, K.

AU - Baratz, D.

AU - Comp, R.

AU - Gotfried, M.

AU - Ross, B.

AU - DeLaCruz, V.

AU - Fu, L.

AU - Harker, S.

AU - Franzen, K.

AU - Gröschel, A.

AU - Kraft, M.

PY - 2011/9/1

Y1 - 2011/9/1

N2 - Airway bypass is a bronchoscopic lung-volume reduction procedure for emphysema whereby transbronchial passages into the lung are created to release trapped air, supported with paclitaxel-coated stents to ease the mechanics of breathing. The aim of the EASE (Exhale airway stents for emphysema) trial was to evaluate safety and efficacy of airway bypass in people with severe homogeneous emphysema. We undertook a randomised, double-blind, sham-controlled study in 38 specialist respiratory centres worldwide. We recruited 315 patients who had severe hyperinflation (ratio of residual volume [RV] to total lung capacity of ≥0·65). By computer using a random number generator, we randomly allocated participants (in a 2:1 ratio) to either airway bypass (n=208) or sham control (107). We divided investigators into team A (masked), who completed pre-procedure and post-procedure assessments, and team B (unmasked), who only did bronchoscopies without further interaction with patients. Participants were followed up for 12 months. The 6-month co-primary efficacy endpoint required 12 or greater improvement in forced vital capacity (FVC) and 1 point or greater decrease in the modified Medical Research Council dyspnoea score from baseline. The composite primary safety endpoint incorporated five severe adverse events. We did Bayesian analysis to show the posterior probability that airway bypass was superior to sham control (success threshold, 0·965). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00391612. All recruited patients were included in the analysis. At 6 months, no difference between treatment arms was noted with respect to the co-primary efficacy endpoint (30 of 208 for airway bypass vs 12 of 107 for sham control; posterior probability 0·749, below the Bayesian success threshold of 0·965). The 6-month composite primary safety endpoint was 14·4 (30 of 208) for airway bypass versus 11·2 (12 of 107) for sham control (judged non-inferior, with a posterior probability of 1·00 [Bayesian success threshold >0·95]). Although our findings showed safety and transient improvements, no sustainable benefit was recorded with airway bypass in patients with severe homogeneous emphysema. Broncus Technologies.

AB - Airway bypass is a bronchoscopic lung-volume reduction procedure for emphysema whereby transbronchial passages into the lung are created to release trapped air, supported with paclitaxel-coated stents to ease the mechanics of breathing. The aim of the EASE (Exhale airway stents for emphysema) trial was to evaluate safety and efficacy of airway bypass in people with severe homogeneous emphysema. We undertook a randomised, double-blind, sham-controlled study in 38 specialist respiratory centres worldwide. We recruited 315 patients who had severe hyperinflation (ratio of residual volume [RV] to total lung capacity of ≥0·65). By computer using a random number generator, we randomly allocated participants (in a 2:1 ratio) to either airway bypass (n=208) or sham control (107). We divided investigators into team A (masked), who completed pre-procedure and post-procedure assessments, and team B (unmasked), who only did bronchoscopies without further interaction with patients. Participants were followed up for 12 months. The 6-month co-primary efficacy endpoint required 12 or greater improvement in forced vital capacity (FVC) and 1 point or greater decrease in the modified Medical Research Council dyspnoea score from baseline. The composite primary safety endpoint incorporated five severe adverse events. We did Bayesian analysis to show the posterior probability that airway bypass was superior to sham control (success threshold, 0·965). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00391612. All recruited patients were included in the analysis. At 6 months, no difference between treatment arms was noted with respect to the co-primary efficacy endpoint (30 of 208 for airway bypass vs 12 of 107 for sham control; posterior probability 0·749, below the Bayesian success threshold of 0·965). The 6-month composite primary safety endpoint was 14·4 (30 of 208) for airway bypass versus 11·2 (12 of 107) for sham control (judged non-inferior, with a posterior probability of 1·00 [Bayesian success threshold >0·95]). Although our findings showed safety and transient improvements, no sustainable benefit was recorded with airway bypass in patients with severe homogeneous emphysema. Broncus Technologies.

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