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Wu Z, Smith DJF, Yazbeck L, Saunders P, Smith JA, Maher TM, Molyneaux PL. Cough Severity Visual Analog Scale Assesses Cough Burden and Predicts Survival in Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2024; 209:1165-1167. [PMID: 38301238 DOI: 10.1164/rccm.202311-2169le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/01/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Zhe Wu
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - David J F Smith
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Leda Yazbeck
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Peter Saunders
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; and
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Hastings Centre for Pulmonary Research and Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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2
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Nizza IE, Smith JA, Kirkham JA. Picturing oneself over time: a multi-modal interpretative phenomenological analysis of pain management trajectories. Eur J Pain 2024; 28:741-753. [PMID: 38102753 DOI: 10.1002/ejp.2214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Chronic pain (CP) can be a disabling condition with impacts that affect the sense of identity of those who live with it. This article idiographically describes the longitudinal evolution of the sense of self of participants following their referral to a pain management service and participation in a pain management programme (PMP). METHODS Participants were interviewed three times: before they attended a PMP, and 1 and 6 months after the PMP. Data included the drawings of themselves that participants created at each interview and the transcripts of the interviews guided by the drawings, analysed longitudinally using interpretative phenomenological analysis. RESULTS This paper describes in detail the cases of four participants: two who experienced a positive albeit troubled trajectory following their PMP and two who did not experience any positive change. The results provide a nuanced account of how the impacts of CP on identity can evolve, with different people engaging with different aspects of a PMP and some people not engaging at all, and how pain self-management strategies enable those that do engage to cope in times of difficulty. CONCLUSIONS Participant responses to PMP participation are idiosyncratic and interviews with drawings of self analysed longitudinally can help illustrate processes of change. SIGNIFICANCE Not enough is understood about why some people get limited benefits from pain services. This idiographic longitudinal study illustrates how the impact of CP on identity can evolve when people are introduced to pain self-management, with some embracing change and others resisting it. For clinicians, this study describes four detailed CP individual paths, showing the interaction between contextual and idiosyncratic aspects. This is also the first study to use multiple drawings of self to explore the impacts of illness on identity longitudinally. In a person-centred approach to treatment, the drawings of self could also be adopted as a tool in clinician-patient conversations to gain a deeper understanding of the impacts of living with CP.
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Affiliation(s)
- I E Nizza
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - J A Smith
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - J A Kirkham
- Kent Community Health NHS Trust, Ashford, UK
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3
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Affiliation(s)
- Richard D Turner
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, England
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, King's College London, London, England
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4
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Smith JA. The Therapeutic Landscape in Chronic Cough. Lung 2024; 202:5-16. [PMID: 38127133 PMCID: PMC10896934 DOI: 10.1007/s00408-023-00666-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
In recent years, there has been a substantial increase in the development of antitussive therapies and the first new therapy, gefapixant has been licenced in Europe. This review describes current unlicenced treatments for chronic cough and details treatments currently in development for refractory chronic cough and cough in idiopathic pulmonary fibrosis, as well as compounds previously explored.
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Affiliation(s)
- Jaclyn A Smith
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester and Manchester Academic Health Science Centre, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, UK.
- Manchester University NHS Foundation Trust, Manchester, UK.
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5
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Holt KJ, Smith JA. How often do healthy people cough? Respir Res 2023; 24:275. [PMID: 37951970 PMCID: PMC10638680 DOI: 10.1186/s12931-023-02585-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023] Open
Abstract
Objective cough frequency has been reported in several respiratory conditions but the amount that healthy individuals cough daily is unclear. Seventy-nine healthy volunteers (38 males, median [IQR] age 41y [IQR 30-53]) completed 24-hour ambulatory cough monitoring (VitaloJAK™). The audio recording was filtered using a custom written algorithm to remove non-cough sounds and then all individual explosive cough sounds in the filtered file were tagged electronically by trained cough counters. Most coughing occurred during the day and cough numbers over 24 h were generally low (geometric mean of 4.6 coughs) but there was large variability; ranging from 0 to 136 coughs overall. Cough frequency was independent of participant characteristics apart from sex with males coughing significantly, 4-5 fold, more than females during the day and over 24 h (median [IQR] 16.1 [3.8-33.4] vs. 4.1 [1.0-15.0] total coughs; p = 0.015). This is the first report to describe cough frequency in a balanced group of healthy adults using an accurate cough monitoring system. The data reveal a further example of sexual dimorphism in cough, which warrants additional investigation.
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Affiliation(s)
- Kimberley J Holt
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.
- Manchester University NHS Foundation Trust, Manchester, UK.
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
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Maher RE, Barry PJ, Emmott E, Jones AM, Lin L, McNamara PS, Smith JA, Lord RW. Influence of highly effective modulator therapy on the sputum proteome in cystic fibrosis. J Cyst Fibros 2023:S1569-1993(23)01669-7. [PMID: 37951788 DOI: 10.1016/j.jcf.2023.10.019] [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: 07/26/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND There have been dramatic clinical improvements in people with cystic fibrosis (PwCF) commenced on the cystic fibrosis conductance regulator (CFTR) modulator elexacaftor/tezacaftor/ivacaftor (ETI). Sputum proteomics is a powerful research technique capable of identifying important airway disease mechanisms. Using this technique, we evaluated how ETI changes the sputum proteome in PwCF. METHODS Sputum samples from 21 CF subjects pre- and post- ETI, 6 CF controls ineligible for ETI, and 15 healthy controls were analysed by liquid chromatography mass spectrometry. RESULTS Post-ETI, mean FEV1 % increased by 13.7 % (SD 7.9). Principal component and hierarchical clustering analysis revealed that the post-ETI proteome shifted to an intermediate state that was distinct from pre-ETI and healthy controls, even for those achieving normal lung function. Functional analysis showed incomplete resolution of neutrophilic inflammation. The CF control sputum proteome did not alter. At the protein-level many more proteins increased in abundance than decreased following ETI therapy (80 vs 30; adjusted p value <0.05), including many that have anti-inflammatory properties. Of those proteins that reduced in abundance many were pro-inflammatory neutrophil-derived proteins. Several important respiratory proteases were unchanged. CONCLUSIONS Sputum proteomics can provide insights into CF lung disease mechanisms and how they are modified by therapeutic intervention, in this case ETI. This study identifies imbalances in pro- and anti- inflammatory proteins in sputum that partially resolve with ETI even in those achieving normal spirometry values. This post-ETI intermediate state could contribute to ongoing airway damage and therefore its relevance to clinical outcomes needs to be established.
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Affiliation(s)
- Rosemary E Maher
- Centre for Proteome Research, Department of Biochemistry & Systems Biology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Peter J Barry
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - Edward Emmott
- Centre for Proteome Research, Department of Biochemistry & Systems Biology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Andrew M Jones
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, M13 9PL, UK
| | - Lijing Lin
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Paul S McNamara
- Department of Child Health (University of Liverpool), Institute in the Park, Alder Hey Children's Hospital, Eaton Rd, Liverpool, L12 2AP, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, M13 9PL, UK; Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
| | - Robert W Lord
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, M13 9PL, UK.
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Song WJ, Dupont L, Birring SS, Chung KF, Dąbrowska M, Dicpinigaitis P, Ribas CD, Fontana G, Gibson PG, Guilleminault L, Hull JH, Idzko M, Kardos P, Kim HJ, Lai K, Lavorini F, Millqvist E, Morice AH, Niimi A, Parker SM, Satia I, Smith JA, van den Berg JW, McGarvey LP. Consensus goals and standards for specialist cough clinics: the NEUROCOUGH international Delphi study. ERJ Open Res 2023; 9:00618-2023. [PMID: 38020564 PMCID: PMC10658629 DOI: 10.1183/23120541.00618-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background Current guidelines on the management of chronic cough do not provide recommendations for the operation of specialist cough clinics. The objective of the present study was to develop expert consensus on goals and standard procedures for specialist cough clinics. Methods We undertook a modified Delphi process, whereby initial statements proposed by experts were categorised and presented back to panellists over two ranking rounds using an 11-point Likert scale to identify consensus. Results An international panel of 57 experts from 19 countries participated, with consensus reached on 15 out of 16 statements, covering the aims, roles and standard procedures of specialist cough clinics. Panellists agreed that specialist cough clinics offer optimal care for patients with chronic cough. They also agreed that history taking should enquire as to cough triggers, cough severity rating scales should be routinely used, and a minimum of chest radiography, spirometry and measurements of type 2 inflammatory markers should be undertaken in newly referred patients. The importance of specialist cough clinics in promoting clinical research and cough specialty training was acknowledged. Variability in healthcare resources and clinical needs between geographical regions was noted. Conclusions The Delphi exercise provides a platform and guidance for both established cough clinics and those in planning stages.
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Affiliation(s)
- Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Lieven Dupont
- Department of Respiratory Diseases, University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Surinder S. Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Kian Fan Chung
- Experimental Studies Unit, National Heart and Lung Institute, Imperial College London, London, UK
| | - Marta Dąbrowska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Peter Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center Bronx, Bronx, NY, USA
| | - Christian Domingo Ribas
- Servicio de Neumología, Hospital Parc Taulí, Sabadell, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Giovanni Fontana
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Peter G. Gibson
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Laurent Guilleminault
- Service de Pneumologie-Allergologie, Pôle des Voies Respiratoires, Hôpital Larrey and Center for Pathophysiology Toulouse Purpan, INSERM U1043, CNRS UMR 5282, Toulouse III University, Toulouse, France
| | - James H. Hull
- Royal Brompton Hospital, Guy's and St Thomas’ NHS Trust, London, UK
| | - Marco Idzko
- Department of Pneumology, University Hospital Vienna AKH, Medical University of Vienna, Vienna, Austria
| | - Peter Kardos
- Centre of Allergy, Respiratory and Sleep Medicine, Maingau Clinic of the Red Cross, Frankfurt am Main, Germany
| | - Hyun Jung Kim
- Institute for Evidence-Based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kefang Lai
- The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Eva Millqvist
- Department of Allergology, Institution of Internal Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Alyn H. Morice
- Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Akio Niimi
- School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | | | - Imran Satia
- Department of Medicine, McMaster University and Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
| | - Jaclyn A. Smith
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester and Manchester University NHS Trust, Manchester, UK
| | | | - Lorcan P. McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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8
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Hall TR, MacDonald JE, Bylinowski KM, Alvarez EA, Hardesty MM, Smith JA. Management of chemotherapy hypersensitivity reactions and desensitization: An SGO clinical practice statement. Gynecol Oncol 2023; 177:180-185. [PMID: 37717346 DOI: 10.1016/j.ygyno.2023.08.017] [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: 12/31/2022] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE The goal of this practice statement is to help members and their multidisciplinary teams recognize infusion reactions and hypersensitivity reactions in the clinical setting. It will provide recommendations to help guide response to reactions and desensitization when appropriate, to promote safe use of chemotherapeutic agents among all providers in the delivery process. METHODS A multi-disciplinary team of healthcare professionals from the Society of Gynecologic Oncology Education Committee collaborated to review peer reviewed literature and guidelines to develop a practice statement on the management of chemotherapy hypersensitivity reactions and desensitization regimens. RESULTS There is always potential for a patient to have a reaction to any medication, with both infusion reactions and hypersensitivity reactions potentially occurring in the treatment of gynecologic cancers. Premedication to prevent reactions should be given at least prior to infusion for regimens that include the most common agents associated with reactions. At the time when reaction is occurring it might be difficult to distinguish between an infusion reaction versus true hypersensitivity given the similarities in signs and symptoms, therefore it is important that orders to manage reactions be included in every chemotherapy order set so the infusion nurse can provide immediate interventions while waiting for the provider to arrive to assess the patient. Desensitization is a potential option to allow the patient to continue to receive the offending agent. While a variety of desensitization regimens have been presented in the literature, the goal is to minimize steps and variability to decrease opportunity for errors during chemotherapy preparation or administration. CONCLUSION Incorporating a review of the literature and clinical experience from the SGO Education Committee, this paper provides an overview of current approaches for prevention and management of reactions to commonly used chemotherapy agents for gynecologic cancers.
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Affiliation(s)
- T R Hall
- Baylor College of Medicine, Houston, TX, United States of America.
| | - J E MacDonald
- Medical University of South Carolina, Charleston, SC, United States of America
| | - K M Bylinowski
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - E A Alvarez
- University of California - San Francisco, San Francisco, CA, United States of America
| | - M M Hardesty
- Alaska Women's Cancer Care, Anchorage, AK, United States of America
| | - J A Smith
- UT Health McGovern Medical School, Houston, TX, United States of America
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Saunders P, Wu Z, Fahy WA, Stewart ID, Saini G, Smith DJF, Braybrooke R, Stock C, Renzoni EA, Johnson SR, Jenkins RG, Belvisi MG, Smith JA, Maher TM, Molyneaux PL. The Burden and Impact of Cough in Patients with Idiopathic Pulmonary Fibrosis: An Analysis of the Prospective Observational PROFILE Study. Ann Am Thorac Soc 2023; 20:1267-1273. [PMID: 37159951 PMCID: PMC10502892 DOI: 10.1513/annalsats.202302-174oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/09/2023] [Indexed: 05/11/2023] Open
Abstract
Rationale: Cough is a commonly reported symptom in idiopathic pulmonary fibrosis (IPF) that negatively impacts patient-reported quality of life (QoL). However, both the burden of cough at diagnosis and the behavior of cough over time have not been systematically described in patients with IPF. Objectives: By utilizing data prospectively collected as part of the PROFILE study, we sought to assess cough burden and the impact that this has on QoL within a cohort of patients with newly diagnosed IPF. We also reexamined the previously described relationship between cough and mortality and the association of cough with the MUC5B promoter polymorphism. Methods: The PROFILE study is a multicenter, prospective, observational, longitudinal cohort study of incident IPF. Scores on the Leicester Cough Questionnaire (LCQ) were recorded at baseline in 632 subjects and then repeated 6 monthly in a subset (n = 216) of the cohort. Results: The median LCQ score at diagnosis was 16.1 (interquartile range, 6.5). LCQ scores remained stable over the subsequent year in the majority of patients. There was a weak association between LCQ score and baseline lung function, with worse cough-related QoL associated with more severe physiological impairment. Cough scores were not associated with subsequent mortality after correcting for baseline lung function. Furthermore, there was no relationship between LCQ score and MUC5B promoter polymorphism status. Conclusions: The burden of cough in IPF is high. Although cough is weakly associated with disease severity at baseline, cough-specific QoL, as measured by the LCQ, confers no prognostic value. Cough-specific QoL burden remains relatively stable over time and does not associate with MUC5B promoter polymorphism.
