Skip to main content
Top
Published in: Trials 1/2024

Open Access 01-12-2024 | Tiotropium | Study protocol

A placebo-controlled, crossover trial to investigate the efficacy of tiotropium bromide or placebo added to usual care in stable symptomatic post-hematopoietic stem cell transplantation (HSCT) bronchiolitis obliterans syndrome (BOS)

Authors: Naeemeh Dini, Amin Pastaki Khoshbin, Rasoul Aliannejad, Hooman Bakhshandeh, Katayoun Najafizadeh, Mahshid Mehdizadeh, Shahideh Amini

Published in: Trials | Issue 1/2024

Login to get access

Abstract

Background

Despite the fundamental progress in hematopoietic stem cell transplant, this treatment is also associated with complications. Graft-versus-host disease is a possible complication of HSCT. Bronchiolitis obliterans syndrome (BOS) is the pulmonary form of this syndrome. Due to the high morbidity and mortality rate of BOS, various studies have been conducted in the field of drug therapy for this syndrome, although no standard treatment has yet been proposed. According to the hypotheses about the similarities between BOS and chronic obstructive pulmonary disease, the idea of using tiotropium bromide as a bronchodilator has been proposed.

Method/design

A randomized, double-blind, placebo-controlled, and crossover clinical trial is being conducted to evaluate the efficacy of tiotropium in patients with BOS. A total of 20 patients with BOS were randomly assigned (1:1) to receive a once-daily inhaled capsule of either tiotropium bromide (KP-Tiova Rotacaps 18 mcg, Cipla, India) or placebo for 1 month. Patients will receive tiotropium bromide or placebo Revolizer added to usual standard care. Measurements will include spirometry and a 6-min walking test.

Ethics/dissemination

This study was approved by the Research Ethics Committees of Imam Khomeini Hospital Complex, Tehran University of Medical Science. Recruitment started in September 2022, with 20 patients randomized. The treatment follow-up of participants with tiotropium is currently ongoing and is due to finish in April 2024. The authors will disseminate the findings in peer-reviewed publications, conferences, and seminar presentations.

