Chronic Obstructive Pulmonary DiseasePhase 1/2MORPHEUS I/IIaNCT04427826
Efficacy of Morphine in Reducing the Rate of Early Non-Invasive Ventilation Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease, Phase I/IIa
A Phase 1/2 study testing Morphine hydrochloride in people with Chronic Obstructive Pulmonary Disease, run by University Hospital, Grenoble at 1 site in France.
Trial summary
Acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) are a major source of morbidity and mortality for patients and cost to the society. In case of acute respiratory failure with hypercapnia and acidosis, Non Invasive Ventilation (NIV) is preferred as a first line treatment. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Chronic Obstructive Pulmonary Disease
- What is being tested?
- Morphine hydrochloride
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 24 participants
- Where
- 1 siteFrance
- Study dates
- 8 Dec 2020to Jan 2028
- Phase
- Phase 1/2
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients Aged ≥ 18 years
- Current or former smoker at least 10 packs-years
- Patient with a history of COPD according to the Gold guidelines , after review of the medical record by the physician in charge
- Acute exacerbation of COPD (greater degradation of respiratory symptoms than the usual daily variations and requiring a modification of therapeutic management)
- Need to implement NIV treatment (respiratory acidosis with pH<7.35)
- Ventilation frequency > 20min
- Affiliation to the French security system (or equivalent)
- Written informed consent from the patient or his surrogates. In patients who are not able to consent on admission an emergency inclusion procedure will be allowed, with a mandatory delayed consent.
Who cannot join
- Patient already treated by NIV during admission (e. g. introduction in pre-hospital by SMUR) or started more than one hour ago in the department.
- Sedative (barbiturates, benzodiazepines and related substances and other sedatives) or morphine treatment within 24 hours before inclusion
- Chronic alcoholism
- Contra-indication to NIV: disturbances of consciousness (Glasgow < 11) except moderate hypercapnic encephalopathy; indication of immediate intubation; risk of inhalation; sputum impossible; hemodynamic instability; inability to remove the mask; trauma, surgery or facial malformation; patients with pH < 7.25 can only be included in intensive care unit or in the vital emergency room of the emergency department, under continuous monitoring
- NIV with palliative purpose from the outset with death expected within 24 hours of inclusion
- Non-communicative patient or significant dementia making them unable to participate in the study
Show all 11Show fewer
- Contra-indication to morphine without acute respiratory distress
- Pregnant or breastfeeding women
- Major mentioned in Articles L1121-6 and 1121-8 of French public health cod
- Patients in a period of exclusion from other research involving the human person type 1 or 2
- Subject cannot be contacted in case of emergency
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
France1 site, 1 recruiting
- Recruiting
Emergency Department of Grenoble Alpes University Hospital
Grenoble, Isère, Auvergne-Rhône-Alpes, 38043
Damien VIGLINO, MD, PhD, 0033476766784, DViglino@chu-grenoble.fr
Prudence MABIALA MAKELE, PhD, 0033476766784, pmabialamakele@chu-grenoble.fr
About this study
Official title: Efficacy of Morphine in Reducing the Rate of Early Non-Invasive Ventilation (NIV) Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD), Phase I/IIa
Acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) are a major source of morbidity and mortality for patients and cost to the society. In case of acute respiratory failure with hypercapnia and acidosis, Non Invasive Ventilation (NIV) is preferred as a first line treatment.
NIV failures are not uncommon, from 15% in intensive care to 25 - 30% in emergency departments. They most often occur at the start of the NIV or in the hours that follow. There are many reasons for these failure. Among these are; dyspnea, discomfort, the pain related to the exacerbation and also to the NIV are frequently noted.
Read more
The use of certain drugs with anxiolytic, hypnotic and/or analgesic properties could also be useful. Some sedatives and opioids have already been studied in this indication but without a therapeutic trial and satisfactory methodology. Among the molecules of interest, Morphine seems interesting . It's administration could reduce the ventilatory rate, intensity of dyspnea, pain and anxiety as well as dynamic hyperinflation.
