Week 23 Respirology. Other Asthma & COPD Medications Self Learning Module

Transcription

1 Week 23 Respirology Other Asthma & COPD Medications Self Learning Module

2 DISCLOSURE Relevant relationships with commercial entities [None] Potential for conflicts of interest within this presentation [None] Steps taken to review and mitigate potential bias [Review with faculty, use of generic names and concordance with accepted practice guidelines]

3 MODULE OBJECTIVES By the end of the module, you should be able to: 1. To be able to describe important drug classes utilized in the management of respiratory disease and their mechanisms of action

4 LECTURE OBJECTIVES By the end of this lecture, the learner should be able to: 1. List 3 rd and 4 th line agents for asthma and COPD

5 Leukotriene Receptor Antagonists (LTRA) Montelukast, Zafirlukast MOA: Block effects of cysteinyl leukotrienes which are potent bronchoconstrictors Used in ASTHMA only Inferior to ICS in asthma May be useful in subsets (pediatric, asthma + nasal polyps + acetylsalicyclic acid (ASA) sensitivity) Common side effects: headaches Rare: Eosinophilic Granulomatosis with Polyangitis (EGPA) and Psychiatric symptoms including suicidal ideation Oral tablet given daily BID

6 Omalizumab MOA: monoclonal antibody against immunoglobulin E (IgE) Used in ASTHMA (allergic) uncontrolled by high dose ICS Common: Transient injection site reactions Rare: Arterial thromboembolism, anaphylaxis ~ % Injectable agent dosed based on body weight and serum IgE levels every 2 4 weeks Cannot be self administered High cost

7 Roflumilast MOA: Selective PDE4 inhibitor which decreases inflammation & inhibits collagen deposition and fibroblast proliferation Used in COPD only Significant drug interactions due to CYP metabolism Common side effects: diarrhea, weight loss, nausea Rare: Psychiatric side effects (insomnia, anxiety, and depression) Oral tablet given daily High cost

8 Theophylline MOA: Antiinflammatory at low doses and Bronchodilator at higher doses Used rarely in COPD and in ASTHMA Significant number of drug interactions Side effects: headache, nausea and vomiting, diuresis, and gastroesophageal reflux Toxic concentrations, seizures and cardiac arrhythmias Side effects are common at drug levels required for bronchodilatory effect Must use sustained release product to minimize a/e

9 KEY MESSAGES 1. LTRA are commonly used in pediatric populations to avoid steroid adverse effects 2. Omalizumab is beneficial in the subgroup of patients with difficult to treat allergic asthma 3. Roflumilast and theophylline are rarely used, uncertain the additional benefit in adding to maximum conventional therapies

10 MODULE OBJECTIVES By now, you should be able to: 1. List 3 rd and 4 th line agents for asthma and COPD

11 References Leukotriene receptor Antagonists Normansell R, Walker S, Milan SJ, Walters EH, Nair P. Omalizumab for asthma in adults and children. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD DOI: / CD pub4. Omalizumab and the risk of malignancy: results from a pooled analysis. J Allergy Clin Immunol Apr;129(4):983 9.e6. Incidence of malignancy in patients with moderate to severe asthma treated with or without omalizumab. J Allergy Clin Immunol Sep;134(3): e4. EXCELS study results do not rule out potential cancer risk with omalizumab. J Allergy Clin Immunol Jan;135(1):289 Roflumilast: a review of its use in the treatment of COPD. Int J Chron Obstruct Pulmon Dis Jan 6;11: doi: /COPD.S ecollection Roflumiliast Common Drug Review _e.pdf Roflumilast in the management of chronic obstructive pulmonary disease. Am J Health Syst Pharm Dec 1;70(23): doi: /ajhp Chong J, Leung B, Poole P. Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD DOI: / CD pub4. Theophylline. Am J Respir Crit Care Med Oct 15;188(8): doi: /rccm PP.