Trial registration

Iranian Registry of Clinical Trial (IRCT) IRCT20200415047080N3. Registered on 2022–07-12, 1401/04/21.
Appendix
Available only for authorised users
Literature
1.
go back to reference Ditschkowski M, Elmaagacli A, Koldehoff M, Gromke T, Trenschel R, Beelen D. Bronchiolitis obliterans after allogeneic hematopoietic SCT: further insight—new perspectives? Bone Marrow Transplant. 2013;48(9):1224.CrossRefPubMed Ditschkowski M, Elmaagacli A, Koldehoff M, Gromke T, Trenschel R, Beelen D. Bronchiolitis obliterans after allogeneic hematopoietic SCT: further insight—new perspectives? Bone Marrow Transplant. 2013;48(9):1224.CrossRefPubMed
2.
go back to reference Grønningsæter IS, Tsykunova G, Lilleeng K, Ahmed AB, Bruserud Ø, Reikvam H. Bronchiolitis obliterans syndrome in adults after allogeneic stem cell transplantation-pathophysiology, diagnostics and treatment. Expert Rev Clin Immunol. 2017;13(6):553–69.CrossRefPubMed Grønningsæter IS, Tsykunova G, Lilleeng K, Ahmed AB, Bruserud Ø, Reikvam H. Bronchiolitis obliterans syndrome in adults after allogeneic stem cell transplantation-pathophysiology, diagnostics and treatment. Expert Rev Clin Immunol. 2017;13(6):553–69.CrossRefPubMed
3.
go back to reference Kaner RJ, Zappetti D, Negrin RS. Pulmonary complications after allogeneic hematopoietic cell transplantation. UpToDate [online serial] Waltham, MA: UpToDate; 2022. Kaner RJ, Zappetti D, Negrin RS. Pulmonary complications after allogeneic hematopoietic cell transplantation. UpToDate [online serial] Waltham, MA: UpToDate; 2022.
4.
go back to reference Martin PJ, Lee SJ, Przepiorka D, Horowitz MM, Koreth J, Vogelsang GB, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: VI. The 2014 Clinical Trial Design Working Group report. Biol Blood Marrow Transplant. 2015;21(8):1343–59.CrossRefPubMedPubMedCentral Martin PJ, Lee SJ, Przepiorka D, Horowitz MM, Koreth J, Vogelsang GB, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: VI. The 2014 Clinical Trial Design Working Group report. Biol Blood Marrow Transplant. 2015;21(8):1343–59.CrossRefPubMedPubMedCentral
5.
go back to reference Barker AF, Bergeron A, Rom WN, Hertz MI. Obliterative bronchiolitis. N Engl J Med. 2014;370(19):1820–8.CrossRefPubMed Barker AF, Bergeron A, Rom WN, Hertz MI. Obliterative bronchiolitis. N Engl J Med. 2014;370(19):1820–8.CrossRefPubMed
6.
go back to reference Soubani A, Uberti J. Bronchiolitis obliterans following haematopoietic stem cell transplantation. Eur Respir J. 2007;29(5):1007–19.CrossRefPubMed Soubani A, Uberti J. Bronchiolitis obliterans following haematopoietic stem cell transplantation. Eur Respir J. 2007;29(5):1007–19.CrossRefPubMed
7.
go back to reference Bergeron A, Godet C, Chevret S, Lorillon G, De Latour RP, De Revel T, et al. Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosis. Bone Marrow Transplant. 2013;48(6):819.CrossRefPubMed Bergeron A, Godet C, Chevret S, Lorillon G, De Latour RP, De Revel T, et al. Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosis. Bone Marrow Transplant. 2013;48(6):819.CrossRefPubMed
8.
go back to reference Santo Tomas LH, Loberiza FR Jr, Klein JP, Layde PM, Lipchik RJ, Rizzo JD, et al. Risk factors for bronchiolitis obliterans in allogeneic hematopoietic stem-cell transplantation for leukemia. Chest. 2005;128(1):153–61.CrossRefPubMed Santo Tomas LH, Loberiza FR Jr, Klein JP, Layde PM, Lipchik RJ, Rizzo JD, et al. Risk factors for bronchiolitis obliterans in allogeneic hematopoietic stem-cell transplantation for leukemia. Chest. 2005;128(1):153–61.CrossRefPubMed
9.
go back to reference Zeiser R, Blazar BR. Pathophysiology of chronic graft-versus-host disease and therapeutic targets. N Engl J Med. 2017;377(26):2565–79.CrossRefPubMed Zeiser R, Blazar BR. Pathophysiology of chronic graft-versus-host disease and therapeutic targets. N Engl J Med. 2017;377(26):2565–79.CrossRefPubMed
10.
go back to reference Martin PJ, Storer BE, Rowley SD, Flowers ME, Lee SJ, Carpenter PA, et al. Evaluation of mycophenolate mofetil for initial treatment of chronic graft-versus-host disease. Blood. 2009;113(21):5074–82.CrossRefPubMedPubMedCentral Martin PJ, Storer BE, Rowley SD, Flowers ME, Lee SJ, Carpenter PA, et al. Evaluation of mycophenolate mofetil for initial treatment of chronic graft-versus-host disease. Blood. 2009;113(21):5074–82.CrossRefPubMedPubMedCentral