The investigators believe that morphine administration will decrease the rate of early NIV failure by improving comfort (decreased dyspnea and pain) and ventilation (decreased respiratory rate and increase in tidal volume) in patients with exacerbations of COPD.
However, before considering a randomized phase III efficacy study, it is necessary to determine the optimal dose of morphine in this indication, through a phase I/II dose-finding study taking into accounts both the efficacy and toxicity of morphine.
The main objective of this study, is to determine the optimal dose of morphine administered at the initiation of NIV in patient with acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD), which is defined as the maximum gain function combining the probability of dose-limiting toxicity with PaCO2.Therefore, the impact of morphine administration on the physiological parameters of NIV- COPD exacerbation patients will be assessed.
Read the detailed description
Patients included in this dose-finding study will be enrolled consecutively after consent and verification of the selection criteria, with a minimum of 24 hours after completion of previous patient follow-up.
Prior to the administration of morphine, the following exams will be performed: clinical, paraclinical and biological parameters.
NIV will be started and performed in BiPAP pressure mode with facial mask. A Tidal Volume (Vt) to the maximum of 6 - 8ml/kg, an expiratory positive airway pressure (EPAP) of 5cm H2O and the FiO2 set at 35%. The settings will be adapted according to the SpO2 (88%≤SpO2≤92%) and the clinical tolerance.
Thereafter, the patients included will receive a single open-label injection of morphine (T0) at the dose closest to that defined by the model (estimation by Bayesian method) from among the following 4 doses: 0.02; 0.04; 0.07 and 0.1mg/kg.
A double check of the preparation of the dose administered will be carried out by a physician and a nurse in an emergency department.
Each result is aimed to refine the gain function which will be used to estimate the optimal dose for the next patient. The dose to be administered to the next patient will be determined by the Clinical Investigation Centre based on the data of the previous patient. It will be determined using a gain function whose objective is to represent the best compromise between efficacy and safety. It assigns a value to the patient representing the benefit: in case of toxicity this value will be 0; otherwise it will be equal to the decrease in PaCO2.
Constant monitoring for up to 4 hours will be done as part of this study to detect the occurrence of adverse events. In particular, the following will be monitored: disturbances of consciousness, vomiting or secretions requiring airway protection; hemodynamic instability; restlessness and/or inability to keep the mask on. Therefore, ongoing monitoring for routine patient care may be extended at the discretion of the clinical physician in charge of the patient.
Follow-up of patients will be done in 15 minutes, 1 hour, 4 hours (or NIV stop) and 24 hours. Clinical, paraclinical, biological parameters and the occurrence of adverse events will be performed in 15 minutes, 1 and 4 hours follow-up. During 24 hours only the occurrence of adverse event will be reported.
The trial shall be concluded when the maximum number of patients is reached (N=24), or when a sufficiently accurate estimate of the dose maximizing the benefit-risk balance is obtained while remaining within the toxicity limit set at a 30% probability of DLT. The precision of this estimate will be measured by the ratio of the upper and lower bounds of the confidence interval. If this ratio is less than 5, the precision is considered to be sufficient to stop the study.
Four groups of data will be collected at different times: biological parameter, clinical and paraclinical parameters as well adverse event.
Clinical parameter: demographic variable (gender, age), weight, height, BMI, Richmond Agitation- Sedation Scale, Visual analog scale of dyspnea (Borg scale), numerical rating scale for pain assessment.
Paraclinical parameter: Vital parameters: heart rate, respiratory rate, blood pressure, ventilatory rate, SpO2, NIV settings, EPAP, IPAP and Tidal Volume.
Biological parameter: Blood count, arterial blood gas, chemistry panel.
outcome measure: Optimal dose is defined as the dose associated with the maximum of gain function, used to determine the best compromise between efficacy and toxicity.
