Twelve-month positive outcomes of Zephyr endobronchial valves in severe emphysema patients:LIBERATE trial

Introduction: Zephyr® Endobronchial Valve (EBV®) treatment in severe emphysema patients, improves lung function, exercise capacity and quality of life. Objective: Evaluate effectiveness and safety of EBV treatment in severe emphysema. Methods: 190 severe heterogeneous emphysema subjects (M47%/F53%) with hyperinflation (FEV1 27.4 %pred; RV 224.5 %pred) and absent collateral ventilation (Chartis®) were randomized 2:1 (EBV:Standard-of-Care (SoC). Responders were classified according to established Minimal Clinically Important Differences for outcome measures. Results: At 12-months 84.2% EBV subjects had a target lobe volume reduction ≥350mL. Between group differences (ΔEBV–SoC) for mean changes from baseline were significant (p<0.05) at 12 months: ΔFEV1= +0.106L (17.6%); ΔSGRQ= -7.1 points; ΔBODE Index= -1.2 points; and Δ6MWD= +39.3m. Responder rates significantly favored EBV over SoC for all measures. Major serious adverse events in the EBV group <45 days post-procedure were pneumothorax (EBV 26.6% vs SoC 0%), COPD exacerbations (7.8% vs 4.8%), and death (3.1% vs 0%). Between 45-days out to 12-months, these were COPD exacerbations (23.0% vs 30.6%) and death (0.8% vs 1.6%). Conclusions: Zephyr EBV treatment provides durable, clinically meaningful improvements in lung function, exercise capacity, dyspnea and quality of life in hyperinflated, severe emphysema patients with absent collateral ventilation