AIRFLOW-2 トライアル：Targeted lung denervation (TLD) なんだかなぁ

COPDへのTargeted lung denervation (TLD) 治療　3年間効果続く
https://kaigyoi.blogspot.com/2018/08/copdtargeted-lung-denervation-tld-3.html



AIRFLOW-2 trial の報告だが、全般的にunder-powerでなんとも言えない報告になっている

LAMA vs LABA/LAMA vs LAMA+TLD 比較報告だったらなぁ

LAMA/LABA versus LAMA (tiotropium)The Committee noted that there was some evidence to suggest that all LAMA/LABAs were superior to tiotropium (18mcg) in improving lung function, symptom control and health-related quality of life, and reducing exacerbations. There were no significant differences in adverse event rates. The Committee concluded that all LAMA/LABAs were clinically superior to LAMA. ( http://www.ace-hta.gov.sg/our-guidance/lama-_-lama-laba-for-chronic-obstructive-pulmonary-disease.html)

Meeting Coverage
ERS　：　https://erscongress.org/programme-2018/access-the-programme-2018.html
Lung Denervation Cuts COPD-Related Events, Admissions
One-time therapy showed most benefit in highly symptomatic patients
by Ian Ingram, Deputy Managing Editor, MedPage Today
September 19, 2018
https://www.medpagetoday.com/meetingcoverage/ers/75179

中等度/重症COPDのトップと言えるtargeted lung denervation (TLD) にて半数超で呼吸器関連イベント半減超減の効果（3ヶ月〜6.5ヶ月間)

TLD+tiotropiumのランダム化にてsham行為比較で 呼吸器系副事象イベント　32% vs 71%

COPD急性増悪には有意差無しだったが、入院必要な重症急性増悪では有意差を認めるリスク減少がＴＬＤで認められた p=0.039


6ヶ月、12ヶ月時点での有効性、QOLエンドポイントではTLD優勢で、underpowerのため有意さ認めずと発表者

Modified Medical Research Council (mMRC) dyspnea scale:

• -0.47 with TLD versus -0.26 with sham at 6 months
• -0.46 versus -0.21 at 12 months, respectively

St. George's Respiratory Questionnaire COPD score:

• -8.31 versus -3.76 at 6 months
• -5.30 versus -2.50 at 12 months

FEV1はTLDが有意に効果あるよう(128 mL vs 86 mL)だが、12ヶ月時点で継続せず (78 mL versus 104 mL)
FVCは両時点ともTLD優勢　:6ヶ月：253 versus 147、 12ヶ月：253 versus 211


Source Reference: Slebos D, et al “A double-blind, randomized, sham-controlled study of targeted lung denervation in patients with moderate to severe COPD” ERS 2018; Abstract OA4929.