News in brief: Epilepsy therapy could be first drug for OSA; Is paracetamol linked to COPD exacerbations? Tezepelumab fails to cut steroid use in asthma patients

Wednesday, 20 Apr 2022

Epilepsy therapy could be first drug for OSA

Carbonic anhydrase (CA) inhibition has been shown to reduce the number of breathing pauses and promote oxygenation during the night in patients with obstructive sleep apnea.

A German RCT randomised 59 patients with moderate or severe sleep apnea to either 400 or 200 mg of sulthiame or placebo for four weeks.

Breathing pauses in the higher dose treated groups decreased on average more than 20 per hour from baseline. For just over a third of patients in the study, only half of their breathing pauses were left, and in one in five the number fell by at least 60 percent.

CA inhibitors are already used for treatment of disorders including glaucoma and epilepsy which makes fast-tracking development of the first drug for sleep apnea practicable.

Side effects including headache and breathlessness were reported and more common in the higher dose group.

Read more in the American Journal of Respiratory and Critical Care Medicine.

Is paracetamol linked to COPD exacerbations?

Researchers have identified a complex pattern of association between the duration, dose and recency of paracetamol exposure and COPD exacerbation in elderly Australians.

The study of 3,500 patients found a decreased rate of COPD exacerbation in the first week after initiation of paracetamol, which changed to a small increased rate after approximately 4 to 6 weeks of continuous paracetamol use.

“However, the rate decreased to baseline levels for durations longer than 2 months. There was also a short-term increased rate after stopping paracetamol, which was dependent on dose, duration and time since stopping.”

The investigators said the short-term and delayed effects of paracetamol are suggestive of an adaptive response of lung glutathione levels.

“Our finding that the risk of hospitalisation for a COPD exacerbation fluctuated with time assist in explaining the conflicting results from previous studies regarding the potential impact of paracetamol with other respiratory diseases, particularly asthma,” they concluded.

Read more in Respiratory Research

Tezepelumab fails to cut corticosteroid use in asthma patients

The monoclonal antibody tezepelumab has failed to reduce corticosteroid use in patients with corticosteroid-dependent asthma.

In the phase 3 RCT, 150 patients with corticosteroid-dependent asthma were randomly assigned to receive either tezepelumab 210mg (n=74) or placebo (n=76).

The results shows that the cumulative odds of achieving a category of greater percentage reduction in an oral corticosteroid dose for daily maintenance at week 48 were similar in both groups, and thus the primary endpoint was not met.

Of note, the research found that the same odds were higher with tezepelumab than placebo in patients with a higher baseline blood eosinophil level of at least 150 cells per μL (OR 2·58), but not in those with counts below (OR 0·40).

Publication of the results closely follows AstraZeneca’s request to the National Institute for Health and Care Excellence (NICE) to delay evaluation of tezepelumab for treating severe asthma, to allow for collection of further information to support the drug’s NHS use.

Read more in The Lancet Respiratory Medicine

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