1
|
Dicpinigaitis PV, Birring SS, Blaiss M, McGarvey LP, Morice AH, Pavord ID, Satia I, Smith JA, La Rosa C, Li Q, Nguyen AM, Schelfhout J, Tzontcheva A, Muccino D. Demographic, clinical, and patient-reported outcome data from 2 global, phase 3 trials of chronic cough. Ann Allergy Asthma Immunol 2023; 130:60-66. [PMID: 35569802 DOI: 10.1016/j.anai.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The current characterization of patients with refractory or unexplained chronic cough (RCC and UCC, respectively) primarily stems from relatively small clinical studies. OBJECTIVE To report the baseline medical history and clinical characteristics of individuals with RCC or UCC who were enrolled in COUGH-1 and COUGH-2, 2 large, global, phase 3 trials of gefapixant, a P2 × 3-receptor antagonist. METHODS Adults with a chronic cough lasting for more than 1 year, diagnosis of RCC or UCC, and score greater than 40 mm on a 100-mm cough severity visual analog scale at both screening and baseline were eligible for enrollment. Demographics, medical history, and cough characteristics were collected at baseline. Cough-related measures included objective cough frequency, cough severity visual analog scale, Leicester Cough Questionnaire, and Hull Airway Reflux Questionnaire. The data were summarized using descriptive statistics. RESULTS Of 2044 participants, 75% were women; mean age was 58 years, and mean cough duration was approximately 11 years. Among all participants, 73% were previously diagnosed with asthma, gastroesophageal reflux disease, or upper airway cough syndrome. The mean Leicester Cough Questionnaire total score was 10.4, with domain scores reflecting impaired cough-specific quality of life across physical, psychological, and social domains. The mean Hull Airway Reflux Questionnaire score was 39.6, with some of the most burdensome reported items being consistent with features of cough-reflex hypersensitivity. Participant characteristics and cough burden were comparable across geographic regions. CONCLUSION Participants with RCC or UCC had characteristics consistent with published demographics associated with chronic cough. These data reflect a global population with burdensome cough of long duration and substantial impairment to quality of life. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers: COUGH-1, NCT03449134 (https://www. CLINICALTRIALS gov/ct2/show/NCT03449134); COUGH-2, NCT03449147 (https://clinicaltrials.gov/ct2/show/NCT03449147).
Collapse
Affiliation(s)
| | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Michael Blaiss
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Lorcan P McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Science, Queen's University Belfast, Belfast, Northern Ireland
| | - Alyn H Morice
- Hull York Medical School, Cottingham, United Kingdom
| | - Ian D Pavord
- Oxford National Institute for Health Research (NIHR) Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Imran Satia
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Jaclyn A Smith
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester & Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | | | - Qing Li
- Merck & Co, Inc, Kenilworth, New Jersey
| | | | | | | | | |
Collapse
|
2
|
Niimi A, Sagara H, Kikuchi M, Arano I, Sato A, Shirakawa M, La Rosa C, Muccino D. A phase 3, randomized, double-blind, clinical study to evaluate the long-term safety and efficacy of gefapixant in Japanese adult participants with refractory or unexplained chronic cough. Allergol Int 2022; 71:498-504. [PMID: 35752582 DOI: 10.1016/j.alit.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In two phase 3, global clinical trials (COUGH-1 and COUGH-2), the P2X3-receptor antagonist gefapixant significantly reduced objective 24-h cough frequency in participants with refractory or unexplained chronic cough (RCC or UCC) at a dosage of 45 mg twice daily (BID), with an acceptable safety profile. The primary objective of this phase 3, randomized, double-blind, parallel-group study was to assess the safety and tolerability of gefapixant in Japanese participants with RCC or UCC (ClinicalTrials.gov, NCT03696108; JAPIC-CTI, 184154). METHODS Participants aged ≥20 years with chronic cough lasting ≥4 months and a diagnosis of RCC or UCC despite treatment in accordance with Japanese Respiratory Society guidelines were randomized 1:1 to receive gefapixant 15 or 45 mg BID for 52 weeks. The primary objective was to evaluate the safety and tolerability of gefapixant, including adverse events (AEs) and discontinuations due to AEs. Cough-specific quality of life was assessed using the Leicester Cough Questionnaire as a secondary objective. RESULTS Of 169 randomized and treated participants, 63% were female and mean age was 58 years. Adverse events were reported by 79 (94%) and 82 (96%) participants in the 15- and 45-mg BID groups, respectively. Most treatment-related AEs were taste related. Discontinuations due to AEs occurred in 6 (7%) and 17 (20%) participants receiving gefapixant 15 or 45 mg BID, respectively. There were no serious treatment-related AEs or deaths. Leicester Cough Questionnaire total scores improved from baseline through Week 52. CONCLUSIONS Gefapixant had an acceptable safety profile, with no serious treatment-related AEs in Japanese participants.
