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Use of low-dose oral theophylline as an adjunct to inhaled corticosteroids in preventing exacerbations of chronic obstructive pulmonary disease: Study protocol for a randomised controlled trial

Devereux, Graham; Cotton, Seonaidh; Barnes, Peter; Briggs, Andrew; Burns, Graham; Chaudhuri, Rekha; Chrystyn, Henry; Davies, Lisa; De Soyza, Anthony; Fielding, Shona; Gompertz, Simon; Haughney, John; Lee, Amanda J.; McCormack, Kirsty; McPherson, Gladys; Morice, Alyn; Norrie, John; Sullivan, Anita; Wilson, Andrew; Price, David

Authors

Graham Devereux

Seonaidh Cotton

Peter Barnes

Andrew Briggs

Graham Burns

Rekha Chaudhuri

Henry Chrystyn

Lisa Davies

Anthony De Soyza

Shona Fielding

Simon Gompertz

John Haughney

Amanda J. Lee

Kirsty McCormack

Gladys McPherson

John Norrie

Anita Sullivan

Andrew Wilson

David Price



Abstract

© Devereux et al. Background: Chronic obstructive pulmonary disease (COPD) is associated with high morbidity, mortality, and health-care costs. An incomplete response to the anti-inflammatory effects of inhaled corticosteroids is present in COPD. Preclinical work indicates that 'low dose' theophylline improves steroid responsiveness. The Theophylline With Inhaled Corticosteroids (TWICS) trial investigates whether the addition of 'low dose' theophylline to inhaled corticosteroids has clinical and cost-effective benefits in COPD. Method/Design: TWICS is a randomised double-blind placebo-controlled trial conducted in primary and secondary care sites in the UK. The inclusion criteria are the following: an established predominant respiratory diagnosis of COPD (post-bronchodilator forced expiratory volume in first second/forced vital capacity [FEV1/FVC] of less than 0.7), age of at least 40 years, smoking history of at least 10 pack-years, current inhaled corticosteroid use, and history of at least two exacerbations requiring treatment with antibiotics or oral corticosteroids in the previous year. A computerised randomisation system will stratify 1424 participants by region and recruitment setting (primary and secondary) and then randomly assign with equal probability to intervention or control arms. Participants will receive either 'low dose' theophylline (Uniphyllin MR 200 mg tablets) or placebo for 52 weeks. Dosing is based on pharmacokinetic modelling to achieve a steady-state serum theophylline of 1-5 mg/l. A dose of theophylline MR 200 mg once daily (or placebo once daily) will be taken by participants who do not smoke or participants who smoke but have an ideal body weight (IBW) of not more than 60 kg. A dose of theophylline MR 200 mg twice daily (or placebo twice daily) will be taken by participants who smoke and have an IBW of more than 60 kg. Participants will be reviewed at recruitment and after 6 and 12 months. The primary outcome is the total number of participant-reported COPD exacerbations requiring oral corticosteroids or antibiotics during the 52-week treatment period. Discussion: The demonstration that 'low dose' theophylline increases the efficacy of inhaled corticosteroids in COPD by reducing the incidence of exacerbations is relevant not only to patients and clinicians but also to health-care providers, both in the UK and globally.

Citation

Devereux, G., Cotton, S., Barnes, P., Briggs, A., Burns, G., Chaudhuri, R., …Price, D. (2015). Use of low-dose oral theophylline as an adjunct to inhaled corticosteroids in preventing exacerbations of chronic obstructive pulmonary disease: Study protocol for a randomised controlled trial. Trials, 16(1), Article 267. https://doi.org/10.1186/s13063-015-0782-2

Journal Article Type Article
Acceptance Date May 27, 2015
Online Publication Date Jun 10, 2015
Publication Date Jun 10, 2015
Deposit Date May 12, 2022
Publicly Available Date May 27, 2022
Journal Trials
Print ISSN 1745-6215
Electronic ISSN 1745-6215
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 16
Issue 1
Article Number 267
DOI https://doi.org/10.1186/s13063-015-0782-2
Keywords COPD; Theophylline; Inhaled corticosteroids; Exacerbation; Randomised controlled trial
Public URL https://hull-repository.worktribe.com/output/3609997

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Publisher Licence URL
http://creativecommons.org/licenses/by/4.0

Copyright Statement
© 2015 Devereux et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.







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