Head-to-head: lung volume reduction surgery vs endobronchial valves

LVRS was not highly superior to bronchoscopic lung volume reduction with valve placement for emphysema patients eligible for both treatment options.

LVRS and BLVR improvements on the i-BODE index score at 12 months were comparable

Although LVRS and endobronchial valves (EBVs) have both demonstrated to improve lung function, exercises capacity, and quality-of-life for patients with emphysema, no existing clinical trials have directly compared LVRS with the use of EBVs1,2. The randomised, single-blind CELEB trial (ISRCTN19684749) assessed whether LVRS was superior to BLVR in patients with emphysema who were suitable for both procedures (n=88)3. The primary endpoint was the i-BODE index score at 12 months, a measure that includes FEV1% predicted, exercise capacity, dyspnoea, and BMI. Ms Sara Buttery (Royal Brompton and Harefield NHS Foundation Trust, UK) presented the results.

The improvements on the i-BODE index score at 12 months were comparable for LVRS and BLVR (-1.10 vs -0.82; 95% CI (-)0.62‒1.17; P=0.54). Analysis of the single components of the i-BODE index score did not reveal a significant advantage of 1 treatment over the other. Moreover, the residual volume% predicted was similar in the LVRS arm (-36.1) and BLVR arm (-30.1; P=0.81). Finally, the safety of the procedures appeared to be similar, with 1 death at 12 months in each arm of the study. 

Ms Buttery concluded that LVRS was not substantially superior to BLVR in the current trial. A larger trial (NCT04537182) is underway to confirm these findings and evaluate the cost-benefit of the 2 treatments.

References
  1. Criner G, et al. Am J Respir Crit Care Med. 2011;184(7).
  2. Kemp SV, et al. Am J Respir Crit Care Med. 2017;196(12).
  3. Buttery S, et al. Comparative Effect of Lung volume reduction surgery for Emphysema and Bronchoscopic lung volume reduction with valve placement: the CELEB trial. ALERT 4, RCT4448, ERS International Congress 2022, Barcelona, Spain, 4–6 September.