Collapse
Affiliation(s)
- Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
3
|
Blaiss M, Dicpinigaitis P, Birring S, McGarvey L, Morice A, Pavord I, Satia I, Smith J, La Rosa C, Li Q, Nguyen AM, Schelfhout J, Tzontcheva A, Muccino D. Comparisons Of Baseline Characteristics And Treatment Efficacy In Individuals With Refractory Or Unexplained Chronic Cough Enrolled In Phase 3 Trials Of Gefapixant. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
4
|
Nguyen AM, Schelfhout J, Muccino D, Bacci ED, La Rosa C, Vernon M, Birring SS. Leicester Cough Questionnaire validation and clinically important thresholds for change in refractory or unexplained chronic cough. Ther Adv Respir Dis 2022; 16:17534666221099737. [PMID: 35614875 PMCID: PMC9149626 DOI: 10.1177/17534666221099737] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The Leicester Cough Questionnaire (LCQ), a cough-specific quality-of-life measure, evaluates the impact of cough across physical, psychological, and social domains in patients with chronic cough (CC). This study assessed the psychometric properties of the LCQ. METHODS Data from a phase IIb, randomized controlled trial of the P2X3-receptor antagonist gefapixant were analyzed (NCT02612610). Subjective [Cough Severity Diary, cough severity visual analogue scale, and patient global impression of change (PGIC)] and objective (awake and 24-h cough frequency) data were used to validate the LCQ for use in patients with refractory or unexplained CC (RCC and UCC, respectively). Psychometric analyses included confirmatory factor analyses, internal consistency and test-retest reliability, validity, responsiveness, and estimated within-patient thresholds for clinically meaningful change. RESULTS Model-fit values for the proposed three-factor LCQ domains and most individual items were acceptable. Analyses suggest that a mean improvement ranging from 1.3 to 2.3 points for the LCQ total and ⩾0.8, ⩾0.9, and ⩾0.8 points for physical, psychological, and social domain scores, respectively, had the best sensitivity and/or specificity for predicting patient ratings of improvement on the PGIC. CONCLUSIONS The LCQ is a valid and reliable measure to evaluate cough-specific quality of life and is a fit-for-purpose measure for use in patients with RCC or UCC. Although a single threshold for defining clinically meaningful change depends on the context of use, the results can help guide both treatment decisions and drug development. Therefore, clinicians may consider a ⩾1.3-point increase in the LCQ total score as clinically meaningful.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Surinder S. Birring
- Centre for Human & Applied Physiological
Sciences, School of Basic & Medical Biosciences, Faculty of Life
Sciences & Medicine, King’s College London, Denmark Hill, London SE5
9RS, UK
| |
Collapse
|
5
|
Martin Nguyen A, Bacci ED, Vernon M, Birring SS, Rosa CL, Muccino D, Schelfhout J. Validation of a visual analog scale for assessing cough severity in patients with chronic cough. Ther Adv Respir Dis 2021; 15:17534666211049743. [PMID: 34697975 PMCID: PMC8552382 DOI: 10.1177/17534666211049743] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Patients with chronic cough experience considerable burden. The cough
severity visual analog scale (VAS) records patients’ assessment of cough
severity on a 100-mm linear scale ranging from “no cough” (0 mm) to “worst
cough” (100 mm). Although cough severity scales are widely used in clinical
practice and research, their use in patients with refractory or unexplained
chronic cough has not been formally validated. Methods: This analysis includes data from a phase 2b randomized controlled trial of
the P2X3-receptor antagonist gefapixant for treatment of refractory or
unexplained chronic cough (NCT02612610). Cough severity VAS scores were
assessed at baseline and Weeks 4, 8, and 12. The cough severity VAS was
validated using several outcomes, including the Cough Severity Diary (CSD),
Leicester Cough Questionnaire (LCQ), patient global impression of change
(PGIC) scale, and objective cough frequency. Validation metrics included
test–retest reliability, convergent and known-groups validity,
responsiveness, and score interpretation (i.e., clinically meaningful change
threshold). Results: The analysis included 253 patients (median age, 61.0 years; females, 76%).
