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First in Human Study to Assess an Implant to Treat Severe Emphysema

Bronchoscopic RElease of Air Trapped in Hyperinflated Emphysematous Lung

Status
Completed
Phases
Unknown
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT05854550
Acronym
BREATHE-1
Enrollment
48
Registered
2023-05-11
Start date
2023-05-05
Completion date
2026-02-16
Last updated
2026-03-31

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Emphysema or COPD

Keywords

hyperinflation, air-trapping, emphysema, COPD

Brief summary

The goal of this clinical trial is to test the feasibility of an implant for severe emphysema in up to 30 participants. The main questions it aims to answer are: Is it safe? Does it work? Participants who meet eligibility criteria will have up to two procedures 30 days apart, in which up to 3 implants will be placed in each lung during the procedure(s). Participants will be asked to return for follow-up visits at 30 days, and 3, 6, and 12 months after the procedure(s).

Detailed description

This is a first-in-human, prospective, multi-center, single-arm study assessing the safety, feasibility and preliminary efficacy of the Apreo Implant for severe emphysema in up to 30 participants. Initially all participants will undergo an Apreo Procedure involving placement of up to three implants in a native bronchial tree of one lung followed by a second Apreo Procedure 30 days later to place up to three implants in the contralateral native lung bronchial tree if indicated. Once the fifth participant has undergone his or her first implantation procedure, implantations in currently enrolled or new participants will be paused to allow for a Safety Review Committee (SRC) to convene and review safety data once the 5th participant has completed the 7-day phone follow-up after their second Apreo Procedure (or first if only one procedure). This would be at a minimum acute procedural safety for up to 10 implantation procedures conducted in these first 5 participants, 30-day safety assessments for all 5 participants after their first lung implantations, bronchoscopic inspection 30 days after implantation of all implants in the first lung, and 7-day safety data after their first and second lung implantations. The SRC will provide comments and recommendations, including the restart of implantation for new participants, if deemed appropriate. After the first 10 participants have completed the 7-day phone follow-up after the second Apreo Procedure (or first if only one procedure), their safety data will be reviewed by the SRC. This would include at a minimum acute procedural safety for up to 20 implantation procedures conducted in these first 10 participants, 30-day safety assessments for all 10 participants after their first lung implantations, bronchoscopic inspection 30 days after implantation of all implants in the first lung, and 7-day safety data after their first and second lung implantations. Following the review of the first 10 participants' safety data, the SRC may allow any subsequently enrolled participants to undergo one Apreo Procedure (rather than two separate procedures if appropriate for a participant) to deploy Apreo Implants in both the left and right lung airways as indicated or to continue to have all participants undergo two separate Apreo Procedures if indicated. A total of up to 30 participants will be enrolled overall. All participants will be followed at 30 days, three, six and twelve months post the first Apreo Procedure.

Interventions

One or two procedures involving placement of up to three Apreo implants in the bronchial tree of each lung.

Sponsors

Apreo Health, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
35 Years to 80 Years
Healthy volunteers
No

Inclusion criteria

1. Age ≥ 35 and ≤ 80 years old 2. Computed tomography (CT) scan evidence of homogeneous or heterogeneous emphysema 3. At least one target lobe with \> 35% destruction (percent of voxels with \< -950 Hounsfield units on CT) 4. Post-bronchodilator ratio of FEV1/FVC \< 0.7 at screening 5. Post-bronchodilator FEV1 percent predicted ≥20% and ≤50% of predicted at screening 6. Post-bronchodilator RV \> 180% predicted 7. Post-bronchodilator RV/TLC ≥ 0.55 at screening 8. Marked dyspnea, scoring ≥ 2 on the modified Medical Research Council scale of 0-4 9. Cotinine testing at screening indicates nonsmoker and stopped smoking at least 8 weeks before entering the trial and agrees to refrain from smoking for duration of study participation 10. Participation in a pulmonary rehabilitation program and/or confirmed to have been engaged or attempted regular physical activity in the 12 months prior to the first Apreo Procedure and agrees to continue or restart regular physical activity for the duration of the study 11. Fully vaccinated for Covid-19 (up to date per Australian Government Guidelines) and has current pneumococcus and influenza vaccination (or documented clinical intolerance) 12. Cognitively and physically able to provide written informed consent and complete participant questionnaires

