J M Bradley, R Anand, B O'Neill, K Ferguson, M Clarke, M Carroll, J Chalmers, A De Soyza, J Duckers, A T Hill, M R Loebinger, F Copeland, CLEAR study group... et al (see below)

Link to publication page: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3766-9

Journal Ref: Trials. 2019 Dec 19;20(1):747. Dec 19;20(1):747. doi: 10.1186/s13063-019-3766-9.

Abstract:

Full Authors: Judy Martina Bradley 1, Rohan Anand 2, Brenda O'Neill 3, Kathryn Ferguson 4, Mike Clarke 5, Mary Carroll 6, James Chalmers 7, Anthony De Soyza 8, Jamie Duckers 9, Adam T Hill 10, Michael R Loebinger 11, Fiona Copeland 12, Evie Gardner 13, Christina Campbell 13, Ashley Agus 13, Alistair McGuire 14, Roisin Boyle 13, Fionnuala McKinney 13, Naomi Dickson 13, Danny F McAuley 2, Stuart Elborn 2, CLEAR study group

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.

Trial registration: EudraCT number: 2017-000664-14 (first entered in the database on 20 October 2017). ISRCTN.com, ISRCTN89040295. Registered on 6 July/2018. Funder: National Institute for Health Research, Health Technology Assessment Programme (15/100/01).

Sponsor: Belfast Health and Social Care Trust. Ethics Reference Number: 17/NE/0339. Protocol version: v3.0 Final_14052018.