Clinical efficacy of a selective phosphodiesterase-4 inhibitor (roflumilast) in patients with chronic obstructive pulmonary disease and metabolic syndrome
Abstract
The article provides data on the assessment of the clinical efficacy of long-term use of a selective inhibitor of phosphodiesterase-4 (roflumilast) in patients with chronic obstructive pulmonary disease in combination with metabolic syndrome. The study included 106 patients with COPD in combination with metabolic syndrome. The main parameters for assessing the effectiveness were: the frequency and duration of exacerbations, the dynamics of the severity of productive cough, the severity of dyspnea on the mMRC scale, CAT test, FEV1, the levels of pro-inflammatory markers — C-reactive protein, interleukin-6, leptin. Results and conclusions: the addition of roflumilast to the standard bronchodilator therapy of patients with bronchitic COPD phenotype in combination with metabolic syndrome helps to reduce the frequency and duration of exacerbations, has a positive effect on the severity of the main clinical symptoms, helps to reduce the activity of the systemic inflammatory response and improve the prognosis for this category of patients.
About the Authors
G. L. Ignatova
South-Urals State Medical University
Russian Federation
Russian Federation
Chelyabinsk
E. V. Blinova
South-Urals State Medical University
Russian Federation
Russian Federation
Chelyabinsk
M. S. Belsner
South-Urals State Medical University
Russian Federation
Russian Federation
Chelyabinsk
References
1. Хроническая обструктивная болезнь легких. Клинические рекомендации. Москва, 2021. URL: http://disuria.ru/_ld/10/1081_kr21J44MZ.pdf (дата обращения: 13.12.2021).
2. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. 2021. URL: https://goldcopd.org (дата обращения: 13.12.2021).
3. Верткин А. Л., Скотников А. С. Коморбидность // Лечащий врач. 2013. № 6. С. 66–69.
4. Caram L. M., Ferrari R., Naves C. R. et al. Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease // Clinics (San Paulo). 2013. Т. 68, № 6. С. 772–776.
5. Huang Y. S., Feng Y. C., Zhang J. et al. Impact of chronic obstructive pulmonary diseases on left ventricular diastolic function in hospitalized elderly patients // Clin. Interv. Aging. 2014. Т. 10. С. 81–87.
6. Mannino D. M., Thorn D., Swensen A. et al. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD // Eur. Respir. J. 2008. Т. 32, № 4. С. 962–969.
7. Sinden N. J., Stockley R. A. Chronic obstructive pulmonary disease: an update of treatment related to frequently associated comorbidities // Ther. Adv. Chron. Dis. 2010. Т. 1, № 2. С. 43–57.
8. Nussbaumer-Ochsner Y., Rabe K. F. Systemic manifestations of COPD // Chest. 2011. Т. 139, № 1. С. 165–173.
9. Valvi J., Mannino D. M., Muellerova H. et al. Fibrinogen, chronic obstructive pulmonary disease (COPD) and outcomes in two United States cohort // Int. J. Chron. Obstruct. Pulmon. Dis. 2012. Т. 7. С. 173–182.
10. Barnes P. J., Celli B. R. Systemic manifestations and comorbidities of COPD // Eur. Respir. J. 2009. Т. 33, № 5. С. 1165–1185.
11. Agusti A., Faner R. Systemic inflammation and comorbidities in chronic obstructive pulmonary disease // Proc. Am. Thorac. Soc. 2012. Т. 9, № 2. С. 43–46.
12. Drummond M. B., Dasenbrook E. C., Pitz M. W. et al. Inhaled corticosteroids in patients with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis // JAMA. 2008. Т. 300, № 20. С. 2407–2416.
13. Clini E., Crisafulli E., Radaeli A. et al. COPD and the metabolic syndrome: an intriguing association // Int. Emerg. Med. 2013. Т. 8, № 4. С. 283–289.
14. Wells C. E., Baker E. H. Metabolic syndrome and diabetes mellitus in COPD // COPD and Comorbidity: Eur. Respir. Monograph. / edited by Rabe K. F., Wedzicha J. A., Wouters E. F. M. 2013. С. 117–134.
15. Hurst J. R., Vestbo J., Anzueto A. et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease // N. Engl. J. Med. 2010. Т. 363, № 12. С. 1128–1138.
16. Wedzicha J. A., Seemungal T. A. R. COPD exacerbations: defining their cause and prevention // Lancet. 2007. Т. 370, № 9589. С. 786–796.
17. Decramer M., Celli B., Kesten S. et al. Frequency of exacerbations adversely impacts the course of COPD // A41. Chronic obstructive pulmonary disease exacerbations: epidemiology and outcomes. American Thoracic Society, 2010. С. A1526–A1526.
18. Donaldson G. C., Wedzicha J. A. COPD exacerbations .1: Epidemiology // Thorax. 2006. Т. 61, № 2. С. 164–168.
19. Soler-Cataluña J. J., Martínez-García M. A., Román Sánchez P. et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease // Thorax. 2005. Т. 60, № 11. С. 925–931.
