Post on 08-Aug-2019
Alessandro Laviano
Cachessia Respiratoria
Il sottoscritto
ai sensi dell’art. 76 comma 4 dell’Accordo Stato-Regioni del 2 febbraio 2017 e in accordo con il Codice Etico della SIMI dichiara
per l’evento in oggetto l’esistenza negli ultimi due anni di rapporti di natura finanziaria e lavorativa con le seguenti imprese commerciali operanti in ambito sanitario: Baxter, Fresenius Kabi, Nutricia, Smartfish
Alessandro Laviano
Cachessia respiratoria
alessandro.laviano@uniroma1.it
XI Congresso SIMI Lazio-Molise (Roma, 31 Marzo – 1 Aprile 2017)
Vanfleteren LEGW et al. Lancet Respir Med 2016; 4:911-924
Vanfleteren LE et al. Am J Resp Crit Care Med 2013; 187:728-735
Vanfleteren LEGW et al. Lancet Respir Med 2016; 4:911-924
Schols AM et al. Eur Resp J 2014; 44:1504-520
Schols AM et al. Eur Resp J 2014; 44:1504-520
von Haehling et S al. J Cachexia Sarcopenia Muscle 2016; 7:507-509
Lainscak M et al. J Cachexia Sarcopenia Muscle 2011; 2:81-86
Schols AM et al. Eur Resp J 2014; 44:1504-520
Toosidazeh N et al. PLoS ONE 2017; 12(2):e0172766
Byun MK et al. Int J Chron Obstruct Pulmon Dis 2017; 12:669-675
Vanfleteren LEGW et al. Lancet Respir Med 2016; 4:911-924
Vanfleteren LEGW et al. Lancet Respir Med 2016; 4:911-924
TMN increases the energy stores in cachectic patients
-500
0
500
1000
1500
2000
2500
Total fat mass appendicular Lean BodyMass
Change from BL to week 12 in body composition (g)
TMN
Isocaloriccomparator
0
0,5
1
1,5
2
2,5
3
weight
Change from BL to week 12 in weight (kg)
TMN
Isocaloriccomparator
Remune and the isocaloric comparator show similar weight gain, but Remune has a statistically significant increase in fat mass vs the comparator. Little or no change in muscle mass is most likely due to lack of exercise during study
*
TMN improves dyspnea and fatigue during the 6-minute walking test
-30
-20
-10
0
10
20
30
40
Dis
tan
ce c
ove
red
(m
)
Change from baseline to week 12
TMN
Isocaloric comparator
Imp
rovem
ent
Deterio
ration
a) b)
-1,5
-1
-0,5
0
0,5
1
1,5
2
Post-walk fatigue Post-walk dyspnoea
Ch
ange
fro
m b
ase
line
to
we
ek
12
TMN
Isocaloric comparator
Imp
rovem
ent
Deterio
ration
*
Post walk dyspnea and fatigue showed clinical relevant improvement in patients treated with TMN. It was statistically significant for dyspnea and also for fatigue when corrected for disease severity.
(Adj. for COPD severity)
*
TMN functional improvement is associated with improved activity related QoL
TMN Comp TMN Comp TMN Comp TMN Comp
Mean baseline value: 37.1 37.8 59.1 59.7 49.4 48.3 22.2 24.2
Mean week 12 value: 35.9 40.6 57.5 58.0 43.4 52.3 23.9 27.7
Estimated effect size,
mean (95% CI): –4.09 (–9.4, 1.21) –1.56 (–11.2, 8.11) –8.65 (–15.9, –1.4) –2.3 (–8.0, 3.5)
p value: 0.1259 0.7449 0.0214 0.4225
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-8
-6
-4
-2
0
2
4
6
8
Total score Symptoms subscale Activity subscale Impact subscale
Ch
ange
fro
m b
ase
line
to
we
ek
12
TMN
Deterio
ration
Im
pro
vemen
t
*
A change of 4 points in St Georges Respiratory
Questionnaire (SGRQ) is seen as a clinically relevant
improvement
Reduced inflammatory activity may be a major underlying mechanism to the positive functional effects of TMN
TMN Comp TMN Comp TMN Comp TMN Comp
Mean baseline value: 4.0 3.9 3.8 4.2 4.7 4.1 8.5 11.0
Mean week 12 value: 4.9 7.2 3.4 4.2 4.3 4.4 8.4 11.1
Estimated effect size, mean (95% CI):
0.70 ( 0.39, 1.27) 0.87 (0.74, 1.02) 0.94 (0.78, 1.14) 0.90 (0.73, 1.10)
p value: 0.2352 0.0899 0.5241 0.2872
-2
-1
0
1
2
3
4
5
CRP (mg/L) IL-6 (pg/mL) IL-8 (pg/mL) TNF (pg/mL)
Ch
ange
fro
m b
ase
line
to w
eek
12
TMN
Isocaloric comparatorIn
creased
inflam
matio
n
Decreased
in
flamm
ation
Conclusioni
• Lo stato nutrizionale è un importante determinante della
prognosi clinica della BPCO.
• Il rischio nutrizionale può essere valutato tramite la
registrazione longitudinale di peso e composizione
corporea.
• La patogenesi della cachessia respiratoria è complessa.
• L’intervento nutrizionale deve essere sempre associato ad
esercizio fisico.
• L’uso di specifici nutrienti per controllare la risposta
infiammatoria sembra una promettente terapia per
migliorare l’outcome.
Thank you.