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Nitinol coils improve function, quality of life in patients with emphysema

Use of nitinol coils in addition to usual care to treat patients with severe emphysema improved function, quality of life and 6-minute walk test scores, according to recent research from The Journal of the American Medical Association.

“In this preliminary study of patients with severe emphysema followed up for 6 months, bronchoscopic treatment with nitinol coils compared with usual care resulted in improved exercise capacity with high short-term costs,” Gaëtan Deslée, MD, PhD, of the Service de Pneumologie at Hôpital Universitaire de Reims in Reims, France, and colleagues wrote.

Deslée and colleagues randomly assigned 100 patients (71% men; mean age 62 years) to receive either the standard care of rehabilitation and bronchodilators with or without inhaled corticosteroids and oxygen or standard care plus a bilateral coil treatment in which 10 coils per lobe were placed in two bilateral lobes across two procedures, according to the abstract. Patients’ lung function, quality of life (measured by the St. George’s Respiratory Questionnaire), 6-minute walk test function, total cost, total effectiveness, morbidity and mortality were determined to measure the success of the bilateral coil treatment.

The researchers found an improvement of 54 meters in the 6-minute walk test in 18 patients in the bilateral coil group compared with nine patients in the control group, according to the abstract (mean group difference = 18%; 95% CI, 4 to ∞). Results of FEV₁ was +0.09 L (95% CI, 0.05 to ∞) at 6 months and +0.08 L (95% CI, 0.03 to ∞) at 12 months. For the 6-minute walk test, there was an improvement of +21 meters at 6 months (95% CI, –4 to ∞) and 12 months (95% CI, –4 to ∞). There was also a decrease in St. George’s Respiratory Questionnaire scores of −13.4 points (95% CI, −8 to ∞) at 6 months and −10.6 points (95% CI, −5.8 to ∞) at 12 months.

Of note, there were seven deaths (bilateral coil group, n = 4; control group, n = 3) within 12 months. Deslée and colleagues also noted a total mean cost difference of $47,908 per patient per year between the two groups (95% CI, $47,879 to $48,073) and an “incremental cost-effectiveness ratio was $782,598 per additional quality-adjusted life-year,” according to the abstract.

“Further investigation is needed to assess durability of benefit and long-term cost implications,” Deslée and colleagues wrote. – by Jeff Craven

Disclosure: Deslée and one other researchers serve on the speakers bureau for PneumRx. Please see the full study for a list of all other researchers’ relevant financial disclosures.