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Affiliation(s)
- Peter Saunders
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Zhe Wu
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - William A. Fahy
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Iain D. Stewart
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Gauri Saini
- Centre for Respiratory Research, NIHR Biomedical Research Centre, Translational Medical Sciences, University of Nottingham, Nottingham, United Kingdom
| | - David J. F. Smith
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Rebecca Braybrooke
- Centre for Respiratory Research, NIHR Biomedical Research Centre, Translational Medical Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Carmel Stock
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Elisabetta A. Renzoni
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon R. Johnson
- Centre for Respiratory Research, NIHR Biomedical Research Centre, Translational Medical Sciences, University of Nottingham, Nottingham, United Kingdom
| | - R. Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Maria G. Belvisi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Jaclyn A. Smith
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, United Kingdom
| | - Toby M. Maher
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Hastings Centre for Pulmonary Research and Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Philip L. Molyneaux
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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Maher TM, Avram C, Bortey E, Hart SP, Hirani N, Molyneux PL, Porter JC, Smith JA, Sciascia T. Nalbuphine Tablets for Cough in Patients with Idiopathic Pulmonary Fibrosis. NEJM Evid 2023; 2:EVIDoa2300083. [PMID: 38320144 DOI: 10.1056/evidoa2300083] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Nalbuphine for Cough with Idiopathic Pulmonary FibrosisIn patients with idiopathic pulmonary fibrosis, cough may have a negative impact on daily life. In a randomized, 22-day treatment period, placebo-controlled, crossover trial, extended-release nalbuphine (NAL ER), an opioid agonist-antagonist, was compared to placebo for cough control and adverse effects. During active treatment there was a 75.1% reduction in daytime objective cough frequency compared with 22.6% in the placebo treatment period. Nausea, fatigue, constipation, and dizziness were more common with NAL ER than with placebo.
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Affiliation(s)
- Toby M Maher
- Keck School of Medicine, University of Southern California, Los Angeles
- National Heart and Lung Institute, Imperial College London, London
| | - Cristina Avram
- Northwest Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Enoch Bortey
- Pharmaceutical Development Strategies, LLC, Chapel Hill, NC
| | | | - Nikhil Hirani
- Centre for Inflammation Research, University of Edinburgh, Edinburgh
| | | | - Joanna C Porter
- UCL Respiratory, University College London, London
- ILD Service, University College London Hospitals, London
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
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Birring SS, Dicpinigaitis PV, Smith JA, Morice AH, McGarvey LP, Pavord ID, Nguyen AM, Schelfhout J, Li Q, Iskold B, Green SA, Philip G, Muccino DR, La Rosa C. Efficacy and Safety of Gefapixant for Refractory or Unexplained Chronic Cough over 52 Weeks. Am J Respir Crit Care Med 2023; 207:1539-1542. [PMID: 36996347 PMCID: PMC10263136 DOI: 10.1164/rccm.202211-2128le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
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
| | | | - Jaclyn A. Smith
- Division of Immunology, Immunity to Infection & Respiratory Medicine, University of Manchester and Manchester University National Health Service Trust, Manchester, United Kingdom
| | | | - Lorcan P. McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - Ian D. Pavord
- Oxford National Institute for Health Research Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; and
| | | | | | - Qing Li
- Merck & Co., Inc., Rahway, New Jersey
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12
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Dicpinigaitis PV, Morice AH, Smith JA, Sher MR, Vaezi M, Guilleminault L, Niimi A, Gude K, Krahn U, Saarinen R, Pires PV, Wosnitza M, McGarvey L. Efficacy and Safety of Eliapixant in Refractory Chronic Cough: The Randomized, Placebo-Controlled Phase 2b PAGANINI Study. Lung 2023:10.1007/s00408-023-00621-x. [PMID: 37261531 DOI: 10.1007/s00408-023-00621-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The PAGANINI study evaluated the efficacy and safety of the selective P2X3 antagonist eliapixant in patients with refractory chronic cough (RCC). METHODS PAGANINI was a randomized, double-blind, parallel-group, placebo-controlled, multicenter, dose-finding, phase 2b study. Adults with RCC lasting ≥ 12 months and cough severity ≥ 40 mm on a visual analog scale at screening were enrolled. Participants were randomized 1:1:1:1 to twice-daily 25 mg, 75 mg, or 150 mg oral eliapixant or placebo for 12 weeks. The primary endpoint was change from baseline in 24-h cough count after 12 weeks of intervention. RESULTS Overall, 310 participants were randomized to twice-daily eliapixant 25 mg (n = 75), 75 mg (n = 78), 150 mg (n = 80), or placebo (n = 77). A statistically significant dose-response signal with eliapixant was detected for the primary endpoint (all dose-response models, adjusted p < 0.1; one-sided). Adverse events (AEs) were reported in 39 (51%) participants with placebo and 43-51 (57-65%) participants receiving eliapixant. The most common AE was dysgeusia, occurring in 1% (n = 1) of the placebo group and 1-16% (n = 1-13) of the eliapixant groups in a dose-related manner. One case of a moderate drug-induced liver injury occurred in a participant receiving 150 mg twice-daily eliapixant. CONCLUSION Eliapixant demonstrated efficacy and a favorable taste tolerability profile in RCC. However, a drug-induced liver injury contributed to intensified liver monitoring in clinical trials with eliapixant and discontinuation of the entire development program in all indications by Bayer AG. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04562155; registered September 18, 2020.
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Affiliation(s)
- Peter V Dicpinigaitis
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Alyn H Morice
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Jaclyn A Smith
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Michael Vaezi
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laurent Guilleminault
- Pôle des Voies Respiratoires, CHU de Toulouse, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, Toulouse, France
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University, Nagoya, Japan
| | | | - Ulrike Krahn
- Research and Development, Bayer AG, Wuppertal, Germany
| | | | | | | | - Lorcan McGarvey
- Wellcome Wolfson Institute of Experimental Medicine, Queen's University Belfast, Belfast, UK.
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13
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Birring SS, Morice AH, Dicpinigaitis PV, McGarvey LP, Pavord ID, Green SA, Philip G, Smith JA. Reply to: What the Placebo Tells Us about Chronic Cough. Am J Respir Crit Care Med 2023. [PMID: 37104844 DOI: 10.1164/rccm.202304-0709le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Surinder S Birring
- Department of respiratory medicine, London, United Kingdom of Great Britain and Northern Ireland;
| | - Alyn H Morice
- Hull York Medical School, 12195, Hull, United Kingdom of Great Britain and Northern Ireland
| | - Peter V Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center, Medicine, Bronx, New York, United States
| | - Lorcan P McGarvey
- Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Ian D Pavord
- Oxford University, Nuffield department of Medicine, Respiratory Medicine, Oxford, Oxfordshire, United Kingdom of Great Britain and Northern Ireland
| | | | - George Philip
- Merck & Co Inc, 2793, Rahway, New Jersey, United States
| | - Jaclyn A Smith
- The University of Manchester, 5292, Division of Infection, Immunity and Respiratory Medicine, Manchester, Greater Manchester, United Kingdom of Great Britain and Northern Ireland
- Manchester University NHS Foundation Trust, 5293, Respiratory Medicine, Manchester, Greater Manchester, United Kingdom of Great Britain and Northern Ireland
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14
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Schmidt BE, Washam P, Davis PED, Nicholls KW, Holland DM, Lawrence JD, Riverman KL, Smith JA, Spears A, Dichek DJG, Mullen AD, Clyne E, Yeager B, Anker P, Meister MR, Hurwitz BC, Quartini ES, Bryson FE, Basinski-Ferris A, Thomas C, Wake J, Vaughan DG, Anandakrishnan S, Rignot E, Paden J, Makinson K. Publisher Correction: Heterogeneous melting near the Thwaites Glacier grounding line. Nature 2023; 615:E21. [PMID: 36829047 PMCID: PMC10017506 DOI: 10.1038/s41586-023-05861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- B E Schmidt
- Department of Astronomy, Cornell University, Ithaca, NY, USA. .,Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA.
| | - P Washam
- Department of Astronomy, Cornell University, Ithaca, NY, USA.,Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - D M Holland
- Courant Institute of Mathematical Sciences, New York University, New York, NY, USA.,Center for Global Sea Level Change, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - J D Lawrence
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - K L Riverman
- Department of Environmental Studies, University of Portland, Portland, OR, USA
| | - J A Smith
- British Antarctic Survey, Cambridge, UK
| | - A Spears
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - D J G Dichek
- Department of Astronomy, Cornell University, Ithaca, NY, USA.,Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
| | - A D Mullen
- Department of Astronomy, Cornell University, Ithaca, NY, USA.,Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
| | - E Clyne
- Department of Geosciences, Pennsylvania State University, State College, PA, USA.,Environmental Studies, Lewis & Clark College, Portland, OR, USA
| | - B Yeager
- Center for Global Sea Level Change, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - P Anker
- British Antarctic Survey, Cambridge, UK
| | - M R Meister
- Department of Astronomy, Cornell University, Ithaca, NY, USA.,Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
| | - B C Hurwitz
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - E S Quartini
- Department of Astronomy, Cornell University, Ithaca, NY, USA.,Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
| | - F E Bryson
- Department of Astronomy, Cornell University, Ithaca, NY, USA.,Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA.,School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - A Basinski-Ferris
- Courant Institute of Mathematical Sciences, New York University, New York, NY, USA
| | - C Thomas
- British Antarctic Survey, Cambridge, UK
| | - J Wake
- British Antarctic Survey, Cambridge, UK
| | | | - S Anandakrishnan
- Department of Geosciences, Pennsylvania State University, State College, PA, USA
| | - E Rignot
- Department of Earth System Science, University of California, Irvine, Irvine, CA, USA
| | - J Paden
- Center for Remote Sensing and Integrated Systems, University of Kansas, Lawrence, KS, USA
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McGarvey L, Smith JA, Morice A, Birring SS, Chung KF, Dicpinigaitis PV, Niimi A, Benninger MS, Sher M, Matsunaga Y, Miyazaki S, Machida M, Ishihara H, Mahmood A, Gomez JC. A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Phase 2b Trial of P2X3 Receptor Antagonist Sivopixant for Refractory or Unexplained Chronic Cough. Lung 2023; 201:25-35. [PMID: 36512069 PMCID: PMC9745691 DOI: 10.1007/s00408-022-00592-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION To determine the optimal dose of sivopixant, a highly selective P2X3 receptor antagonist, for refractory or unexplained chronic cough (RCC/UCC). METHODS In this phase 2b, randomized, double-blind, placebo-controlled, parallel-group, multicenter trial, patients received sivopixant 50, 150, or 300 mg or placebo once daily for 4 weeks. The primary endpoint was a change from baseline in 24-h cough frequency (coughs/h) with sivopixant vs placebo. RESULTS Overall, 390/406 randomized patients completed the study. Placebo-adjusted changes in hourly cough count over 24 h were 13.17% (P = 0.3532), - 1.77% (P = 0.8935), and - 12.47% (P = 0.3241) and in cough severity (visual analog scale) were 1.75 mm (P = 0.5854), - 1.21 mm (P = 0.7056), and - 6.55 mm (P = 0.0433) with sivopixant 50, 150, and 300 mg, respectively. Placebo-adjusted changes from baseline in Leicester Cough Questionnaire total scores were - 0.37 (P = 0.4207), - 0.07 (P = 0.8806), and 0.69 (P = 0.1473) with sivopixant 50, 150, and 300 mg, respectively. Additionally, 61.3%, 78.3%, 86.8%, and 71.4% of patients receiving sivopixant 50, 150, and 300 mg and placebo, respectively, reported any improvements in Patient Global Impression of Change. The incidence of treatment-emergent adverse events (TEAEs) was 25.7%, 32.0%, 49.0%, and 20.6% in sivopixant 50, 150, and 300 mg and placebo groups, respectively; all TEAEs in the sivopixant group were mild-to-moderate. CONCLUSION Sivopixant did not demonstrate a statistically significant difference vs placebo in change from baseline in 24-h cough frequency. The dose of 300 mg has potential for RCC/UCC, showing the greatest improvements in cough frequency and patient-reported outcomes and dose-related mild to moderate reversible taste disturbance, although further trials are needed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04110054; registered September 26, 2019.
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Affiliation(s)
| | - Jaclyn A Smith
- University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Alyn Morice
- University of Hull, Castle Hill Hospital, Hull, UK
| | - 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
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College London & Royal Brompton and Harefield Hospitals, London, UK
| | - Peter V Dicpinigaitis
- Albert Einstein College of Medicine, Montefiore Medical Center, Division of Critical Care Medicine, Bronx, NY, USA
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University, Nagoya, Japan
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16
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Schmidt BE, Washam P, Davis PED, Nicholls KW, Holland DM, Lawrence JD, Riverman KL, Smith JA, Spears A, Dichek DJG, Mullen AD, Clyne E, Yeager B, Anker P, Meister MR, Hurwitz BC, Quartini ES, Bryson FE, Basinski-Ferris A, Thomas C, Wake J, Vaughan DG, Anandakrishnan S, Rignot E, Paden J, Makinson K. Heterogeneous melting near the Thwaites Glacier grounding line. Nature 2023; 614:471-478. [PMID: 36792738 PMCID: PMC9931587 DOI: 10.1038/s41586-022-05691-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/22/2022] [Indexed: 02/17/2023]
Abstract
Thwaites Glacier represents 15% of the ice discharge from the West Antarctic Ice Sheet and influences a wider catchment1-3. Because it is grounded below sea level4,5, Thwaites Glacier is thought to be susceptible to runaway retreat triggered at the grounding line (GL) at which the glacier reaches the ocean6,7. Recent ice-flow acceleration2,8 and retreat of the ice front8-10 and GL11,12 indicate that ice loss will continue. The relative impacts of mechanisms underlying recent retreat are however uncertain. Here we show sustained GL retreat from at least 2011 to 2020 and resolve mechanisms of ice-shelf melt at the submetre scale. Our conclusions are based on observations of the Thwaites Eastern Ice Shelf (TEIS) from an underwater vehicle, extending from the GL to 3 km oceanward and from the ice-ocean interface to the sea floor. These observations show a rough ice base above a sea floor sloping upward towards the GL and an ocean cavity in which the warmest water exceeds 2 °C above freezing. Data closest to the ice base show that enhanced melting occurs along sloped surfaces that initiate near the GL and evolve into steep-sided terraces. This pronounced melting along steep ice faces, including in crevasses, produces stratification that suppresses melt along flat interfaces. These data imply that slope-dependent melting sculpts the ice base and acts as an important response to ocean warming.
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Affiliation(s)
- B E Schmidt
- Department of Astronomy, Cornell University, Ithaca, NY, USA.
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA.
| | - P Washam
- Department of Astronomy, Cornell University, Ithaca, NY, USA
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - D M Holland
- Courant Institute of Mathematical Sciences, New York University, New York, NY, USA
- Center for Global Sea Level Change, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - J D Lawrence
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - K L Riverman
- Department of Environmental Studies, University of Portland, Portland, OR, USA
| | - J A Smith
- British Antarctic Survey, Cambridge, UK
| | - A Spears
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - D J G Dichek
- Department of Astronomy, Cornell University, Ithaca, NY, USA
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
| | - A D Mullen
- Department of Astronomy, Cornell University, Ithaca, NY, USA
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
| | - E Clyne
- Department of Geosciences, Pennsylvania State University, State College, PA, USA
- Environmental Studies, Lewis & Clark College, Portland, OR, USA
| | - B Yeager
- Center for Global Sea Level Change, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - P Anker
- British Antarctic Survey, Cambridge, UK
| | - M R Meister
- Department of Astronomy, Cornell University, Ithaca, NY, USA
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
| | - B C Hurwitz
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - E S Quartini
- Department of Astronomy, Cornell University, Ithaca, NY, USA
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
| | - F E Bryson
- Department of Astronomy, Cornell University, Ithaca, NY, USA
- Department of Earth and Atmospheric Sciences, Cornell University, Ithaca, NY, USA
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - A Basinski-Ferris
- Courant Institute of Mathematical Sciences, New York University, New York, NY, USA
| | - C Thomas
- British Antarctic Survey, Cambridge, UK
| | - J Wake
- British Antarctic Survey, Cambridge, UK
| | | | - S Anandakrishnan
- Department of Geosciences, Pennsylvania State University, State College, PA, USA
| | - E Rignot
- Department of Earth System Science, University of California, Irvine, Irvine, CA, USA
| | - J Paden
- Center for Remote Sensing and Integrated Systems, University of Kansas, Lawrence, KS, USA
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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).
