Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Lei UM (1), Kam KW (1), Wong TC (2), Sun WY (3)
Affiliation :
(1) Department of Pharmacy, (2) Department of Medicine, Haven of Hope Hospital
(3) School of Pharmacy, The Chinese University of Hong Kong
Introduction :
Roflumilast is used in severe chronic obstructive pulmonary disease (COPD), reducing episodes of moderate and severe exacerbation. However, its efficacy when used in a low dose is lacking.
Objectives :
This study aims to evaluate the use of roflumilast in a local extended care hospital, assessing the efficacy and safety of roflumilast in the treatment of COPD, as well as its usage pattern.
Methodology :
A retrospective, non-interventional medical record review with patients on roflumilast in Haven of Hope Hospital was performed. All eligible record was followed by 2 years after the initiation of roflumilast. Primary outcomes were the prevalence of patients who were on 250 mcg roflumilast as maintenance therapy and the pre- and post-treatment annualized rate of hospitalization due to respiratory causes, which were compared at 3, 6, 12 and 24 months after treatment initiation. Secondary outcomes were commonly reported side effects of roflumilast therapy and common reasons that prevent dose escalation.
Result & Outcome :
Among 212 patients, 74 (34.9%) patients were on 250 mcg of roflumilast. Patients who were on 250 mcg roflumilast as maintenance therapy had an older age (76.1 vs 73.2, p=0.007), lower body weight (46.3 vs 55.1, p=0.005), a higher proportion of female patients (8.1% vs 0%, p=0.002), a lower prevalence of depression at baseline (13.5% vs 0.7%, p<0.001) and higher portion of these patients started roflumilast during hospitalization (79.7% vs 62.3%, p=0.006) when compared to those who successfully titrated up to full dose. No significant difference was identified for changes in annualized rate of hospitalization due to respiratory causes except at 24 months after treatment initiation (p=0.026). Adverse effects were reported in 52 (24.5%) patients. Commonly reported side effects included decreased appetite (13.7%), weight loss (4.7%) and diarrhea (2.8%).
Patients with more advanced age, low body weight, who was female and who had concomitant depression tend to receive a lower dose of roflumilast. Extra care should be given to these patients. There were signals showing low dose roflumilast may have effects on lowering hospitalized exacerbation rate. However, no conclusive recommendations could be made regarding the efficacy of low dose roflumilast due to inconsistent statistical results.
