Aggravated Airway Inflammation: Research on Genomics and Optimal Medical Care (AirGOs-medical)
- Conditions
- Chronic Rhinosinusitis (Diagnosis)
- Interventions
- Drug: Placebo Oral TabletDrug: Acetyl Salicylic Acid
- Registration Number
- NCT03825757
- Lead Sponsor
- Sanna Salmi
- Brief Summary
The study is performed as a randomized double-blinded prospective controlled trial. A total of 72 adult Acetyl salicylic acid (ASA) -exacerbated respiratory disease (AERD) -patients with uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) will be recruited. Those negative to ASA-challenge test will not enter the Clinical Trial . All patients entering the Clinical Trial, have undergone earlier ethmoidal surgery (partial/total) and have not gained disease control. F-helicobacter antigen is tested and treatment is given if indicated. The patients are recruited at the Helsinki University Hospital (HUH). The study will be monitored by a professional monitor. Electronic CRF and paper/electronic patient questionnaires provided by HUS will be used (eCRF and patient questionnairea, Granitics).
- Detailed Description
Randomization and the treatment arms I-II: The patients are randomized to two treatment arms I) ASA- desensitization po tablet daily for 11 months (n=36) II) Placebo po tablet daily for 11 months (n=18).
ASA challenge and desensitization (Primaspan) /Placebo: is conducted according to modified international protocol. FEV1 should be at least 1.5 L and \> 60% of predicted before challenge or desensitization. On the first day every patient will receive 25 mg + 25 mg ASA at a hospital setting. On the second day every patient will receive 50 mg + 25 mg ASA at a hospital setting. On the third day every patient will receive 75 mg + 25 mg ASA at a hospital setting. On the fourth day every patient will receive 100 mg + 25 mg ASA at a hospital setting.
During the ASA challenge, patient who is ASA-challenge positive is then randomized and starts the trial so that he/she uses blinded ½ tablet of 250 mg ASA or ½ tablet of placebo daily at home for the next 1 month. After this period of 1 month, the dosing is increased at hospital setting, so that the patient receives blindly 250 mg ASA 1/2 tablet + 1/2 tablet or placebo 1/2 tablet + 1/2 tablet. Thereafter he/she will continue using blindly 250 mg ASA 1 tablet or placebo 1 tablet daily at home for the next 10 months. If the patient does not tolerate the up-dosing of ASA/placebo, he/she will continue using blindly ½ tablet of 250 mg ASA/placebo daily at home for the next 10 months. The total duration of the ASA/placebo treatment is 11 months. We additionally take nasal, blood and urine samples during the trial.
Follow-ups. The symptom questionnaire and interview of side-effects are performed during each visit. Lung function (eNO, nNO, PEF, spirometry) is monitored and the patient will visit doctor and/or nurse at 1, 5, 11, and 12 months post-starting with the treatment. Samples are taken during recruitment visit, before and after ASA-challenge and at 5, 11 and 12 months post-starting with the treatment. We also monitor side-effects, exacerbations, need of medication (po. cortisocteroids; antibiotics) and satisfaction to treatment.
Primary end point is change in nasal endoscopic nasal polyp score at -4 days vs. +11 months post-randomization. Secondary end point is change in Sinonasal Outcome Test -22 (SNOT-22) score at -4 days vs. +11 months post-randomization, and change in relative Forced expiratory volume in 1 second (FEV1 %) without bronchodilator at -1 month vs. +11 months post-randomization.
Safety (complications, adverse effects), costs and loss of productivity between study arms will be compared.
Trial medication will be discontinued, if surgery is needed before the end of follow-up.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 40
ALL these need to be positive:
- Endoscopic nasal polyp score ≥4
- SNOT-22 ≥30
- Sinus Computed tomography Lund-Mackay score ≥14. The new sinus CT scans are needed if the previous sinus CT scans have been performed over 36 months before recruitment visit or if there is a suspicion of complication of CRS (f.ex. mucocele, invasive fungal rhinosinusitis)
- ≥1 previous partial/total ethmoidectomy surgery.
In addition, patient should have a history of at least one of the following:
>1 oral corticosteroids during the past two years >3 antibiotic courses during the past two years. In patients with contraindication/adverse effects in using oral steroids additional criteria are not required.
- complication of CRS (f.e. mucocele, invasive fungal rhinosinusitis)
- bleeding diathesis
- pregnancy/ breastfeeding
- cystic fibrosis
- primary ciliary dyskinesia (PCD)
- sarcoidosis
- granulomatosis with polyangitis (GPA)
- eosinophilic granulomatosis with polyangitis (EGPA)
- immunosuppression (diagnosed Spesific antibody deficiency (SAD), CVI, HIV
- use of biologicals/immunosuppressive medication
- immunotherapy
- Daily use of systemic corticosteroids (Prednisolon 10mg or equivalent) -communication problems (f.e. neurological/psychiatric disease, language skills) -unlikely to comply
- other severe disease
- uncontrolled asthma
- ASA-challenge negative
- gastric ulcer
- anticoagulant treatment
- SSRI-depression medication
- beta-blocker
- severe chronic urticaria
- ASA anaphylaxis
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo tablet Placebo Oral Tablet Placebo Oral Tablet: 1/2 tablet once daily during 1 month. 1 tablet once daily during 10 months. If not tolerated the dose 1 tablet x1/day, the patient is allowed to continue with the dose of 1/2 tablet x1/day. Primaspan tablet 250 mg Acetyl Salicylic Acid Primaspan tablet 250 mg (Acetyl salicylic acid): 1/2 tablet once daily during 1 month. 1 tablet once daily during 10 months. If not tolerated the dose 1 tablet x1/day, the patient is allowed to continue with the dose of 1/2 tablet x1/day.
- Primary Outcome Measures
Name Time Method Change in endoscopic Nasal polyp score of both sides of the nasal cavity. at -4 days vs. at 11 months post-randomization Change means differences between at time -4 days versus (vs.) at time +11 months post-randomization. Minimum value is 0. Maximum value is 8. A higher score means worse outcome.
- Secondary Outcome Measures
Name Time Method Change in Sinonasal outcome test 22 (SNOT22). Validated nose-specific quality of life questionnaire, 0-110 points. at -4 days vs. at 11 months post-randomization Change means differences between at time -4 days vs. +11 months post-randomization. A higher score means worse outcome.
Change in the Relative forced expiratory volume in 1 second (FEV1%) without bronchodilator. at -1 month vs. at 11 months post-randomization Change means differences between at time -1 month vs. +11 months post-randomization. A higher value means better outcome. FEV1% is measured by Spirometry.
Trial Locations
- Locations (1)
Helsinki University Hospital
🇫🇮Helsinki, Finland