Exclusion criteria

1. Arterial blood PaCO2 \> 60 mmHg (8 kPa) or PaO2 ≤ 45 mmHg (6 kPa) 2. DLCO \<20% at screening 3. Steroid therapy of 10 mg prednisolone (prednisone) or more per day 4. Three or more acute exacerbations of COPD in the past year before enrollment 5. Two or more hospitalizations for acute exacerbations of COPD or respiratory infections in the past year before enrollment 6. Any acute exacerbation of COPD or respiratory infection less than 4 weeks before the first Apreo Procedure 7. Previous lung volume reduction surgery or lobectomy, segmentectomy or bullectomy, vapor, glue, or other pulmonary device implant 8. Known history of pulmonary arterial hypertension 9. Presence of a giant bulla (≥ 30% of hemithorax) 10. History of excessive dynamic airway collapse of the trachea or main bronchi 11. History of adult asthma or chronic bronchitis 12. Presence of suspicious pulmonary nodule/infiltrate that requires additional follow-up, diagnostics or treatment 13. Unequivocal and symptomatic bronchiectasis 14. Unequivocal lung cancer or other current cancer diagnosis except non-metastasized basal cell skin cancer 15. Uncontrolled hypertension (blood pressure that is inadequately treated or resistant to treatment) with a systolic \> 200 mmHg or diastolic \> 110 mmHg at screening or prior to first Apreo Procedure 16. Uncorrectable coagulopathy or other condition likely to increase risk of peri- or post- Apreo Procedure bleeding 17. On anticoagulant or antiplatelet therapy and unable or unwilling to hold for Apreo Procedure 18. Coronary artery disease with angina 19. History of myocardial infarction within 6 months 20. History of a stroke less than 1 year before the first Apreo Procedure 21. Clinical history of heart failure with documented LVEF ≤ 40% 22. Clinical history of diabetes with a HbA1c \> 9.0% 23. Estimated glomerular filtration rate (eGFR) \<30 mL/min/1.73m2 (CKD-EPI) OR participant with kidney failure (Stage 5 kidney disease) 24. Mechanical ventilator dependence except participants using nocturnal bi-level positive airway pressure (biPAP) or continuous positive airway pressure (CPAP) are allowed if it would not preclude safe implantation of the study device 25. Pregnant, lactating, or women of childbearing potential who plan to become pregnant within the study duration 26. Known hypersensitivity to nitinol 27. Significantly immunocompromised, such as organ transplant recipients, those with congenital immune deficiencies, AIDS, or severe rheumatoid arthritis 28. Any disease or condition likely to limit survival to less than one year 29. Concomitant illnesses or medications that may pose a significant increased risk for complications following an Apreo Procedure 30. Currently enrolled in another trial and actively receiving experimental treatment 31. Any condition in the opinion of the investigator that would interfere with safe and complete collection of study data including the safe conduction of bronchoscopy procedures

Design outcomes

Primary

MeasureTime frameDescription
Rate of Serious Adverse Events (SAE) at 6 Months6 MonthsRate of occurrence of serious adverse events related to the study device and/or study procedure through 6 months post-study procedure

