Management of Cough in Patients with Chronic Obstructive Pulmonary Disease: Results of the Multicenter Randomized Placebo-Controlled Clinical Trial

Abstract

Sergey N Avdeev,1 Alexander A Vizel,2 Vladimir N Abrosimov3 ,† Andrey A Zaicev,4 Galina L Ignatova,5 Rustem F Khamitov,2 Marina P Mikhaylusova,6 Julia S Shapovalova,7 Elena F Pavlysh,8 Basil I Trofimov,9 Alexander V Emelyanov,10 Tatiana I Martynenko,11 Vladimir A Martynenko,12 Natalia E Kostina,13 Danila A Chizhov,14 Olga Yu Chizhova,10 Natalia A Kuzubova,15 Elena V Makova,16 Ekaterina V Makarova17,18 1I.M. Sechenov First Moscow State Medical University, Moscow, Russia; 2Kazan State Medical University, Kazan, Russia; 3Ryazan State Medical University Named After Academician I.P. Pavlov, Ryazan, Russia; 4The Main Military Clinical Hospital Named After Academician N.N. Burdenko, Moscow, Russia; 5Regional Clinical Hospital No. 4, Chelyabinsk, Russia; 6Pirogov Russian National Research Medical University, Moscow, Russia; 7Chelyabinsk Road Clinical Hospital "Russian Railways", Chelyabinsk, Russia; 8Nikiforov's All-Russian Center for Emergency and Radiation Medicine of the Emergencies, St. Petersburg, Russia; 9I.P. Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; 10North-Western State Medical University Named After I.I. Mechnikov, St. Petersburg, Russia; 11Regional State City Hospital No. 5, Barnaul, Russia; 12Regional State Clinical Hospital, Barnaul, Russia; 13Voronezh Regional Clinical Hospital No. 1, Voronezh, Russia; 14St. Petersburg State City Polyclinic No. 106, St. Petersburg, Russia; 15St. Petersburg State Vvedenskaya City Clinical Hospital, St. Petersburg, Russia; 16State Samara City Hospital No. 4, Samara, Russia; 17Privolzhsky Research Medical University, Nizhny Novgorod, Russia; 18State City Clinical Hospital No. 10, Nizhny Novgorod, Russia†Professor Vladimir Abrosimov passed away on January 22, 2019Correspondence: Sergey N AvdeevI.M. Sechenov First Moscow State Medical University, 8– 2, Trubetskaya St., Moscow, 119991, RussiaTel +7-495-465-74-15Fax +7-495-465-52-64Email serg_avdeev@list.ruBackground: Chronic cough declines quality of life and increases risk of complications in patients with chronic obstructive pulmonary disease (COPD). Reducing cough severity and associated negative effects is important therapeutic goal in COPD. Rengalin with anti- and protussive activity is based on technologically processed antibodies to bradykinin, histamine and morphine.Aim: To evaluate efficacy and safety of Rengalin in treatment of cough in patients with COPD.Methods: Patients (n=238, mean age 64.3± 8.2 years) with stable COPD and persistent cough despite maintenance therapy (anticholinergics, beta-2-adrenergic agonists, inhaled corticosteroids) were included and randomized in the study. The severity of cough assessment (according to the "Cough Severity Score"), COPD impact on patient's life (COPD Assessment Test, CAT), and spirometry were performed at screening. Patients took Rengalin or Placebo 2 tablets 2 times daily for 4 weeks. The endpoints were proportion of patients who responded to treatment, dynamics of cough severity, and severity of COPD symptoms. Intention-to-treat (per protocol) analysis was performed.Results: Positive response to Rengalin was recorded in 83.6 [85.7]% (vs 72.6 [72.7]% in Placebo group, p=0.0422 [p=0.0163]). Double decrease of cough severity was reported in 42.2 [43.8]% in Rengalin group (versus 32.7 [32.7]% in Placebo; p=0.1373 [p=0.0907]). The total CAT score decreased by 3.3± 4.2 [3.6± 3.9] points (versus 2.5± 4.1 [2.5± 4.2] in Placebo group); the difference between groups was 0.79± 4.16 [1.04± 4.02] points (p=0.0870 [p=0.0416]). The number of patients with adverse events (AEs) in Rengalin (n=13) and Placebo (n=12) groups did not have significant differences (p=1.00). No AEs with certain relationship with study drug were registered.Conclusion: Rengalin is an effective and safe drug in patients with stable COPD and persistent cough, despite stable doses of maintenance therapy according to the GOLD guidelines. Four-week therapy decreases severity of cough by two times in more than 40% of patients.Trial Registration: ClinicalTrials.gov (id: NCT03159091).Keywords: cough, cough management, chronic obstructive pulmonary disease, treatment, Rengalin