With limited options in the treatment paradigm for refractory or unexplained chronic cough, P2X3 receptor antagonists have shown great promise in clinical trials. We were delighted to speak to Dr. Imran Satia (McMaster University, Hamilton, ON, Canada) to discuss the current unmet needs when treating chronic cough and the investigational P2X3 receptor antagonists currently in clinical trials.
The abstract ‘Gefapixant efficacy and safety in participants with history of refractory or unexplained chronic cough for ≥1 vs <1 year‘ was presented at ERS 2023, 9 – 13 September 2023.
Questions
- What are the unmet needs in the treatment paradigm for chronic cough? (0:19)
- What P2X3 receptor antagonists are currently in development for the treatment of chronic cough? (2:02)
Disclosures: Imran Satia discloses consulting for Bellus, Merck, Genentech, and Respiplus; receiving grant/research support from GSK, and Merck; serving on advisory boards for Bellus; receiving honoraria from Novartis; and participating in speaker’s bureaus with AstraZeneca, GSK, and Merck.
Support: Interview and filming supported by Touch Medical Media Ltd. Interview conducted by Shanice Allen.
Filmed in coverage of the ERS Annual Meeting.
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What are the unmet needs in the treatment paradigm for chronic cough?Â
Chronic cough is defined as a cough lasting >8 weeks and globally affects 10% of the population. Chronic cough increases with aging, peaks in the 50-60’s, and is twice as common in females than men. Chronic cough is also one of the commonest reasons for going to see a doctor and being referred to see a specialist. Patients with chronic cough often cough hundreds of times per day which leads to distressing physical, psychological and social consequences, especially in the post-COVID era.
Patients with chronic cough are often treated for asthma, reflux disease or nasal disease but a proportion have persistent coughing despite treating these conditions or there is no evidence of an underlying disease. We call this either refractory (RCC) or unexplained chronic cough (UCC). Unfortunately, there are no licensed treatments for this condition, so physicians will try pain killers such as opioids, anti-epilepsy drugs or anti-depressants. These medications were not developed to treat chronic cough, and many patients cannot tolerate these medications because of side effects or risk of falls and addiction. We therefore badly need to understand why patients develop RCC/UCC, how best to investigate and manage in primary and secondary care and most importantly to develop new treatments which are tolerable and effective.
What P2X3 receptor antagonists are currently in development for the treatment of chronic cough?
Gefapixant is the medication that has completed clinical development from phase 1 to phase 3, and is currently under regulatory review by the European medicines agency, the FDA, MHRA and health Canada. It is currently licensed in Japan and Switzerland. There is also another p2x3 antagonist called camlipixant which has been shown to be safe, efficacious and tolerable in phase 1 and phase 2, and the phase 3 trial is currently ongoing.