It combines:
- The probability of dose - limiting toxicity (DTL), defined as the occurrence of one or more of the following criteria occurring within 4 hours of morphine administration:
- Respiratory Rate ≤ 10/min;
- Richmond Agitation-Sedation Scale (RASS) < -2
- Vomiting
- Naloxone administration.
- Efficacy and toxicity defined by:
- PaCO2 1 hour after morphine injection, according to the hormetic dose-response model ("J-curve": efficacy first increases with the dose, then reach a maximum and decreases in case of excessive bradypnea).
Study design:
Estimation of enrollment: Up to 24 participants. The calculation of the sample size was carried out by simulating several scenarios based on the prior to be used in the study. The simulated scenarios are as follows: one with low toxicity (5% at 0.02 mg/kg and 30% at 0.1 mg/kg), one with high toxicity (10% at 0.02 mg/kg and 40% at 0.04 mg/kg) and one where the toxicity is identical to the prior.
Simulation results showed a number of subjects required up to 24, with a median of 6 to 11, according to the scenario. The investigators therefore chose to define a maximum number of patients to 24, which is higher than the average of the worst-case scenario and corresponds to the maximum number of patients required among the 100 simulations of the worst-case scenario. However, it is very likely that the inclusions will be stopped earlier, when the accuracy is satisfactory.
Analysis:
The method used will be an adaptive Bayesian dose-finding procedure for a binary response (DLT), and a continuous response (PaCO2 used as a biomarker of efficacy and toxicity, following a hormetic response), using a gain function which objectively represent the compromise between efficiency and safety. The investigators will use a function already described in the literature .
No interim analysis planned for this study.
- Conditions
- Chronic Obstructive Pulmonary Disease
- Being tested
- Morphine hydrochloride
- Keywords
- Acute exacerbation, COPD, NIV, Morphine, DLT
- Medical subject headings
- Pulmonary Disease, Chronic Obstructive
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Morphine hydrochlorideDrug
A single open-label injection of morphine (T0) at the dose closest to that defined by the model (estimation by Bayesian method) from among the following 4 doses: 0.02; 0.04; 0.07 and 0.1mg/kg will be adminestred to the patients.
| Study group | Role | What they receive |
|---|---|---|
| Patient admitted for acute Exacerbation of Chronic Obstructive | Experimental | Patient admitted for acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and required NIV Receives: Drug: Morphine hydrochloride |
What is being measured
The primary outcome is the main question the study is designed to answer.
The probability of dose - limiting toxicity (DTL), defined as the occurrence of one or more of the following criteria occurring within 4 hours of morphine administration
Respiratory Rate ≤ 10/min; Richmond Agitation-Sedation Scale (RASS) < -2;Vomiting and Naloxone administration
Measured: 4 hours
Efficacy and toxicity
PaCO2 1 hour after morphine injection, according to the hormetic dose-response model
Measured: 1 hour
Secondary outcomes (1)
Percentage of adverse events
Percentage of adverse event occurred
Measured: 1, 4 and 24 hours
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Jun 2020
- Study start8 Dec 2020
- Primary completion8 Jun 2027 (estimated)
- Study completionJan 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (14)Papers the sponsor has linked to this study.
- Other trials for Chronic Obstructive Pulmonary DiseaseStudies of the same condition, open and under way.
- More trials run by University Hospital, GrenobleThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1/2
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Model description
- Phase I / IIa prospective, monocentric and open therapeutic study
- Masking
- None (open label)
- Enrolment
- 24 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University Hospital, Grenoble
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Damien VIGLINO, MD, PhD, Principal investigator, Grenoble Alpes University Hospital, HP2 laboratory - INSERM U1042 and Grenoble Alpes University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04427826
- Sponsor's protocol ID
- 2019-004274-25
- Other IDs
- 2019-004274-25, 2019
- Acronym
- MORPHEUS I/IIa
- Status last verified
- Apr 2026
- First submitted
- 8 Jun 2020
- Last updated
- 15 Apr 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: The international writing and publication rules (The Uniform Requirements for Manuscripts of the ICMJE, April 2010) will be followed. The minimum anonymized source data for performing the statistical analysis will be made public at the time of publication, with the article, or deposited in an appropriate public database. Other anonymized data may be available from the principal investigator upon reasonable request and with the consent of the sponsor. In accordance with the French law n ° 2002-303 of March 4th, 2002, the subjects can be informed, at their request, of the overall results of the research. In this study, the investigators commit to individually communicating the overall results to each subject participating in the research by a short (popularized) summary and associated with a copy of the scientific article.