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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
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Schelfhout J, Nguyen AM, Birring SS, Bacci ED, Vernon M, Muccino DR, La Rosa C, Smith JA. Validation and Meaningful Change Thresholds for an Objective Cough Frequency Measurement in Chronic Cough. Lung 2022; 200:717-724. [PMID: 36348054 PMCID: PMC9675653 DOI: 10.1007/s00408-022-00587-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Objective cough frequency is used to assess efficacy of chronic cough (CC) treatments. The objective of this study was to explore the relationship between objective cough frequency and cough-specific patient-reported outcomes (PROs) and estimate a clinically meaningful change threshold (MCT) for objective cough frequency. METHODS Data collected in a phase 2b study in participants with refractory or unexplained CC were used to investigate the relationship between 24-h cough frequency (measured using an ambulatory cough monitor) and cough-specific PROs (i.e., cough severity visual analog scale, cough severity diary, Leicester Cough Questionnaire). Convergent validity was assessed using Spearman ρ. An MCT for 24-h cough frequency was estimated using the patient global impression of change (PGIC) scale as an anchor. RESULTS Correlations between 24-h cough frequency and cough-specific PROs at baseline, Week 4, and Week 12 were significant (P < 0.0001) but low to moderate in strength (ρ = 0.30-0.58). Participants categorized as very much improved/much improved (i.e., PGIC of 1 or 2) or minimally improved (i.e., PGIC of 3) had mean 24-h cough frequency reductions of 55% and 30%, respectively. Receiver operating characteristic curve analysis suggested that a 24-h cough frequency reduction of 38% optimizes sensitivity and specificity for predicting a PGIC score of 1-3. CONCLUSION Objective 24-h cough frequency is significantly associated with cough-specific PROs, but cough frequency and PROs most likely capture distinct aspects of CC. A ≥ 30% reduction in 24-h cough frequency is a reasonable MCT to define treatment response in CC clinical trials.
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Affiliation(s)
| | | | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | | | | | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, 2nd Floor Education and Research Centre, University of Manchester and Manchester University NHS Foundation Trust, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK.
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Maher RE, Barrett E, Beynon RJ, Harman VM, Jones AM, McNamara PS, Smith JA, Lord RW. The relationship between lung disease severity and the sputum proteome in cystic fibrosis. Respir Med 2022; 204:107002. [DOI: 10.1016/j.rmed.2022.107002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/17/2022] [Accepted: 09/24/2022] [Indexed: 10/31/2022]
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Smith JA, Kitt MM, Bell A, Noulin N, Tzontcheva A, Seng MM, Lu S. Treatment with the P2X3-Receptor Antagonist Gefapixant for Acute Cough in Induced Viral Upper Respiratory Tract Infection: A Phase 2a, Randomized, Placebo-Controlled Trial. Pulm Ther 2022; 8:297-310. [PMID: 35969360 PMCID: PMC9458823 DOI: 10.1007/s41030-022-00193-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 12/03/2021] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Available therapies for acute cough, a condition frequently caused by a viral upper respiratory tract infection (URTI), have shown limited evidence of efficacy. Gefapixant, a P2X3-receptor antagonist, has demonstrated efficacy and safety in studies of the treatment of refractory or unexplained chronic cough, but its efficacy for treating acute cough has not been previously studied. METHODS This was a phase 2a, randomized, double-blind, placebo-controlled, parallel-group, pilot study. Healthy volunteers were randomized 1:1 to receive twice-daily gefapixant 45 mg or placebo and inoculated with human rhinovirus 16 to induce URTI and cough. Participants were observed while quarantined for 7 days after the start of treatment. The primary endpoint was awake cough frequency on day 3, which was objectively measured with a cough-recording device. Secondary endpoints included change from baseline to day 3 in subjective cough severity measures (cough severity visual analog scale, Cough Severity Diary) and cough-specific quality of life (Leicester Cough Questionnaire-acute). RESULTS Of the 46 participants who met inclusion criteria [mean (standard deviation, SD) age, 24.6 (6.5) years; females, n = 8], 40 completed the study (gefapixant, n = 21; placebo, n = 19). There was no significant difference in awake cough frequency on day 3 between the gefapixant and placebo groups [least squares means, 2.4 versus 2.7 coughs per hour, respectively; mean difference (95% confidence interval, CI), -0.3 (-2.3, 1.7); P = 0.75]. There were no significant between-group differences for any of the secondary endpoints. Peak cough frequency was low and occurred later in the study than expected (days 4-5). The safety profile was consistent with that of previous studies of gefapixant. CONCLUSION Compared with placebo, gefapixant did not reduce the frequency or severity of acute cough secondary to induced URTI. Induced viral URTI produced mild symptoms, including lower cough frequency than observed in previous studies of patients selected for acute cough associated with naturally occurring URTI. TRIAL REGISTRATION ClinicalTrials.gov, NCT03569033; EudraCT, 2017-000472-28; protocol number, MK-7264-013.
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Affiliation(s)
- Jaclyn A Smith
- Division of Infection, Immunity & Respiratory Medicine, 2nd Floor Education & Research Centre, University of Manchester, Manchester University NHS Foundation Trust, Southmoor Rd, Wythenshawe, M23 9LT, Manchester, UK.
| | | | - Alan Bell
- hVIVO, a subsidiary of Open Orphan Plc, London, UK
| | | | | | | | - Susan Lu
- Merck & Co., Inc., Rahway, NJ, USA
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21
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Abstract
Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.
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Affiliation(s)
- Kian Fan Chung
- Experimental Studies Unit, National Heart & Lung Institute, Imperial College London, London, UK
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, London, UK
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Division of Child Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kefang Lai
- The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | | | - 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
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Victoria, Australia.
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22
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Friedrich C, Francke K, Gashaw I, Scheerans C, Klein S, Fels L, Smith JA, Hummel T, Morice A. Safety, Pharmacodynamics, and Pharmacokinetics of P2X3 Receptor Antagonist Eliapixant (BAY 1817080) in Healthy Subjects: Double-Blind Randomized Study. Clin Pharmacokinet 2022; 61:1143-1156. [PMID: 35624408 PMCID: PMC9349145 DOI: 10.1007/s40262-022-01126-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
Background and Objective There is no licensed treatment for refractory chronic cough; off-label therapies have limited efficacy and can produce adverse effects. Excessive adenosine triphosphate signaling via P2X3 receptors is implicated in refractory chronic cough, and selective P2X3 receptor antagonists such as eliapixant (BAY 1817080) are under investigation. The objective of the study was to investigate the safety and tolerability of ascending repeated oral doses of eliapixant in healthy volunteers. Methods We conducted a repeated-dose, double-blind, randomized, placebo-controlled study in 47 healthy male individuals. Subjects received repeated twice-daily ascending oral doses of eliapixant (10, 50, 200, and 750 mg) or placebo for 2 weeks. The primary outcome was frequency and severity of adverse events. Other outcomes included pharmacokinetics and evaluation of taste disturbances, which have occurred with the less selective P2X3 receptor antagonist gefapixant. Results Peak plasma concentrations of eliapixant were reached 3–4 h after administration of the first and subsequent doses. With multiple dosing, steady-state plasma concentrations were reached after ~ 6 days, and plasma concentrations predicted to achieve ≥ 80% P2X3 receptor occupancy (the level required for efficacy) were reached at 200 and 750 mg. Increases in plasma concentrations with increasing doses were less than dose proportional. After multiple dosing, mean plasma concentrations of eliapixant showed low peak–trough fluctuations and were similar for 200- and 750-mg doses. Eliapixant was well tolerated with a low incidence of taste-related adverse events. Conclusions Eliapixant (200 and 750 mg) produced plasma concentrations that cover the predicted therapeutic threshold over 24 h, with good safety and tolerability. These results enabled eliapixant to progress to clinical trials in patients with refractory chronic cough. Clinical Trial Registration Clinicaltrials.gov: NCT03310645 (initial registration: 16 October, 2017). Supplementary Information The online version contains supplementary material available at 10.1007/s40262-022-01126-1. There are few effective treatments for patients with a long-term (chronic) cough. It is thought that chronic cough is caused by nerves becoming oversensitive, wrongly causing a cough when there is no need. We tested a new drug called eliapixant in 47 healthy men. Eliapixant reduces the excessive nerve signaling responsible for chronic cough. We looked for side effects of eliapixant and measured how it behaves in the body. In particular we looked for side effects relating to the sense of taste because gefapixant, a similar drug to eliapixant, can affect taste. Participants took one of four eliapixant doses or a placebo twice daily for 2 weeks. The highest levels of eliapixant in the blood were seen 3–4 h after taking the drug, and stable concentrations were seen after about 6 days. At the two highest doses, eliapixant reached concentrations in the body that should be high enough to work in patients with chronic cough. Side effects were generally similar between eliapixant and placebo. Taste-related side effects were mild and went away without needing treatment. The positive results of this study meant that eliapixant could be tested in patients with chronic cough.
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Affiliation(s)
- Christian Friedrich
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany.
| | - Klaus Francke
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Isabella Gashaw
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany.,Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Christian Scheerans
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Stefan Klein
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Lueder Fels
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Jaclyn A Smith
- University of Manchester, Manchester University NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Alyn Morice
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
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23
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McGarvey LP, Birring SS, Morice AH, Dicpinigaitis PV, Pavord ID, Schelfhout J, Nguyen AM, Li Q, Tzontcheva A, Iskold B, Green SA, Rosa CL, Muccino DR, Smith JA. Efficacy and safety of gefapixant, a P2X 3 receptor antagonist, in refractory chronic cough and unexplained chronic cough (COUGH-1 and COUGH-2): results from two double-blind, randomised, parallel-group, placebo-controlled, phase 3 trials. Lancet 2022; 399:909-923. [PMID: 35248186 DOI: 10.1016/s0140-6736(21)02348-5] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/13/2021] [Accepted: 10/18/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Gefapixant is an oral P2X3 receptor antagonist that has previously shown efficacy and safety in refractory chronic cough and unexplained chronic cough. We therefore aim to confirm the efficacy and safety of gefapixant in participants with refractory chronic cough and unexplained chronic cough. METHODS COUGH-1 and COUGH-2 were both double-blind, randomised, parallel-group, placebo-controlled, phase 3 trials. COUGH-1 was done in 156 sites in 17 countries and COUGH-2 in 175 sites in 20 countries. We enrolled participants who were 18 years or older with a diagnosis of refractory chronic cough or unexplained chronic cough of 1 year duration or more. Participants were also required to have a cough severity visual analogue scale score of 40 mm or more at screening and baseline. Eligible participants were randomly allocated (1:1:1), using a computer-generated allocation schedule, to one of three treatment groups: placebo, gefapixant 15 mg twice per day, or gefapixant 45 mg twice per day. All study treatments were given orally. Participants were treated over a 12-week main study period in COUGH-1 and a 24-week main study period in COUGH-2; followed by extension periods for a total of up to 52 weeks of treatment in both trials. The primary outcome was placebo-adjusted mean change in 24-h cough frequency at 12 weeks in COUGH-1 and 24 weeks in COUGH-2. Both studies were registered with ClinicalTrials.gov, NCT03449134 (COUGH-1) and NCT03449147 (COUGH-2). FINDINGS From March 14, 2018, (first participant screened) to July 26, 2019, (last participant screened) 732 patients were recruited in COUGH-1 and 1317 in COUGH-2. COUGH-1 randomly assigned and treated 730 participants (243 [33×3%] with placebo, 244 [33×4%] with gefapixant 15 mg twice per day, and 243 [33×3%] with gefapixant 45 mg twice per day); COUGH-2 randomly assigned and treated 1314 participants (435 [33×1%] with placebo, 440 [33×5%] with gefapixant 15 mg twice per day, and 439 [33×4%] with gefapixant 45 mg twice per day). Participants were mostly female (542 [74×2%] of 730 in COUGH-1 and 984 [74×9%] of 1314 in COUGH-2). The mean age was 59×0 years (SD 12×6) in COUGH-1 and 58×1 years (12×1) in COUGH-2, and the mean cough duration was 11·6 years (SD 9·5) in COUGH-1 and 11·2 years (9·8) in COUGH-2. Gefapixant 45 mg twice per day showed significant reductions in 24-h cough frequency compared with placebo at week 12 in COUGH-1 (18·5% [95% CI 32·9-0·9]; p=0·041) and at week 24 in COUGH-2 (14·6% [26·1-1·4]; p=0·031). Gefapixant 15 mg twice per day did not show a significant reduction in cough frequency versus placebo in both studies. The most common adverse events were related to taste disturbance: ageusia (36 [4·9%] of 730 in COUGH-1 and 86 [6·5%] of 1314 in COUGH-2), dysgeusia (118 [16·2%] in COUGH-1 and 277 [21·1%] in COUGH-2), hypergeusia (3 [0·4%] in COUGH-1 and 6 [0×5%] in COUGH-2), hypogeusia (19 [2·6%] in COUGH-1 and 80 [6·1%] in COUGH-2), and taste disorder (28 [3·8%] in COUGH-1 and 46 [3·5%] in COUGH-2). INTERPRETATION Gefapixant 45 mg twice per day is the first treatment to show efficacy with an acceptable safety profile in phase 3 clinical trials for refractory chronic cough or unexplained chronic cough. FUNDING Merck Sharp & Dohme.