20. Айсанов З. Р., Авдеев С. Н., Архипов В. В. и др. Национальные клинические рекомендации по диагностике и лечению хронической обструктивной болезни легких: алгоритм принятия клинических решений // Пульмонология. 2017. Т. 27, № 1. С. 13–20.
21. Aisanov Z., Avdeev S., Arkhipov V. et al. Russian guidelines for the management of COPD: algorithm of pharmacologic treatment // Int. J. Chron. Obstruct. Pulmon. Dis. 2018. Т. 13. С. 183–187.
22. Barnes P. J., Adcock I. M. Glucocorticosteroid resistance in inflammatory disease // Lancet. 2009. Т. 373, № 9678. С. 1905–1917.
23. Sing S., Amin A., Loke Y. Long-term use of inhaled corticosteroids and risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis // Arch. Intern. Med. 2009. Т. 169, № 3. С. 219–229.
24. Calverley P. M. A., Stockley R. A., Seemungal T. A. R. et al. Reported pneumonia in patients with COPD: findings from the INSPIRE study // Chest. 2011. Т. 139, № 3. С. 505–512.
25. Loke Y. K., Cavallazzi R., Singh S. Risk of fractures with inhaled corticosteroids in COPD: systematic review and meta-analysis of randomised controlled trials and observational studies // Thorax. 2011. Т. 66, № 8. С. 699–708.
26. Suissa S., Kezouth A., Ernst P. Inhaled corticosteroids and the risk of diabetes onset and progression // Am. J. Med. 2010. Т. 123, № 11. С. 1001–1006.
27. Rabe K. F. Roflumilast for the treatment of chronic obstructive pulmonary disease // Expert Rev. Resp. Med. 2010. Т. 4, № 5. С. 543–555.
28. Hatzelmann A., Morcillo E. J., Lungarella G. et al. The preclinical pharmacology of roflumilast — a selective, oral phosphodiesterase 4 inhibitor in development for chronic obstructive pulmonary disease // Pulm. Pharmacol. Ther. 2010. Т. 23, № 4. С. 235–256.
29. Giembycz M. A. Development status of second generation PDE4 inhibitors for asthma and COPD: the story so far // Monaldi Arch. Chest Dis. 2002. Т. 57, № 1. С. 48–64.
30. Martinez F. J., Calverley P. M., Goehring U. M. et al. Effect of roflumilast on exacerbations in patients with severe chronic obstructive pulmonary disease uncontrolled by combination therapy (REACT): a multicentre randomised controlled trial // Lancet. 2015. Т. 385, № 9971. С. 857–866.
31. Глобальная стратегия диагностики, лечения и профилактики хронической обструктивной болезни легких (пересмотр 2012 г.) / пер. с англ. под ред. А. С. Белевского. Москва: Российское респираторное общество, 2013.
32. Tashkin D. P. Variations in FEV1 decline over time in chronic obstructive pulmonary disease and its implications // Curr. Opin. Pulm. Med. 2013. Т. 19, № 2. С. 116–124.
33. Soler-Cataluna J. J., Martinez-Garcia M. A., Roman Sanchez P. et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease // Thorax. 2005. Т. 60, № 11. С. 925–931.
34. Burgel P. R., Nesme-Meyer P., Chanez P. et al. Cough and sputum production are associates with frequent exacerbations and hospitalizations in COPD subjects // Chest. 2009. Т. 135, № 4. С. 975–982.
35. Speizer F. E., Fay M. E., Dockery D. W. et al. Chronic obstructive pulmonary disease mortality in six U.S. cities // Am. Rev. Respir. Dis. 1989. Т. 140, № 3 (ч. 2). С. S49–S55.
36. Lange P., Nyboe J., Appleyard M. et al. Relation of ventilatory impairment and of chronic mucus hypersecretion to mortality from obstructive lung disease and from all causes // Thorax. 1990. Т. 45, № 8. С. 579–585.
37. Киреев С. А., Рязанов А. С., Еременко Н. Н. и др. ХОБЛ в сочетании с метаболическим синдромом: особенности клинических проявлений и лабораторные показатели системного воспаления // Биомедицина. 2010. № 4. С. 40–45.
38. Calverley P. M., Rabe K. F., Goehring U. M. et al. Roflumilast in symptomatic chronic obstructive pulmonary disease: two randomised clinical trials // Lancet. 2009. Т. 374, № 9691. С. 685–694.
39. Al Ghobain M. The effect of obesity on spirometry tests among healthy non-smoking adults // BMC Pulm. Med. 2012. Т. 12. С. 10.
40. Loscalzo J. Systems biology and personalized medicine: a network approach to human disease // Proc. Am. Thorac. Soc. 2011. Т. 8, № 2. С. 196–198.
41. Морбидное ожирение / под общ. ред. акад. РАН И. И. Дедова. Москва: Медицинское информационное агентство, 2014. 608 с.
Review
For citations:
Ignatova G.L., Blinova E.V., Belsner M.S. Clinical efficacy of a selective phosphodiesterase-4 inhibitor (roflumilast) in patients with chronic obstructive pulmonary disease and metabolic syndrome. Title in english. 2021;16(4):8-15. (In Russ.)
Views:
105
Email this article 