Test–retest reliability of the cough severity VAS was moderate (intraclass
correlation coefficient, 0.51). The cough severity VAS had acceptable
convergent validity with other related measures (Pearson r
of 0.53 and -0.41 for CSD and LCQ total scores, respectively;
p < 0.0001 for each). Known-groups validity was
supported by significant differences in mean cough severity VAS scores
across severity groups defined using CSD, LCQ, and cough frequency tertiles.
A large effect size was observed in patients with the greatest improvements
in PGIC (Cohen d = -1.8). A ⩾ 30-mm reduction in the cough
severity VAS was estimated as a clinically meaningful change threshold for
clinical trials in chronic cough. Conclusions: The cough severity VAS is a valid and responsive measure. A cough severity
VAS reduction of ⩾ 30 mm can discriminate clinically meaningful changes in
chronic cough severity in clinical studies.
Collapse
Affiliation(s)
| | | | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | | | | |
Collapse
|
6
|
Muccino D, Philip G, Morice A, Birring S, Mcgarvey L, Dicpinigaitis P, Pavord I, Tershakovec A, Kitt M, Assaid C, Smith J. Rationale and design of two, phase 3, randomized controlled trials (COUGH-1 and COUGH-2) of gefapixant, a P2X3 receptor antagonist, in refractory and unexplained chronic cough. World Allergy Organ J 2020. [DOI: 10.1016/j.waojou.2020.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
7
|
Muccino D, Philip G, Birring S, Morice A, Sher M, Mcgarvey L, Kitt M, Tershakovec A, Xu Z, Smith J. Patient characteristics and triggers eliciting refractory chronic cough. World Allergy Organ J 2020. [DOI: 10.1016/j.waojou.2020.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
8
|
Muccino D, Morice A, Birring A, Mcgarvey L, Dicpinigaitis P, Pavord I, La Rosa C, Urdaneta E, Assaid C, Smith J. BASELINE CHARACTERISTICS FROM A PHASE 3, RANDOMIZED CONTROLLED TRIAL (COUGH-2) OF GEFAPIXANT, A P2X3 RECEPTOR ANTAGONIST, IN REFRACTORY OR UNEXPLAINED CHRONIC COUGH. Chest 2020. [DOI: 10.1016/j.chest.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
9
|
Sher M, Birring S, Morice A, McGarvey L, Smith J, Wu WC, Schelfhout J, Muccino D. Evaluation of co-morbid conditions among refractory or unexplained chronic cough patients in two phase 2 randomized controlled trials. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
10
|
Mehta A, Birring S, McGarvey L, Smith J, Morice A, Sher M, Schelfhout J, Muccino D. BENEFITS OBSERVED WITH PATIENT-REPORTED OUTCOMES IN A PHASE 2B CLINICAL TRIAL OF GEFAPIXANT, A P2X3 RECEPTOR ANTAGONIST IN CHRONIC COUGH. Chest 2019. [DOI: 10.1016/j.chest.2019.08.1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
11
|
Mehta A, Morice A, Birring S, McGarvey L, Sher M, Muccino D, Smith J. CONSISTENCY OF IMPROVEMENT WITH GEFAPIXANT, A P2X3 RECEPTOR ANTAGONIST, IN CHRONIC COUGH PATIENTS DURING WAKING HOURS AND OVER 24 HOURS. Chest 2019. [DOI: 10.1016/j.chest.2019.08.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
12
|
Muccino D, Green S. Update on the clinical development of gefapixant, a P2X3 receptor antagonist for the treatment of refractory chronic cough. Pulm Pharmacol Ther 2019; 56:75-78. [PMID: 30880151 DOI: 10.1016/j.pupt.2019.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
