A 2 × 2 factorial, randomised, open-label trial to determine the clinical and cost-effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care over 52 weeks in adults with bronchiectasis: a protocol for the CLEAR clinical trial

Judy Martina Bradley, Rohan Anand, Brenda O’neill, Kathryn Ferguson, Mike Clarke, Mary Carroll, James Chalmers, Anthony De Soyza, Jamie Duckers, Adam T. Hill, Michael R. Loebinger, Fiona Copeland, Evie Gardner, Christina Campbell, Ashley Agus, Alistair Mcguire, Roisin Boyle, Fionnuala Mckinney, Naomi Dickson, Danny F. McauleyStuart Elborn

Research output: Contribution to journalArticle

Abstract

Background
Current guidelines for the management of bronchiectasis (BE) highlight the lack of evidence to recommend mucoactive agents, such as hypertonic saline (HTS) and carbocisteine, to aid sputum removal as part of standard care. We hypothesise that mucoactive agents (HTS or carbocisteine, or a combination) are effective in reducing exacerbations over a 52-week period, compared to usual care.

Methods
This is a 52-week, 2 × 2 factorial, randomized, open-label trial to determine the clinical effectiveness and cost effectiveness of HTS 6% and carbocisteine for airway clearance versus usual care - the Clinical and cost-effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care (CLEAR) trial. Patients will be randomised to (1) standard care and twice-daily nebulised HTS (6%), (2) standard care and carbocisteine (750 mg three times per day until visit 3, reducing to 750 mg twice per day), (3) standard care and combination of twice-daily nebulised HTS and carbocisteine, or (4) standard care. The primary outcome is the mean number of exacerbations over 52 weeks. Key inclusion criteria are as follows: adults with a diagnosis of BE on computed tomography, BE as the primary respiratory diagnosis, and two or more pulmonary exacerbations in the last year requiring antibiotics and production of daily sputum.

Discussion
This trial’s pragmatic research design avoids the significant costs associated with double-blind trials whilst optimising rigour in other areas of trial delivery. The CLEAR trial will provide evidence as to whether HTS, carbocisteine or both are effective and cost effective for patients with BE.
Original languageEnglish
Number of pages10
JournalTrials
Volume20
Issue number747
Early online date19 Dec 2019
DOIs
Publication statusE-pub ahead of print - 19 Dec 2019

Keywords

  • Clinical trial protocol
  • Factorial design
  • Bronchiectasis
  • Hypertonic saline
  • Carbocisteine
  • Exacerbation
  • SWAT

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    Bradley, J. M., Anand, R., O’neill, B., Ferguson, K., Clarke, M., Carroll, M., Chalmers, J., De Soyza, A., Duckers, J., Hill, A. T., Loebinger, M. R., Copeland, F., Gardner, E., Campbell, C., Agus, A., Mcguire, A., Boyle, R., Mckinney, F., Dickson, N., ... Elborn, S. (2019). A 2 × 2 factorial, randomised, open-label trial to determine the clinical and cost-effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care over 52 weeks in adults with bronchiectasis: a protocol for the CLEAR clinical trial. Trials, 20(747 ). https://doi.org/10.1186/s13063-019-3766-9