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New drug class reduces COPD exacerbations

A new class of drugs for chronic obstructive pulmonary disease improves lung function and reduces the likelihood of exacerbations, but do not improve patients’ quality of life, according to a Cochrane systematic review.

The researchers reviewed 23 trials involving over 15,000 patients prescribed the oral phosphodiesterase 4 inhibitors roflumilast and cilomast.

NICE is due to publish a technology appraisal on roflumilast January.

Treatment with a PDE4 inhibitor was associated with a 22% lower likelihood of an exacerbation compared with placebo, but more participants in the treatment groups experienced non-serious adverse events compared with controls, particularly gastrointestinal symptoms and headache.

Treatment with a PDE4 inhibitor was associated with a significant improvement in FEV1over the trial period compared with placebo, with a mean difference of 45.59mL, regardless of COPD severity or concomitant COPD treatment.

But there were only small non-significant improvements in quality of life and COPD related symptoms, and no change in exercise tolerance.

Lead researcher Dr Phillippa Poole, associate professor in medicine at the University of Auckland, said: ‘Phosphodiesterase 4 inhibitors join an increasing list of treatments for COPD that improve lung function slightly and reduce exacerbations, but have not yet been shown to increase life expectancy. Encouraging people with COPD to continue to take these medicines in the absence of symptomatic relief may be challenging.’

Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD002309