Research on emerging pharmacotherapy for numerous respiratory conditions was presented at the 2023 European Respiratory Society International Congress (ERS 2023), which took place in Milan, Italy, from September 9 to 13. Pharmacotherapy research findings on long COVID-19 symptom reduction, improving the quality of life in pulmonary arterial hypertension (PAH), and chronic cough treatment are summarized here, along with findings on the relationship between childhood asthma and pollen counts.
Table of Contents
PAH and Treprostinil
Patients with PAH and no comorbidities who were treated with inhaled treprostinil experienced better quality of life outcomes, including improvement in their 6-minute walk distance (6MWD), according to research presented at ERS 2023. Notably, outcomes were better for those without vs with comorbidities.1
Although comorbidities are common in older patients with PAH, the effect of comorbidities on PAH treatment response has not been well understood.
Researchers therefore conducted a post-hoc analysis of the TRIUMPH study (ClinicalTrials.gov Identifier: NCT02342808) of inhaled treprostinil for PAH, comparing treatment outcomes of study participants with and without comorbidities.
Of the 235 trial participants included in the post hoc analysis, 125 had at least 1 comorbidity, including 62 who received treprostinil (median age, 58; 77.4% female; mean weight, 81.7 kg) and 63 who received placebo (median age, 57; 79.4% female; mean weight, 79.6 kg). The 110 participants who did not have any comorbidities included 53 patients receiving treprostinil (median age, 53; 84.9% female; mean weight, 74.8 kg) and 57 receiving placebo (median age, 47; 84.2% female; mean weight, 73.1 kg). Notably, the cohort with comorbidities included more men; patients in this group also had higher weight and a lower 6MWD at baseline.
Researchers compared patients with and without comorbidities treated with treprostinil with respect to change in 6MWD from baseline to after inhalation of treprostinil. Significant improvement in 6MWD was experienced by both groups; however, those without comorbidities saw greater improvement (27 m; P =.0057 vs 20 m; P =.027, respectively).
Additionally, patients receiving inhaled treprostinil vs placebo experienced improved exercise capacity, and this benefit was not influenced by the presence of comorbidities.
Long COVID-19 Symptoms and Chlorpheniramine
Patients treated with either 1% or 0.4% intranasal chlorpheniramine (iCPM) for 10 days during an acute COVID-19 infection experienced fewer long COVID-19 symptoms than patients not treated with iCPM, according to study findings presented at ERS 2023.2
Investigators explored how the development of post COVID-19 symptoms differed in patients with COVID-19 who were treated with iCPM vs placebo in addition to standard-of-care treatment. The researchers conducted 2 separate analyses:
- in the first analysis, 120 patients (with acute COVID-19 when the Omicron 23A variant was prevalent) received a 10-day course of 1% iCPM, followed up by a phone call 5 to 16 months after treatment;
- in the second analysis, 139 patients (with acute COVID-19 when the Omicron 22F variant was prevalent) received a 10-day course of 0.4% iCPM, followed up by a phone call 3 to 9 months after treatment.
In both analyses, patients were asked to self-report post COVID-19 symptoms using a 17-question survey developed by the investigators. The survey assessed the presence of symptoms like headaches, fatigue, and loss of taste or smell.
The researchers found that in both analyses, patients receiving iCPM had significantly fewer long COVID-19 symptoms than patients receiving placebo.
Overall, said the investigators, these findings indicate that “participants who received the iCPM [intranasal chlorpheniramine] had significantly less long term post-COVID symptoms. This suggests a potential benefit from iCPM in preventing or reducing the occurrence of these symptoms.”
Childhood Asthma and Pollen Exposure in Infancy
“Pollen exposure is an environmental risk factor for asthma symptoms and allergic reactions in children,” noted researchers presenting findings on the effects of in-utero and early life pollen exposure at ERS 2023. The researchers found that pollen exposure during these periods increased the likelihood a child would develop asthma by 6 years of age.3
The study authors measured prenatal pollen exposure as the total pollen count during 40 weeks of pregnancy and postnatal exposure was the total pollen count from birth to the start of the pollen season. The researchers also collected information on patient demographics, asthma diagnosis, and risk factors via a patient questionnaire.
The researchers found a significant association between increased pollen exposure during pregnancy (odds ratio [OR], 1.14; 95% CI, 1.05-1.24; P =.002) and a child’s first year of life (OR, 1.18; 95% CI, 1.08-1.29; P =.0003) and the development of asthma by 6 years of age.
“We conclude that higher early life (both pre- and postnatal) exposure is strongly associated with asthma development,” said the study authors. “Further studies are needed to validate these findings and to elucidate the mechanisms of early life exposures to pollen on childhood asthma etiology,” they added.
Chronic Cough, SUI, and Gefapixant
Research presented at ERS 2023 included a post hoc analysis of a clinical trial (ClinicalTrials.gov Identifier: NCT04193176) that found gefapixant significantly reduced cough-induced stress urinary incontinence (cSUI) in women with refractory or unexplained chronic cough (RCC/UCC) and SUI.4
The post hoc analysis assessed an endpoint not evaluated in the original clinical trial: the proportion of women using gefapixant vs placebo who experienced meaningful reductions in cough severity, as measured by the Cough Severity Diary (CSD). The post hoc investigators found that more participants using gefapixant vs placebo experienced clinically meaningful reductions in cough severity.
Gefapixant is a P2X3 receptor antagonist that is intended to reduce cough via activation airway C-fibers. The original phase 3b clinical trial involved 359 women (176 receiving gefapixant 45 mg twice daily and 183 receiving placebo) with a 12-month or greater history of RCC/UCC and a 3-month or greater history of SUI with at least 2 cSUI episodes daily. The endpoints of the post hoc analysis were improvements of at least 1.3 points or 2.7 points in patients’ total CSD score as well as improvement in their mean CSD score.
The researchers found more patients receiving gefapixant vs placebo achieved reductions in CSD of either 1.3 points or greater (gefapixant, 64.2% vs placebo, 54.6%) or 2.7 points or greater (gefapixant, 45.4% vs placebo, 38.2%). Patients who received gefapixant also saw increased mean CSD changes from baseline to week 12 compared with placebo (-2.51 vs -2.05, respectively).
In citing study limitations, the investigators noted that the original clinical trial was not powered for CSD comparisons.
Overall, study authors concluded, “Gefapixant improved patient-reported cough severity in women with RCC/UCC and cSUI vs pbo [placebo].”
Notably, recently published research has found that use of gefapixant 45 mg and 60 mg is associated with adverse events, especially those that are related to taste.