Publications
Wedzicha JA Ers Co-Chair, Miravitlles M, Hurst JR, Calverley PM, Albert RK, Anzueto A, Criner GJ, Papi A, Rabe KF, Rigau D, Sliwinski P, Tonia T, Vestbo J, Wilson KC, Krishnan JA Ats Co-Chair. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017 Mar 15;49(3):1600791. doi: 10.1183/13993003.00791-2016. Print 2017 Mar.
PubMed 28298398Bounes V, Charriton-Dadone B, Levraut J, Delangue C, Carpentier F, Mary-Chalon S, Houze-Cerfon V, Sommet A, Houze-Cerfon CH, Ganetsky M. Predicting morphine related side effects in the ED: An international cohort study. Am J Emerg Med. 2017 Apr;35(4):531-535. doi: 10.1016/j.ajem.2016.11.053. Epub 2016 Nov 30.
PubMed 28117179Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DM, Lopez Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017 Mar 1;195(5):557-582. doi: 10.1164/rccm.201701-0218PP.
PubMed 28128970Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006 Sep;28(3):523-32. doi: 10.1183/09031936.06.00124605. Epub 2006 Apr 12.
PubMed 16611654Schmidt SA, Johansen MB, Olsen M, Xu X, Parker JM, Molfino NA, Lash TL, Sorensen HT, Christiansen CF. The impact of exacerbation frequency on mortality following acute exacerbations of COPD: a registry-based cohort study. BMJ Open. 2014 Dec 19;4(12):e006720. doi: 10.1136/bmjopen-2014-006720.
PubMed 25526796Hartl S, Lopez-Campos JL, Pozo-Rodriguez F, Castro-Acosta A, Studnicka M, Kaiser B, Roberts CM. Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit. Eur Respir J. 2016 Jan;47(1):113-21. doi: 10.1183/13993003.01391-2014. Epub 2015 Oct 22.
PubMed 26493806Mackay AJ, Hurst JR. COPD exacerbations: causes, prevention, and treatment. Med Clin North Am. 2012 Jul;96(4):789-809. doi: 10.1016/j.mcna.2012.02.008. Epub 2012 Mar 16.
PubMed 22793945Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P Members Of The Steering Committee, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S Members Of The Task Force. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017 Aug 31;50(2):1602426. doi: 10.1183/13993003.02426-2016. Print 2017 Aug.
PubMed 28860265Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017 Jul 13;7(7):CD004104. doi: 10.1002/14651858.CD004104.pub4.
PubMed 28702957Ko BS, Ahn S, Lim KS, Kim WY, Lee YS, Lee JH. Early failure of noninvasive ventilation in chronic obstructive pulmonary disease with acute hypercapnic respiratory failure. Intern Emerg Med. 2015 Oct;10(7):855-60. doi: 10.1007/s11739-015-1293-6. Epub 2015 Sep 4.
PubMed 26341216Maignan M, Chauny JM, Daoust R, Duc L, Mabiala-Makele P, Collomb-Muret R, Roustit M, Maindet C, Pepin JL, Viglino D. Pain during exacerbation of chronic obstructive pulmonary disease: A prospective cohort study. PLoS One. 2019 May 24;14(5):e0217370. doi: 10.1371/journal.pone.0217370. eCollection 2019.
