Options Emerging for Pulmonary Hypertension, Chronic Cough

Ingrid Hein

May 15, 2017

WASHINGTON — Results from the MERIT study, which looks at the safety and efficacy of macitentan, an endothelin receptor antagonist approved for use in patients with pulmonary arterial hypertension, will be among the highlights here at the American Thoracic Society (ATS) 2017 International Conference.

The researchers evaluated the drug in patients with chronic thromboembolic pulmonary hypertension who were deemed inoperable, said Zea Borok, MD, from the University of Southern California in Los Angels, who is chair of the ATS international conference committee.

"That's tantalizing," she told Medscape Medical News.

Evidence from a phase 2 trial looking at the effect of MK-7264, a P2X3 receptor antagonist, in patients with refractory chronic cough will also be presented.

"This affects a lot of patients with lung disease," said Dr Borok. "There will definitely be a lot of interest in that."

Another treatment in the spotlight will be a new drug for patients with idiopathic pulmonary fibrosis. "There's a shortage of drugs for this, and they tend to not be hugely efficacious. We really need better therapies, and this sounds promising," she reported.

Dr Borok said she is looking forward to a presentation on a web-based intervention designed to improve adherence to lung protective ventilation by Gordon Rubenfeld, MD, who is a "leader from Toronto."

Ventilation can affect survival, she explained, so this could be important if it can be generalized to the intensive care unit.

A presentation on the global spread of Mycobacterium abscessus clones in patients with cystic fibrosis will also be of interest, she pointed out.

"The researchers are using state-of-the-art whole-genome sequencing to analyze the origin of infection. A cluster suggesting that there was transmission from person to person will be very interesting to look at," Dr Borok told Medscape Medical News.

For the first time, we will have a rally in the capital to advocate for our patients, and for pulmonary respiratory science.

Researchers and thoracic specialists will come together at this meeting, not only to discuss new treatments and new findings, but also to make themselves heard, said David Gozal, MD, outgoing president of the ATS.

"For the first time, we will have a rally in the capital to advocate for our patients, and for pulmonary respiratory science," he told Medscape Medical News. "Science is important."

The thoracic community has been very vocal about this, he explained. "We want to reflect their voice; this is for the future of our patients. It's critical to develop new therapies and diagnoses for lung diseases."

Politics and the Environment

The concept that origins of adult disease start early in a person's life will be the focus of the keynote lecture delivered by Nobel laureate James Heckman, PhD, from the Center for the Economics of Human Development at the University of Chicago, who was one of the early proponents of the idea of poverty as a chronic disease.

"This will set the tone for the rest of the conference," Dr Gozal explained, and highlight "the importance of looking at disease as early as when a person is still in the womb."

Another keynote, on the application of hypoxia-inducible factor 1 (HIF-1) to pulmonary medicine, will be delivered by Gregg Semenza, MD, PhD, from the Johns Hopkins University School of Medicine in Baltimore.

Dr Semenza was part of the team that discovered HIF-1, which helps cells cope with low oxygen levels. "It should be an outstanding presentation," Dr Gozal said.

Dr Semenza won the 2016 Albert Lasker Basic Medical Research Award — along with William Kaelin Jr, MD, from the Dana-Farber Cancer Institute in Boston, and Sir Peter Ratcliffe, FRS, from Oxford University in the United Kingdom — for the "discovery of essential pathways by which human and animal cells sense and adapt to the presence of oxygen," he added.

And during a talk on evolution and changes in biology, K.R. Johnson, from the Smithsonian Institution in Washington, "will show that climate change is real, how it led to extinction in the past, and how it may reflect in future if we don't do anything about it," Dr Gozal reported.

Boot Camp and Professional Training

During the boot camp for residents, 250 nominated individuals will have "2 days of intensive exposure to 'best of' principles," he explained. "This is extremely popular."

Medical students from the local area are invited to participate in a 1-day pulmonary care session to help them decide what to focus on. "We hope that some of them will join ATS and enhance the pipeline for our disciplines," he added.

There will also be a day focused on fellows already in training. "They will get state-of-the-art presentations in their area, with cases, and presentations on evidence-based approaches to managing patients. This is all done on a volunteer basis by our members," Dr Gozal told Medscape Medical News.

Conference organizers try to accommodate the language needs of ATS members, who come from 108 countries. "There will be talks in Spanish and Turkish, and the Chinese society will also give a presentation," he said. This brings peers from their own region together and creates opportunities for synergy.

Dr Borok and Dr Gozal have disclosed no relevant financial relationships.

Follow Medscape Pulmonary Medicine on Twitter @MedscapeLung and Ingrid Hein @ingridhein

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