Impact of erdosteine on exacerbations in moderate COPD

Abstract

Impact of erdosteine on exacerbations in moderate COPD

Introduction: Prophylactic treatment with LABA/ICS in moderate COPD affects the number of exacerbations and their treatment (Martinez AJRCCM 2018). Little is known about the effect of antioxidants on exacerbation treatment. We evaluated the effect of erdosteine on exacerbations, antibiotic and oral corticosteroid (OCS) use and health status in moderate COPD.

Methods: In this post-hoc analysis of RESTORE study (Dal Negro ERJ 2017), 254 patients with moderate COPD (GOLD 2) received erdosteine 300 mg bid or placebo added to usual therapy for 12 months. We determined antibiotic and OCS use, exacerbation duration and St George’s Respiratory Questionnaire (SGRQ) scores. Subjective COPD severity scores were rated at baseline, 6 and 12 months. A p value <0.05 was considered nominally significant.

Results: With erdosteine 43/126 patients exacerbated (7 moderate), compared to 62/128 with placebo (14 moderate). Erdosteine-treated patients with moderate or severe exacerbations took OCS on fewer days compared to placebo (11.4 vs 13.3), required less antibiotics (71.4% vs 85.8%) (p <0.05). Total OCS exposure was significantly less with erdosteine (p<0.05) due to shorter treatment periods (p<0.04). Erdosteine-treated patients who exacerbated showed greater improvements in SGRQ with significantly more reporting a 4 point decrease in total score despite their exacerbation (p<0.001). Similar changes were seen in subjective disease severity scores, regardless of exacerbation severity.

Conclusions: In GOLD 2 patients erdosteine decreased the frequency and changed the treatment of exacerbations, lessening their impact. Preventing exacerbations in moderate COPD produces clinically meaningful benefits.