PubMed 31125359Yeung WY, Reigner B, Beyer U, Diack C, Sabanes Bove D, Palermo G, Jaki T. Bayesian adaptive dose-escalation designs for simultaneously estimating the optimal and maximum safe dose based on safety and efficacy. Pharm Stat. 2017 Nov;16(6):396-413. doi: 10.1002/pst.1818. Epub 2017 Jul 9.
PubMed 28691311Jolliet P, Ouanes-Besbes L, Abroug F, Ben Khelil J, Besbes M, Garnero A, Arnal JM, Daviaud F, Chiche JD, Lortat-Jacob B, Diehl JL, Lerolle N, Mercat A, Razazi K, Brun-Buisson C, Durand-Zaleski I, Texereau J, Brochard L; E.C.H.O. ICU Trial Investigators. A Multicenter Randomized Trial Assessing the Efficacy of Helium/Oxygen in Severe Exacerbations of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2017 Apr 1;195(7):871-880. doi: 10.1164/rccm.201601-0083OC.
PubMed 27736154Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ. 2003 Jan 25;326(7382):185. doi: 10.1136/bmj.326.7382.185.
PubMed 12543832
Study at a glance
From the registry record, last updated by the sponsor on 15 Apr 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Efficacy of Morphine in Reducing the Rate of Early Non-Invasive Ventilation (NIV) Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD), Phase I/IIa
- ClinicalTrials.gov ID
- NCT04427826
- Acronym / sponsor ID
- MORPHEUS I/IIa / 2019-004274-25
- Conditions
- Chronic Obstructive Pulmonary Disease
- Keywords
- Acute exacerbation, COPD, NIV, Morphine, DLT
- Phase
- Phase 1/2
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 24 participants (estimated)
- Lead sponsor
- University Hospital, GrenobleUniversity, hospital or other
- Study start
- 8 Dec 2020 (actual)
- Primary completion
- 8 Jun 2027 (estimated)
- Study completion
- Jan 2028 (estimated)
- First posted
- 11 Jun 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) are a major source of morbidity and mortality for patients and cost to the society. In case of acute respiratory failure with hypercapnia and acidosis, Non Invasive Ventilation (NIV) is preferred as a first line treatment.
NIV failures are not uncommon, from 15% in intensive care to 25 - 30% in emergency departments. They most often occur at the start of the NIV or in the hours that follow. There are many reasons for these failure. Among these are; dyspnea, discomfort, the pain related to the exacerbation and also to the NIV are frequently noted.
The use of certain drugs with anxiolytic, hypnotic and/or analgesic properties could also be useful. Some sedatives and opioids have already been studied in this indication but without a therapeutic trial and satisfactory methodology. Among the molecules of interest, Morphine seems interesting . It's administration could reduce the ventilatory rate, intensity of dyspnea, pain and anxiety as well as dynamic hyperinflation.
The investigators believe that morphine administration will decrease the rate of early NIV failure by improving comfort (decreased dyspnea and pain) and ventilation (decreased respiratory rate and increase in tidal volume) in patients with exacerbations of COPD.
However, before considering a randomized phase III efficacy study, it is necessary to determine the optimal dose of morphine in this indication, through a phase I/II dose-finding study taking into accounts both the efficacy and toxicity of morphine.
The main objective of this study, is to determine the optimal dose of morphine administered at the initiation of NIV in patient with acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD), which is defined as the maximum gain function combining the probability of dose-limiting toxicity with PaCO2.Therefore, the impact of morphine administration on the physiological parameters of NIV- COPD exacerbation patients will be assessed.
Detailed description
Patients included in this dose-finding study will be enrolled consecutively after consent and verification of the selection criteria, with a minimum of 24 hours after completion of previous patient follow-up.
Prior to the administration of morphine, the following exams will be performed: clinical, paraclinical and biological parameters.
