Randomized trial of zileuton for treatment of COPD exacerbations requiring hospitalization.

Abstract

RATIONALE:

Leukotrienes have been implicated in the pathogenesis of acute exacerbations of COPD, but leukotriene modifiers have not been studied as a possible therapy for exacerbations.

OBJECTIVE:

We sought to test the safety and efficacy of adding oral zileuton (a 5-lipoxygenase inhibitor) to usual treatment for acute exacerbations of COPD requiring hospitalization.

METHODS:

Randomized double-blind, placebo-controlled, parallel group study of zileuton 600 mg orally, 4 times daily versus placebo for 14 days starting within 12 hours of hospital admission for COPD exacerbation. Primary outcome measure was hospital length of stay; secondary outcomes included treatment failure and biomarkers of leukotriene production.

MAIN FINDINGS:

Sixty subjects were randomized to zileuton and 59 to placebo (the study was stopped short of enrollment goals because of slow recruitment). There was no difference in hospital length of stay (3.75 +/- 2.19 vs. 3.86 +/- 3.06 days for zileuton vs. placebo, p = 0.39) or treatment failure (23% vs. 27% for zileuton vs. placebo, p = 0.63) despite a decline in urinary LTE(4) levels in the zileuton-treated group as compared to placebo at 24 hours (change in natural log-transformed ng/mg creatinine -1.38 +/- 1.19 vs. 0.14 +/- 1.51, p < 0.0001) and 72 hours (-1.32 +/- 2.08 vs. 0.26 +/- 1.93, p<0.006). Adverse events were similar in both groups.

PRINCIPAL CONCLUSIONS:

While oral zileuton during COPD exacerbations that require hospital admission is safe and reduces urinary LTE(4) levels, we found no evidence suggesting that this intervention shortened hospital stay, with the limitation that our sample size may have been insufficient to detect a modest but potentially meaningful clinical improvement.

• Authors: Prescott G Woodruff, Richard K Albert, William C Bailey, Richard Casaburi, John E Connett, John A D Cooper Jr, Gerard J Criner, Jeffrey L Curtis, Mark T Dransfield, Meilan K Han, Sarah M Harnden, Victor Kim, Nathaniel Marchetti, Fernando J Martinez, Charlene E McEvoy, Dennis E Niewoehner, John J Reilly, Kathryn Rice, Paul D Scanlon, Steven M Scharf, Frank C Sciurba, George R Washko, Stephen C Lazarus, Copd Clinical Research Network
• Journal: COPD (COPD) Vol. 8 Issue 1 Pg. 21-9 (Feb 2011) ISSN: 1541-2563 [Electronic] England
• PMID: 21299475 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Biomarkers
• Lipoxygenase Inhibitors
• Leukotriene B4
• Leukotriene E4
• zileuton
• Hydroxyurea

Topics

• Aged
• Biomarkers (blood, urine)
• Double-Blind Method
• Drug Administration Schedule
• Female
• Hospitalization
• Humans
• Hydroxyurea (administration & dosage, adverse effects, analogs & derivatives, pharmacology, therapeutic use)
• Length of Stay
• Leukotriene B4 (blood)
• Leukotriene E4 (urine)
• Lipoxygenase Inhibitors (administration & dosage, adverse effects, pharmacology, therapeutic use)
• Male
• Middle Aged
• Pulmonary Disease, Chronic Obstructive (blood, drug therapy, urine)
• Treatment Failure
• Treatment Outcome