Active Substance: roflumilast
Common Name: roflumilast
ATC Code: R03DX07
Marketing Authorisation Holder: Takeda GmbH
Active Substance: roflumilast
Authorisation Date: 2010-07-05
Therapeutic Area: Pulmonary Disease, Chronic Obstructive
Pharmacotherapeutic Group: Drugs for obstructive airway diseases
Daxas is indicated for maintenance treatment of severe chronic obstructive pulmonary disease (COPD) (FEV1 post-bronchodilator less than 50% predicted) associated with chronic bronchitis in adult patients with a history of frequent exacerbations as add-on to bronchodilator treatment.
What is Daxas?
Daxas is a medicine that contains the active substance roflumilast. It is available as yellow, D-shaped tablets (500 micrograms).
What is Daxas used for?
Daxas is used to treat severe chronic obstructive pulmonary disease (COPD) in adults who have chronic bronchitis (long-term inflammation of their airways), and whose COPD flares up frequently. COPD is a long-term disease in which the airways and air sacs inside the lungs become damaged or blocked, leading to difficulty breathing air in and out of the lungs.
Daxas is not used on its own but as an ‘add-on’ to treatment with bronchodilators (medicines that widen the airways in the lungs).
The medicine can only be obtained with a prescription.
How is Daxas used?
The recommended dose of Daxas is one tablet once a day. The tablets should be swallowed with water at the same time each day. Patients may need to take Daxas for several weeks before it starts to have an effect.
How does Daxas work?
The active substance in Daxas, roflumilast, belongs to a group of medicines called ‘phosphodiesterase-type-4 (PDE4) inhibitors’. It blocks the action of the PDE4 enzyme, which is involved in the inflammation process that leads to COPD. By blocking the action of PDE4, roflumilast reduces the inflammation in the lungs, helping to reduce the patient’s symptoms or to prevent them from getting worse.
How has Daxas been studied?
The effects of Daxas were first tested in experimental models before being studied in humans.
Daxas has been compared with placebo (a dummy treatment) in two main studies involving over 3,000 adults with severe COPD who had had at least one flare-up of their disease in the past year. The patients could continue to receive treatment with a bronchodilator during the study. The main measure of effectiveness was the improvement in forced expiratory volumes (FEV1) and the reduction in the number of moderate or severe flare-ups of their COPD over a year of treatment. FEV1 is the most air a person can breathe out in one second.
What benefit has Daxas shown during the studies?
Daxas was shown to be more effective than placebo at treating COPD. At the beginning of the study, both groups of patients had an FEV1 of around 1 litre (1,000 ml). After a year, the patients who took Daxas had an average increase of 40 ml while those given placebo had an average decrease of 9 ml. In addition, the patients who took Daxas had an average of 1.1 moderate or severe flare-ups of their disease, compared with 1.4 flare-ups in the patients who took placebo.
What is the risk associated with Daxas?
The most common side effects with Daxas (seen in between 1 and 10 patients in 100) are decreased weight, decreased appetite, insomnia (difficulty sleeping), headache, diarrhoea, nausea (feeling sick) and abdominal pain (stomach ache). Because patients taking Daxas may lose weight, they are advised to weigh themselves on a regular basis. The doctor may stop treatment with Daxas if the patient loses too much weight. For the full list of all side effects reported with Daxas, see the package leaflet.
Daxas should not be used in people who may be hypersensitive (allergic) to roflumilast or any of the other ingredients. It must not be used in patients who have moderate or severe problems with their liver. Daxas is not recommended in patients with diseases that severely weaken the immune system (the body's natural defences). Because there have been rare cases of patients taking Daxas feeling suicidal, the medicine is also not recommended in patients who have had depression with suicidal thoughts.
Why has Daxas been approved?
The CHMP noted that there was a need for new COPD treatments and that the main studies showed a modest benefit of Daxas in patients with severe COPD. This benefit was seen on top of the effects of the treatments that the patients were already receiving. After considering all of the available data on the effects of the medicine, the Committee decided that Daxas’s benefits are greater than its risks and recommended that it be given marketing authorisation.
What measures are being taken to ensure the safe use of Daxas?
The company that makes Daxas will ensure that healthcare professionals who will prescribe the medicine in all Member States of the European Union (EU) are provided with educational materials containing information on the medicine’s side effects and how it should be used. The company will also provide cards for patients, telling them what information that they need to give their doctor about their symptoms and past illnesses to help the doctor know whether Daxas is appropriate for them. The card will include an area where patients can record their weight.
Other information about Daxas
The European Commission granted a marketing authorisation valid throughout the EU for Daxas on 5 July 2010. The marketing authorisation is valid for five years, after which it can be renewed.
For more information about treatment with Daxas, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.
Source: European Medicines Agency