Severe COPD Treatment Medication Wins FDA Approval

People with chronic obstructive pulmonary disease (COPD)—a lung condition that’s one of the biggest killers in the nation—now have a new treatment option: a once-a-day medication called Daliresp (roflumilast) for severe Copd treatment.The U.S. Food and Drug Administration (FDA) approved the drug. But the process was not smooth sailing. an FDA advisory panel recommended against approving the drug.

Even though the FDA almost always follows the advice of such expert panels, the agency went ahead and gave Daliresp for Copd treatment a thumbs up anyway.So should COPD patients be worried about taking the copd drug? No, says FDA spokesperson Morgan Liscinsky. According to Liscinsky, even though the FDA panel recommended against the drugs approval, “the final 10-to-5 vote by the advisory committee does not fully describe how the committee members viewed the evidence to support the safety and efficacy of roflumilast.

“On separate questions, the panel had actually voted 9-to-6 in favor of adequate demonstration of efficacy (meaning that the studies suggested that the drug actually worked) and, again, 9-to-6 in favor of adequate demonstration of safety, says Liscinsky. “There was considerable positive opinion regarding its safety or efficacy.”But the committee had been asked to vote on a broader indication for the “maintenance treatment of COPD,” which Liscinsky says the data did not support, rather than a more narrow use for treating the Copd of exacerbations.

Exacerbations are periods when Severe COPD, such as shortness of breath and coughing, can get much worse due to an infection or other problem, and patients can wind up in the hospital.Another major issue that held the panel back from giving the drug its blessing was that the group had to vote on whether it should be approved for a larger group of COPD patients. “People with mild disease could have been included in the [advisory committees] vote, and thats the major difference,” says Stephen Rennard, MD, a professor of medicine at the University of Nebraska Medical Center, in Omaha. Dr. Rennard is also a consultant to Forest Laboratories and Nycomed, the U.S. and European/Canadian companies, respectively, that own the license for roflumilast.

When the FDA finally approved Daliresp for Severe COPD treatment, it was to treat bronchitis-related Symptoms, such as cough and excess mucous in people with severe or very severe COPD who have a history of exacerbations. Dalirespfor Copd treatment is not approved for people who have COPD involving emphysema or for patients younger than 18.

(The study was conducted in patients 40 and older.)Dr. Rennard, who was a presenter at the FDA advisory committee in 2010, thinks that “if the committee had voted on the narrower indication, it probably would have gone through,” meaning the advisory committee would have said yes to the drugs approval for patients with at least severe COPD. He adds that it was in the severe and very severe COPD groups that Daliresp trials found the drug to have the clearest benefit.Of the 12 million people in the U.S. who are estimated to have Severe COPD, Dr. Rennard says that approximately 3 million have severe COPD and chronic bronchitis and could benefit from Daliresp for Copd treatment.

Many products use a combination of one or more COPD drugs; in addition to Advair, examples include brand name drugs like Combivent and Symbicort.Two trials published in the Lancet in 2009 looked at the effect of Daliresp in patients who were already taking salmeterol or tiotropium, and found that Daliresp improved lung function more than either bronchodilator alone. The authors suggest that Daliresp for Copd treatment gives added benefit because it has an anti-inflammatory effect while the bronchodilators open up the airways.

One advantage of Daliresp for Copd treatment is that it comes in pill form, which should make it more attractive to patients.Dr. Boethel says he was heartened by the FDAs approval of Daliresp for Copd Symptoms treatment.”Pulmonologists always get a little excited when something new comes out that may give our patients some relief,” says Dr. Boethel. “But this still remains a pretty bad disease. COPD is one of the few diseases that the mortality has increased since the ’60s. We used to think of COPD as a disease of elderly men, primarily veterans, and now its more a disease of people under 65 and it affects women more than men.”But as with all drugs, “Daliresp for Severe COPD treatment should be used cautiously and the potential benefits need to be considered against the potential risks,” Dr. Rennard says.