title: Bronchoscopic lung-volume reduction with Exhale airway stents for emphysema (EASE trial): randomised, sham-controlled, multicentre trial.
abstract: BACKGROUND
  Airway bypass is a bronchoscopic lung-volume reduction procedure for emphysema whereby transbronchial passages into the lung are created to release trapped air, supported with paclitaxel-coated stents to ease the mechanics of breathing. The aim of the EASE (Exhale airway stents for emphysema) trial was to evaluate safety and efficacy of airway bypass in people with severe homogeneous emphysema.
  
  
  METHODS
  We undertook a randomised, double-blind, sham-controlled study in 38 specialist respiratory centres worldwide. We recruited 315 patients who had severe hyperinflation (ratio of residual volume [RV] to total lung capacity of ≥0·65). By computer using a random number generator, we randomly allocated participants (in a 2:1 ratio) to either airway bypass (n=208) or sham control (107). We divided investigators into team A (masked), who completed pre-procedure and post-procedure assessments, and team B (unmasked), who only did bronchoscopies without further interaction with patients. Participants were followed up for 12 months. The 6-month co-primary efficacy endpoint required 12% or greater improvement in forced vital capacity (FVC) and 1 point or greater decrease in the modified Medical Research Council dyspnoea score from baseline. The composite primary safety endpoint incorporated five severe adverse events. We did Bayesian analysis to show the posterior probability that airway bypass was superior to sham control (success threshold, 0·965). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00391612.
  
  
  RESULTS
  All recruited patients were included in the analysis. At 6 months, no difference between treatment arms was noted with respect to the co-primary efficacy endpoint (30 of 208 for airway bypass vs 12 of 107 for sham control; posterior probability 0·749, below the Bayesian success threshold of 0·965). The 6-month composite primary safety endpoint was 14·4% (30 of 208) for airway bypass versus 11·2% (12 of 107) for sham control (judged non-inferior, with a posterior probability of 1·00 [Bayesian success threshold >0·95]).
  
  
  CONCLUSIONS
  Although our findings showed safety and transient improvements, no sustainable benefit was recorded with airway bypass in patients with severe homogeneous emphysema.
  
  
  BACKGROUND
  Broncus Technologies.
authors: National Institute for Health Research Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust, Imperial College, London, UK. pallav.shah@imperial.ac.uk
authors: P L
authors: PL
authors: Shah
authors: D-J
authors: DJ
authors: Slebos
authors: P F G
authors: PF
authors: Cardoso
authors: E
authors: E
authors: Cetti
authors: K
authors: K
authors: Voelker
authors: B
authors: B
authors: Levine
authors: M E
authors: ME
authors: Russell
authors: J
authors: J
authors: Goldin
authors: M
authors: M
authors: Brown
authors: J D
authors: JD
authors: Cooper
authors: G W
authors: GW
authors: Sybrecht
mesh_terms: D000368:Aged; D001999:Bronchoscopy; D004311:Double-Blind Method; D054855:Drug-Eluting Stents; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D012115:Residual Volume; D014109:Total Lung Capacity; D014797:Vital Capacity
chemical_list: D017239:Paclitaxel