NIV will be started and performed in BiPAP pressure mode with facial mask. A Tidal Volume (Vt) to the maximum of 6 - 8ml/kg, an expiratory positive airway pressure (EPAP) of 5cm H2O and the FiO2 set at 35%. The settings will be adapted according to the SpO2 (88%≤SpO2≤92%) and the clinical tolerance.
Thereafter, the patients included will receive a single open-label injection of morphine (T0) at the dose closest to that defined by the model (estimation by Bayesian method) from among the following 4 doses: 0.02; 0.04; 0.07 and 0.1mg/kg.
A double check of the preparation of the dose administered will be carried out by a physician and a nurse in an emergency department.
Each result is aimed to refine the gain function which will be used to estimate the optimal dose for the next patient. The dose to be administered to the next patient will be determined by the Clinical Investigation Centre based on the data of the previous patient. It will be determined using a gain function whose objective is to represent the best compromise between efficacy and safety. It assigns a value to the patient representing the benefit: in case of toxicity this value will be 0; otherwise it will be equal to the decrease in PaCO2.
Constant monitoring for up to 4 hours will be done as part of this study to detect the occurrence of adverse events. In particular, the following will be monitored: disturbances of consciousness, vomiting or secretions requiring airway protection; hemodynamic instability; restlessness and/or inability to keep the mask on. Therefore, ongoing monitoring for routine patient care may be extended at the discretion of the clinical physician in charge of the patient.
Follow-up of patients will be done in 15 minutes, 1 hour, 4 hours (or NIV stop) and 24 hours. Clinical, paraclinical, biological parameters and the occurrence of adverse events will be performed in 15 minutes, 1 and 4 hours follow-up. During 24 hours only the occurrence of adverse event will be reported.
The trial shall be concluded when the maximum number of patients is reached (N=24), or when a sufficiently accurate estimate of the dose maximizing the benefit-risk balance is obtained while remaining within the toxicity limit set at a 30% probability of DLT. The precision of this estimate will be measured by the ratio of the upper and lower bounds of the confidence interval. If this ratio is less than 5, the precision is considered to be sufficient to stop the study.
Four groups of data will be collected at different times: biological parameter, clinical and paraclinical parameters as well adverse event.
Clinical parameter: demographic variable (gender, age), weight, height, BMI, Richmond Agitation- Sedation Scale, Visual analog scale of dyspnea (Borg scale), numerical rating scale for pain assessment.
Paraclinical parameter: Vital parameters: heart rate, respiratory rate, blood pressure, ventilatory rate, SpO2, NIV settings, EPAP, IPAP and Tidal Volume.
Biological parameter: Blood count, arterial blood gas, chemistry panel.
outcome measure: Optimal dose is defined as the dose associated with the maximum of gain function, used to determine the best compromise between efficacy and toxicity.
It combines:
- The probability of dose - limiting toxicity (DTL), defined as the occurrence of one or more of the following criteria occurring within 4 hours of morphine administration:
- Respiratory Rate ≤ 10/min;
- Richmond Agitation-Sedation Scale (RASS) < -2
- Vomiting
- Naloxone administration.
- Efficacy and toxicity defined by:
- PaCO2 1 hour after morphine injection, according to the hormetic dose-response model ("J-curve": efficacy first increases with the dose, then reach a maximum and decreases in case of excessive bradypnea).
Study design:
Estimation of enrollment: Up to 24 participants. The calculation of the sample size was carried out by simulating several scenarios based on the prior to be used in the study. The simulated scenarios are as follows: one with low toxicity (5% at 0.02 mg/kg and 30% at 0.1 mg/kg), one with high toxicity (10% at 0.02 mg/kg and 40% at 0.04 mg/kg) and one where the toxicity is identical to the prior.
Simulation results showed a number of subjects required up to 24, with a median of 6 to 11, according to the scenario. The investigators therefore chose to define a maximum number of patients to 24, which is higher than the average of the worst-case scenario and corresponds to the maximum number of patients required among the 100 simulations of the worst-case scenario. However, it is very likely that the inclusions will be stopped earlier, when the accuracy is satisfactory.
