Usage of Spirometry in Managing IgG Therapy in CVID With Airway Disease
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Hizentra.
- Who it may be relevant to
- Registry conditions: Common Variable Immunodeficiency. Basic parameters: from 21 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United States
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
A Prospective Study of the Utility of Spirometry to Identify and Manage Immunoglobulin Replacement Dosage in Primary Antibody Deficiency in Patients With Potentially Reversible Airway Disease
Overview
Although there is evidence in the literature that gammaglobulin replacement therapy can lead to a reduction in the prevalence of pulmonary infection and improved lung function, there is no published study to guide immunologists regarding the use of spirometry in titrating IG therapy to assist in the management of immunodeficiency patients with regards to gammaglobulin replacement therapy. The investigators propose to study the use of spirometry to identify patients that could potentially benefit from an increase in IGRT. The investigators will identify 22 common variable immune deficiency (CVID) study subjects on stable IGRT replacement therapy equivalent to 0.40 to 0.60 gm/kg per 4 weeks who have evidence of mild to moderate obstruction as assessed by an FEF25-75% between 50% and 80% of predicted. Patients who are on Hizentra will be preferentially recruited. Of these 22, 11 will be identified at random and treated for 6 months at their current dose (control population). The remaining 11 study subjects (treatment group) will have their level of IGRT increased by the equivalent of 0.05 gm/kg in dose per 4 weeks, adjusted for bioavailability as per manufacturer's instructions. On average, rounded up to the nearest gram, this will typically increase their dose of Hizentra by 2 gm per week.
Detailed description
The key finding of the published retrospective study was that common variable immune deficiency (CVID) patients with moderate, presumed reversible, obstruction on stable, therapeutic doses of IgG who exhibited a decline in lung function from one clinic visit to the next responded to an increased dose of IgG with an improvement in lung function as assessed by spirometry.
The investigators now wish perform a clinical trial to assess whether primary antibody deficiency patients receiving IGRT who fit in this range of obstruction, i.e. an FEF25-75% that is 50-80% of predicted, will demonstrate an increase in lung function, as assessed by spirometry, after increasing the dose of IGRT. The presumption is that obstruction at this level is most likely due to the effects of subclinical infections that can be reduced or avoided by increasing the amount of gammaglobulin received by the patients.
Interventions
- Drug Hizentra
subjects level of immunoglobulin replacement therapy will be adjusted for bioavailability as per manufacturer's instructions
Primary outcome measures
- FEV1 at baseline [Time frame: baseline]
- FEV1 at 3 months [Time frame: 3 months]
- FEV1 at 6 months. [Time frame: 6 months]
- FVC at baseline [Time frame: baseline]
- FVC at 3 months [Time frame: 3 months]
- FVC at 6 months. [Time frame: 6 months]
- FEF25-75% at baseline [Time frame: baseline]
- FEF25-75% at 3 months [Time frame: 3 months]
- FEF25-75% at 6 months [Time frame: 6 months]
- FEV1/FVC ratio at baseline [Time frame: baseline]
Secondary outcome measures (3)
- FACIT score at baseline and monthly on therapy [Time frame: 6 months]
- PADQOL-16 at baseline and monthly on therapy [Time frame: 6 months]
- St. George's Respiratory Questionnaire at baseline and monthly on therapy [Time frame: 6 months]
Eligibility criteria
Inclusion criteria
- Patients who meet criteria for common variable immune deficiency (CVID) who are on stable IGRT for at least 3 months and who have an FEF25-75% between 50% and 80% of predicted.
- Patients who are already on Hizentra will be preferred.
Exclusion criteria
- Age <21 or cannot perform spirometry.
- Smokers with 20 pack years or more, and active smokers will not be included among the study subjects, but will be considered separately as an ancillary study.
- Patients with specific antigen-specific antibody deficiencies or X-linked agammaglobulinemia on IGRT will not be included among the 20 study subjects, but will be considered separately in ancillary studies.
- Patients with heart failure, TB, bronchiolitis, or lymphangioleiomyomatosis.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: Yes
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Open label
- Primary purpose
- Treatment
Study locations
United States · 1 center
- Community Health 20 — Birmingham
Identifiers
NCT: NCT05193552 · I300005696 · 2024805