Oleh Admin Kalbe Medical pada January 04, 2017 07:30

Roflumilast Efektif untuk Terapi PPOK

PPOK (penyakit paru obstruktif kronik) ditandai dengan limitasi aliran udara yang tidak sepenuhnya bisa pulih kembali, dan telah menjadi salah satu masalah kesehatan mayor di dunia. Terapi PPOK saat ini bertujuan untuk menurunkan dampak yang mungkin terhadap status kesehatan pasien seperti gejala, derajat limitasi aliran udara, dan risiko jangka panjang, meliputi eksaserbasi, komorbiditas, dan mortalitas. Terapi farmakologi yang ideal dapat mengurangi gejala, frekuensi dan keparahan eksaserbasi, serta memperbaiki status kesehatan dan toleransi latihan dari pasien. Namun, pilihan farmakoterapi untuk terapi PPOK masih terbatas.

Munculnya isoenzim phosphodiesterase 4 (PDE4) dalam berbagai tipe sel yang berdampak pada PPOK akan membuatnya menjadi target yang menjanjikan dalam terapi modifikasi penyakit. Roflumilast, suatu penghambat phosphide stressor 4, mempunyai afinitas yang tinggi terhadap PDE4. Bukti saat ini menunjukkan bahwa roflumilast efektif dalam terapi PPOK, khususnya dalam mencegah eksaserbasi akut PPOK.

Suatu studi meta-analisis sebelumnya yang melibatkan 11 uji klinik dan 9.675 pasien menunjukkan hasil bahwa roflumilast secara bermakna menurunkan tingkat eksaserbasi rata-rata dan memperbaiki volume ekspirasi paksa dalam satu detik (FEV1) dan parameter spirometrik pasca-bronkodilator lainnya (kapasitas vital paksa, dll). Selanjutnya suatu studi sistematik baru juga telah dilakukan untuk menilai efek klinis dan keamanan dari roflumilast dalam terapi PPOK stabil menggunakan data uji klinik acak (RCT) yang dicari dari MEDLINE, EMBASE, dan Cochrane Controlled Trials Register. RCT yang melaporkan efek terapi roflumilast pada PPOK diidentifikasi. Data yang relevan diekstraksi dan dilakukan suatu meta-analisis.

Hasilnya menunjukkan bahwa terdapat total 9 artikel dan 13 RCT yang didientifikasi. Secara keseluruhan, 29,1% subjek pada kelompok roflumilast menunjukkan bukti eksaserbasi dibanding 32,2% pada kelompok plasebo. Penggunaan roflumilast menurunkan eksaserbasi PPOK dibandingkan dengan plasebo (OR = 0,82; 95% CI = 0,75-0,9). Kualitas hidup dan spirometri juga mengalami perbaikan. Untuk pasien yang mendapat pra-bronkodilator basal, volume ekspirasi paksa rata-rata pada detik pertama menunjukkan bukti perubahan jika mendapat roflumilast (64,88 mL; 95% CI = 54,09-75,66). Sedangkan yang mendapat plasebo tidak menunjukkan bukti perubahan.

Dari hasil studi meta-analisis tersebut disimpulkan bahwa roflumilast secara nyata mencegah eksaserbasi akut dari PPOK. Roflumilast terbukti mampu memperbaiki spirometri PPOK pasien. Efek samping tidak meningkat secara bermakna pada kelompok roflumilast dibanding kelompok kontrol. Pasien PPOK dapat mendapatkan manfaat dari terapi roflumilast. Namun lebih banyak studi acak diperlukan untuk mendukung kesimpulan studi ini lebih lanjut. (EKM)

Image : Ilustrasi
Referensi:
1.Yuan L, Dai X, Yang M, Cai Q, Shao N. Potential treatment benefits and safety of roflumilast in COPD: A systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2016;11:1477-83. doi: 10.2147/COPD.S106370.
2.Yan JH, Gu WJ, Pan L. Efficacy and safety of roflumilast in patients with stable chronic obstructive pulmonary disease: A meta-analysis. Pulm Pharmacol Ther. 2014;27(1):83-9. doi: 10.1016/j.pupt.2013.04.004.

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