title: A randomized controlled trial to evaluate the lung clearance index as an outcome measure for early phase studies in patients with cystic fibrosis.
abstract: BACKGROUND
  Outcome measures that can evaluate treatment efficacy are important to enhance development of new therapeutic agents for Cystic Fibrosis (CF). We investigated whether the lung clearance index (LCI) measured by multiple breath washout (MBW) can detect a treatment effect of hypertonic saline (HS) inhalation after single dosing within a 24 h period.
  
  
  METHODS
  In this randomized controlled cross-over trial, CF patients received inhalation of HS and isotonic saline (IS). MBW and spirometry were performed at 5 time points over 24 h. LCI was measured using both a nitrogen washout technique (LCIN2) and sulfur hexafluoride as a tracer gas (LCISF6). The primary endpoint was the change in the LCIN2 between baseline and 24 h. Secondary endpoints included change in LCISF6 and spirometry outcomes.
  
  
  RESULTS
  Twenty-one patients were randomized. Sixteen completed all study visits and all time point measurements. Eighteen patients contributed to the intention to treat analysis. Significant changes were not detected for either LCI or the spirometry outcomes. However, the primary outcome parameter (change in LCI between the baseline visits and 24 h after inhalation) demonstrated a trend towards improved LCI, in the HS treatment arm compared with the IS treatment arm, -0.60 LCIN2 (SE 0.32), p = 0.08); similar trends were not observed for spirometric measures. The overall effect size of HS was smaller than in previous studies of longer duration.
  
  
  CONCLUSIONS
  These data suggest that LCI may potentially be used as an outcome measure in early phase trials with therapeutic agents that have a larger treatment effects than a single inhalation of HS.
authors: Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada; Child Health and Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada. Electronic address: reshma.amin@sickkids.ca.
authors: Reshma
authors: R
authors: Amin
authors: Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada; Physiology and Experimental Medicine, Research Institute, Hospital for Sick Children, Toronto, Canada.
authors: Sanja
authors: S
authors: Stanojevic
authors: Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada.
authors: Mica
authors: M
authors: Kane
authors: Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada.
authors: Hailey
authors: H
authors: Webster
authors: Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada; Physiology and Experimental Medicine, Research Institute, Hospital for Sick Children, Toronto, Canada.
authors: Felix
authors: F
authors: Ratjen
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D001944:Breath Tests; D002648:Child; D018592:Cross-Over Studies; D003550:Cystic Fibrosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D005740:Gases; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D008450:Maximal Midexpiratory Flow Rate; D008875:Middle Aged; D009584:Nitrogen; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012965:Sodium Chloride; D013147:Spirometry; D013459:Sulfur Hexafluoride; D016896:Treatment Outcome; D014797:Vital Capacity; D055815:Young Adult
chemical_list: D005740:Gases; D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride; D009584:Nitrogen; D013459:Sulfur Hexafluoride
keywords: Cystic fibrosis; Hypertonic saline; Lung clearance index