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Affiliation(s)
- Lorcan P McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - 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
| | - Alyn H Morice
- Respiratory Medicine, Hull York Medical School, Cottingham, UK
| | | | - Ian D Pavord
- Oxford National Institute for Health Research Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Qing Li
- Clinical Research, Merck & Co, Kenilworth, NJ, USA
| | | | - Beata Iskold
- Clinical Research, Merck & Co, Kenilworth, NJ, USA
| | | | | | | | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
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24
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Kum E, Guyatt GH, Munoz C, Beaudin S, Li SA, Abdulqawi R, Badri H, Boulet LP, Chen R, Dicpinigaitis P, Dupont L, Field SK, French CL, Gibson PG, Irwin RS, Marsden P, McGarvey L, Smith JA, Song WJ, O'Byrne PM, Satia I. Assessing cough symptom severity in refractory or unexplained chronic cough: findings from patient focus groups and an international expert panel. ERJ Open Res 2022; 8:00667-2021. [PMID: 35295233 PMCID: PMC8918938 DOI: 10.1183/23120541.00667-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cough symptom severity represents an important subjective end-point to assess the impact of therapies for patients with refractory or unexplained chronic cough (RCC/UCC). As existing instruments assessing the severity of cough are neither widely available nor tested for measurement properties, we aim to develop a new patient-reported outcome measure addressing cough severity. Objective The aim of this study was to establish items and domains that would inform development of a new cough severity instrument. Methods Three focus groups involving 16 adult patients with RCC/UCC provided data that we analysed using directed content analysis. Discussions led to consensus among an international panel of 15 experts on candidate items and domains to assess cough severity. Results The patient focus group provided 48 unique items arranged under broad domains of urge-to-cough sensations and cough symptom. Feedback from expert panel members confirmed the appropriateness of items and domains, and provided an additional subdomain related to cough triggers. The final conceptual framework comprised 51 items in the following domains: urge-to-cough sensations (subdomains: frequency and intensity) and cough symptom (subdomains: triggers, control, frequency, fit/bout duration, intensity, quality and associated features/sequelae). Conclusions Consensus findings from patients and international experts established domains of urge-to-cough and cough symptom with associated subdomains and relevant items. The results support item generation and content validity for a novel patient-reported outcome measure for use in health research and clinical practice. The urge-to-cough (subdomains: frequency and intensity) and cough symptom (subdomains: triggers, control, frequency, fit/bout duration, intensity, quality, and associated features/sequelae) represent domains to assess cough severity in RCC/UCChttps://bit.ly/3fI6qkC
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25
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Singh D, Beier J, Astbury C, Belvisi MG, Da Silva CA, Jauhiainen A, Jimenez E, Lei A, Necander S, Smith JA, Hamrén UW, Xin W, Psallidas I. The novel bronchodilator navafenterol: a phase 2a, multi-centre, randomised, double-blind, placebo-controlled crossover trial in COPD. Eur Respir J 2021; 59:13993003.00972-2021. [PMID: 34503985 PMCID: PMC8989052 DOI: 10.1183/13993003.00972-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/08/2021] [Indexed: 11/05/2022]
Abstract
Background Navafenterol (AZD8871) belongs to a new class of bronchodilator, the single-molecule muscarinic antagonist and β-agonist, developed for the treatment of COPD. This study aimed to evaluate the efficacy, pharmacokinetics and safety of navafenterol versus placebo and an active comparator treatment for moderate-to-severe COPD. Methods This phase 2a, randomised, multicentre (Germany and UK), double-blind, double-dummy, three-way complete crossover study (ClinicalTrials.gov identifier: NCT03645434) compared 2 weeks’ treatment of once-daily navafenterol 600 µg via inhalation with placebo and a fixed-dose combination bronchodilator (umeclidinium/vilanterol (UMEC/VI); 62.5 µg/25 µg) in participants with moderate-to-severe COPD. The primary outcome was change from baseline in trough forced expiratory volume in 1 s (FEV1) on day 15. Secondary end-points included change from baseline in peak FEV1; change from baseline in Breathlessness, Cough and Sputum Scale (BCSS); change from baseline in COPD Assessment Tool (CAT); adverse events; and pharmacokinetics. Results 73 participants were randomised. After 14 days, trough FEV1 was significantly improved with navafenterol compared with placebo (least-squares (LS) mean difference 0.202 L; p<0.0001). There was no significant difference in FEV1 between navafenterol and UMEC/VI (LS mean difference −0.046 L; p=0.075). COPD symptoms (CAT and BCSS) showed significantly greater improvements with both active treatments versus placebo (all p<0.005). Novel objective monitoring (VitaloJAK) showed that cough was reduced with both active treatments compared with placebo. Safety profiles were similar across the treatment groups and no serious adverse events were reported in the navafenterol treatment period. Conclusion Once-daily navafenterol was well tolerated, improved lung function and reduced COPD-related symptoms, similar to an established once-daily fixed-dose combination bronchodilator. Navafenterol, a novel dual-pharmacology bronchodilator for COPD, improved lung function, reduced COPD symptoms and decreased objective cough counts, to a similar extent to umeclidinium/vilanterolhttps://bit.ly/3lV886y
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Affiliation(s)
- Dave Singh
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester, UK .,Division of Infection, Immunity and Respiratory Medicine, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Jutta Beier
- insaf Respiratory Research Institute Wiesbaden, Wiesbaden, Germany
| | - Carol Astbury
- Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Maria G Belvisi
- Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.,Respiratory Pharmacology Group, Airway Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Carla A Da Silva
- Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Alexandra Jauhiainen
- BioPharma Early Biometrics and Statistical Innovation, Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Eulalia Jimenez
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Barcelona, Spain
| | - Alejhandra Lei
- Patient Safety BioPharma, Chief Medical Office, R&D, AstraZeneca, Barcelona, Spain
| | - Sofia Necander
- Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Ulrika Wählby Hamrén
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Wenjing Xin
- BioPharma Early Biometrics and Statistical Innovation, Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Ioannis Psallidas
- Research and Early Development, Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
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26
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Morice A, Smith JA, McGarvey L, Birring SS, Parker SM, Turner A, Hummel T, Gashaw I, Fels L, Klein S, Francke K, Friedrich C. Eliapixant (BAY 1817080), a P2X3 receptor antagonist, in refractory chronic cough: a randomised, placebo-controlled, crossover phase 2a study. Eur Respir J 2021; 58:2004240. [PMID: 33986030 PMCID: PMC8607926 DOI: 10.1183/13993003.04240-2020] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/05/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND ATP acting via P2X3 receptors is an important mediator of refractory chronic cough (RCC). This phase 2a double-blinded crossover study assessed the safety, tolerability and efficacy of eliapixant (BAY 1817080), a selective P2X3 receptor antagonist, in adults with RCC attending specialist centres. METHODS In period A, patients received placebo for 2 weeks then eliapixant 10 mg for 1 week. In period B, patients received eliapixant 50, 200 and 750 mg twice daily for 1 week per dose level. Patients were randomised 1:1 to period A-B (n=20) or B-A (n=20). The primary efficacy end-point was change in cough frequency assessed over 24 h. The primary safety end-point was frequency and severity of adverse events (AEs). RESULTS 37 patients completed randomised therapy. Mean cough frequency fell by 17.4% versus baseline with placebo. Eliapixant reduced cough frequency at doses ≥50 mg (reduction versus placebo at 750 mg: 25% (90% CI 11.5-36.5%); p=0.002). Doses ≥50 mg also significantly reduced cough severity. AEs, mostly mild or moderate, were reported in 65% of patients with placebo and 41-49% receiving eliapixant. Cumulative rates of taste-related AEs were 3% with placebo and 5-21% with eliapixant; all were mild. CONCLUSIONS Selective P2X3 antagonism with eliapixant significantly reduced cough frequency and severity, confirming this as a viable therapeutic pathway for RCC. Taste-related side-effects were lower at therapeutic doses than with the less selective P2X3 antagonist gefapixant. Selective P2X3 antagonism appears to be a novel therapeutic approach for RCC.
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Affiliation(s)
- Alyn Morice
- Respiratory Research Group, Hull York Medical School, University of Hull, Hull, UK
| | - Jaclyn A Smith
- Manchester University NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Lorcan McGarvey
- Wellcome Wolfson Institute of Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College Hospital, London, UK
| | - Sean M Parker
- North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Alice Turner
- Institute of Applied Health Research and Population Sciences, University of Birmingham, Birmingham, UK
| | - Thomas Hummel
- Smell and Taste Clinic, Dept of Otorhinolaryngology, TU Dresden, Dresden, Germany
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27
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Abdulqawi R, Satia I, Holt KJ, Dockry R, Sen S, Smith JA. An open-label study of the tolerability and potential efficacy of memantine for treating refractory chronic cough. ERJ Open Res 2021; 7:00447-2021. [PMID: 34549048 PMCID: PMC8450582 DOI: 10.1183/23120541.00447-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Refractory chronic cough (RCC) is defined as cough lasting longer than 8 weeks either in the absence of an identifiable underlying cause or that remains resistant to treating any potential underlying causes [1]. Affected patients have a poor quality of life and suffer from fatigue, disturbed sleep, incontinence, frustration, anxiety, and depression [2]. Despite being a debilitating condition, no licensed treatment is available. Blocking NMDA receptors with memantine in refractory chronic cough patients is poorly tolerated and demonstrates no improvement in coughhttps://bit.ly/3kgx2g1
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Affiliation(s)
- Rayid Abdulqawi
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, UK.,King Fahad Specialist Hospital-Dammam, and Dept of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Manchester University NHS Foundation Trust, Manchester, UK.,These authors contributed equally
| | - Imran Satia
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, UK.,McMaster University, Dept of Medicine, Division of Respirology, Hamilton, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada.,These authors contributed equally
| | - Kimberley J Holt
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - Rachel Dockry
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - Shilpi Sen
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Jaclyn A Smith
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
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28
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Horsley AR, Belcher J, Bayfield K, Bianco B, Cunningham S, Fullwood C, Jones A, Shawcross A, Smith JA, Maitra A, Gilchrist FJ. Longitudinal assessment of lung clearance index to monitor disease progression in children and adults with cystic fibrosis. Thorax 2021; 77:357-363. [PMID: 34301741 PMCID: PMC8938654 DOI: 10.1136/thoraxjnl-2021-216928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 01/20/2021] [Accepted: 06/05/2021] [Indexed: 12/02/2022]
Abstract
Background Lung clearance index (LCI) is a valuable research tool in cystic fibrosis (CF) but clinical application has been limited by technical challenges and uncertainty about how to interpret longitudinal change. In order to help inform clinical practice, this study aimed to assess feasibility, repeatability and longitudinal LCI change in children and adults with CF with predominantly mild baseline disease. Methods Prospective, 3-year, multicentre, observational study of repeated LCI measurement at time of clinical review in patients with CF >5 years, delivered using a rapid wash-in system. Results 112 patients completed at least one LCI assessment and 98 (90%) were still under follow-up at study end. The median (IQR) age was 14.7 (8.6–22.2) years and the mean (SD) FEV1 z-score was −1.2 (1.3). Of 81 subjects with normal FEV1 (>−2 z-scores), 63% had raised LCI (indicating worse lung function). For repeat stable measurements within 6 months, the mean (limits of agreement) change in LCI was 0.9% (−18.8% to 20.7%). A latent class growth model analysis identified four discrete clusters with high accuracy, differentiated by baseline LCI and FEV1. Baseline LCI was the strongest factor associated with longitudinal change. The median total test time was under 19 min. Conclusions Most patients with CF with well-preserved lung function show stable LCI over time. Cluster behaviours can be identified and baseline LCI is a risk factor for future progression. These results support the use of LCI in clinical practice in identifying patients at risk of lung function decline.
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Affiliation(s)
- Alex R Horsley
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK .,Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Katie Bayfield
- Respiratory Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Brooke Bianco
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Steve Cunningham
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Catherine Fullwood
- Statistics, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK.,MAHSC Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Andrew Jones
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Anna Shawcross
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
| | - Anirban Maitra
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Francis J Gilchrist
- Academic Department of Child Health, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,Institute of Applied Clinical Sciences, Keele University, Keele, UK
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29
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Dockry RJ, Farrelly CL, Mitchell J, Corfield DR, Smith JA. Chronic cough is associated with increased reporting of autonomic symptoms. ERJ Open Res 2021; 7:00105-2021. [PMID: 34262966 PMCID: PMC8273294 DOI: 10.1183/23120541.00105-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/26/2021] [Indexed: 01/21/2023] Open
Abstract
Background Patients with some neuronal hypersensitivity syndromes experience increased autonomic symptoms. Chronic cough is thought to be a neuronal hypersensitivity disorder and, therefore, may be associated with increased autonomic symptoms. Methods 96 chronic cough subjects were recruited from the tertiary cough clinic based at Wythenshawe Hospital, Manchester, UK; 76 healthy controls were also recruited. Subjects were aged >18 years. Those with significant respiratory disease, significant smoking history or taking medication known to affect cough or autonomic function were excluded. Subjects completed the Composite Autonomic Symptom Score (COMPASS) 31 autonomic symptom questionnaire, the Cough Quality of Life Questionnaire (CQLQ) and a cough severity visual analogue scale (VAS). Results 96 chronic cough subjects and 76 healthy volunteers were included in the final analysis. Mann–Whitney U-tests comparing COMPASS 31 scores in both groups showed that the total COMPASS 31 score was significantly higher in the patient group (median 18.4, interquartile range (IQR) 7.5–32.0) than the control group (median 3.6, IQR 1.1–9.5; p<0.001). The chronic cough subjects had significantly higher symptom scores than the healthy volunteer groups in all domains (p≤0.001) except vasomotor symptoms (p=0.770). There was a positive association between COMPASS 31 and CQLQ in the patient group (p<0.001, r=0.432) but not COMPASS 31 and VAS (p=0.227). Interpretation Chronic cough patients do indeed report more frequent and severe autonomic symptoms than healthy volunteers, indicating that this population may suffer from dysautonomia. At present, it remains unclear whether this occurs as a result of the cough or whether both the cough and dysfunction are part of some wider vagal pathology. Chronic refractory cough patients report a greater range and severity of autonomic symptoms when compared to healthy volunteers. This may suggest that the cough is part of a wider vagal pathology.https://bit.ly/33hzJEt
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Affiliation(s)
- Rachel J Dockry
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Carmen L Farrelly
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Joanne Mitchell
- NIHR Manchester Clinical Research Facility at University Hospital of South Manchester, Manchester, UK
| | | | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,NIHR Manchester Clinical Research Facility at University Hospital of South Manchester, Manchester, UK
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Martinez FJ, Afzal AS, Smith JA, Ford AP, Li JJ, Li Y, Kitt MM. Treatment of Persistent Cough in Subjects with Idiopathic Pulmonary Fibrosis (IPF) with Gefapixant, a P2X3 Antagonist, in a Randomized, Placebo-Controlled Clinical Trial. Pulm Ther 2021; 7:471-486. [PMID: 34152585 PMCID: PMC8589896 DOI: 10.1007/s41030-021-00162-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/17/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Chronic cough is a highly problematic symptom for patients with idiopathic pulmonary fibrosis (IPF); limited therapeutic options are available. We evaluated gefapixant, a P2X3 receptor antagonist, for the treatment of chronic cough in IPF. METHODS This randomized, double-blind, placebo-controlled, crossover study included subjects with IPF. Sequence A included gefapixant 50 mg BID (period 1; 14 days) followed by placebo (period 2; 14 days); sequence B had the opposite sequence of treatments. This regimen was specified in a protocol amendment that modified the original active treatment regimen of gefapixant 50 mg BID for 10 days and 150 mg BID for 4 days. Patients randomized to the original treatment regimen were excluded from efficacy analyses but included in safety assessments. The primary efficacy endpoint was change from baseline in awake cough frequency (coughs/hour) from periods 1 and 2 combined. Adverse events (AEs) were monitored throughout the study. RESULTS A total of 51 subjects were randomized, 44 of whom were randomized to treatment sequences evaluated in the primary efficacy analysis (i.e., 22 subjects in sequence A and 22 subjects in sequence B); seven subjects received the treatment assigned before the protocol amendment and were excluded from efficacy analyses. The change from baseline in awake cough frequency from periods 1 and 2 combined (mixed model for repeated measures analysis) did not demonstrate a significant reduction versus placebo in cough at day 14 (p = 0.90); in a post hoc analysis of log-transformed data p value for reduction versus placebo at day 14 was 0.07. The most common AEs were related to taste (dysgeusia and ageusia). CONCLUSIONS Gefapixant was generally well tolerated but was not associated with a significant improvement in chronic cough in subjects with IPF as defined by the primary endpoint in this study. TRIAL REGISTRATION NCT02502097.
