Real-life effectiveness of different treatment modalities of asthma or COPD in patients with...
-
Upload
christal-wilkins -
Category
Documents
-
view
219 -
download
1
Transcript of Real-life effectiveness of different treatment modalities of asthma or COPD in patients with...
![Page 1: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/1.jpg)
Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer10:00–10.20
![Page 2: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/2.jpg)
Real-life effectiveness of different treatment modalities of
asthma or COPD in patients with significant comorbidities
![Page 3: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/3.jpg)
Weight Loss (Cachexia)
CardiovascularDisease
Anaemia
Osteoporosis
Depression
Muscle Weakness &
Wasting
Agustí A. PATS 2006
COPD
![Page 4: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/4.jpg)
Vanfleteren et al. AJRCCM 2013
97.7% of all 213 patients had ≥1 comorbidities and 53.5% had ≥4 comorbidities97.7% of all 213 patients had ≥1 comorbidities and 53.5% had ≥4 comorbidities
![Page 5: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/5.jpg)
Co-morbidity and prognosis
Mannino et al, ERJ 2008
Time to first hospitalisation within 5 years
NoneOneTwoThree
No co-morbidities
Death within 5 years
![Page 6: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/6.jpg)
Chest 2006;129;285-291
![Page 7: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/7.jpg)
Questions
• What is the best treatment option for COPD and CVD?– LAMA vs ICS/LABA
• Bonus effects on Co-morbid conditions?– Statins– Roflimulast
![Page 8: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/8.jpg)
P P
Rho A
MLCK
MLCP
ROCK (Rho kinase)
PPP P
PPP P
PPP P
PPP P
F-actin
Stress fibre
Actinpolimerization
Statins
![Page 9: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/9.jpg)
Lm(µ
m)
Am J Physiol Lung Cell Mol Physiol 294: L882–L890, 2008
![Page 10: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/10.jpg)
E.V. Ponte et al Allergy 2008;63:564
*
***
***
Excluded
Excluded
![Page 11: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/11.jpg)
BUD 400x2BUD Double dose
add Montelukast
Clinical Outcome of Montelukast as Partner Agent to Corticosteroid Therapy
Price D et al. Thorax 2003;58:211–216
![Page 12: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/12.jpg)
Smokers Ex-smokers Never-smokers
-300
-200
-100
0
100
200
300
400
500
600p=0.605 p=0.386 p=0.019
F
EV
(m
l)
Smokers Ex-smokers Never-smokers
-2
-1
0
1p=0.865 p=0.108 p=0.004
A
sth
ma
sco
re
Cigarette Smoking Impairs the Therapeutic response to Oral Corticosterods in Asthma.Chauduri et al. AJRCCM 2003;168:1308-11
![Page 13: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/13.jpg)
Questions
• What is the best treatment option for Asthma and Rhinitis?
• Optimal management of smoking asthmatics?
![Page 14: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/14.jpg)
REG Priorities (I)
• Results from clinical trials should always be accomplished by comments on feasibility /generalizability to the target population.
• These data will be provided by the company seeking for registration.
![Page 15: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/15.jpg)
REG Priorities (II)
• In order to get a drug reimbursed, the company must commit itself to provide reasonably priced placebo to competitive or independent researchers.
• This in order to facilitate company independent clinical trials.
![Page 16: Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20.](https://reader036.fdocuments.in/reader036/viewer/2022081513/56649d0b5503460f949de058/html5/thumbnails/16.jpg)
REG Priorities (III)
• Add-on value of a treatment should be taken into consideration when a drug is launched for a specific treatment.
Example 1• A drug can have a small effect on lung function
(FEV), but a fair effect on physical performance. Moreover, It has a good effect on a pathophysiological relevant biomarker.
Example 2• A drug have a minor effect on lung function (FEV)
and on nasal symptoms and in obese asthmatics, weight is often reduced.