The International Nocturnal Oxygen (INOX) Trial
This trial is active, not recruiting.
|Conditions||chronic obstructive pulmonary disease, nocturnal desaturation|
|Treatments||concentrator, sham concentrator|
|Collaborator||Canadian Institutes of Health Research (CIHR)|
|Start date||October 2010|
|End date||January 2019|
|Trial size||243 participants|
|Trial identifier||NCT01044628, MCT-99512|
Background: Long-term oxygen therapy (LTOT) is the only component of the management of chronic obstructive pulmonary disease (COPD) that improves survival in patients with severe daytime hypoxemia (defined as an arterial oxygen pressure [paO2] measured in stable state <=55 mmHg or in the range 56-59 mmHg when clinical evidence of pulmonary hypertension or polycythemia are noted). In Canada, LTOT is usually provided by a stationary oxygen concentrator and is recommended to be used for at least 15-18 hours a day. Several studies have demonstrated a deterioration in arterial blood gas pressures and oxygen saturation during sleep in patients with COPD. Sleep-related oxygen desaturation often occurs in patients not qualifying for LTOT. The suggestion has been made that the natural progression of COPD to its end stages of chronic pulmonary hypertension, severe hypoxemia, right heart failure, and death is dependent upon the severity of desaturation occurring during sleep. This is an attractive hypothesis and is supported by the fact that hypoxemic episodes during sleep are accompanied by substantial increases in pulmonary arterial pressure and often by important cardiac arrhythmias. Supplemental nocturnal oxygen alleviates both the acute increases in pulmonary arterial pressure and the cardiac arrhythmias. It has been suggested that, over the long run, nocturnal oxygen therapy (N-O2) may halt the progression of long-standing cor pulmonale and prolong survival. Probably due to the fact that the recommendations of scientific societies regarding the indications for and use of N-O2 in COPD not qualifying for conventional LTOT are presently imprecise, a number of patients are currently treated with N-O2 although the beneficial effects of this therapy have not been confirmed.
Primary objective: To determine, in patients with COPD not qualifying for LTOT but who present significant nocturnal arterial oxygen desaturation, whether N-O2 provided for a period of 3 years decreases mortality or delay the prescription of LTOT.
Secondary objectives: To estimate, in the same population, the cost-utility ratio of nocturnal oxygen therapy over a 3-year period.
Hypotheses: In patients with COPD not qualifying for LTOT but who present significant nocturnal arterial oxygen desaturation, N-O2 provided for a period of 3 years is effective in decreasing mortality or delaying the requirement for LTOT; and is cost-effective and favorably compares to other medical interventions.
Study design: We propose a 3-year, multi-center, placebo-controlled, randomized trial of nocturnal oxygen therapy added to usual care in patients presenting sleep-related oxygen desaturation who do not qualify for LTOT.
Inclusion criteria: (1) patients with a diagnosis of COPD supported by an history of past smoking and obstructive disease with FEV1/FVC < 70%; (2) a saturation at rest < 95% ; (3) patients fulfilling our definition of nocturnal oxygen desaturation: >=30% of the recording time with transcutaneous arterial oxygen saturation <90% on at least one of two consecutive recordings.
Intervention: nocturnal oxygen therapy: N-O2 will be delivered overnight to allow the oxygen saturation to be >90%.
Placebo: The patients allocated in the control group will receive room air delivered by defective concentrator. The comparison will be double blind.
Primary outcomes: The primary outcomes of this trial are mortality from all cause or requirement for LTOT (composite outcome).
Secondary outcomes: Secondary outcomes will include quality of life and utility measures, costs from a societal perspective and compliance with oxygen therapy.
Trial duration: The follow-up period lasts at least 3 years. We expect this trial to be completed within 5 years.
Sample size calculation: The sample size should give 90% chance of showing a 30% relative reduction in event rates between the two study groups (i.e., an event rate in the intervention and placebo groups of 28% and 40% respectively). We calculated that 300 patients per group are needed to complete this study (630 to account for potential withdrawal).
