Durable effect of endobronchial valves in severe emphysema

Durable benefits for endobronchial one-way SVS valves over only medical management for hyperinflation in severe heterogenous emphysema.

Significant benefits observed for severe dyspnoea

Minimally invasive, bronchoscopic placement of endobronchial one-way valves have demonstrated to improve pulmonary function, reduce hyperinflation, and increase dyspnoea in patients with COPD and emphysema1. However, it is not established whether this treatment is superior to ‘no intervention’ in the long term. The EMPROVE trial (NCT01812447) randomised 174 patients with severe heterogenous emphysema 2:1 to active treatment with the SVS on top of medical management or to medical management alone. Assessed were several quality-of-life (QoL) endpoints to compare the 2 arms of the trial. The positive primary results of the trial were published in 20192. At ERS 2022, Prof. Gerard Criner (Temple University, PA, USA) presented the results after 24 months of follow-up3

The results displayed significant benefits of the intervention arm over the control arm in terms of severe dyspnoea (P<0.01), St George’s Respiratory Questionnaire total score (P<0.05), the COPD assessment test score (P<0.05), and FEV1 (P<0.05). Although the intervention arm was associated with a higher rate of serious adverse events in the short term (0 to 6 months; 28.3% vs 8.5%; P=0.003), this pattern was no longer significant in the long-term (>12 to 24 months; 29.6% vs 20.5%; P=0.309), indicating durability of the procedure. 

“The EMPROVE trial demonstrated that SVS treatment provides a long-term clinical benefit in disease-specific health-related QoL, dyspnoea, and lung function in patients with severe heterogenous emphysema,” concluded Prof. Criner.

  1. Hartman JE, et al. Eur Respir Rev.2019;28(152):180121.
  2. Criner G, et al. Am J Respir Crit Care Med. 2019; 200(11):1354–1362.
  3. Criner G, et al. Sustained health-related quality of life in patients with severe heterogenous emphysema treated with spiration valve system at 24-month follow-up (EMPROVE). ALERT 4, RCT4449, ERS International Congress 2022, Barcelona, Spain, 4–6 September.