Phenotyping emphysema and airways disease: Clinical value of quantitative radiological techniques

Table 4 Summary of interventional drug trials using computed tomography measures as an outcome measure

Ref.	Study design	Pt N°	Duration	CT measure	Drug	Result
Usual COPD
Shaker et al[75]	RCT	254	2-4 yr	Perc15 and -910HU	Budesonide or placebo	Annual fall in Perc15 ↑in the placebo arm vs budesonide (P = 0.09) Annual increase in -910HU↓in the budesonide arm (P = 0.02)
Hoshino et al[76]	RCT	54	16 wk	%WA, LA, BWT	Tiotropium, Indacaterol or both	Combination therapy resulted in a ↓in %WA and wall thickness (P < 0.01)
Nordenmark et al[77]	RCT	36	12 wk	BWT, air trapping index and %WA	Reversible neutrophil elastase inhibitor 60 mg BD	No difference
Shimizu et al[78]	Inter-ventional trial	23	1 wk	Airway inner luminal area	SFC	Ct detected the significant change in airway inner luminal area r = 0.65, P < 0.001
Alpha 1 Antitrypsin deficiency
Stolk et al[79]	RCT	262	1 yr	Perc15	Parlovarotene	No benefit on lung density
Mao et al[80]	RCT-pilot study	20	9 mo	-910HU	ATRA	No benefit
Roth et al[81]	RCT feasibility study	148	9 mo	-910HU	Patients received ATRA either LD, HD, 13-cRA or placebo	No definitive clinical benefits
Dirksen et al[82]	RCT	32	3 yr	Perc15	Alpha1-antitrysin	CT analysis showed a non-significant trend towards a favourable effect. CT lung density twice as sensitive as PFTs
Dirksen et al[72] (EXACTLE)	RCT	77	2-2.5 yr	Perc15	Prolastin	CT densitometry more sensitive measure for the detection of emphysema progression than PFTs or health status indices
Chapman et al[73]	RCT	180	2 yr	Perc15	Alpha 1 proteinase inhibitor	Annual rate of density decline at TLC ↓in treatment group (P = 0.03)

CT: Computed tomography; WA: Wall area; LA: Luminal area; BWT: Bronchial wall thickening; SFC: Salmeterol/fluticasone; LD: Low dose; HD: High dose; 13-cRA: 13-cis retinoic acid; ATRA: All trans retinoic acid; RCT: Randomised controlled trial; TLC: Total lung capacity.