Secondary

MeasureTime frameDescription
Device Evaluation: Device Deployment AssessmentDuring ProcedureEvaluation of the ability to deploy the Apreo Implant in target airways (There is no scale - questions are assessed individually)
Device Evaluation: Device Usability SurveyDuring ProcedureEvaluate operator device use challenges (There is no scale - questions are assessed individually)
Device Evaluation: Instructions for Use (IFU) SurveyDuring ProcedureEvaluate operator understanding of instructions for use (There is no scale - questions are assessed individually)
Efficacy Evaluation: Airway Patency at 30 Days30 DaysAssess implant obstruction bronchoscopically using semi-quantitative scale (0 =no narrowing of the airway to 5= \>75% to 100% narrowing)
Efficacy Evaluation: Airway Patency at 3 Months3 MonthsAssess implant obstruction bronchoscopically using semi-quantitative scale (0 =no narrowing of the airway to 5= \>75% to 100% narrowing)
Efficacy Evaluation: Airway Patency at 6 Months6 MonthsAssess implant obstruction bronchoscopically using semi-quantitative scale (0 =no narrowing of the airway to 5= \>75% to 100% narrowing)
Efficacy Evaluation: Airway Patency at 12 Months12 MonthsAssess implant obstruction bronchoscopically using semi-quantitative scale (0 =no narrowing of the airway to 5= \>75% to 100% narrowing)
Efficacy Evaluation: Mucus Assessment at 30 Days30 DaysAssess mucus within the Apreo Implant bronchoscopically using a semi-quantitative scale (0=No mucus to 5=copious mucus)
Efficacy Evaluation: Mucus Assessment at 3 Months3 MonthsAssess mucus within the Apreo Implant bronchoscopically using a semi-quantitative scale (0=No mucus to 5=copious mucus)
Efficacy Evaluation: Mucus Assessment at 6 Months6 MonthsAssess mucus within the Apreo Implant bronchoscopically using a semi-quantitative scale (0=No mucus to 5=copious mucus)
Efficacy Evaluation: Mucus Assessment at 12 Months12 MonthsAssess mucus within the Apreo Implant bronchoscopically using a semi-quantitative scale (0=No mucus to 5=copious mucus)
Efficacy Evaluation: Computed Tomography (CT) Scan at 6 Months6 MonthsCT evaluation of Apreo Implant diameter
Efficacy Evaluation: CT Scan at 12 Months12 MonthsCT evaluation of Apreo Implant diameter
Efficacy Evaluation: Forced Expiratory Volume in 1 Second (FEV1) at 1-3 Days1-3 DaysChange in FEV1 between Baseline and 1-3 days post-procedure
Efficacy Evaluation: FEV1 at 30 Days30 DaysChange in FEV1 between Baseline and 30 days post-procedure
Efficacy Evaluation: FEV1 at 3 Months3 MonthsChange in FEV1 between Baseline and 3 months post-procedure
Efficacy Evaluation: FEV1 at 6 Months6 MonthsChange in FEV1 between Baseline and 6 months post-procedure
Efficacy Evaluation: FEV1 at 12 Months12 MonthsChange in FEV1 between Baseline and 12 months post-procedure
Efficacy Evaluation: Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) at 6 Months6 MonthsChange in DLCO between baseline and 6 months post-procedure
Efficacy Evaluation: Residual Volume (RV) at 6 Months6 MonthsChange in RV between baseline and 6 months as assessed by quantitative CT
Efficacy Evaluation: Residual Volume (RV) at 12 Months12 MonthsChange in RV between baseline and 12 months as assessed by quantitative CT
Efficacy Evaluation: Arterial Blood Gas (ABG): PaO2 at 6 Months6 MonthsChange in PaO2 between baseline and 6 months
Efficacy Evaluation: Arterial Blood Gas (ABG): PaCO2 at 6 Months6 MonthsChange in PaCO2 between baseline and 6 months
Safety: Procedural ComplicationsThrough 24 hours post-procedurePercentage of participants with acute procedural complications within 24 hours of study procedure
Safety: Rate of SAEsThrough 12 MonthsRate of occurrence of serious adverse events related to the device and/or Apreo procedure through 12 months