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Affiliation(s)
- Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York City, NY, USA.
| | | | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - Yuping Li
- GetStat Solutions, LLC, Palo Alto, CA, USA
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Smith JA, Holt K, Dockry R, Sen S, Sheppard K, Turner P, Czyzyk P, McGuinness K. Performance of a digital signal processing algorithm for the accurate quantification of cough frequency. Eur Respir J 2021; 58:13993003.04271-2020. [PMID: 33875494 DOI: 10.1183/13993003.04271-2020] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/25/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - Kimberley Holt
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - Rachel Dockry
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - Shilpi Sen
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Kitty Sheppard
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Philip Turner
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Paul Czyzyk
- Manchester University NHS Foundation Trust, Manchester, UK
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Smith JA, Harle A, Dockry R, Holt K, Russell P, Molassiotis A, Yorke J, Robinson R, Birrell MA, Belvisi MG, Blackhall F. Aprepitant for Cough in Lung Cancer. A Randomized Placebo-controlled Trial and Mechanistic Insights. Am J Respir Crit Care Med 2021; 203:737-745. [PMID: 32966755 PMCID: PMC7958516 DOI: 10.1164/rccm.202006-2359oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/18/2020] [Indexed: 01/26/2023] Open
Abstract
Rationale: Effective cough treatments are a significant unmet need in patients with lung cancer. Aprepitant is a licensed treatment for nausea and vomiting, which blocks substance P activation of NK-1 (neurokinin 1) receptors, a mechanism also implicated in cough.Objectives: To assess aprepitant in patients with lung cancer with cough and evaluate mechanisms in vagal nerve tissue.Methods: Randomized double-blind crossover trial of patients with lung cancer and bothersome cough. They received 3 days of aprepitant or matched placebo; after a 3-day washout, patients crossed to the alternative treatment. The primary endpoint was awake cough frequency measured at screening and Day 3 of each treatment; secondary endpoints included patient-reported outcomes. In vitro, the depolarization of isolated guinea pig and human vagus nerve sections in grease-gap recording chambers, indicative of sensory nerve activation, was measured to evaluate the mechanism.Measurements and Main Results: Twenty patients with lung cancer enrolled, with a mean age 66 years (±7.7); 60% were female and 80% had non-small cell cancer, 50% had advanced stage, and 55% had World Health Organization performance status 1. Cough frequency improved with aprepitant, reducing by 22.2% (95% confidence interval [CI], 2.8-37.7%) over placebo while awake (P = 0.03), 30.3% (95% CI, 12.7-44.3) over 24 hours (P = 0.002), and 59.8% (95% CI, 15.1-86.0) during sleep (P = 0.081). Patient-reported outcomes all significantly improved. Substance P depolarized both guinea pig and human vagus nerve. Aprepitant significantly inhibited substance P-induced depolarization by 78% in guinea pig (P = 0.0145) and 94% in human vagus (P = 0.0145).Conclusions: Substance P activation of NK-1 receptors appears to be an important mechanism driving cough in lung cancer, and NK-1 antagonists show promise as antitussive therapies.
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Affiliation(s)
- Jaclyn A. Smith
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre
- Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Amélie Harle
- Division of Molecular and Clinical Cancer Sciences, Manchester Academic Health Sciences Centre, and
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Rachel Dockry
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre
- Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Kimberley Holt
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre
- Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Philip Russell
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Alex Molassiotis
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Ryan Robinson
- Division of Airway Disease, Respiratory Pharmacology Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Mark A. Birrell
- Division of Airway Disease, Respiratory Pharmacology Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
- Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Maria G. Belvisi
- Division of Airway Disease, Respiratory Pharmacology Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
- Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Fiona Blackhall
- Division of Molecular and Clinical Cancer Sciences, Manchester Academic Health Sciences Centre, and
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
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Satia I, Iovoli E, Holt K, Woodcock AA, Belcher J, Smith JA. Reply to: Noxious cold stimulation: pro–con perspectives on the hypothermic effect on experimentally evoked cough. Eur Respir J 2021; 57:57/3/2100245. [DOI: 10.1183/13993003.00245-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/21/2022]
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Smith JA, West PW. Branching Out in Chronic Cough: Evidence for Increased Airway Nerve Density. Am J Respir Crit Care Med 2021; 203:283-284. [PMID: 32926806 PMCID: PMC7874324 DOI: 10.1164/rccm.202008-3292ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jaclyn A Smith
- Division of Infection Immunity and Respiratory Medicine University of Manchester, Manchester United Kingdom.,Manchester University NHS Foundation Trust Wythenshawe Hospital Manchester, United Kingdom and
| | - Peter W West
- Lydia Becker Institute of Immunology and Inflammation University of Manchester Manchester, United Kingdom
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Christiansen C, Castillo-Fernandez JE, Domingo-Relloso A, Zhao W, El-Sayed Moustafa JS, Tsai PC, Maddock J, Haack K, Cole SA, Kardia SLR, Molokhia M, Suderman M, Power C, Relton C, Wong A, Kuh D, Goodman A, Small KS, Smith JA, Tellez-Plaza M, Navas-Acien A, Ploubidis GB, Hardy R, Bell JT. Novel DNA methylation signatures of tobacco smoking with trans-ethnic effects. Clin Epigenetics 2021; 13:36. [PMID: 33593402 PMCID: PMC7888173 DOI: 10.1186/s13148-021-01018-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 10/15/2020] [Accepted: 01/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Smoking remains one of the leading preventable causes of death. Smoking leaves a strong signature on the blood methylome as shown in multiple studies using the Infinium HumanMethylation450 BeadChip. Here, we explore novel blood methylation smoking signals on the Illumina MethylationEPIC BeadChip (EPIC) array, which also targets novel CpG-sites in enhancers. METHOD A smoking-methylation meta-analysis was carried out using EPIC DNA methylation profiles in 1407 blood samples from four UK population-based cohorts, including the MRC National Survey for Health and Development (NSHD) or 1946 British birth cohort, the National Child Development Study (NCDS) or 1958 birth cohort, the 1970 British Cohort Study (BCS70), and the TwinsUK cohort (TwinsUK). The overall discovery sample included 269 current, 497 former, and 643 never smokers. Replication was pursued in 3425 trans-ethnic samples, including 2325 American Indian individuals participating in the Strong Heart Study (SHS) in 1989-1991 and 1100 African-American participants in the Genetic Epidemiology Network of Arteriopathy Study (GENOA). RESULTS Altogether 952 CpG-sites in 500 genes were differentially methylated between smokers and never smokers after Bonferroni correction. There were 526 novel smoking-associated CpG-sites only profiled by the EPIC array, of which 486 (92%) replicated in a meta-analysis of the American Indian and African-American samples. Novel CpG sites mapped both to genes containing previously identified smoking-methylation signals and to 80 novel genes not previously linked to smoking, with the strongest novel signal in SLAMF7. Comparison of former versus never smokers identified that 37 of these sites were persistently differentially methylated after cessation, where 16 represented novel signals only profiled by the EPIC array. We observed a depletion of smoking-associated signals in CpG islands and an enrichment in enhancer regions, consistent with previous results. CONCLUSION This study identified novel smoking-associated signals as possible biomarkers of exposure to smoking and may help improve our understanding of smoking-related disease risk.
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Affiliation(s)
- C Christiansen
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | | | - A Domingo-Relloso
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
- Department of Statistics and Operative Research, University of Valencia, Valencia, Spain
| | - W Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - J S El-Sayed Moustafa
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - P-C Tsai
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - J Maddock
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - K Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio, USA
| | - S A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, USA
| | - S L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - M Molokhia
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - M Suderman
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - C Power
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - C Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - A Wong
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - D Kuh
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - A Goodman
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - K S Small
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - J A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - M Tellez-Plaza
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - A Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - G B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - R Hardy
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - J T Bell
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
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Lee KK, Davenport PW, Smith JA, Irwin RS, McGarvey L, Mazzone SB, Birring SS. Global Physiology and Pathophysiology of Cough: Part 1: Cough Phenomenology - CHEST Guideline and Expert Panel Report. Chest 2021; 159:282-293. [PMID: 32888932 PMCID: PMC8640837 DOI: 10.1016/j.chest.2020.08.2086] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022] Open
Abstract
The purpose of this state-of-the-art review is to update the American College of Chest Physicians 2006 guideline on global physiology and pathophysiology of cough. A review of the literature was conducted using PubMed and MEDLINE databases from 1951 to 2019 and using prespecified search terms. We describe the basic phenomenology of cough patterns, behaviors, and morphological features. We update the understanding of mechanical and physiological characteristics of cough, adding a contemporary view of the types of cough and their associated behaviors and sensations. New information about acoustic characteristics is presented, and recent insights into cough triggers and the patient cough hypersensitivity phenotype are explored. Lastly, because the clinical assessment of patients largely focuses on the duration rather than morphological features of cough, we review the morphological features of cough that can be measured in the clinic. This is the first of a two-part update to the American College of Chest Physicians 2006 cough guideline; it provides a more global consideration of cough phenomenology, beyond simply the mechanical aspects of a cough. A greater understanding of the typical features of cough, and their variations, may allow a more informed interpretation of cough measurements and the clinical relevance for patients.
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Affiliation(s)
- Kai K Lee
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, England
| | - Paul W Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, FL
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, MA
| | - Lorcan McGarvey
- Centre for Experimental Medicine, Department of Medicine, Queen's University Belfast, Belfast, Northern Ireland.
| | - Stuart B Mazzone
- Department of Anatomy and Neuroscience, School of Biomedical Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, England
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Abdulqawi R, Satia I, Kanemitsu Y, Khalid S, Holt K, Dockry R, Woodcock AA, Smith JA. A Randomized Controlled Trial to Assess the Effect of Lidocaine Administered via Throat Spray and Nebulization in Patients with Refractory Chronic Cough. J Allergy Clin Immunol Pract 2020; 9:1640-1647. [PMID: 33259976 DOI: 10.1016/j.jaip.2020.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/28/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Refractory chronic cough (RCC) is a debilitating condition for which there are no licensed treatments. Lidocaine is a nonselective inhibitor of voltage-gated sodium channels with potential antitussive effects, but randomized placebo-controlled studies evaluating its efficacy in RCC are lacking. OBJECTIVE To investigate the efficacy of nebulized lidocaine and lidocaine throat spray versus matched placebos in RCC. METHODS This was a randomized, double-blind, double-dummy, placebo-controlled, 3-way crossover study, comparing the effect of single doses of nebulized lidocaine with lidocaine delivered by a throat spray and matched placebo. The primary end point was cough frequency over the 10 hours following treatment. Secondary end points were visual analog scale scores for urge-to-cough and cough severity; an exploratory analysis evaluated hourly cough rates up to 5 hours after treatment. RESULTS Twenty-six subjects with RCC were recruited (22 females; mean age, 53.5 ± 12.1 years; FEV1 %predicted, 105.2 ± 16.8 L; forced vital capacity %predicted, 112.4 ± 18 L). Lidocaine throat spray, but not nebulized lidocaine, significantly reduced 10-hour cough frequency as compared with placebo (throat spray, 22.6 coughs/h; nebulization, 26.9 coughs/h; and placebos, 27.6 coughs/h; P = .04,). Lidocaine throat spray showed the greatest effect on cough compared with placebo in the first hour after administration (31.7 coughs/h vs 74.2 coughs/h; P = .004). Both nebulizer and spray treatments significantly alleviated urge-to-cough and cough severity visual analog scale scores compared with placebo (P < .05). There were no serious adverse events associated with lidocaine therapy. CONCLUSIONS Lidocaine throat spray was effective in reducing cough frequency in patients with RCC. Voltage-gated sodium channel inhibitors applied to pharynx have potential as therapies for RCC.
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Affiliation(s)
- Rayid Abdulqawi
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, United Kingdom; Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia; Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Imran Satia
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, United Kingdom; McMaster University, Department of Medicine, Division of Respirology, Hamilton, ON, Canada
| | - Yoshihiro Kanemitsu
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom; Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Saifudin Khalid
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, United Kingdom; East Lancashire Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom
| | - Kimberley Holt
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Rachel Dockry
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Ashley A Woodcock
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Jaclyn A Smith
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom.
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Muccino DR, Morice AH, Birring SS, Dicpinigaitis PV, Pavord ID, Assaid C, Kleijn HJ, Hussain A, La Rosa C, McGarvey L, Smith JA. Design and rationale of two phase 3 randomised controlled trials (COUGH-1 and COUGH-2) of gefapixant, a P2X3 receptor antagonist, in refractory or unexplained chronic cough. ERJ Open Res 2020; 6:00284-2020. [PMID: 33263037 PMCID: PMC7682670 DOI: 10.1183/23120541.00284-2020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/29/2020] [Indexed: 11/06/2022] Open
Abstract
Background We present study designs, dose selection and preliminary patient characteristics from two phase 3 clinical trials of gefapixant, a P2X3 receptor antagonist, in refractory chronic cough (RCC) or unexplained chronic cough (UCC). Methods COUGH-1 (NCT03449134) and COUGH-2 (NCT03449147) are randomised, placebo-controlled, double-blind, parallel-group trials in subjects with RCC or UCC (age ≥18 years; cough duration ≥1 year; Cough Severity Visual Analogue Scale score ≥40 mm). The primary efficacy study periods are 12 weeks (40-week extension; COUGH-1) and 24 weeks (28-week extension; COUGH-2). Interventions include placebo, gefapixant 15 mg and gefapixant 45 mg (1:1:1 ratio). The primary efficacy endpoints are average 24-h cough frequency at Week 12 (COUGH-1) and Week 24 (COUGH-2). Awake cough frequency, patient-reported outcomes and responder analyses are secondary endpoints. Results The doses of 45 mg (to provide maximal efficacy and acceptable tolerability) and 15 mg (to provide acceptable efficacy and improved tolerability) were selected based on phase 1 and 2 studies. In COUGH-1, 730 participants have been randomised and treated; 74% are female with mean age of 59 years (39% over 65 years), and mean baseline duration of cough of 11.5 years. In COUGH-2, 1314 participants have been randomised and treated; 75% are female with mean age of 58 years (33% over 65 years), and mean baseline duration of cough of 11.1 years. Conclusions These global studies include participants with baseline characteristics consistent with previous RCC and UCC studies and will inform the efficacy and safety profile of gefapixant in the treatment of patients with RCC and UCC. This protocol describes the design of two global, phase 3 studies with >2000 participants with refractory or unexplained chronic cough, designed to confirm efficacy and safety of gefapixant, a P2X3 receptor antagonist, at doses of 45 mg and 15 mghttps://bit.ly/2Xzgu74
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Affiliation(s)
| | | | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
| | | | - Ian D Pavord
- Oxford NIHR Respiratory BRC, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | | | | | | | | | - Lorcan McGarvey
- Wellcome-Wolfson Institute of Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester and Manchester University NHS Trust, Manchester, UK
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Smith JA, Kitt MM, Morice AH, Birring SS, McGarvey LP, Sher MR, Li YP, Wu WC, Xu ZJ, Muccino DR, Ford AP, Smith J, McGarvey L, Birring S, Hull J, Carr WW, Goldsobel AB, Gross GN, Holcomb JR, Hussain I, Sher M, Spangenthal S, Storms W, Morice A, Elkayam D, Steven GC, Krainson J, Fakih FA, Matz J, Brooks GD, Casale T, Berman GD, Condemi JJ, Greos LS, Gogate SU, Sher ER, Friesen JH, Schenkel EJ, Bernstein DI, Corren J, Sundar K, Gotfried MH, Montanaro A, Lumry WR, Amar NJ, Kaplan MS, Prenner BM, Murphy TR, Good JS, Parker S, Harrison T, Pavord I, Brightling C, Djukanovic R, McQuaid D, Denenberg M, Ettinger NA, Iyer V. Gefapixant, a P2X3 receptor antagonist, for the treatment of refractory or unexplained chronic cough: a randomised, double-blind, controlled, parallel-group, phase 2b trial. The Lancet Respiratory Medicine 2020; 8:775-785. [DOI: 10.1016/s2213-2600(19)30471-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 01/02/2023]
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Hilton E, Satia I, Holt K, Woodcock AA, Belcher J, Smith JA. The Effect of Pain Conditioning on Experimentally Evoked Cough: Evidence of Impaired Endogenous Inhibitory Control Mechanisms in Refractory Chronic Cough. Eur Respir J 2020; 56:2001387. [PMID: 32703776 DOI: 10.1183/13993003.01387-2020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/28/2020] [Indexed: 01/31/2023]
Abstract
The pathophysiology of refractory chronic cough (RCC) is unclear. We hypothesised that endogenous inhibitory control mechanisms, such as those activated by noxiousstimuli inducing pain (conditioned pain modulation (CPM)), may be capable of inhibiting coughing and urge to cough evoked by inhaled capsaicin. Furthermore, these mechanisms may be impaired in patients with RCC.The objective was to investigate the effects of pain on cough and urge to cough (UTC) in healthy volunteers (HV) and RCC. HV and RCC patients underwent a randomised, controlled, 4-way cross-over study comparing the effect of 4 interventions on capsaicin evoked coughing and UTC. The interventions comprised immersing a hand in i) noxious cold-water, ii) warm water, iii) warm water but instructed to voluntarily supress coughing and iv) no intervention. The co-primary outcomes were numbers of evoked coughs and UTC scores.Twenty HV (mean age 50.1(±SD14.2), M:F 10:10) and 20 RCC (age 60.1(±7.9), M:F 9:11) participated. Overall, noxious cold water reduced capsaicin evoked UTC scores and cough numbers compared with warm water (1.6 (95% C.I. 1.3-2.0) versus 2.2 (1.8-2.6) p<0.001; 4.8 coughs (3.7-6.2) versus 7.9 coughs (6.7-9.5) p<0.001, respectively). HV and RCC demonstrated similar reductions in the UTC during noxious cold-water immersion, but noxious cold water and voluntary suppression interventions were less effective in RCC than HV in reducing capsaicin evoked cough (p=0.041).Endogenous inhibitory control mechanisms, specifically those activated by pain, can reduce both coughing and the UTC. Impairment of endogenous inhibitory control mechanisms may contribute to excessive coughing in RCC.
