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Doxycycline for COPD in HIV-Infected Patients

Information source: Weill Medical College of Cornell University
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: HIV; Chronic Obstructive Pulmonary Disease (COPD); Emphysema

Intervention: Doxycycline (Drug)

Phase: N/A

Status: Recruiting

Sponsored by: Weill Medical College of Cornell University

Official(s) and/or principal investigator(s):
Robert Kaner, MD, Principal Investigator, Affiliation: Weill Cornell Medical College-New York Presbyterian Hospital
Marshall Glesby, MD, Study Chair, Affiliation: Weill Cornell Medical College-New York Presbyterian Hospital

Overall contact:
Charleen Hollmann, PhD, MPA, RN CCRP, Phone: 646-962-2672, Email: chollmann@med.cornell.edu

Summary

In the context of improved survival from HIV infection itself, chronic obstructive pulmonary disease (COPD); a form of lung disease that includes emphysema, which makes breathing difficult) is emerging as an important cause of morbidity and perhaps ultimately mortality in this population. HIV-infected patients are at increased risk of chronic obstructive pulmonary disease, likely due to multiple factors, including an increased presence of smoking, chronic inflammation and progression of immunodeficiency, oxidant stress (excessive levels of natural chemicals called oxidants and free radicals that can damage tissue), and respiratory infections. While natural history data on COPD are limited in the era of potent antiretroviral therapy, earlier data suggest that the course of emphysema may be accelerated in this population. Our preliminary data suggest that several matrix metalloproteinases (MMPs) derived from alveolar macrophages (a type of immune cell found in the lungs) have an increased cellular response in HIV-infected smokers, which could contribute to accelerated emphysema. Matrix metalloproteinases are enzymes that break down the structural support of tissues, including the airways in the lung. Based on these observations, the investigators hypothesize that pharmacologic inhibition of matrix metalloproteinases by doxycycline will favorably modify the natural history of chronic obstructive pulmonary disease in HIV-infected patients. To test this hypothesis, the investigators propose conducting a proof of concept pilot study as a prelude to a possible phase II randomized, placebo-controlled trial (testing safety and efficacy in a larger population controlled with a "sugar pill") of doxycycline for COPD in HIV-infected patients should the proof of concept be successful. Our research team is lead by a pulmonologist/researcher with expertise in HIV-associated COPD and an infectious diseases specialist/clinical trials expert.

Clinical Details

Official title: Doxycycline for COPD in HIV-Infected Patients

Study design: Allocation: Randomized, Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Double Blind (Subject, Caregiver, Investigator), Primary Purpose: Treatment

Primary outcome: Number of participants with adverse events as a measure of safety and tolerability

Secondary outcome: Measure of physiologic and biologic effects based on levels of MMP activity in epithelial lining fluid before and after study drug administration.

Detailed description: Chronic obstructive pulmonary disease (COPD) is emerging as an important cause of morbidity in HIV-infected patients, likely due to multiple factors, including an increased prevalence of smoking, chronic inflammation and immune activation, oxidant stress and respiratory infections. Our preliminary data suggest that several lung matrix metalloproteinases (MMPs) are upregulated in HIV-infected smokers, which could contribute to accelerated emphysema by virtue of their ability to degrade extracellular matrix and basement membrane components. Our Specific Aim is to determine the safety, tolerability, and biologic effects of twice daily doxycycline for 6 months in HIV-infected subjects with COPD. To address this aim, we will conduct a randomized, double-blind, placebo-controlled pilot study of doxycycline 100 mg twice daily in 30 HIV-infected subjects with COPD (2: 1 doxy: placebo). The primary endpoint will be safety/tolerability and secondary endpoints will include change in FEV1, reduction of MMP activity in epithelial lining fluid and cells obtained by bronchoscopy and doxycycline levels in blood, ELF and bronchoalveolar lavage (BAL) cell pellets. In addition to providing novel insights into the biologic effects of doxycycline in the lung, the pilot study will inform selection of endpoints for a phase II trial, which ultimately will address an unmet medical need for novel interventions for COPD/emphysema in HIV-infected patients.

Eligibility

Minimum age: 18 Years. Maximum age: 85 Years. Gender(s): Both.

Criteria:

Inclusion Criteria: 1. Documented HIV infection 2. Cluster of differentiation 4 (CD4) cell count >200 cells/mm3 3. HIV RNA < 400 copies/ml 4. Stable antiretroviral therapy for at least 12 weeks 5. Fulfills GOLD definition for COPD [post-bronchodilator with a forced expiratory volume at one second and forced vital capacity ration (FEV1/FVC) < 0. 7] and/or has radiographic evidence of emphysema 6. Current or history of smoking with minimum 3 pack-year history 7. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) less than 3 x upper limit of normal 8. For women of childbearing potential: willingness to use 2 forms of birth control Exclusion Criteria: 1. Pulmonary infection, COPD exacerbation, or acute opportunistic infection within 30 days of entry 2. Conditions associated with increased sedation of bronchoscopy risk, including but not limited to Gold class 3 or 4 COPD, requirement for home oxygen, hypercapneic respiratory failure, poorly control hypertension 3. Known allergy/intolerance to doxycycline, atropine, or any local anesthetic 4. Inability to provide informed consent 5. Pregnant or lactating women 6. Men must agree not to attempt to make a woman pregnant of participate in sperm donation during the study and for 6 weeks after discontinuing the drug 7. Receipt of any investigational drug within 28 days 8. End stage renal disease 9. Cirrhosis 10. International normalized ration (INR) > 1. 4 11. Platelets < 80,000 12. Any condition including active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements or increase the risk of bronchoscopy

Locations and Contacts

Charleen Hollmann, PhD, MPA, RN CCRP, Phone: 646-962-2672, Email: chollmann@med.cornell.edu

Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York 10021, United States; Recruiting
Marie Guevarra, MS, Phone: 646-962-4563, Email: mag3007@med.cornell.edu
Aileen Orpilla, BE, Phone: 646-962-4564, Email: aio2001@med.cornell.edu
Robert Kaner, MD, Principal Investigator
Marshall Glesby, MD, Sub-Investigator
Ronald Crystal, MD, Sub-Investigator
Domenick Falcone, MD, Sub-Investigator
Thomas Walsh, MD, Sub-Investigator
Emilay Florez, BA, Sub-Investigator
Sandra Hyde, BS, Sub-Investigator
Odelya Pagovich, MD, Sub-Investigator
Sarah O'Beirne, MD, Sub-Investigator
Kirsis Ham, MSN, Sub-Investigator
Lourdes Sanso, MD, Sub-Investigator
Additional Information

Starting date: January 2014
Last updated: April 19, 2015

Page last updated: August 23, 2015

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