Extracorporeal photopheresis (ECP) in the treatment of chronic lung allograft dysfunction (CLAD): a prospective, multicentre, open-label, randomised controlled trial studying the addition of ECP to standard care in the treatment of bilateral lung transplant patients with CLAD (E-CLAD UK).
Author
Fisher, Andrew JWhite, Michael
Goudie, Nicola
Kershaw, Anneka
Phillipson, Julia
Bardgett, Michelle
Lally, Joanne
Bevin-Nicholls, Alex
Chadwick, Thomas
Bryant, Andrew
Russell, Sian
Smith, Hesther
Frisby, Laura
Errington, Rebecca
Carby, Martin
Thompson, Richard
Santhanakrishnan, Karthik
Parmar, Jasvir
Lordan, James L
Vale, Luke
Hancock, Helen
Exley, Catherine
Gennery, Andrew R
Wason, James Ms
Publication date
2024-05-09
Metadata
Show full item recordAbstract
Background: Long-term survival after lung transplantation is limited compared with other organ transplants. The main cause is development of progressive immune-mediated damage to the lung allograft. This damage, which can develop via multiple immune pathways, is captured under the umbrella term chronic lung allograft dysfunction (CLAD). Despite the availability of powerful immunosuppressive drugs, there are presently no treatments proven to reverse or reliably halt the loss of lung function caused by CLAD. The aim of the E-CLAD UK trial is to determine whether the addition of immunomodulatory therapy, in the form of extracorporeal photopheresis (ECP), to standard care is more efficacious at stabilising lung function in CLAD compared with standard care alone. Methods and analysis: E-CLAD UK is a Phase II clinical trial of an investigational medicinal product (Methoxsalen) delivered to a buffy coat prepared via an enclosed ECP circuit. Target recruitment is 90 bilateral lung transplant patients identified as having CLAD and being treated at one of the five UK adult lung transplant centres. Participants will be randomised 1:1 to intervention plus standard of care, or standard of care alone. Intervention will comprise nine ECP cycles spread over 20 weeks, each course involving two treatments of ECP on consecutive days. All participants will be followed up for a period of 24 weeks.The primary outcome is lung function stabilisation derived from change in forced expiratory volume in one second and forced vital capacity at 12 and 24 weeks compared with baseline at study entry. Other parameters include change in exercise capacity, health-related quality of life and safety. A mechanistic study will seek to identify molecular or cellular markers linked to treatment response and qualitative interviews will explore patient experiences of CLAD and the ECP treatment.A patient and public advisory group is integral to the trial from design to implementation, developing material to support the consent process and interview materials. Ethics and dissemination: The East Midlands-Derby Research Ethics Committee has provided ethical approval (REC 22/EM/0218). Dissemination will be via publications, patient-friendly summaries and presentation at scientific meetings. Trial registration number: EudraCT number 2022-002659-20; ISRCTN 10615985.Citation
Fisher AJ, White M, Goudie N, Kershaw A, Phillipson J, Bardgett M, Lally J, Bevin-Nicholls A, Chadwick T, Bryant A, Russell S, Smith H, Frisby L, Errington R, Carby M, Thompson R, Santhanakrishnan K, Parmar J, Lordan JL, Vale L, Hancock H, Exley C, Gennery AR, Wason JM. Extracorporeal photopheresis (ECP) in the treatment of chronic lung allograft dysfunction (CLAD): a prospective, multicentre, open-label, randomised controlled trial studying the addition of ECP to standard care in the treatment of bilateral lung transplant patients with CLAD (E-CLAD UK). BMJ Open Respir Res. 2024 May 9;11(1):e001995. doi: 10.1136/bmjresp-2023-001995.Type
ArticleOther
Additional Links
http://bmjopenrespres.bmj.com/PMID
38724453Journal
BMJ Open Respiratory ResearchPublisher
BMJ Publishing Groupae974a485f413a2113503eed53cd6c53
10.1136/bmjresp-2023-001995