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Affiliation(s)
- Emma Hilton
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Equal contributors
| | - Imran Satia
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Canada
- Equal contributors
| | - Kimberley Holt
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Ashley A Woodcock
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - John Belcher
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
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Conejos-Sánchez I, Gallon E, Niño-Pariente A, Smith JA, De la Fuente AG, Di Canio L, Pluchino S, Franklin RJM, Vicent MJ. Polyornithine-based polyplexes to boost effective gene silencing in CNS disorders. Nanoscale 2020; 12:6285-6299. [PMID: 31840717 DOI: 10.1039/c9nr06187h] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Gene silencing therapies have successfully suppressed the translation of target proteins, a strategy that holds great promise for the treatment of central nervous system (CNS) disorders. Advances in the current knowledge on multimolecular delivery vehicles are concentrated on overcoming the difficulties in delivery of small interfering (si)RNA to target tissues, which include anatomical accessibility, slow diffusion, safety concerns, and the requirement for specific cell uptake within the unique environment of the CNS. The present work addressed these challenges through the implementation of polyornithine derivatives in the construction of polyplexes used as non-viral siRNA delivery vectors. Physicochemical and biological characterization revealed biodegradability and biocompatibility of our polyornithine-based system and the ability to silence gene expression in primary oligodendrocyte progenitor cells (OPCs) effectively. In summary, the well-defined properties and neurological compatibility of this polypeptide-based platform highlight its potential utility in the treatment of CNS disorders.
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Affiliation(s)
- I Conejos-Sánchez
- Centro de Investigación Príncipe Felipe. Polymer Therapeutics Laboratory, C/Eduardo Primo Yúfera, 3, 46012 Valencia, Spain.
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42
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Smith JA, McGarvey L, Morice AH, Birring SS, Wedzicha JA, Notari M, Zapata A, Segarra R, Seoane B, Jarreta D. The Effect of Aclidinium on Symptoms Including Cough in Chronic Obstructive Pulmonary Disease: A Phase 4, Double-Blind, Placebo-controlled, Parallel-Group Study. Am J Respir Crit Care Med 2020; 200:642-645. [PMID: 30951372 PMCID: PMC6727161 DOI: 10.1164/rccm.201901-0048le] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jaclyn A Smith
- Manchester University NHS Foundation TrustManchester, United Kingdom.,University of ManchesterManchester, United Kingdom
| | | | | | - Surinder S Birring
- King's College LondonLondon, United Kingdom.,King's College HospitalLondon, United Kingdom
| | | | - Massimo Notari
- A. Menarini Farmaceutica Internazionale s.r.l.Florence, Italy
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43
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Smith JA, Wortley MA, Bonvini S, Birrell M, Belvisi MG. "Truth is ever to be found in simplicity, and not in the multiplicity and confusion of things" - Sir Isaac Newton. Eur Respir J 2020; 55:55/2/1901566. [PMID: 32029640 DOI: 10.1183/13993003.01566-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/01/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK .,Manchester University NHS Foundation Trust, Manchester, UK
| | - Mike A Wortley
- Respiratory Pharmacology Group, Airway Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Sara Bonvini
- Respiratory Pharmacology Group, Airway Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Mark Birrell
- Respiratory Pharmacology Group, Airway Disease, National Heart and Lung Institute, Imperial College London, London, UK.,Respiratory, Inflammation and Autoimmune (RIA), BioPharmaceuticals R&D, AstraZeneca, Sweden
| | - Maria G Belvisi
- Respiratory Pharmacology Group, Airway Disease, National Heart and Lung Institute, Imperial College London, London, UK.,Respiratory, Inflammation and Autoimmune (RIA), BioPharmaceuticals R&D, AstraZeneca, Sweden
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44
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Smith JA, Kitt MM, Butera P, Smith SA, Li Y, Xu ZJ, Holt K, Sen S, Sher MR, Ford AP. Gefapixant in two randomised dose-escalation studies in chronic cough. Eur Respir J 2020; 55:13993003.01615-2019. [DOI: 10.1183/13993003.01615-2019] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/19/2019] [Indexed: 12/24/2022]
Abstract
Background and objectivesGefapixant has previously demonstrated efficacy in the treatment of refractory chronic cough at a high daily dose. The current investigations explore efficacy and tolerability of gefapixant, a P2X3 receptor antagonist, for the treatment of chronic cough using a dose-escalation approach.Materials and methodsTwo randomised, double-blind, placebo-controlled, crossover, dose-escalation studies recruited participants with refractory chronic cough. Patients were assigned to receive ascending doses of gefapixant (study 1: 50–200 mg, study 2: 7.5–50 mg) or placebo for 16 days, then crossed-over after washout. The primary end-point was awake cough frequency assessed using a 24-h ambulatory cough monitor at baseline and on day 4 of each dose. Patient-reported outcomes included a cough severity visual analogue scale and the cough severity diary.ResultsIn clinical studies, gefapixant doses ≥30 mg produced maximal improvements in cough frequency compared with placebo (p<0.05); reported cough severity measures improved at similar doses. Taste disturbance exhibited a different relationship with dose, apparently maximal at doses ≥150 mg.ConclusionsP2X3 antagonism with gefapixant demonstrates anti-tussive efficacy and improved tolerability at lower doses than previously investigated. Studies of longer duration are warranted.
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45
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Crous PW, Wingfield MJ, Lombard L, Roets F, Swart WJ, Alvarado P, Carnegie AJ, Moreno G, Luangsaard J, Thangavel R, Alexandrova AV, Baseia IG, Bellanger JM, Bessette AE, Bessette AR, De la Peña-Lastra S, García D, Gené J, Pham THG, Heykoop M, Malysheva E, Malysheva V, Martín MP, Morozova OV, Noisripoom W, Overton BE, Rea AE, Sewall BJ, Smith ME, Smyth CW, Tasanathai K, Visagie CM, Adamčík S, Alves A, Andrade JP, Aninat MJ, Araújo RVB, Bordallo JJ, Boufleur T, Baroncelli R, Barreto RW, Bolin J, Cabero J, Caboň M, Cafà G, Caffot MLH, Cai L, Carlavilla JR, Chávez R, de Castro RRL, Delgat L, Deschuyteneer D, Dios MM, Domínguez LS, Evans HC, Eyssartier G, Ferreira BW, Figueiredo CN, Liu F, Fournier J, Galli-Terasawa LV, Gil-Durán C, Glienke C, Gonçalves MFM, Gryta H, Guarro J, Himaman W, Hywel-Jones N, Iturrieta-González I, Ivanushkina NE, Jargeat P, Khalid AN, Khan J, Kiran M, Kiss L, Kochkina GA, Kolařík M, Kubátová A, Lodge DJ, Loizides M, Luque D, Manjón JL, Marbach PAS, Massola NS, Mata M, Miller AN, Mongkolsamrit S, Moreau PA, Morte A, Mujic A, Navarro-Ródenas A, Németh MZ, Nóbrega TF, Nováková A, Olariaga I, Ozerskaya SM, Palma MA, Petters-Vandresen DAL, Piontelli E, Popov ES, Rodríguez A, Requejo Ó, Rodrigues ACM, Rong IH, Roux J, Seifert KA, Silva BDB, Sklenář F, Smith JA, Sousa JO, Souza HG, De Souza JT, Švec K, Tanchaud P, Tanney JB, Terasawa F, Thanakitpipattana D, Torres-Garcia D, Vaca I, Vaghefi N, van Iperen AL, Vasilenko OV, Verbeken A, Yilmaz N, Zamora JC, Zapata M, Jurjević Ž, Groenewald JZ. Fungal Planet description sheets: 951-1041. Persoonia 2019; 43:223-425. [PMID: 32214501 PMCID: PMC7085856 DOI: 10.3767/persoonia.2019.43.06] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 10/09/2019] [Indexed: 11/25/2022]
Abstract
Novel species of fungi described in this study include those from various countries as follows: Antarctica, Apenidiella antarctica from permafrost, Cladosporium fildesense from an unidentified marine sponge. Argentina, Geastrum wrightii on humus in mixed forest. Australia, Golovinomyces glandulariae on Glandularia aristigera, Neoanungitea eucalyptorum on leaves of Eucalyptus grandis, Teratosphaeria corymbiicola on leaves of Corymbia ficifolia, Xylaria eucalypti on leaves of Eucalyptus radiata. Brazil, Bovista psammophila on soil, Fusarium awaxy on rotten stalks of Zea mays, Geastrum lanuginosum on leaf litter covered soil, Hermetothecium mikaniae-micranthae (incl. Hermetothecium gen. nov.) on Mikania micrantha, Penicillium reconvexovelosoi in soil, Stagonosporopsis vannaccii from pod of Glycine max. British Virgin Isles, Lactifluus guanensis on soil. Canada, Sorocybe oblongispora on resin of Picea rubens. Chile, Colletotrichum roseum on leaves of Lapageria rosea. China, Setophoma caverna from carbonatite in Karst cave. Colombia, Lareunionomyces eucalypticola on leaves of Eucalyptus grandis. Costa Rica, Psathyrella pivae on wood. Cyprus, Clavulina iris on calcareous substrate. France, Chromosera ambigua and Clavulina iris var. occidentalis on soil. French West Indies, Helminthosphaeria hispidissima on dead wood. Guatemala, Talaromyces guatemalensis in soil. Malaysia, Neotracylla pini (incl. Tracyllales ord. nov. and Neotracylla gen. nov.) and Vermiculariopsiella pini on needles of Pinus tecunumanii. New Zealand, Neoconiothyrium viticola on stems of Vitis vinifera, Parafenestella pittospori on Pittosporum tenuifolium, Pilidium novae-zelandiae on Phoenix sp. Pakistan, Russula quercus-floribundae on forest floor. Portugal, Trichoderma aestuarinum from saline water. Russia, Pluteus liliputianus on fallen branch of deciduous tree, Pluteus spurius on decaying deciduous wood or soil. South Africa, Alloconiothyrium encephalarti, Phyllosticta encephalarticola and Neothyrostroma encephalarti (incl. Neothyrostroma gen. nov.) on leaves of Encephalartos sp., Chalara eucalypticola on leaf spots of Eucalyptus grandis × urophylla, Clypeosphaeria oleae on leaves of Olea capensis, Cylindrocladiella postalofficium on leaf litter of Sideroxylon inerme, Cylindromonium eugeniicola (incl. Cylindromonium gen. nov.) on leaf litter of Eugenia capensis, Cyphellophora goniomatis on leaves of Gonioma kamassi, Nothodactylaria nephrolepidis (incl. Nothodactylaria gen. nov. and Nothodactylariaceae fam. nov.) on leaves of Nephrolepis exaltata, Falcocladium eucalypti and Gyrothrix eucalypti on leaves of Eucalyptus sp., Gyrothrix oleae on leaves of Olea capensis subsp. macrocarpa, Harzia metrosideri on leaf litter of Metrosideros sp., Hippopotamyces phragmitis (incl. Hippopotamyces gen. nov.) on leaves of Phragmites australis, Lectera philenopterae on Philenoptera violacea, Leptosillia mayteni on leaves of Maytenus heterophylla, Lithohypha aloicola and Neoplatysporoides aloes on leaves of Aloe sp., Millesimomyces rhoicissi (incl. Millesimomyces gen. nov.) on leaves of Rhoicissus digitata, Neodevriesia strelitziicola on leaf litter of Strelitzia nicolai, Neokirramyces syzygii (incl. Neokirramyces gen. nov.) on leaf spots of Syzygium sp., Nothoramichloridium perseae (incl. Nothoramichloridium gen. nov. and Anungitiomycetaceae fam. nov.) on leaves of Persea americana, Paramycosphaerella watsoniae on leaf spots of Watsonia sp., Penicillium cuddlyae from dog food, Podocarpomyces knysnanus (incl. Podocarpomyces gen. nov.) on leaves of Podocarpus falcatus, Pseudocercospora heteropyxidicola on leaf spots of Heteropyxis natalensis, Pseudopenidiella podocarpi, Scolecobasidium podocarpi and Ceramothyrium podocarpicola on leaves of Podocarpus latifolius, Scolecobasidium blechni on leaves of Blechnum capense, Stomiopeltis syzygii on leaves of Syzygium chordatum, Strelitziomyces knysnanus (incl. Strelitziomyces gen. nov.) on leaves of Strelitzia alba, Talaromyces clemensii from rotting wood in goldmine, Verrucocladosporium visseri on Carpobrotus edulis. Spain, Boletopsis mediterraneensis on soil, Calycina cortegadensisi on a living twig of Castanea sativa, Emmonsiellopsis tuberculata in fluvial sediments, Mollisia cortegadensis on dead attached twig of Quercus robur, Psathyrella ovispora on soil, Pseudobeltrania lauri on leaf litter of Laurus azorica, Terfezia dunensis in soil, Tuber lucentum in soil, Venturia submersa on submerged plant debris. Thailand, Cordyceps jakajanicola on cicada nymph, Cordyceps kuiburiensis on spider, Distoseptispora caricis on leaves of Carex sp., Ophiocordyceps khonkaenensis on cicada nymph. USA, Cytosporella juncicola and Davidiellomyces juncicola on culms of Juncus effusus, Monochaetia massachusettsianum from air sample, Neohelicomyces melaleucae and Periconia neobrittanica on leaves of Melaleuca styphelioides × lanceolata, Pseudocamarosporium eucalypti on leaves of Eucalyptus sp., Pseudogymnoascus lindneri from sediment in a mine, Pseudogymnoascus turneri from sediment in a railroad tunnel, Pulchroboletus sclerotiorum on soil, Zygosporium pseudomasonii on leaf of Serenoa repens. Vietnam, Boletus candidissimus and Veloporphyrellus vulpinus on soil. Morphological and culture characteristics are supported by DNA barcodes.
