Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema
LIBERATE trial design and results
Design
Multicentre randomised controlled trial
Treatment
Zephyr endobronchial valves plus medical management
Control
Medical management alone
Population
190 patients with heterogeneous emphysema and little or no collateral ventilation in the target lobe
Follow-up
12 months
Primary endpoint
Proportion with an FEV1 improvement of at least 15% at 12 months
Result
Zephyr valves produced clinically meaningful benefits in lung function, exercise tolerance, dyspnoea and quality of life sustained to at least 12 months, with an acceptable safety profile in patients with little or no collateral ventilation in the target lobe.
Secondary endpoints
Six-minute walk distance, St George's Respiratory Questionnaire, dyspnoea score, pneumothorax
Zephyr EBV provides clinically meaningful benefits in lung function, exercise tolerance, dyspnea, and quality of life out to at least 12 months, with an acceptable safety profile in patients with little or no collateral ventilation in the target lobe.
The trial authors, in the published abstract
How it has aged
Achieves bronchoscopically what NETT achieved surgically, in a comparable phenotype and without a thoracotomy. The selection criterion is absolute: valves only work when the target lobe has no collateral ventilation, which must be demonstrated before the procedure. Pneumothorax is the characteristic complication and occurs in roughly a quarter of patients.
Publications
A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE)
Criner GJ, Sue R, Wright S, et al. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE). Am J Respir Crit Care Med 2018 Nov 1;198(9):1151-1164.
Clinically meaningful gains in FEV1, exercise tolerance, dyspnoea and quality of life at 12 months
Benefit confined to target lobes without collateral ventilation
Acceptable safety profile, with pneumothorax the characteristic complication