Analysis:
The method used will be an adaptive Bayesian dose-finding procedure for a binary response (DLT), and a continuous response (PaCO2 used as a biomarker of efficacy and toxicity, following a hormetic response), using a gain function which objectively represent the compromise between efficiency and safety. The investigators will use a function already described in the literature .
No interim analysis planned for this study.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
- Model description
- Phase I / IIa prospective, monocentric and open therapeutic study
| Arm | Type | Receives |
|---|---|---|
| Patient admitted for acute Exacerbation of Chronic Obstructive | Experimental | Drug: Morphine hydrochloridePatient admitted for acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and required NIV |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Patients Aged ≥ 18 years
- Current or former smoker at least 10 packs-years
- Patient with a history of COPD according to the Gold guidelines , after review of the medical record by the physician in charge
- Acute exacerbation of COPD (greater degradation of respiratory symptoms than the usual daily variations and requiring a modification of therapeutic management)
- Need to implement NIV treatment (respiratory acidosis with pH<7.35)
Key exclusion criteria (11 listed)
- Patient already treated by NIV during admission (e. g. introduction in pre-hospital by SMUR) or started more than one hour ago in the department.
- Sedative (barbiturates, benzodiazepines and related substances and other sedatives) or morphine treatment within 24 hours before inclusion
- Chronic alcoholism
- Contra-indication to NIV: disturbances of consciousness (Glasgow < 11) except moderate hypercapnic encephalopathy; indication of immediate intubation; risk of inhalation; sputum impossible; hemodynamic instability; inability to remove the mask; trauma, surgery or facial malformation; patients with pH < 7.25 can only be included in intensive care unit or in the vital emergency room of the emergency department, under continuous monitoring
- NIV with palliative purpose from the outset with death expected within 24 hours of inclusion
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Morphine hydrochlorideA single open-label injection of morphine (T0) at the dose closest to that defined by the model (estimation by Bayesian method) from among the following 4 doses: 0.02; 0.04; 0.07 and 0.1mg/kg will be adminestred to the patients. | Drug | Patient admitted for acute Exacerbation of Chronic Obstructive |
Primary outcome
The probability of dose - limiting toxicity (DTL), defined as the occurrence of one or more of the following criteria occurring within 4 hours of morphine administration
Time frame: 4 hours
Respiratory Rate ≤ 10/min; Richmond Agitation-Sedation Scale (RASS) < -2;Vomiting and Naloxone administration
Efficacy and toxicity
Time frame: 1 hour
PaCO2 1 hour after morphine injection, according to the hormetic dose-response model
1 secondary outcome
Percentage of adverse events
Time frame: 1, 4 and 24 hours
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Apr 2026.
- Background: PubMed 28298398Wedzicha JA Ers Co-Chair, Miravitlles M, Hurst JR, Calverley PM, Albert RK, Anzueto A, Criner GJ, Papi A, Rabe KF, Rigau D, Sliwinski P, Tonia T, Vestbo J, Wilson KC, Krishnan JA Ats Co-Chair. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017 Mar 15;49(3):1600791. doi: 10.1183/13993003.00791-2016. Print 2017 Mar.
- Background: PubMed 28117179Bounes V, Charriton-Dadone B, Levraut J, Delangue C, Carpentier F, Mary-Chalon S, Houze-Cerfon V, Sommet A, Houze-Cerfon CH, Ganetsky M. Predicting morphine related side effects in the ED: An international cohort study. Am J Emerg Med. 2017 Apr;35(4):531-535. doi: 10.1016/j.ajem.2016.11.053. Epub 2016 Nov 30.
- Results publication: PubMed 28128970Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DM, Lopez Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017 Mar 1;195(5):557-582. doi: 10.1164/rccm.201701-0218PP.
- Results publication: PubMed 16611654Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006 Sep;28(3):523-32. doi: 10.1183/09031936.06.00124605. Epub 2006 Apr 12.