11.
go back to reference Gilman AL, Schultz KR, Goldman FD, Sale GE, Krailo MD, Chen Z, et al. Randomized trial of hydroxychloroquine for newly diagnosed chronic graft-versus-host disease in children: a Children’s Oncology Group study. Biol Blood Marrow Transplant. 2012;18(1):84–91.CrossRefPubMed Gilman AL, Schultz KR, Goldman FD, Sale GE, Krailo MD, Chen Z, et al. Randomized trial of hydroxychloroquine for newly diagnosed chronic graft-versus-host disease in children: a Children’s Oncology Group study. Biol Blood Marrow Transplant. 2012;18(1):84–91.CrossRefPubMed
12.
go back to reference Flowers ME, Martin PJ. Evaluation of thalidomide for treatment or prevention of chronic graft-versus-host disease. Leuk Lymphoma. 2003;44(7):1141–6.CrossRefPubMed Flowers ME, Martin PJ. Evaluation of thalidomide for treatment or prevention of chronic graft-versus-host disease. Leuk Lymphoma. 2003;44(7):1141–6.CrossRefPubMed
13.
go back to reference Koc S, Leisenring W, Flowers ME, Anasetti C, Deeg HJ, Nash RA, et al. Therapy for chronic graft-versus-host disease: a randomized trial comparing cyclosporine plus prednisone versus prednisone alone. Blood. 2002;100(1):48–51.CrossRefPubMed Koc S, Leisenring W, Flowers ME, Anasetti C, Deeg HJ, Nash RA, et al. Therapy for chronic graft-versus-host disease: a randomized trial comparing cyclosporine plus prednisone versus prednisone alone. Blood. 2002;100(1):48–51.CrossRefPubMed
14.
go back to reference Bergeron A, Chevret S, Chagnon K, Godet C, Bergot E, de LatourPeffault R, et al. Budesonide/formoterol for bronchiolitis obliterans after hematopoietic stem cell transplantation. Am J Respir Crit Care Med. 2015;191(11):1242–9.CrossRefPubMed Bergeron A, Chevret S, Chagnon K, Godet C, Bergot E, de LatourPeffault R, et al. Budesonide/formoterol for bronchiolitis obliterans after hematopoietic stem cell transplantation. Am J Respir Crit Care Med. 2015;191(11):1242–9.CrossRefPubMed
15.
go back to reference Khalid M, Al Saghir A, Saleemi S, Al Dammas S, Zeitouni M, Al Mobeireek A, et al. Azithromycin in bronchiolitis obliterans complicating bone marrow transplantation: a preliminary study. Eur Respir J. 2005;25(3):490–3.CrossRefPubMed Khalid M, Al Saghir A, Saleemi S, Al Dammas S, Zeitouni M, Al Mobeireek A, et al. Azithromycin in bronchiolitis obliterans complicating bone marrow transplantation: a preliminary study. Eur Respir J. 2005;25(3):490–3.CrossRefPubMed
16.
go back to reference Vos R, Vanaudenaerde BM, Ottevaere A, Verleden SE, De Vleeschauwer SI, Willems-Widyastuti A, et al. Long-term azithromycin therapy for bronchiolitis obliterans syndrome: divide and conquer? J Heart Lung Transplant. 2010;29(12):1358–68.CrossRefPubMed Vos R, Vanaudenaerde BM, Ottevaere A, Verleden SE, De Vleeschauwer SI, Willems-Widyastuti A, et al. Long-term azithromycin therapy for bronchiolitis obliterans syndrome: divide and conquer? J Heart Lung Transplant. 2010;29(12):1358–68.CrossRefPubMed
17.
go back to reference Williams KM, Cheng GS, Pusic I, Jagasia M, Burns L, Ho VT, et al. Fluticasone, azithromycin, and montelukast treatment for new-onset bronchiolitis obliterans syndrome after hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2016;22(4):710–6.CrossRefPubMed Williams KM, Cheng GS, Pusic I, Jagasia M, Burns L, Ho VT, et al. Fluticasone, azithromycin, and montelukast treatment for new-onset bronchiolitis obliterans syndrome after hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2016;22(4):710–6.CrossRefPubMed
18.
go back to reference Zeiser R, Burchert A, Lengerke C, et al. Ruxolitinib in corticosteroid-refractory graft-versus-host disease after allogeneic stem cell transplantation: a multicenter survey. Leukemia. 2015;29(10):2062–8.CrossRefPubMedPubMedCentral Zeiser R, Burchert A, Lengerke C, et al. Ruxolitinib in corticosteroid-refractory graft-versus-host disease after allogeneic stem cell transplantation: a multicenter survey. Leukemia. 2015;29(10):2062–8.CrossRefPubMedPubMedCentral
19.