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Affiliation(s)
- P W Crous
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
- Department of Biochemistry, Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute (FABI), Faculty of Natural and Agricultural Sciences, University of Pretoria, Private Bag X20, Hatfield 0028, Pretoria, South Africa
| | - M J Wingfield
- Department of Biochemistry, Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute (FABI), Faculty of Natural and Agricultural Sciences, University of Pretoria, Private Bag X20, Hatfield 0028, Pretoria, South Africa
| | - L Lombard
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
| | - F Roets
- Department of Conservation Ecology and Entomology, Stellenbosch University, Stellenbosch 7600, South Africa
| | - W J Swart
- Department of Plant Sciences (Division of Plant Pathology), University of the Free State, P.O. Box 339, Bloemfontein 9300, South Africa
| | - P Alvarado
- ALVALAB, La Rochela 47, 39012 Santander, Spain
| | - A J Carnegie
- Forest Health & Biosecurity, Forest Science, NSW Department of Primary Industries, Level 12, 10 Valentine Ave, Parramatta NSW 2150, Australia
| | - G Moreno
- Departamento de Ciencias de la Vida (Área de Botánica), Facultad de Ciencias, Universidad de Alcalá, E-28805 Alcalá de Henares, Madrid, Spain
| | - J Luangsaard
- National Center for Genetic Engineering and Biotechnology (BIOTEC), 113 Thailand Science Park, Phahonyothin Rd., Khlong Nueng, Khlong Luang, Pathum Thani 12120, Thailand
| | - R Thangavel
- Plant Health and Environment Laboratory, Ministry for Primary Industries, P.O. Box 2095, Auckland 1140, New Zealand
| | - A V Alexandrova
- Lomonosov Moscow State University (MSU), Faculty of Biology, 119234, 1, 12 Leninskie Gory Str., Moscow, Russia
- Joint Russian-Vietnamese Tropical Research and Technological Center, Hanoi, Vietnam
- Peoples' Friendship University of Russia (RUDN University) 6 Miklouho-Maclay Str., 117198, Moscow, Russia
| | - I G Baseia
- Departamento Botânica e Zoologia, Centro de Biociências, Universidade Federal do Rio Grande do Norte, Campus Universitário, 59072-970 Natal, RN, Brazil
| | - J-M Bellanger
- CEFE, CNRS, Université de Montpellier, Université Paul-Valéry Montpellier 3, EPHE, IRD, INSERM, 1919 route de Mende, F-34293 Montpellier Cedex 5, France
| | | | | | - S De la Peña-Lastra
- Departamento de Edafoloxía e Química Agrícola, Facultade de Biología, Universidade de Santiago de Compostela, 15782-Santiago de Compostela, Spain
| | - D García
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Spain
| | - J Gené
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Spain
| | - T H G Pham
- Joint Russian-Vietnamese Tropical Research and Technological Center, Hanoi, Vietnam
- Saint Petersburg State Forestry University, 194021, 5U Institutsky Str., Saint Petersburg, Russia
| | - M Heykoop
- Departamento de Ciencias de la Vida (Área de Botánica), Facultad de Ciencias, Universidad de Alcalá, E-28805 Alcalá de Henares, Madrid, Spain
| | - E Malysheva
- Komarov Botanical Institute of the Russian Academy of Sciences, Prof. Popov Str. 2, RUS-197376, Saint Petersburg, Russia
| | - V Malysheva
- Komarov Botanical Institute of the Russian Academy of Sciences, Prof. Popov Str. 2, RUS-197376, Saint Petersburg, Russia
| | - M P Martín
- Real Jardín Botánico RJB-CSIC, Plaza de Murillo 2, 28014 Madrid, Spain
| | - O V Morozova
- Joint Russian-Vietnamese Tropical Research and Technological Center, Hanoi, Vietnam
- Komarov Botanical Institute of the Russian Academy of Sciences, Prof. Popov Str. 2, RUS-197376, Saint Petersburg, Russia
| | - W Noisripoom
- National Center for Genetic Engineering and Biotechnology (BIOTEC), 113 Thailand Science Park, Phahonyothin Rd., Khlong Nueng, Khlong Luang, Pathum Thani 12120, Thailand
| | - B E Overton
- Department of Biology, 205 East Campus Science Center, Lock Haven University, Lock Haven, PA 17745 USA
| | - A E Rea
- Department of Biology, 205 East Campus Science Center, Lock Haven University, Lock Haven, PA 17745 USA
| | - B J Sewall
- Department of Biology, 1900 North 12th Street, Temple University, Philadelphia, PA 19122 USA
| | - M E Smith
- Department of Plant Pathology & Florida Museum of Natural History, 2527 Fifield Hall, Gainesville FL 32611, USA
| | - C W Smyth
- Department of Biology, 205 East Campus Science Center, Lock Haven University, Lock Haven, PA 17745 USA
| | - K Tasanathai
- National Center for Genetic Engineering and Biotechnology (BIOTEC), 113 Thailand Science Park, Phahonyothin Rd., Khlong Nueng, Khlong Luang, Pathum Thani 12120, Thailand
| | - C M Visagie
- Department of Biochemistry, Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute (FABI), Faculty of Natural and Agricultural Sciences, University of Pretoria, Private Bag X20, Hatfield 0028, Pretoria, South Africa
- Biosystematics Division, Agricultural Research Council - Plant Health and Protection, P. Bag X134, Queenswood, Pretoria 0121, South Africa
| | - S Adamčík
- Institute of Botany, Plant Science and Biodiversity Centre, Slovak Academy of Sciences, Dúbravská cesta 9, SK-84523, Bratislava, Slovakia
| | - A Alves
- Departamento de Biologia, CESAM, Universidade de Aveiro, 3810-193 Aveiro, Portugal
| | - J P Andrade
- Universidade Estadual de Feira de Santana, Bahia, Brazil and Faculdades Integradas de Sergipe, Sergipe, Brazil
| | - M J Aninat
- Servicio Agrícola y Ganadero, Laboratorio Regional Valparaíso, Unidad de Fitopatología, Antonio Varas 120, Valparaíso, Código Postal 2360451, Chile
| | - R V B Araújo
- Instituto de Biologia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - J J Bordallo
- Laboratorio de Investigacion, San Vicente Raspeig, 03690 Alicante, Spain
| | - T Boufleur
- Departamento de Fitopatologia e Nematologia, Escola Superior de Agricultura "Luiz de Queiroz", Universidade de São Paulo, Caixa Postal 09, CEP 13418-900, Piracicaba-SP, Brazil
| | - R Baroncelli
- Instituto Hispano-Luso de Investigaciones Agrarias (CIALE), University of Salamanca, Calle del Duero, 12; 37185 Villamayor (Salamanca), Spain
| | - R W Barreto
- Departamento de Fitopatologia, Universidade Federal de Viçosa, Viçosa, 36570-900, MG, Brazil
| | - J Bolin
- 7340 Viale Sonata, Lake Worth, FL 33467, USA
| | - J Cabero
- Asociación Micológica Zamorana, 49080 Zamora, Spain
| | - M Caboň
- Institute of Botany, Plant Science and Biodiversity Centre, Slovak Academy of Sciences, Dúbravská cesta 9, SK-84523, Bratislava, Slovakia
| | - G Cafà
- CABI Europe-UK, Bakeham Lane, Egham, Surrey TW20 9TY, UK
| | - M L H Caffot
- Instituto de Ecorregiones Andinas (INECOA), CONICET-Universidad Nacional de Jujuy, CP 4600, San Salvador de Jujuy, Jujuy, Argentina
| | - L Cai
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China
| | - J R Carlavilla
- Departamento de Ciencias de la Vida (Área de Botánica), Facultad de Ciencias, Universidad de Alcalá, E-28805 Alcalá de Henares, Madrid, Spain
| | - R Chávez
- Facultad de Química y Biología, Universidad de Santiago de Chile (USACH), Alameda 3363, Estación Central, 917002, Santiago, Chile
| | - R R L de Castro
- Departamento de Fitopatologia e Nematologia, Escola Superior de Agricultura "Luiz de Queiroz", Universidade de São Paulo, Caixa Postal 09, CEP 13418-900, Piracicaba-SP, Brazil
| | - L Delgat
- Department of Biology, Ghent University, Karel Lodewijk Ledeganckstraat 35, Ghent, Belgium
| | | | - M M Dios
- Departamento de Biología, Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Catamarca, Av. Belgrano 300, San Fernando del Valle de Catamarca, Catamarca, Argentina
| | - L S Domínguez
- Laboratorio de Micología, Instituto Multidisciplinario de Biología Vegetal, CONICET, Universidad Nacional de Córdoba, CC 495, 5000, Córdoba, Argentina
| | - H C Evans
- CAB International, UK Centre, Egham, Surrey TW20 9TY, UK
| | - G Eyssartier
- Attaché honoraire au Muséum national d'histoire naturelle de Paris, 180 allée du Château, F-24660 Sanilhac, France
| | - B W Ferreira
- Departamento de Fitopatologia, Universidade Federal de Viçosa, Viçosa, 36570-900, MG, Brazil
| | | | - F Liu
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China
| | | | | | - C Gil-Durán
- Facultad de Química y Biología, Universidad de Santiago de Chile (USACH), Alameda 3363, Estación Central, 917002, Santiago, Chile
| | - C Glienke
- Federal University of Paraná, Curitiba, Brazil
| | - M F M Gonçalves
- Departamento de Biologia, CESAM, Universidade de Aveiro, 3810-193 Aveiro, Portugal
| | - H Gryta
- Université Paul Sabatier, CNRS, IRD, UMR5174 EDB (Laboratoire Évolution et Diversité Biologique), 118 route de Narbonne, F-31062 Toulouse, France
| | - J Guarro
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Spain
| | - W Himaman
- Forest Entomology and Microbiology Research Group, Department of National Parks, Wildlife and Plant Conservation, 61 Phaholyothin Road, Chatuchak, Bangkok 10900, Thailand
| | - N Hywel-Jones
- BioAsia Life Sciences Institute, 1938 Xinqun Rd, Pinghu, Zhejiang 314200, PR China
| | - I Iturrieta-González
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Spain
| | - N E Ivanushkina
- All-Russian collection of microorganisms (VKM), IBPM RAS, prospect Nauki, 5, Pushchino, Moscow Region, Russia
| | - P Jargeat
- Université Paul Sabatier, CNRS, IRD, UMR5174 EDB (Laboratoire Évolution et Diversité Biologique), 118 route de Narbonne, F-31062 Toulouse, France
| | - A N Khalid
- Department of Botany, University of Punjab, Quaid e Azam campus, Lahore 54590, Pakistan
| | - J Khan
- Center for Plant Sciences and Biodiversity, University of Swat, KP, Pakistan
| | - M Kiran
- Department of Botany, University of Punjab, Quaid e Azam campus, Lahore 54590, Pakistan
| | - L Kiss
- Centre for Crop Health, University of Southern Queensland, Toowoomba 4350, Queensland, Australia
| | - G A Kochkina
- All-Russian collection of microorganisms (VKM), IBPM RAS, prospect Nauki, 5, Pushchino, Moscow Region, Russia
| | - M Kolařík
- Laboratory of Fungal Genetics and Metabolism, Institute of Microbiology of the CAS, v.v.i., Vídeňská 1083, 142 20 Prague 4, Czech Republic
- Department of Botany, Faculty of Science, Charles University, Benátská 2, 12801 Prague 2, Czech Republic
| | - A Kubátová
- Department of Botany, Faculty of Science, Charles University, Benátská 2, 12801 Prague 2, Czech Republic
| | - D J Lodge
- Department of Plant Pathology, 2105 Miller Plant Sciences Bldg., University of Georgia, Athens, GA 30606, USA
| | | | - D Luque
- C/Severo Daza 31, 41820 Carrión de los Céspedes (Sevilla), Spain
| | - J L Manjón
- Departamento de Ciencias de la Vida (Área de Botánica), Facultad de Ciencias, Universidad de Alcalá, E-28805 Alcalá de Henares, Madrid, Spain
| | - P A S Marbach
- Federal University of Recôncavo da Bahia, Bahia, Brazil
| | - N S Massola
- Departamento de Fitopatologia e Nematologia, Escola Superior de Agricultura "Luiz de Queiroz", Universidade de São Paulo, Caixa Postal 09, CEP 13418-900, Piracicaba-SP, Brazil
| | - M Mata
- Departamento de Ciencias de la Vida (Área de Botánica), Facultad de Ciencias, Universidad de Alcalá, E-28805 Alcalá de Henares, Madrid, Spain
| | - A N Miller
- University of Illinois Urbana-Champaign, Illinois Natural History Survey, 1816 South Oak Street, Champaign, Illinois, 61820, USA
| | - S Mongkolsamrit
- National Center for Genetic Engineering and Biotechnology (BIOTEC), 113 Thailand Science Park, Phahonyothin Rd., Khlong Nueng, Khlong Luang, Pathum Thani 12120, Thailand
| | - P-A Moreau
- Université de Lille, Faculté de pharmacie de Lille, EA 4483, F-59000 Lille, France
| | - A Morte
- Departamento de Biología Vegetal (Botánica), Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain
| | - A Mujic
- Department of Biology, Fresno State University, 2555 East San Ramon Ave, Fresno CA 93740, USA
| | - A Navarro-Ródenas
- Departamento de Biología Vegetal (Botánica), Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain
| | - M Z Németh
- Plant Protection Institute, Centre for Agricultural Research, Hungarian Academy of Sciences, Budapest H-1022, Herman Otto út 15, Hungary
| | - T F Nóbrega
- Departamento de Fitopatologia, Universidade Federal de Viçosa, Viçosa, 36570-900, MG, Brazil
| | - A Nováková
- Laboratory of Fungal Genetics and Metabolism, Institute of Microbiology of the CAS, v.v.i., Vídeňská 1083, 142 20 Prague 4, Czech Republic
| | - I Olariaga
- Biology and Geology Physics and Inorganic Chemistry Department, Rey Juan Carlos university, C/Tulipán s/n, 28933 Móstoles, Madrid, Spain
| | - S M Ozerskaya
- All-Russian collection of microorganisms (VKM), IBPM RAS, prospect Nauki, 5, Pushchino, Moscow Region, Russia
| | - M A Palma
- Servicio Agrícola y Ganadero, Laboratorio Regional Valparaíso, Unidad de Fitopatología, Antonio Varas 120, Valparaíso, Código Postal 2360451, Chile
| | | | - E Piontelli
- Universidad de Valparaíso, Facultad de Medicina, Profesor Emérito Cátedra de Micología, Angámos 655, Reñaca, Viña del Mar, Código Postal 2540064, Chile
| | - E S Popov
- Joint Russian-Vietnamese Tropical Research and Technological Center, Hanoi, Vietnam
- Komarov Botanical Institute of the Russian Academy of Sciences, Prof. Popov Str. 2, RUS-197376, Saint Petersburg, Russia
| | - A Rodríguez
- Departamento de Biología Vegetal (Botánica), Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain
| | - Ó Requejo
- Grupo Micológico Gallego, San Xurxo, A Laxe 12b, 36470, Salceda de Caseleas, Spain
| | - A C M Rodrigues
- Programa de Pós-Graduação em Biologia de Fungos, Departamento de Micologia, Universidade Federal de Pernambuco, 50670-420 Recife, PE, Brazil
| | - I H Rong
- Biosystematics Division, Agricultural Research Council - Plant Health and Protection, P. Bag X134, Queenswood, Pretoria 0121, South Africa
| | - J Roux
- Department of Plant and Soil Sciences, Forestry and Agricultural Biotechnology Institute (FABI), Faculty of Natural and Agricultural Sciences, University of Pretoria, Private Bag X20, Hatfield 0028, Pretoria, South Africa
| | - K A Seifert
- Biodiversity (Mycology), Agriculture and Agri-Food Canada, 960 Carling Avenue, Ottawa, ON K1A 0C6, Canada
| | - B D B Silva
- Instituto de Biologia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - F Sklenář
- Laboratory of Fungal Genetics and Metabolism, Institute of Microbiology of the CAS, v.v.i., Vídeňská 1083, 142 20 Prague 4, Czech Republic
- Department of Botany, Faculty of Science, Charles University, Benátská 2, 12801 Prague 2, Czech Republic
| | - J A Smith
- School of Forest Resources and Conservation, University of Florida, Gainesville, Florida 32611-0680, USA
| | - J O Sousa
- Departamento Botânica e Zoologia, Centro de Biociências, Universidade Federal do Rio Grande do Norte, Campus Universitário, 59072-970 Natal, RN, Brazil
| | - H G Souza
- Federal University of Recôncavo da Bahia, Bahia, Brazil
| | - J T De Souza
- Federal University of Lavras, Minas Gerais, Brazil
| | - K Švec
- Laboratory of Fungal Genetics and Metabolism, Institute of Microbiology of the CAS, v.v.i., Vídeňská 1083, 142 20 Prague 4, Czech Republic
- Department of Botany, Faculty of Science, Charles University, Benátská 2, 12801 Prague 2, Czech Republic
| | - P Tanchaud
- 2 rue des Espics, F-17250 Soulignonne, France
| | - J B Tanney
- Pacific Forestry Centre, Canadian Forest Service, Natural Resources Canada, 506 Burnside Road, Victoria, BC V8Z 1M5, Canada
| | - F Terasawa
- Federal University of Paraná, Curitiba, Brazil
| | - D Thanakitpipattana
- National Center for Genetic Engineering and Biotechnology (BIOTEC), 113 Thailand Science Park, Phahonyothin Rd., Khlong Nueng, Khlong Luang, Pathum Thani 12120, Thailand
| | - D Torres-Garcia
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Spain
| | - I Vaca
