Pirfenidone to Prevent Fibrosis in Ards.
Pirfenidone to Prevent Fibrosis in ARDS. A Randomized Controlled Trial - PIONEER
Università Vita-Salute San Raffaele
130 participants
Jun 1, 2022
INTERVENTIONAL
Conditions
Summary
Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury and a major cause of Intensive Care Unit (ICU) admission worldwide. Despite a large number of randomized clinical trials, a specific and effective pharmacological approach for patients with ARDS is still lacking. Fibroproliferation is a crucial part of the host defence response, and severe fibrotic lung disease affects ARDS patients even years after acute phase resolution. Pirfenidone is an oral anti-fibrotic drug, approved and largely used for treatment of idiopathic pulmonary fibrosis (IPF). The effect of Pirfenidone in ARDS has been evaluated only in animal models. This is a randomized controlled study to evaluate for the first time the efficacy of Pirfenidone in ARDS.
Eligibility
Inclusion Criteria12
- Concomitant presence of:
- ARDS (moderate and severe) - Berlin definition
- Within 1 week of a known clinical insult or new or worsening respiratory symptoms
- Bilateral opacities on CXR which are not fully explained by effusions, lobar/lung collapse or nodules
- Respiratory failure not fully explained by cardiac failure or fluid overload
- PaO2/FiO2<200 mmHg with PEEP<=5 cmH2O (invasive mechanical ventilation)
- Inflammatory ARDS phenotype (28), defined by at least one of the following:
- High plasma levels of inflammatory biomarkers
- Vasopressor dependence
- Lower serum bicarbonate or increased serum lactate
- Informed consent expressed by the patient or by legal representative or on the Ethical Committee indication.
- Age >=18 years
Exclusion Criteria13
- Intubated and mechanically ventilated via an endotracheal or tracheostomy tube (>7 days) up to the time of randomization
- ARDS severe or moderate for more than 36 hours
- Untreated pulmonary embolism, pleural effusion or pneumothorax as the primary cause of ARF
- ARF fully explained by left ventricular failure or fluid overload
- Consent declined
- Severe chronic respiratory disease requiring domiciliary ventilation
- Clinical suspicion for significant restrictive lung disease
- Pregnant women or women of childbearing potential who are sexually active
- Known allergy to pirfenidone
- Concomitant use of fluvoxamine
- Known severe hepatic failure
- Known severe renal failure or necessity of dialysis not related to acute disease
- Little chance of survival (SAPS II score>75)
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Interventions
From days 1-7: 801mg/day; from days 8-14:1602mg/day, from day 15 to ICU discharge 2403 mg/day. All drugs will be delivered by a nasogastric tube divided in 3 daily doses.
All drugs will be delivered by a nasogastric tube divided in 3 daily doses.
Locations(17)
View Full Details on ClinicalTrials.gov
For the most up-to-date information, visit the official listing.
NCT05075161