go back to reference Olivieri A, Locatelli F, Zecca M, et al. Imatinib for refractory chronic graft-versus-host disease with fibrotic features. Blood. 2009;114(3):709–18.CrossRefPubMed Olivieri A, Locatelli F, Zecca M, et al. Imatinib for refractory chronic graft-versus-host disease with fibrotic features. Blood. 2009;114(3):709–18.CrossRefPubMed
20.
go back to reference Kawassaki AM, Kawano-Dourado L, Kairalla RA. Tiotropium use and pulmonary function in patients with constrictive bronchiolitis. J Bras Pneumol. 2014;40(1):86–8.CrossRefPubMedPubMedCentral Kawassaki AM, Kawano-Dourado L, Kairalla RA. Tiotropium use and pulmonary function in patients with constrictive bronchiolitis. J Bras Pneumol. 2014;40(1):86–8.CrossRefPubMedPubMedCentral
21.
go back to reference Verleden SE, Sacreas A, Vos R, Vanaudenaerde BM, Verleden GM. Advances in understanding bronchiolitis obliterans after lung transplantation. Chest. 2016;150(1):219–25.CrossRefPubMed Verleden SE, Sacreas A, Vos R, Vanaudenaerde BM, Verleden GM. Advances in understanding bronchiolitis obliterans after lung transplantation. Chest. 2016;150(1):219–25.CrossRefPubMed
22.
go back to reference Toumpanakis D, Loverdos K, Tzouda V, Vassilakopoulou V, Litsiou E, Magkou C, Vassilakopoulos T. Tiotropium bromide exerts anti-inflammatory effects during resistive breathing, an experimental model of severe airway obstruction. Int J Chron Obstruct Pulmon Dis. 2017;12:2207.CrossRefPubMedPubMedCentral Toumpanakis D, Loverdos K, Tzouda V, Vassilakopoulou V, Litsiou E, Magkou C, Vassilakopoulos T. Tiotropium bromide exerts anti-inflammatory effects during resistive breathing, an experimental model of severe airway obstruction. Int J Chron Obstruct Pulmon Dis. 2017;12:2207.CrossRefPubMedPubMedCentral
23.
go back to reference Lim JU, Park S, Yoon JH, Lee SE, Cho BS, Kim YJ, Lee S, Kim HJ, Rhee CK. Efficacy of inhaled tiotropium add-on to budesonide/formoterol in patients with bronchiolitis obliterans developing after hematopoietic stem cell transplantation. Respir Med. 2023;218:107410. https://doi.org/10.1016/j.rmed.2023.107410. Lim JU, Park S, Yoon JH, Lee SE, Cho BS, Kim YJ, Lee S, Kim HJ, Rhee CK. Efficacy of inhaled tiotropium add-on to budesonide/formoterol in patients with bronchiolitis obliterans developing after hematopoietic stem cell transplantation. Respir Med. 2023;218:107410. https://​doi.​org/​10.​1016/​j.​rmed.​2023.​107410.
24.
go back to reference Teixeira MF, Rodrigues JC, Leone C, Adde FV. Acute bronchodilator responsiveness to tiotropium in postinfectious bronchiolitis obliterans in children. Chest. 2013;144(3):974–80.CrossRefPubMed Teixeira MF, Rodrigues JC, Leone C, Adde FV. Acute bronchodilator responsiveness to tiotropium in postinfectious bronchiolitis obliterans in children. Chest. 2013;144(3):974–80.CrossRefPubMed
25.
go back to reference Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin J, Dickersin K, Hróbjartsson A, Schulz KF, Parulekar WR, Krleža-Jerić K, Laupacis A, Moher D. SPIRIT 2013 Explanation and Elaboration: Guidance for protocols of clinical trials. BMJ. 2013;346: e7586.CrossRefPubMedPubMedCentral Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin J, Dickersin K, Hróbjartsson A, Schulz KF, Parulekar WR, Krleža-Jerić K, Laupacis A, Moher D. SPIRIT 2013 Explanation and Elaboration: Guidance for protocols of clinical trials. BMJ. 2013;346: e7586.CrossRefPubMedPubMedCentral
26.
go back to reference The design and analysis of clinical experiments. Fleiss JL. Chichester: Wiley; 1986. p. 263–89. The design and analysis of clinical experiments. Fleiss JL. Chichester: Wiley; 1986. p. 263–89.
Metadata
Title
A placebo-controlled, crossover trial to investigate the efficacy of tiotropium bromide or placebo added to usual care in stable symptomatic post-hematopoietic stem cell transplantation (HSCT) bronchiolitis obliterans syndrome (BOS)
Authors
Naeemeh Dini
Amin Pastaki Khoshbin
Rasoul Aliannejad
Hooman Bakhshandeh
Katayoun Najafizadeh
Mahshid Mehdizadeh
Shahideh Amini
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Trials / Issue 1/2024
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-024-08051-7

Other articles of this Issue 1/2024

Trials 1/2024 Go to the issue