A double-blind randomised placebo-controlled trial investigating the effects of lesogaberan on the objective cough frequency and capsaicin-evoked coughs in patients with refractory chronic cough

被引:15
作者
Badri, Huda [1 ,2 ]
Gibbard, Carmen [1 ]
Denton, Dimitra [1 ]
Satia, Imran [1 ,3 ]
Al-Sheklly, Bashar [1 ]
Dockry, Rachel J. [1 ]
Holt, Kimberley [1 ]
McGuiness, Kevin [4 ]
Treadway, Sam [4 ]
Whorwell, Peter [1 ,4 ]
Houghton, Lesley [1 ,5 ,6 ]
Lee, Augustine [7 ]
Escott, K. Jane [8 ]
Lee, Theresa [7 ]
Wilkinson, Greame [9 ]
Holt, Alison [9 ]
Canning, Brendan J. [10 ]
Smith, Jacky A. [1 ,4 ]
机构
[1] Univ Manchester, Sch Biol Sci, Div Immunol Immun Infect & Resp Med, Manchester, Lancs, England
[2] Pennine Acute NHS Trust, North Manchester Gen Hosp, Manchester, Lancs, England
[3] McMaster Univ, Dept Med, Div Resp Med, Hamilton, ON, Canada
[4] Manchester Univ Fdn Trust, Wythenshawe Hosp, Manchester, Lancs, England
[5] Univ Leeds, Div Gastroenterol & Surg Sci, Leeds Inst Med Res St Jamess, Leeds, W Yorkshire, England
[6] Mayo Clin, Div Gastroenterol & Hepatol, Jacksonville, FL USA
[7] Mayo Clin, Pulm Med, Jacksonville, FL USA
[8] AstraZeneca, BioPharmaceut R&D, Emerging Innovat, Cambridge, England
[9] AstraZeneca, Macclesfield, Cheshire, England
[10] Johns Hopkins Asthma & Allergy Ctr, Baltimore, MD USA
关键词
ESOPHAGEAL SPHINCTER RELAXATIONS; CHRONIC UNEXPLAINED COUGH; GASTROESOPHAGEAL-REFLUX; HEALTH-STATUS; AGONIST; PH; BACLOFEN; MOTILITY;
D O I
10.1183/23120541.00546-2021
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Objective Baclofen is a centrally acting gamma-aminobutyric acid type B (GABA(B)) receptor agonist which reduces gastro-oesophageal reflux and suppresses the cough reflex; however, central nervous system side-effects limit its use. Lesogaberan is a novel peripherally acting GABA(B) agonist, but its effects on refractory chronic cough are unknown. Design We performed a single-centre, placebo-controlled, double-blind randomised crossover study in patients with chronic cough, refractory to the treatment of underlying conditions. Patients were randomised to treatment with lesogaberan 120 mg modified release twice daily or matched placebo for 2 weeks and then crossed over to the alternative therapy after a 2-week washout. The primary end-point was 24-h cough frequency measured with an acoustic monitoring system. In addition, cough responses to capsaicin were measured, and gastro-oesophageal reflux assessed by 24-h pH/impedance at screening. Results 22 patients were randomised to receive lesogaberan/placebo or placebo/lesogaberan (female (73%); mean +/- SD age 63.7 +/- 7.2 years; median (interquartile range) cough duration 10.5 (5.8-17.0) years; mean (95% CI) 45 (29-67) reflux events in 24 h; two patients had abnormal oesophageal acid exposure times). Although lesogaberan reduced cough counts by 26% over placebo, this did not reach statistical significance (p=0.12). However, lesogaberan did significantly improve cough responses to capsaicin (p=0.04) and the number of cough bouts (p=0.04) compared with placebo. Lesogaberan was well tolerated in this study. Conclusions Lesogaberan improved cough hypersensitivity and the number of bouts of coughing, but not coughs per hour. This implies a possible role for peripheral GABA(B) receptors in refractory chronic cough.
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页数:11
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