|United States||No locations recruiting|
|Other countries||No locations recruiting|
|Edmonton, Canada||University of Alberta||no longer recruiting|
|Vancouver, Canada||Vancouver General Hospital||no longer recruiting|
|Winnipeg, Canada||St-Boniface General Hospital||no longer recruiting|
|Moncton, Canada||Hôpital Dr Georges-L. Dumont||no longer recruiting|
|Kingston, Canada||Kingston General Hospital||no longer recruiting|
|Ottawa, Canada||The Ottawa Hospital (General Campus)||no longer recruiting|
|Laval, Canada||Centre de la santé et des services sociaux de Laval (Cité de la Santé de Laval)||no longer recruiting|
|Lévis, Canada||Hôtel-Dieu de Lévis||no longer recruiting|
|Montreal, Canada||Montreal Chest Institute||no longer recruiting|
|Montreal, Canada||Centre Hospitalier Mount-Sinai||no longer recruiting|
|Québec, Canada||Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ)||no longer recruiting|
|Saint-Jérôme, Canada||Hôpital régional de Saint-Jérôme||no longer recruiting|
|Sherbrooke, Canada||CHUS, Fleurimont||no longer recruiting|
|Trois-Rivières, Canada||Centre de recherche Pneumomédic inc.||no longer recruiting|
|Marseille, France||Hôpital Nord de Marseille||no longer recruiting|
|Paris, France||Groupe Hospitalier Pitié - Salpêtrière||no longer recruiting|
|Poitiers, France||CHU de Poitiers||no longer recruiting|
|Portimao, Portugal||Centro Hospitalar do Barlavento Algarvio - EPE||no longer recruiting|
|Coimbra, Portugal||Centro Hospitalar de Coimbra||no longer recruiting|
|Covilha, Portugal||Centro Hospitalar da Cova da Beira||no longer recruiting|
|Lisboa, Portugal||Hospital Pulido Valente - Centro Hospitalar Lisboa Norte||no longer recruiting|
|Matosinhos, Portugal||Hospital Pedro Hispano Unidade Local de Saude de Matosinhos||no longer recruiting|
|Vila Nova de Gaia, Portugal||Centro Hospitalara Vila Nova de Gaia-Espinho EPE||no longer recruiting|
|Galdakao, Spain||Hospital Galdakao-Usansolo||no longer recruiting|
|Getafe, Spain||Hospital Universitario de Getafe||no longer recruiting|
|Madrid, Spain||Hospital Universitario 12 de Octubre||no longer recruiting|
|Santiago de Compostela, Spain||Complexo Hospitalario Universitario de Santiago||no longer recruiting|
|Vitoria-Gasteiz, Spain||Hospital Txagorritxu||no longer recruiting|
|Endpoint classification||efficacy study|
|Intervention model||parallel assignment|
|Masking||double blind (subject, caregiver, outcomes assessor)|
|Primary purpose||supportive care|
Composite outcome: all-cause mortality or requirement for continuous oxygen therapy
time frame: Every 2 months
Quality of life
time frame: Once a year
Health economics: Costs and health care utilization
time frame: Every 2 months
Male or female participants at least 40 years old.
- Patients with a diagnosis of COPD supported by a history of past smoking and obstructive disease: FEV1<70% predicted, FEV1/FVC<70% and a total lung capacity by body plethysmography >80% predicted;
- Stable COPD at study entry, as demonstrated by (1) no acute exacerbation and (2) no change in medications for at least 6 weeks before enrollment in the trial;
- Non-smoking patients for at least 6 months before enrollment in the trial;
- SpO2 at rest < 95%;
- Patients fulfilling the current definition of nocturnal oxygen desaturation, i.e., >=30% of the recording time with transcutaneous arterial oxygen saturation <90% on at least one of two consecutive recordings;
- Ability ot give informed consent.
- Patients with severe hypoxemia fulfilling the usual criteria for continuous oxygen therapy at study entry: PaO2 <=55 mmHg; or PaO2 <= 59 mmHg with clinical evidence of at least one of the following: (1) with right ventricular hypertrophy (P pulmonale on ECG:3 mm leads ll, lll, aVf); (2) right ventricular hypertrophy; (3)Peripheral edema (cor pulmonale); (4) hematocrit >=55%;
- Patients with proven sleep apnea (defined by an apnea/hypopnea index of >=15 events/hour) or suspected sleep apnea on oximetry tracings;
- Patients currently using nocturnal oxygen therapy;
- Patients with known left heart or congenital heart diseases, interstitial lung diseases, bronchiectasis as the main cause of obstructive disease, lung carcinoma, severe obesity (body mass index >= 40 kg/m²), or any other disease that could influence survival.
|Official title||Multi-Center Randomized Placebo-controlled Trial of Nocturnal Oxygen Therapy in Chronic Obstructive Pulmonary Disease. The International Nocturnal Oxygen (INOX) Trial|
|Principal investigator||Yves Lacasse, MD, MSc|
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