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

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Total fat mass appendicular Lean BodyMass

Change from BL to week 12 in body composition (g)

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weight

Change from BL to week 12 in weight (kg)

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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

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TMN improves dyspnea and fatigue during the 6-minute walking test

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Change from baseline to week 12

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Post-walk fatigue Post-walk dyspnoea

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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)

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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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Total score Symptoms subscale Activity subscale Impact subscale

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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

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CRP (mg/L) IL-6 (pg/mL) IL-8 (pg/mL) TNF (pg/mL)

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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.