The FORTITUDE trial will provide head-to-head evidence on the benefits and harms of two commonly prescribed neuromodulators (low-dose morphine and pregabalin), the effectiveness of a virtual cough control therapy, exploratory assessment of potential synergy in combining these interventions, and the long-term outcomes of these treatments in patients with refractory or unexplained chronic cough.
FORTITUDE (FactOrial Randomized TrIal To evalUate neuromoDulators and cough control thErapy) is a 6-week, 2x2 factorial, randomized, open-label trial with an extension observational phase up to 1 year. The trial will include Canadian hospital sites enrolling 124 patients. Patients ≥18 years old with either refractory or unexplained chronic cough will undergo 1:1:1:1 randomization to receive either low-dose morphine (up to 5 mg twice daily) or pregabalin (up to a maximum tolerated dose of 150 mg twice daily) with or without cough control therapy. The cough control therapy will consist of five virtual sessions delivered over 6 weeks by a trained physiotherapist and speech-language pathologist. Change from baseline in 24-hour cough frequency at 6 weeks represents the primary outcome.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
124
Oral morphine sulphate given up to 5 mg twice daily.
Oral morphine sulphate given up to 5 mg twice daily and cough control therapy (5 virtual sessions delivered over 6 weeks by a trained physiotherapist and speech-language pathologist).
Oral pregabalin given up to a maximum tolerated dose of 150 mg twice daily.
Oral pregabalin given up to a maximum tolerated dose of 150 mg twice daily and cough control therapy (5 virtual sessions delivered over 6 weeks by a trained physiotherapist and speech-language pathologist).
Respiratory Clinical Trials Centre, University of Calgary
Calgary, Alberta, Canada
Respiratory Research Lab, McMaster University
Hamilton, Ontario, Canada
St Joseph's Health Care London
London, Ontario, Canada
Institut universitaire de cardiologie et de pneumologie de Quebec - University Laval
Québec, Quebec, Canada
Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke
Sherbrooke, Quebec, Canada
Change from baseline in 24-hour cough frequency (coughs/hour) measured by the VitaloJAK ambulatory cough monitor at 6 weeks
Time frame: 6 weeks
Change from baseline in awake cough frequency (coughs/hour) measured by the VitaloJAK ambulatory cough monitor at 6 weeks
Time frame: 6 weeks
Change from baseline in sleep cough frequency (coughs/hour) measured by the VitaloJAK ambulatory cough monitor at 6 weeks
Time frame: 6 weeks
Change from baseline in cough bouts (defined by inter-cough intervals) measured by the VitaloJAK ambulatory cough monitor at 6 weeks
Time frame: 6 weeks
Change from baseline in cough severity on the McMaster Cough Severity Questionnaire at 6 weeks
Time frame: 6 weeks
Change from baseline in cough severity on the 100-mm visual analogue scale at 6 weeks
Time frame: 6 weeks
Change from baseline in cough-specific quality of life on the Leicester Cough Questionnaire at 6 weeks
Time frame: 6 weeks
Change from week 6 (end of randomized phase) in cough severity on the McMaster Cough Severity Questionnaire at 6 and 12 months
Time frame: 6 and 12 months
Change from week 6 (end of randomized phase) in cough severity on the 100-mm visual analogue scale at 6 and 12 months
Time frame: 6 and 12 months
Change from week 6 (end of randomized phase) in cough-specific quality of life on the Leicester Cough Questionnaire at 6 and 12 months
Time frame: 6 and 12 months
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