1
|
Dixon AE, Que LG, Kalhan R, Dransfield MT, Rogers L, Gerald LB, Kraft M, Krishnan JA, Johnson O, Hazucha H, Roy G, Holbrook JT, Wise RA. Roflumilast May Increase Risk of Exacerbations When Used to Treat Poorly Controlled Asthma in People with Obesity. Ann Am Thorac Soc 2023; 20:206-214. [PMID: 36170654 PMCID: PMC9989863 DOI: 10.1513/annalsats.202204-368oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/28/2022] [Indexed: 02/04/2023] Open
Abstract
Rationale: People with obesity often have severe, difficult-to-control asthma. There is a need to develop better treatments for this population. One potential treatment is roflumilast, a phosphodiesterase 4 inhibitor, as it is reported to have efficacy for the treatment of asthma and can promote weight loss. Objectives: To investigate the potential efficacy of roflumilast for the treatment of poorly controlled asthma in people with obesity. Methods: A randomized, double-masked, placebo-controlled trial of 24 weeks of roflumilast versus placebo for the treatment of poorly controlled asthma in people with obesity (body mass index of 30 kg/m2 or higher). The primary outcome was a change in ACT (Asthma Control Test) score. Results: Twenty-two people were randomized to roflumilast and 16 to placebo. Roflumilast had no effect on change in the ACT (increased by 2.6 [interquartile range (IQR), 0.5-4.4] in those on roflumilast vs. 2.0 [IQR, 0.7-3.3] in those on placebo). Participants assigned to roflumilast had a 3.5-fold (relative risk [RR] 95% confidence interval [CI], 1.3-9.4) increased risk of an episode of poor asthma control and an 8.1-fold (RR 95% CI, 1.01-65.0) increased risk of an urgent care visit for asthma. Ten participants (56%) assigned to roflumilast required a course of oral corticosteroids for asthma exacerbations, and none in the placebo group. Participants losing 5% or more of their body weight experienced a clinically and statistically significant improvement in asthma control (ACT increased by 4.4 [IQR, 2.5-6.3] vs. 1.5 [IQR, 0.0-3.0] in those who lost less than 5%). Conclusions: Roflumilast had no effect on asthma control. Of concern, roflumilast was associated with an increased risk of exacerbation in obese individuals with poorly controlled asthma. These results highlight the importance of studying interventions in different subpopulations of people with asthma, particularly people with obesity and asthma who may respond differently to medications than lean people with asthma. Weight loss of at least 5% was associated with improved asthma control, indicating that interventions other than roflumilast promoting weight loss may have efficacy for the treatment of poorly controlled asthma in people with obesity. Clinical trial registered with www.clinicaltrials.gov (NCT03532490).
Collapse
Affiliation(s)
- Anne E. Dixon
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Loretta G. Que
- Department of Medicine, Duke University Health System, Durham, North Carolina
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Mark T. Dransfield
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Linda Rogers
- Mount Sinai-National Jewish Health Respiratory Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Monica Kraft
- Department of Medicine, College of Medicine, Mel and Enid Zuckerman College of Public Health & Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Jerry A. Krishnan
- Breathe Chicago Center, University of Illinois Chicago, Chicago, Illinois; and
| | - Olivia Johnson
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | | | - Gem Roy
- Bloomberg School of Public Health and
| | | | - Robert A. Wise
- Bloomberg School of Public Health and
- Depatment of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
2
|
Grainge C, Thomas PS, Mak JCW, Benton MJ, Lim TK, Ko FWS. Year in review 2015: Asthma and chronic obstructive pulmonary disease. Respirology 2016; 21:765-75. [PMID: 27028730 DOI: 10.1111/resp.12771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Chris Grainge
- School of Medicine and Public Health, Centre for Asthma and Respiratory Disease, The University of Newcastle.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle
| | - Paul S Thomas
- Inflammation and Infection Research Centre and Prince of Wales' Hospital Clinical School, Faculty of Medicine, University of New South Wales, Kensington.,Department of Respiratory Medicine, Prince of Wales' Hospital, Randwick, New South Wales, Australia
| | - Judith C W Mak
- Department of Medicine and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Melissa J Benton
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado, USA
| | - Tow Keang Lim
- Department of Medicine, National University Hospital, Singapore
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|