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Cazzola M, Rogliani P, Barnes PJ, Blasi F, Celli B, Hanania NA, Martinez FJ, Miller BE, Miravitlles M, Page CP, Tal-Singer R, Matera MG. An Update on Outcomes for COPD Pharmacological Trials: A COPD Investigators Report - Reassessment of the 2008 American Thoracic Society/European Respiratory Society Statement on Outcomes for COPD Pharmacological Trials. Am J Respir Crit Care Med 2023; 208:374-394. [PMID: 37236628 DOI: 10.1164/rccm.202303-0400so] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
Background: In 2008, a dedicated American Thoracic Society/European Respiratory Society task force published a paper on the possible use and limitations of clinical outcomes and biomarkers to evaluate the impact of pharmacological therapy in patients with chronic obstructive pulmonary disease. Since then, our scientific understanding of chronic obstructive pulmonary disease has increased considerably; there has been a progressive shift from a one-size-fits-all diagnostic and therapeutic approach to a personalized approach; and many new treatments currently in development will require new endpoints to evaluate their efficacy adequately. Objectives: The emergence of several new relevant outcome measures motivated the authors to review advances in the field and highlight the need to update the content of the original report. Methods: The authors separately created search strategies for the literature, primarily based on their opinions and assessments supported by carefully chosen references. No centralized examination of the literature or uniform criteria for including or excluding evidence were used. Measurements and Main Results: Endpoints, outcomes, and biomarkers have been revisited. The limitations of some of those reported in the American Thoracic Society/European Respiratory Society task force document have been highlighted. In addition, new tools that may be useful, especially in evaluating personalized therapy, have been described. Conclusions: Because the "label-free" treatable traits approach is becoming an important step toward precision medicine, future clinical trials should focus on highly prevalent treatable traits, and this will influence the choice of outcomes and markers to be considered. The use of the new tools, particularly combination endpoints, could help better identify the right patients to be treated with the new drugs.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Francesco Blasi
- Pulmonology and Cystic Fibrosis Unit, Internal Medicine Department, Foundation Scientific Institute for Research, Hospitalization and Healthcare Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Bartolome Celli
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas
| | - Fernando J Martinez
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clive P Page
- Sackler Institute of Pulmonary Pharmacology, King's College London, London, United Kingdom
| | - Ruth Tal-Singer
- TalSi Translational Medicine Consulting, LLC, Media, Pennsylvania; and
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Polverino F, Sciurba F. Lung volume reduction in COPD: scope or surgery. Eur Respir J 2023; 61:61/4/2300353. [PMID: 37105590 DOI: 10.1183/13993003.00353-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Francesca Polverino
- Pulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Frank Sciurba
- Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Stott-Miller M, Müllerová H, Miller B, Tabberer M, El Baou C, Keeley T, Martinez FJ, Han M, Dransfield M, Hansel NN, Cooper CB, Woodruff P, Ortega VE, Comellas AP, Paine Iii R, Kanner RE, Anderson W, Drummond MB, Kim V, Tal-Singer R, Lazaar AL. Defining Chronic Mucus Hypersecretion Using the CAT in the SPIROMICS Cohort. Int J Chron Obstruct Pulmon Dis 2020; 15:2467-2476. [PMID: 33116463 PMCID: PMC7568676 DOI: 10.2147/copd.s267002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background Chronic cough and phlegm are frequently reported chronic obstructive pulmonary disease (COPD) symptoms. Prior research classified chronic mucus hypersecretion (CMH) based on the presence of these symptoms for ≥3 months, called chronic bronchitis (CB) if respiratory infection symptoms were present for 1–2 years (Medical Research Council [MRC] definition). We explored whether the COPD Assessment Test (CAT), a simple measure developed for routine clinical use, captures CMH populations and outcomes similarly to MRC and St. George’s Respiratory Questionnaire (SGRQ) definitions. Methods We identified CMH in the SPIROMICS COPD cohort using (a) MRC definitions, (b) SGRQ questions for cough and phlegm (both as most/several days a week), and (c) CAT cough and phlegm questions. We determined optimal cut-points for CAT items and described exacerbation frequencies for different CMH definitions. Moderate exacerbations required a new prescription for antibiotics/oral corticosteroids or emergency department visit; severe exacerbations required hospitalization. Results were stratified by smoking status. Results In a population of 1431 participants (57% male; mean FEV1% predicted 61%), 47% and 49% of evaluable participants had SGRQ- or CAT-defined CMH, respectively. A cut-point of ≥2 for cough and phlegm items defined CMH in CAT. Among SGRQ-CMH+ participants, 80% were also defined as CMH+ by the CAT. CMH+ participants were more likely to be current smokers. A higher exacerbation frequency was observed for presence of CMH+ versus CMH− in the year prior to baseline for all CMH definitions; this trend continued across 3 years of follow-up, regardless of smoking status. Conclusion Items from the CAT identified SGRQ-defined CMH, a frequent COPD trait that correlated with exacerbation frequency. The CAT is a short, simple questionnaire and a potentially valuable tool for telemedicine or real-world trials. CAT-based CMH is a novel approach for identifying clinically important characteristics in COPD that can be ascertained in these settings.
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Affiliation(s)
| | | | - Bruce Miller
- GSK R&D, Discovery Medicine, Collegeville, PA, USA
| | - Maggie Tabberer
- GSK R&D Patient-Centred Outcomes: Value, Evidence and Outcomes, Uxbridge, UK
| | | | - Tom Keeley
- GSK R&D Patient-Centred Outcomes: Value, Evidence and Outcomes, Uxbridge, UK
| | | | - Meilan Han
- Division of Pulmonary and Critical Care at the University of Michigan, Ann Arbor, MI, USA
| | - Mark Dransfield
- Children's of Alabama, Children's Health Research Unit/University of Alabama, Birmingham, AB, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Robert Paine Iii
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Richard E Kanner
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Wayne Anderson
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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