Health status in patients with COPD treated with roflumilast: two large noninterventional real-life studies: DINO and DACOTA

Purpose

DINO and DACOTA were prospective, noninterventional studies assessing the health status and quality of life of patients with COPD newly treated with roflumilast 500 μg once-daily add-on therapy.

Patients and methods

Patients were evaluated over 6 months. Clinical COPD questionnaire (CCQ) and COPD assessment test (CAT) scores were recorded at baseline and after 3 and 6 months. In DACOTA, post-bronchodilator FEV1 was recorded at each time point.

Results

Of 5,462 and 3,645 patients recruited into DINO and DACOTA, respectively, 3,274 patients in DINO and 916 patients in DACOTA completed the 6-month visit. Almost all patients had severe or very severe airway obstruction; mean baseline CCQ total score was 3.9 in DINO and 3.7 in DACOTA. Overall, 33.8% of patients in DACOTA and 30.6% in DINO discontinued treatment prematurely. Significant and clinically relevant improvements in CCQ total scores were observed in both studies (mean change from baseline of 1.36 in DINO and 0.91 in DACOTA at Month 6 [all P<0.001]). Changes in CAT total score from baseline to Month 6 indicated that the average clinical impact of COPD was reduced from a severe (score: 21-30) to a moderate (score: 11-20) impairment. In DACOTA, mean change in post-bronchodilator FEV1 was 202 mL (P<0.001). Diarrhea, nausea, and weight decrease were the most frequently reported adverse drug reactions.

Conclusion

In real-life clinical practice, roflumilast treatment as an add-on therapy is associated with clinically relevant improvements in health status and quality of life.

The 2014 Updated GOLD Strategy: A Comparison of the Various Scenarios

Background: The 2014 updated Global initiative for chronic Obstructive Lung Disease (GOLD) strategy added the St. George's Respiratory Questionnaire (SGRQ) as the fourth possible symptoms measure. The impact of the suggested tools for symptoms of COPD and the different definitions of future risk on the frequency distribution and clinical characteristics of the GOLD groups remain unknown. Methods: Demographic and clinical characteristics were assessed in 542 patients with COPD (57.7% male, age 64.6 [9.0] years, FEV₁ 54.7 [22.3]% predicted). Health status was assessed by the COPD-specific SGRQ and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale, anxiety (HADS-A) and depression (HADS-D) subscale. Cohen's Kappa was used to assess agreement between groups. Results: Level of agreement in frequency distribution using the modified Medical Research Council dyspnea (mMRC) scale ≥2, COPD Assessment Test (CAT) ≥10, Clinical COPD Questionnaire (CCQ) ≥1 and SGRQ ≥25 was moderate to very good. Best agreement was reached between CCQ and SGRQ (К = 0.838 or 0.851, p<0.001). Patients classified in mMRC GOLD A reported higher SGRQ scores, higher HADS-A and HADS-D scores compared to patients classified in CAT GOLD A or SGRQ GOLD A. Outcomes were comparable between the risk assessment groups. Conclusions: Choice of the symptom measure impacts GOLD groups more than choice of the exacerbation risk assessment. Health care professionals should be aware that patients are heterogeneous in terms of health status and symptoms of anxiety and depression based on the symptom measure used.