- Facultad de Ciencias, Universidad de Chile, Las Palmeras 3425, Ñuñoa, Santiago, Chile
| | - N Vaghefi
- Centre for Crop Health, University of Southern Queensland, Toowoomba 4350, Queensland, Australia
| | - A L van Iperen
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
| | - O V Vasilenko
- All-Russian collection of microorganisms (VKM), IBPM RAS, prospect Nauki, 5, Pushchino, Moscow Region, Russia
| | - A Verbeken
- Department of Biology, Ghent University, Karel Lodewijk Ledeganckstraat 35, Ghent, Belgium
| | - N Yilmaz
- Department of Biochemistry, Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute (FABI), Faculty of Natural and Agricultural Sciences, University of Pretoria, Private Bag X20, Hatfield 0028, Pretoria, South Africa
| | - J C Zamora
- Museum of Evolution, Uppsala University, Norbyvägen 16, SE-75236 Uppsala, Sweden
- Departamento de Biología Vegetal II, Facultad de Farmacia, Universidad Complutense de Madrid, Ciudad Universitaria, plaza de Ramón y Cajal s/n, E-28040, Madrid, Spain
| | - M Zapata
- Servicio Agrícola y Ganadero, Laboratorio Regional Chillán, Unidad de Fitopatología, Claudio Arrau 738, Chillán, Código Postal 3800773, Chile
| | - Ž Jurjević
- EMSL Analytical, Inc., 200 Route 130 North, Cinnaminson, NJ 08077, USA
| | - J Z Groenewald
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
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Badri H, Smith JA. Emerging targets for cough therapies; NK1 receptor antagonists. Pulm Pharmacol Ther 2019; 59:101853. [PMID: 31622673 DOI: 10.1016/j.pupt.2019.101853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 01/31/2023]
Abstract
Cough is mediated by vagal afferent fibres innervating the larynx and proximal airways. Pre-clinical studies suggest that vagal C fibres produce Substance P, one of the tachykinin family of neuropeptides, which has been shown to enhance cough via the neurokinin-1 (NK-1) receptor and studies in animal models have also shown that NK-1 antagonists are effective at blocking induced cough. In the past, tachykinin receptor antagonists have yielded disappointing results in treating asthma and cough, however most of the activity of the agents tested was restricted to the peripheral nervous system and also the outcomes measures evaluating cough not optimal. More recently a small proof of concept study has suggest that aprepitant, an NK-1 antagonist licensed for the prevention of chemotherapy induced nausea and vomiting, might have beneficial effects on cough frequency in patients with lung cancer. In this review we investigate the current evidence for the anti-tussive effect of these therapies and the clinical trials in progress.
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Affiliation(s)
- Huda Badri
- North Manchester General Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Jaclyn A Smith
- North Manchester General Hospital, Manchester, UK; Manchester University NHS Foundation Trust, UK.
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Horne R, Glendinning E, King K, Chalder T, Sabin C, Walker AS, Campbell LJ, Mosweu I, Anderson J, Collins S, Jopling R, McCrone P, Leake Date H, Michie S, Nelson M, Perry N, Smith JA, Sseruma W, Cooper V. Protocol of a two arm randomised, multi-centre, 12-month controlled trial: evaluating the impact of a Cognitive Behavioural Therapy (CBT)-based intervention Supporting UPtake and Adherence to antiretrovirals (SUPA) in adults with HIV. BMC Public Health 2019; 19:905. [PMID: 31286908 PMCID: PMC6615195 DOI: 10.1186/s12889-019-6893-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 11/12/2018] [Accepted: 04/25/2019] [Indexed: 12/02/2022] Open
Abstract
Background Delay to start antiretroviral therapy (ART) and nonadherence compromise the health and wellbeing of people living with HIV (PLWH), raise the cost of care and increase risk of transmission to sexual partners. To date, interventions to improve adherence to ART have had limited success, perhaps because they have failed to systematically elicit and address both perceptual and practical barriers to adherence. The primary aim of this study is to determine the efficacy of the Supporting UPtake and Adherence (SUPA) intervention. Methods This study comprises 2 phases. Phase 1 is an observational cohort study, in which PLWH who are ART naïve and recommended to take ART by their clinician complete a questionnaire assessing their beliefs about ART over 12 months. Phase 2 is a randomised controlled trial (RCT) nested within the observational cohort study to investigate the effectiveness of the SUPA intervention on adherence to ART. PLWH at risk of nonadherence (based on their beliefs about ART) will be recruited and randomised 1:1 to the intervention (SUPA intervention + usual care) and control (usual care) arms. The SUPA intervention involves 4 tailored treatment support sessions delivered by a Research Nurse utilising a collaborative Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) approach. Sessions are tailored to individual needs and preferences based on the individual patient’s perceptions and practical barriers to ART. An animation series and intervention manual have been developed to communicate a rationale for the personal necessity for ART and illustrate concerns and potential solutions. The primary outcome is adherence to ART measured using Medication Event Monitoring System (MEMS). Three hundred seventy-two patients will be sufficient to detect a 15% difference in adherence with 80% power and an alpha of 0.05. Costs will be compared between intervention and control groups. Costs will be combined with the primary outcome in cost-effectiveness analyses. Quality adjusted life-years (QALYs) will also be estimated over the follow-up period and used in the analyses. Discussion The findings will enable patients, healthcare providers and policy makers to make informed decisions about the value of the SUPA intervention. Trial registration The trial was retrospectively registered 21/02/2014, ISRCTN35514212. Electronic supplementary material The online version of this article (10.1186/s12889-019-6893-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Horne
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK.
| | - E Glendinning
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - K King
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - T Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
| | - C Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - A S Walker
- MRC Clinical Trials Unit at UCL, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - L J Campbell
- HIV Research Centre, King's College London, London, SE5 9RJ, UK
| | - I Mosweu
- Institute of Psychiatry at King's College London, Denmark Hill, London, SE5 8AF, UK
| | - J Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital, E9 6RS, London, UK
| | - S Collins
- HIV i-Base, 107 The Maltings, 169 Tower Bridge Road, London, SE1 3LJ, UK
| | - R Jopling
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - P McCrone
- Institute of Psychiatry at King's College London, Denmark Hill, London, SE5 8AF, UK
| | - H Leake Date
- Departments of of Pharmacy and HIV Medicine, Brighton & Sussex University Hospitals NHS Trust, Brighton, BN2 5B, UK
| | - S Michie
- Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - M Nelson
- Kobler Clinic, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - N Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 5BE, UK
| | - J A Smith
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - W Sseruma
- UK-CAB, 107 The Maltings, 169 Tower Bridge Road, London, SE1 3LJ, UK
| | - V Cooper
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
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Dunseath O, Smith EJW, Al-Jeda T, Smith JA, King S, May PW, Nobbs AH, Hazell G, Welch CC, Su B. Studies of Black Diamond as an antibacterial surface for Gram Negative bacteria: the interplay between chemical and mechanical bactericidal activity. Sci Rep 2019; 9:8815. [PMID: 31217508 PMCID: PMC6584650 DOI: 10.1038/s41598-019-45280-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 06/11/2018] [Accepted: 06/04/2019] [Indexed: 01/19/2023] Open
Abstract
'Black silicon' (bSi) samples with surfaces covered in nanoneedles of length ~5 µm were fabricated using a plasma etching process and then coated with a conformal uniform layer of diamond using hot filament chemical vapour deposition to produce 'black diamond' (bD) nanostructures. The diamond needles were then chemically terminated with H, O, NH2 or F using plasma treatment, and the hydrophilicity of the resulting surfaces were assessed using water droplet contact-angle measurements, and scaled in the order O > H ≈NH2 >F, with the F-terminated surface being superhydrophobic. The effectiveness of these differently terminated bD needles in killing the Gram-negative bacterium E. coli was semi-quantified by Live/Dead staining and fluorescence microscopy, and visualised by environmental scanning electron microscopy. The total number of adhered bacteria was consistent for all the nanostructured bD surfaces at around 50% of the value for the flat diamond control. This, combined with a chemical bactericidal effect of 20-30%, shows that the nanostructured bD surfaces supported significantly fewer viable E. coli than flat surfaces. Moreover, the bD surfaces were particularly effective at preventing the establishment of bacterial aggregates - a precursor to biofilm formation. The percentage of dead bacteria also decreased as a function of hydrophilicity. These results are consistent with a predominantly mechanical mechanism for bacteria death based on the stretching and disruption of the cell membrane, combined with an additional effect from the chemical nature of the surface.
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Affiliation(s)
- O Dunseath
- School of Chemistry, University of Bristol, Bristol, BS8 1TS, United Kingdom
| | - E J W Smith
- School of Chemistry, University of Bristol, Bristol, BS8 1TS, United Kingdom
| | - T Al-Jeda
- School of Chemistry, University of Bristol, Bristol, BS8 1TS, United Kingdom
| | - J A Smith
- School of Chemistry, University of Bristol, Bristol, BS8 1TS, United Kingdom
| | - S King
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, United Kingdom
| | - P W May
- School of Chemistry, University of Bristol, Bristol, BS8 1TS, United Kingdom.
| | - A H Nobbs
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, United Kingdom
| | - G Hazell
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, United Kingdom
| | - C C Welch
- Oxford Instruments Plasma Technology, Yatton, Bristol, BS49 4AP, United Kingdom
| | - B Su
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, United Kingdom
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McGarvey L, Dupont L, Birring SS, Boyd J, Chung KF, Dabrowska M, Domingo C, Fontana G, Guilleminault L, Kardos P, Millqvist E, Morice AH, Smith JA, van den Berg JW, Van de Kerkhove C. New understanding in the treatment of cough (NEUROCOUGH) ERS Clinical Research Collaboration: improving care and treatment for patients with cough. Eur Respir J 2019; 53:53/5/1900787. [PMID: 31147424 DOI: 10.1183/13993003.00787-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/05/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Lorcan McGarvey
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Lieven Dupont
- Dept of Respiratory Diseases, University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
| | | | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Christian Domingo
- Servicio de Neumología, Hospital Parc Taulí, Sabadell, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Giovanni Fontana
- Dept of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Laurent Guilleminault
- Service de pneumologie-allergologie, pôle des voies respiratoires, hôpital Larrey, and Center for Pathophysiology Toulouse Purpan, INSERM U1043, CNRS UMR 5282, Toulouse III University, Toulouse, France
| | - Peter Kardos
- Centre for Allergy, Respiratory and Sleep Medicine at Red Cross Maingau Hospital, Frankfurt, Germany
| | - Eva Millqvist
- Dept of Allergology, Institution of Internal Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Alyn H Morice
- Hull York Medical School, Castle Hill Hospital, Hull, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
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Jorgenson MR, Descourouez JL, Astor BC, Smith JA, Aziz F, Redfield RR, Mandelbrot DA. Very Early Cytomegalovirus Infection After Renal Transplantation: A Single-Center 20-Year Perspective. Virology (Auckl) 2019; 10:1178122X19840371. [PMID: 30983861 PMCID: PMC6448111 DOI: 10.1177/1178122x19840371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 01/10/2019] [Accepted: 02/21/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Cytomegalovirus (CMV) infection risk in the first month after transplantation is felt to be minimal; however, the epidemiology has not been specifically investigated, particularly in the modern era of potent immunosuppressive regimens and universal CMV prophylaxis. Objective: The aim of this study was to describe the incidence of and risk factors associated with CMV occurring less than 30 days after transplant and evaluate the effect of very early CMV on outcomes. Methods: Retrospective, single-center study of adult renal transplant (RTX) recipients between January 1, 1994 and December 31, 2014. Results: A total of 5225 patients who received a renal transplant in the study time period were reviewed for the presence of CMV infection occurring less than 30 days after transplant. Of these, only 14 patients demonstrated this finding for an overall incidence of 0.27%. Half of these patients were considered to be at heightened risk due to being a recipient of a non-primary transplant or on chronic immunosuppression. This left seven patients without known risk factors for very early CMV to evaluate. In this group, time from transplant to CMV infection was 13.5 ± 7 days. The majority (57.1%, n = 4) were high-risk serostatus (CMV D+/R−) and occurred in the valganciclovir era (71.4%, n = 5). Lymphocyte-depleting induction predominated (57.1%, n = 4). Average cold ischemic time (CIT) was 19.7 ± 7.7 hours. Three patients had post-operative complications, two required exploratory-laparotomy for hemorrhage. When evaluating outcomes, 43% (n = 3) had subsequent episodes of CMV infection, 28.6% (n = 2) developed rejection, and 28.6% (n = 2) died. Outcomes between patients with CMV infection less than 30 days and those with CMV infection more than 30 days after transplant were not significantly different. Conclusions: In our review of over 5000 kidney transplants, the incidence of CMV infection in the first 30 days after renal transplant is 0.2%. Notable common patient characteristics include hemorrhage requiring re-operation and prolonged CIT. Outcomes were similar to CMV occurring more than 30 days after transplant. This study should provide the clinician with some reassurance; despite potent immunosuppressive therapy, CMV infection in the first 30 days is unlikely.
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Affiliation(s)
- M R Jorgenson
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - J L Descourouez
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - B C Astor
- Department of Medicine and Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - J A Smith
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - F Aziz
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - R R Redfield
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison WI, USA
| | - D A Mandelbrot
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI, USA
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