Safety: Rate of Adverse Device EffectsThrough 12 MonthsRate of adverse device effects through 12 months post-procedure
Efficacy Evaluation: Forced Expiratory Volume at 1 Second/ Forced Vital Capacity (FEV1/FVC) at 1-3 Days1-3 DaysChange in FEV1/FVC between Baseline and 1-3 days post-procedure
Efficacy Evaluation: FEV1/FVC at 30 Days30 DaysChange in FEV1/FVC between Baseline and 30 days post-procedure
Efficacy Evaluation: FEV1/FVC at 3 Months3 MonthsChange in FEV1/FVC between Baseline and 3 Months post-procedure
Efficacy Evaluation: FEV1/FVC at 6 Months6 MonthsChange in FEV1/FVC between Baseline and 6 Months post-procedure
Efficacy Evaluation: FEV1/FVC at 12 Months12 MonthsChange in FEV1/FVC between Baseline and 12 Months post-procedure
Efficacy Evaluation: RV Assessed by Pulmonary Function Testing at 1-3 Days1-3 DaysChange in RV between Baseline and 1-3 Days
Efficacy Evaluation: RV Assessed by Pulmonary Function Testing at 30 Days30 DaysChange in RV between Baseline and 30 Days
Efficacy Evaluation: RV Assessed by Pulmonary Function Testing at 3 Months3 MonthsChange in RV between Baseline and 3 Months
Efficacy Evaluation: RV Assessed by Pulmonary Function Testing at 6 Months6 MonthsChange in RV between Baseline and 6 Months
Efficacy Evaluation: RV Assessed by Pulmonary Function Testing at 12 Months12 MonthsChange in RV between Baseline and 12 Months
Efficacy Evaluation: Residual Volume/Total Lung Capacity (RV/TLC) at 1-3 Days1-3 DaysChange in RV/TLC between Baseline and 1-3 Days
Efficacy Evaluation: RV/TLC at 30 Days30 DaysChange in RV/TLC between Baseline and 30 Days
Efficacy Evaluation: RV/TLC at 3 Months3 MonthsChange in RV/TLC between Baseline and 3 Months
Efficacy Evaluation: RV/TLC at 6 Months6 MonthsChange in RV/TLC between Baseline and 6 Months
Efficacy Evaluation: RV/TLC at 12 Months12 MonthsChange in RV/TLC between Baseline and 12 Months
Efficacy Evaluation: Forced Vital Capacity (FVC) at 1-3 Days1-3 DaysChange in FVC between Baseline and 1-3 Days
Efficacy Evaluation: FVC at 30 Days30 DaysChange in FVC between Baseline and 30 Days
Efficacy Evaluation: FVC at 3 Months3 MonthsChange in FVC between Baseline and 3 Months
Efficacy Evaluation: FVC at 6 Months6 MonthsChange in FVC between Baseline and 6 Months
Efficacy Evaluation: FVC at 12 Months12 MonthsChange in FVC between Baseline and 12 Months
Efficacy Evaluation: Six Minute Walk Test (6MWT) at 1-3 Days1-3 DaysChange in 6MWT between Baseline and 1-3 Days
Efficacy Evaluation: Six Minute Walk Test (6MWT) at 30 Days30 DaysChange in 6MWT between Baseline and 30 Days
Efficacy Evaluation: Six Minute Walk Test (6MWT) at 3 Months3 MonthsChange in 6MWT between Baseline and 3 Months
Efficacy Evaluation: Six Minute Walk Test (6MWT) at 6 Months6 MonthsChange in 6MWT between Baseline and 6 Months
Efficacy Evaluation: Six Minute Walk Test (6MWT) at 12 Months12 MonthsChange in 6MWT between Baseline and 12 Months
Efficacy Evaluation: Modified Borg Dyspnoea Scale at 1-3 Days1-3 DaysChange in Modified BORG Dyspnea Scale between Baseline and 1-3 Days (scale is 0= no difficulty breathing to 10=maximal difficulty)
Efficacy Evaluation: Modified Borg Dyspnoea Scale at 30 Days30 DaysChange in Modified BORG Dyspnea Scale between Baseline and 30 Days (scale is 0= no difficulty breathing to 10=maximal difficulty)
Efficacy Evaluation: Modified Borg Dyspnoea Scale at 3 Months3 MonthsChange in Modified BORG Dyspnea Scale between Baseline and 3 Months (scale is 0= no difficulty breathing to 10=maximal difficulty)
Efficacy Evaluation: Modified Borg Dyspnoea Scale at 6 Months6 MonthsChange in Modified BORG Dyspnea Scale between Baseline and 6 Months (scale is 0= no difficulty breathing to 10=maximal difficulty)
Efficacy Evaluation: Modified Borg Dyspnoea Scale at 12 Months12 MonthsChange in Modified BORG Dyspnea Scale between Baseline and 12 Months (scale is 0= no difficulty breathing to 10=maximal difficulty)
