Lung Volume Reduction Coil Treatment vs Usual Care in Patients With Severe Emphysema

• Published in: JAMA : the journal of the American Medical Association 2016, Vol.315 (2), p.175-84
• Main Authors: Deslée, Gaëtan, Mal, Hervé, Dutau, Hervé, Bourdin, Arnaud, Vergnon, Jean Michel, Pison, Christophe, Kessler, Romain, Jounieaux, Vincent, Thiberville, Luc, Leroy, Sylvie, Marceau, Armelle, Laroumagne, Sophie, Mallet, Jean Pierre, Dukic, Sylvain, Barbe, Coralie, Bulsei, Julie, Jolly, Damien, Durand-Zaleski, Isabelle, Marquette, Charles Hugo
• Format: Article
• Language: English
• Subjects: Human health and pathology; Life Sciences; Pulmonology and respiratory tract; Santé publique et épidémiologie
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2015.17821

Importance Therapeutic options for severe emphysema are limited. Lung volume reduction using nitinol coils is a bronchoscopic intervention inducing regional parenchymal volume reduction and restoring lung recoil.Objective To evaluate the efficacy, safety, cost, and cost-effectiveness of nitinol coils in treatment of severe emphysema.Design, Setting, and Participants Multicenter 1:1 randomized superiority trial comparing coils with usual care at 10 university hospitals in France. Enrollment of patients with emphysema occurred from March to October 2013, with 12-month follow-up (last follow-up, December 2014).Interventions Patients randomized to usual care (n = 50) received rehabilitation and bronchodilators with or without inhaled corticosteroids and oxygen; those randomized to bilateral coil treatment (n = 50) received usual care plus additional therapy in which approximately 10 coils per lobe were placed in 2 bilateral lobes in 2 procedures.Main Outcomes and Measures The primary outcome was improvement of at least 54 m in the 6-minute walk test at 6 months (1-sided hypothesis test). Secondary outcomes included changes at 6 and 12 months in the 6-minute walk test, lung function, quality of life as assessed by St George’s Respiratory Questionnaire (range, 0-100; 0 being the best and 100 being the worst quality of life; minimal clinically important difference, ≥4), morbidity, mortality, total cost, and cost-effectiveness.Results Among 100 patients, 71 men and 29 women (mean age, 62 years) were included. At 6 months, improvement of at least 54 m was observed in 18 patients (36%) in the coil group and 9 patients (18%) in the usual care group, for a between-group difference of 18% (1-sided 95% CI, 4% to ∞; P = .03). Mean between-group differences at 6 and 12 months in the coil and usual care groups were +0.09 L (95% CI, 0.05 L to ∞) (P = .001) and +0.08 L (95% CI, 0.03 L to ∞) (P = .002) for forced expiratory volume in the first second, +21 m (95% CI, −4 m to ∞) (P = .06) and +21 m (95% CI, −5 m to ∞) (P = .12) for 6-minute walk distance, and −13.4 points (95% CI, −8 points to ∞) and −10.6 points (95% CI, −5.8 points to ∞) for St George’s Respiratory Questionnaire (1-sided P