Chronic cough, or cough lasting >8 weeks, is often associated with underlying medical conditions (ie, asthma, gastroesophageal reflux disease, nonasthmatic eosinophilic bronchitis, and upper-airway cough syndrome). In some patients with chronic cough, treatment of these underlying conditions does not resolve the cough (refractory chronic cough [RCC]), or none of these conditions are present (unexplained chronic cough [UCC]). Despite appropriate medical evaluation, patients with RCC or UCC frequently experience cough persisting for many years, as there are currently no targeted pharmacological approaches approved for the treatment of these conditions. However, the adenosine triphosphate (ATP)-gated P2X3 receptor, a key modulator of the activation of sensory neurons central to the cough reflex, has recently garnered attention as a potential therapeutic target for the treatment of chronic cough. Gefapixant, a first-in-class, non-narcotic, selective antagonist of the P2X3 receptor, recently demonstrated efficacy and was generally well tolerated in phase 2 clinical trials in patients with RCC, validating the utility of targeting this receptor in patients with chronic cough. On the basis of these data, 2 global phase 3 trials, with combined anticipated enrolment exceeding 2000 patients and with treatment durations of up to 1 year, have been initiated. Together, these trials will further evaluate efficacy and safety of gefapixant in the control of cough in patients with RCC or UCC.
Collapse
Affiliation(s)
- David Muccino
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.
| | - Stuart Green
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.
| |
Collapse
|
13
|
Birring S, Muccino D, Bacci ED, Vernon MK, Nguyen AM. Defining Minimal Clinically Important Differences (MCID) on the Leicester Cough Questionnaire (LCQ): Analyses of a Phase 2 Randomized Controlled Trial in Chronic Cough. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
14
|
Joish V, Muccino D, Rao N. Characterize Pulmonary Endarterectomy-Eligible Patients Enrolled in a U.S. Managed Care Plan. Chest 2014. [DOI: 10.1378/chest.1808781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
15
|
Joish V, Muccino D, Golick M, Minai O. Physician Monitoring of Pulmonary Arterial Hypertension Subjects: Results From a Large U.S. Health Insurance Claims Database. Chest 2012. [DOI: 10.1378/chest.1387759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
16
|
Danielian PS, Muccino D, Rowitch DH, Michael SK, McMahon AP. Modification of gene activity in mouse embryos in utero by a tamoxifen-inducible form of Cre recombinase. Curr Biol 1998; 8:1323-6. [PMID: 9843687 DOI: 10.1016/s0960-9822(07)00562-3] [Citation(s) in RCA: 1044] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The ability to generate specific genetic modifications in mice provides a powerful approach to assess gene function. When genetic modifications have been generated in the germ line, however, the resulting phenotype often only reflects the first time a gene has an influence on - or is necessary for - a particular biological process. Therefore, systems allowing conditional genetic modification have been developed (for a review, see [1]); for example, inducible forms of the Cre recombinase from P1 phage have been generated that can catalyse intramolecular recombination between target recognition sequences (loxP sites) in response to ligand [2] [3] [4] [5]. Here, we assessed whether a tamoxifen-inducible form of Cre recombinase (Cre-ERTM) could be used to modify gene activity in the mouse embryo in utero. Using the enhancer of the Wnt1 gene to restrict the expression of Cre-ERTM to the embryonic neural tube, we found that a single injection of tamoxifen into pregnant mice induced Cre-mediated recombination within the embryonic central nervous system, thereby activating expression of a reporter gene. Induction was ligand dependent, rapid and efficient. The results demonstrate that tamoxifen-inducible recombination can be used to effectively modify gene function in the mouse embryo.
Collapse
Affiliation(s)
- P S Danielian
- Department of Molecular and Cellular Biology Harvard University 16 Divinity Avenue, Cambridge Massachusetts 02138 USA
| | | | | | | | | |
Collapse
|