Effect of erdosteine on the rate and duration of COPD exacerbations: the RESTORE study

Roberto W Dal Negro, Jadwiga A Wedzicha, Martin Iversen, Giovanni Fontana, Clive Page, Arrigo F Cicero, Edoardo Pozzi, Peter M A Calverley, RESTORE group, RESTORE study, M Decramer, D Osmanliev, K Kostov, M Peneva, V Kolek, V Kasak, I Pavlisova, J Mares, P Kalina, M Buresova, D Velart, R Ivankova, R Hrdina, P Lange, M Aubier, J F Muir, S Tognella, C Balestriero, G Scarmagnan, F Zecchinato, S Amaducci, M Villani, S Scoditti, F Lavorini, M Moretti, A Tubaldi, G Mattioli, E Guffanti, A Fumagalli, M Del Donno, S Centanni, J Milanowski, H Batura-Gabryel, M Gabricki, E Nizankowska-Mogilnicka, R Chazan, J Klimiuk, I Grzelewska-Rzymowska, S From, Z Bartuzy, V Tudorache, M Marc, I Iovan, D Vancea, F Mihaltan, R Ulmeanu, T Mihaescu, G Jimborean, D Todea, M C Pop, D Bumbacea, H Lescisinova, I Jonner, A Golubov, A Morice, L Davies, L McGarvey, Roberto W Dal Negro, Jadwiga A Wedzicha, Martin Iversen, Giovanni Fontana, Clive Page, Arrigo F Cicero, Edoardo Pozzi, Peter M A Calverley, RESTORE group, RESTORE study, M Decramer, D Osmanliev, K Kostov, M Peneva, V Kolek, V Kasak, I Pavlisova, J Mares, P Kalina, M Buresova, D Velart, R Ivankova, R Hrdina, P Lange, M Aubier, J F Muir, S Tognella, C Balestriero, G Scarmagnan, F Zecchinato, S Amaducci, M Villani, S Scoditti, F Lavorini, M Moretti, A Tubaldi, G Mattioli, E Guffanti, A Fumagalli, M Del Donno, S Centanni, J Milanowski, H Batura-Gabryel, M Gabricki, E Nizankowska-Mogilnicka, R Chazan, J Klimiuk, I Grzelewska-Rzymowska, S From, Z Bartuzy, V Tudorache, M Marc, I Iovan, D Vancea, F Mihaltan, R Ulmeanu, T Mihaescu, G Jimborean, D Todea, M C Pop, D Bumbacea, H Lescisinova, I Jonner, A Golubov, A Morice, L Davies, L McGarvey

Abstract

Oxidative stress contributes to chronic obstructive pulmonary disease (COPD) exacerbations and antioxidants can decrease exacerbation rates, although we lack data about the effect of such drugs on exacerbation duration.The RESTORE (Reducing Exacerbations and Symptoms by Treatment with ORal Erdosteine in COPD) study was a prospective randomised, double-blind, placebo-controlled study, enrolling patients aged 40-80 years with Global Initiative for Chronic Obstructive Lung Disease stage II/III. Patients received erdosteine 300 mg twice daily or placebo added to usual COPD therapy for 12 months. The primary outcome was the number of acute exacerbations during the study.In the pre-specified intention-to-treat population of 445 patients (74% male; mean age 64.8 years, forced expiratory volume in 1 s 51.8% predicted) erdosteine reduced the exacerbation rate by 19.4% (0.91 versus 1.13 exacerbations·patient-1·year-1 for erdosteine and placebo, respectively; p=0.01), due to an effect on mild events; the reduction in the rate of mild exacerbations was 57.1% (0.23 versus 0.54 exacerbations·patient-1·year-1 for erdosteine and placebo, respectively; p=0.002). No significant difference was observed in the rate of moderate and severe exacerbations (0.68 versus 0.59 exacerbations·patient-1·year-1 for erdosteine and placebo, respectively; p=0.054) despite a trend in favour of the comparison group. Erdosteine decreased the exacerbation duration irrespective of event severity by 24.6% (9.55 versus 12.63 days for erdosteine and placebo, respectively; p=0.023). Erdosteine significantly improved subject and physician subjective severity scores (p=0.022 and p=0.048, respectively), and reduced the use of reliever medication (p<0.001), but did not affect the St George's Respiratory Questionnaire score or the time to first exacerbation.In patients with COPD, erdosteine can reduce both the rate and duration of exacerbations. The percentage of patients with adverse events was similar in both the placebo and erdosteine treatment groups.

Trial registration: ClinicalTrials.gov NCT01032304.

Conflict of interest statement

Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com

Copyright ©ERS 2017.

Figures

FIGURE 1
FIGURE 1
Trial profile. Percentages are based on the number of randomised patients in the single treatment group. ITT: intention to treat.
FIGURE 2
FIGURE 2
Mean exacerbation rate in the study period (1 year). ns: not significant.
FIGURE 3
FIGURE 3
Mean exacerbation duration in the study period (1 year).
FIGURE 4
FIGURE 4
Kaplan–Meier plot of probability of being exacerbation-free at each point through the study. Numbers show remaining patients at randomisation and during treatment at 50, 100, 150, 200, 250, 300 and 350 days.

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