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Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Medical management options include using a short-acting beta-2-agonist (SABA) or short-acting muscarinic antagonist (SAMA) initially followed by (if asthmatic features present) either a long-acting beta-2-agonist (LABA) with an inhaled corticosteroid (ICS) or (if no asthmatic features or steroid responsiveness) a LABA + LAMA. Other options include mucolytics, theophylline, roflumilast and long-term oxygen therapy (LTOT).
Economical evaluation
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Roberto W. Dal Negro, Claudio F. Donner
Reports of the economic convenience of antimicrobial agents provide conflicting results (49–51). Some studies emphasize the cost-effectiveness of PDE4 inhibitor roflumilast in the societal perspective (52); of erdosteine (an antioxidant mucoactive drug) in terms of reduction of exacerbation and hospitalization rates over an 8-month daily treatment (53); of α1-antitrypsine supplementation when administered in emphysema patients with α1-antitrypsine deficiency (54), and of both influenza vaccination and pneumococcal conjugate vaccination programmes, particularly in risk groups of COPD subject (55,56).
Pulmonary Disease in the Geriatric Population
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
A full review of pharmacologic management of COPD is beyond the scope of this chapter. All long-acting inhaled therapies (LABAs, corticosteroids, and anticholinergics) have been shown to reduce expected annual decline in lung function,37 and therapeutic combinations of inhalers, particularly in patients with moderate to severe disease, appear to augment airflow, reduce exacerbations and hospitalizations, improve quality of life,38 and lower COPD-related mortality.39 Noninhaled medications, such as theophylline, roflumilast, and intermittent macrolide therapy, also play a role in management of COPD, but are generally adjunctive to the inhaled therapies. For patients with severe or end-stage disease, low dose oral corticosteroid maintenance therapy is sometimes necessary, although evidence supporting its use is lacking.
Topical roflumilast for the treatment of psoriasis
Published in Expert Review of Clinical Immunology, 2023
Anastasia Drakos, Ron Vender, Tiago Torres
An important benefit of roflumilast is its ability to be used in intertriginous and other difficult-to-treat areas. Treatment of intertriginous plaques requires special attention as the skin in these regions is thin, leading to increased systemic absorption and higher risk for adverse events with corticosteroid application, particularly skin atrophy [43–45]. Among patients with mild intertriginous involvement, significant reductions in disease severity (I-IGA success) were reported as early as 2 weeks [38]. By 8 weeks, most patients achieved intertriginous area clearance, as measured by an I-IGA score of 0 [38]. When considering patients with involvement of the knees and elbows, regions where drug absorption is a challenge, similar results were reported [46]. These findings are relevant clinically, as patients with complex body surface area involvement often require multiple therapies for management, compromising adherence [44]. Roflumilast has the potential to simplify the treatment regimen for patients as a single therapeutic option with demonstrated efficacy on multiple body surfaces.
New synthetic pharmacotherapeutic approaches to the treatment of moderate-to-severe plaque psoriasis in adults
Published in Expert Opinion on Pharmacotherapy, 2023
Rithi J. Chandy, Sarah G. Bridgeman, Brandon M. Godinich, Steven R. Feldman
In phase III clinical trials, roflumilast was administered daily with a high water-containing moisturizing cream that also involved ethoxydiglycol, a cosmetic solvent. The patients in this trial received treatment for 12 weeks. A total of 331 patients were randomized into roflumilast 0.3% cream (n = 109), roflumilast 0.15% (n = 113), and vehicle cream (n = 109). The Investigator Global Assessment (IGA) status of ‘clear’ or ‘almost clear’ at week 6 was 28% for the 0.3% group, 23% for the 0.15% group, and 8% for the vehicle group. Overall, there was a grade improvement in IGA scores for 0.3% roflumilast (73%), 0.15% roflumilast (44%), and vehicle groups (29%) [20]. Adverse effects of roflumilast include reports of diarrhea, headache, and pain at the application site [20–23]. However, most patients reported a well-tolerated treatment course. In a subsequent recent study, roflumilast reduced psoriasis severity by week 8 of treatment [8].
More than a random association between chronic obstructive pulmonary disease and psoriatic arthritis: shared pathogenic features and implications for treatment
Published in Expert Review of Clinical Immunology, 2022
Luca Quartuccio, Marco Sebastiani, Francesca Romana Spinelli, Fabiano Di Marco, Rosario Peluso, Salvatore D’Angelo, Alberto Cauli, Maurizio Rossini, Fabiola Atzeni
The development of selective PDE-4 inhibitors in the treatment of COPD offers both anti‐inflammatory and broncho-dilatory effects, with fewer of the adverse effects encountered with non‐selective inhibitors. Additionally, PDE-4 inhibitors may be easier to use because they provide less pharmacokinetic variability and lower potential for drug interactions, compared with non‐selective inhibitors. PDE-4 inhibitors, in particular Roflumilast, have been largely studied to treat chronic airway diseases including COPD and asthma. Most evidence has been gathered for Roflumilast at a dose of 500 μg daily. A recent meta-analysis found 43 RCTs for Roflumilast (28 trials with 18,046 participants), Cilomilast (14 trials with 6457 participants), or Tetomilast (1 trial with 84 participants), with a duration between six weeks and one year or longer, and including people across international study centers with moderate to very severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades II to IV) [38]. Based on the risk benefit ratio, the authors of this review provided cautious support for the use of PDE-4 inhibitors in COPD, placing them as add-on therapy for a subgroup of people with persistent symptoms or exacerbations despite optimal COPD management. Trials with longer follow-up are needed to show whether PDE-4 inhibitors can modify FEV₁ decline, hospitalization, or mortality in COPD [38].