Efficacy Evaluation: COPD Assessment Test (CAT) at 1-3 Days (CAT scores range from 0 to 40, with higher score denoting higher impact of COPD on a participant's life)1-3 DaysChange in CAT between Baseline and 1-3 Days
Efficacy Evaluation: COPD Assessment Test (CAT) at 30 Days (CAT scores range from 0 to 40, with higher score denoting higher impact of COPD on a participant's life)30 DaysChange in CAT between Baseline and 30 Days
Efficacy Evaluation: Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) at 3 Months (CAT scores range from 0 to 40, with higher score denoting higher impact of COPD on a participant's life)3 MonthsChange in CAT between Baseline and 3 Months
Efficacy Evaluation: COPD Assessment Test (CAT) at 6 Months (CAT scores range from 0 to 40, with higher score denoting higher impact of COPD on a participant's life)6 MonthsChange in CAT between Baseline and 6 Months
Efficacy Evaluation: COPD Assessment Test (CAT) at 12 Months (CAT scores range from 0 to 40, with higher score denoting higher impact of COPD on a participant's life)12 MonthsChange in CAT between Baseline and 12 Months
Efficacy Evaluation: St. George's Respiratory Questionnaire for COPD Patients (SGRQ-C) at 1-3 Days (scores range from 0 to 100, with higher scores indicating more limitations to daily living)1-3 DaysChange in SGRQ-C between Baseline and 1-3 Days
Efficacy Evaluation: St. George's Respiratory Questionnaire for COPD Patients (SGRQ-C) at 30 Days (scores range from 0 to 100, with higher scores indicating more limitations to daily living)30 DaysChange in SGRQ-C between Baseline and 30 Days
Efficacy Evaluation: St. George's Respiratory Questionnaire for COPD Patients (SGRQ-C) at 3 Months (scores range from 0 to 100, with higher scores indicating more limitations to daily living)3 MonthsChange in SGRQ-C between Baseline and 3 Months
Efficacy Evaluation: St. George's Respiratory Questionnaire for COPD Patients (SGRQ-C) at 6 Months (scores range from 0 to 100, with higher scores indicating more limitations to daily living)6 MonthsChange in SGRQ-C between Baseline and 6 Months
Efficacy Evaluation: St. George's Respiratory Questionnaire for COPD Patients (SGRQ-C) at 12 Months (scores range from 0 to 100, with higher scores indicating more limitations to daily living)12 MonthsChange in SGRQ-C between Baseline and 12 Months
Efficacy Evaluation: Modified Medical Research Council (mMRC) Dyspnea Scale (0=no breathlessness except with strenuous exercise to 4=too breathless to leave the house or breathless when dressing or undressing) at 1-3 Days1-3 DaysChange in mMRC between Baseline and 1-3 Days
Efficacy Evaluation: Modified Medical Research Council (mMRC) Dyspnea Scale (0=no breathlessness except with strenuous exercise to 4=too breathless to leave the house or breathless when dressing or undressing) at 30 Days30 DaysChange in mMRC between Baseline and 30 Days
Efficacy Evaluation: Modified Medical Research Council (mMRC) Dyspnea Scale (0=no breathlessness except with strenuous exercise to 4=too breathless to leave the house or breathless when dressing or undressing) at 3 Months3 MonthsChange in mMRC between Baseline and 3 Months
Efficacy Evaluation: Modified Medical Research Council (mMRC) Dyspnea Scale (0=no breathlessness except with strenuous exercise to 4=too breathless to leave the house or breathless when dressing or undressing) at 6 Months6 MonthsChange in mMRC between Baseline and 6 Months
Efficacy Evaluation: Modified Medical Research Council (mMRC) Dyspnea Scale (0=no breathlessness except with strenuous exercise to 4=too breathless to leave the house or breathless when dressing or undressing) at 12 Months12 MonthsChange in mMRC between Baseline and 12 Months

Countries

Australia

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Apr 1, 2026