- Results publication: PubMed 25526796Schmidt SA, Johansen MB, Olsen M, Xu X, Parker JM, Molfino NA, Lash TL, Sorensen HT, Christiansen CF. The impact of exacerbation frequency on mortality following acute exacerbations of COPD: a registry-based cohort study. BMJ Open. 2014 Dec 19;4(12):e006720. doi: 10.1136/bmjopen-2014-006720.
- Results publication: PubMed 26493806Hartl S, Lopez-Campos JL, Pozo-Rodriguez F, Castro-Acosta A, Studnicka M, Kaiser B, Roberts CM. Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit. Eur Respir J. 2016 Jan;47(1):113-21. doi: 10.1183/13993003.01391-2014. Epub 2015 Oct 22.
- Results publication: PubMed 22793945Mackay AJ, Hurst JR. COPD exacerbations: causes, prevention, and treatment. Med Clin North Am. 2012 Jul;96(4):789-809. doi: 10.1016/j.mcna.2012.02.008. Epub 2012 Mar 16.
- Results publication: PubMed 28860265Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P Members Of The Steering Committee, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S Members Of The Task Force. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017 Aug 31;50(2):1602426. doi: 10.1183/13993003.02426-2016. Print 2017 Aug.
- Results publication: PubMed 28702957Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017 Jul 13;7(7):CD004104. doi: 10.1002/14651858.CD004104.pub4.
- Results publication: PubMed 26341216Ko BS, Ahn S, Lim KS, Kim WY, Lee YS, Lee JH. Early failure of noninvasive ventilation in chronic obstructive pulmonary disease with acute hypercapnic respiratory failure. Intern Emerg Med. 2015 Oct;10(7):855-60. doi: 10.1007/s11739-015-1293-6. Epub 2015 Sep 4.
- Results publication: PubMed 31125359Maignan M, Chauny JM, Daoust R, Duc L, Mabiala-Makele P, Collomb-Muret R, Roustit M, Maindet C, Pepin JL, Viglino D. Pain during exacerbation of chronic obstructive pulmonary disease: A prospective cohort study. PLoS One. 2019 May 24;14(5):e0217370. doi: 10.1371/journal.pone.0217370. eCollection 2019.
- Results publication: PubMed 28691311Yeung WY, Reigner B, Beyer U, Diack C, Sabanes Bove D, Palermo G, Jaki T. Bayesian adaptive dose-escalation designs for simultaneously estimating the optimal and maximum safe dose based on safety and efficacy. Pharm Stat. 2017 Nov;16(6):396-413. doi: 10.1002/pst.1818. Epub 2017 Jul 9.
- Individual participant dataSharing planned: Yes. The international writing and publication rules (The Uniform Requirements for Manuscripts of the ICMJE, April 2010) will be followed. The minimum anonymized source data for performing the statistical analysis will be made public at the time of publication, with the article, or deposited in an appropriate public database. Other anonymized data may be available from the principal investigator upon reasonable request and with the consent of the sponsor. In accordance with the French law n ° 2002-303 of March 4th, 2002, the subjects can be informed, at their request, of the overall results of the research. In this study, the investigators commit to individually communicating the overall results to each subject participating in the research by a short (popularized) summary and associated with a copy of the scientific article.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Damien VIGLINO, MD, PhD principal investigator
Grenoble Alpes University Hospital, HP2 laboratory - INSERM U1042 and Grenoble Alpes University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1/2 study testing Morphine hydrochloride in people with Chronic Obstructive Pulmonary Disease, run by University Hospital, Grenoble at 1 site in France.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 15 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this combined phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Damien VIGLINO, MD, PhD (0033476766784, DViglino@chu-grenoble.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The probability of dose - limiting toxicity (DTL), defined as the occurrence of one or more of the following criteria occurring within 4 hours of morphine administration (time frame: 4 hours). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04427826, which also lists 14 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Apr 2026.