Recent Advances In Asthma & COPD

Dr.Tinku JosephDM Resident

Pulmonary MedicineAIMS, Kochi

Jan-Dec 2016

Contents

Asthma

COPD

Glycopyrronium + Indacetarol

SPARK, BLAZE, ILLUMINATE , SHINE and ENLIGHTEN (2012-2015)

Increase in Lung function Improvement in health related QoL, and Dyspnea

Glycopyrronium + Indacaterol fixed dose combination

FLAME TRIAL – June 2016

Fluticasone furoate –Vilanterol in COPD

September 2016

ROFLUMILAST

PDE4 inhinbitor Reduce inflammation Inhibits breakdown of

intracellular cyclic AMP Not a bronchodilator – no use

in acute spasm Reduces exacerbations

500mcg OD GI intolerence, headache and

sleep disturbances. AURA study

ROFLUMILAST

Endobronchial valves/coils

Endobronchial valves

Significantly improved FEV1 , 6MWD Adverse events more Pneumothorax Valve replacement

Conclusion – Effective in highly selected patients with out collateral ventilation who are ready to accept adverse events

Revolens study

Coil treatment Homogeneous Emphysema The coil group had significant improvements in lung

function and quality of life at 6 and 12 months. Pneumonia

Endobronchial Coils

Endobronchial Coils

Endobronchial Coils

Taken together, these studies show that endobronchial valves or nitinol coils can:

Improve lung function Exercise tolerance Quality of life in carefully selected patients with

severe emphysema who are willing to accept the associated risks.

Endobronchial valves/coils

Smoking

Varenicline -: first-line drug treatment

Bupropion is a second-line therapy. It may be associated with an increased risk of seizures and drug interactions

Marginal evidence -: Electronic cigarettes might facilitate smoking cessation.

Quit rates are not yet comparable with those of the drugs approved on the Pharmaceutical Benefits Scheme.

Varenicline – 5 trials The first two were dose-finding studies with bupropion as an

active comparator in one Two large phase III studies with identical design compared

varenicline 1mg bid with placebo and bupropion 150 mg bid.

At one year follow-up- varenicline was 2.4 times more effective than placebo and significantly better than bupropion in one of the studies and marginally superior in the other.

The most common side effects were nausea and insomnia

New drugs

Dianicline - 1 phase II trial - Promising results

Rimonabant has shown some short term efficacy. However, its effects do not seem to be significantly better than those for the currently available treatments

The current nicotine “vaccines” clearly do not give very long lasting protection because the antibody titers do not remain elevated for many months.

E-Cigarette

E-cigarette

Vaping Regulation varies from country to country

Achievement of abstinence was substantially lower than the researchers anticipated for the power calculations,

They had insufficient statistical power to conclude superiority of nicotine e-cigarettes to patches or to placebo e-cigarettes.

No significant differences in adverse events were identified.

Reslizumab

Monoclonal antibody to interleukin (IL)-5

FDA approved

Cinquair

Add-on maintenance therapy of severe asthma In patients >18 yrs or older

Eosinophilic phenotype

Reslizumab: Description and Production

Sterile solution in single-use vial 3 mg/kg IV q4wk infused over 20-50 minutes

Adverse Effects

Elevated CPK (14%) Oropharyngeal pain (2.6%) Myalgias (1%) Anaphylaxis (0.3%)

Benralizumab

Investigational molecule Anti-interleukin (IL)-5 receptor antibody. Two trials Reduced exacerbations in patients with moderate to

severe asthma who had elevated peripheral blood eosinophil counts.

November 2016

Benralizumab

Benralizumab

Fluticasone + Salmeterol Small increase in asthma-related deaths associated with salmeterol

Black box warning – FDA

Combined with Fluticasone

Safety of S+F – Multicentric trial 12000 patients

Inhaled F vs. F + S

No differences in SAE, no deaths, no asthma related hospitalizations

The AUSTRI trial

September 2016

September 2016

Omalizumab for allergic asthma in children 6 to 11 years of age

Monoclonal antibody to immunoglobulin E (IgE) Indication-: patients with moderate to severe persistent asthma and

sensitization to perennial aeroallergens who are inadequately controlled on inhaled glucocorticoids

US-FDA has now lowered the approved age range from 12 to 6 years of age,

July 2016

Evaluation of recurrent wheezing in children <2 years of age

ATS recommendation unresponsive to bronchodilators or inhaled or systemic

glucocorticoids Suggested evaluation: videofluoroscopic swallowing study (modified barium

swallow) for possible swallowing dysfunction. 24-hour esophageal pH monitoring for assessment of GERD. FOB- (BAL) to assess for lower airway bacterial infection

August 2016