Thomas H. Goodin, PhD: The Burden of Depression on COPD

Thomas H. Goodin, PhD

Among a series of subgroup analyses of glycopyrrolate inhalation solution (Lonhala Magnair) for the care of chronic obstructive pulmonary disease (COPD) in the pivotal GOLDEN 3 and 4 clinical trials, Sunovion considered the effect of anxiety and depression on lung function rates. And vice versa.

In the second part of an interview series with MD Magazine® regarding new glycopyrrolate inhalation data being presented at the American Thoracic Society (ATS) 2019 International Meeting in Dallas, TX, Thomas H. Goodin, PhD, senior director of Clinical Development at Sunovion, explained the interesting—and sometimes critical—correlation between mental health disorders and COPD symptoms.

MD Mag: What other comorbidities did Sunovion specifically assess in glycopyrrolate?

Goodin: We have a couple of posters on anxiety and depression—that’s a subgroup analysis that we did. That had some very interesting findings, in terms of lung function and symptomology relative to the outcomes.

Depression is low in patients with low comorbidities, but in patients with high comorbidities, its prevalence is about 47%. Anxiety is about 37%. What we found when we combined anxiety and depression in a post hoc analysis is that the lung function improves in both the disorders—but it’s probably more important to characterize these patients as those who exhibit depressive and anxiety symptoms. What we did was look at the patient reports of medical history to their physicians, so we didn’t formally test everyone who came into the trial.

We did some other things that led us to believe that, when a patient reported it, we were fairly confident they really had anxiety and depression.

But what we found was the lung function improved from baseline, but it was less of an effect in patients with anxiety and depression than it was in the population without disorders. So the drug is working, but why did we see differences in effect? There’s a couple of reasons.

One is that people with depression, in literature, are thought to be very noncompliant with their medications—not just COPD therapies, but any medication. Like any drug, if you don’t take it per the prescription, you’ll find it harder for the drug to have aa strong benefit.

But from a mechanistic standpoint, it turns out the primary symptom of people with COPD is dyspnea. It’s the number 1 complaint—it’s the complaint that brings the patient into the doctor’s office for a COPD diagnosis. Imagine if you had anxiety and depression, and you’re short of breath. That only intensifies your anxiety. It can instill a bit of fear into a patient, in instances of sitting down or other activities that push you to breathe faster.

There are some things just behavior-wise we thought would contribute to this, and there’s also things from a mechanistic sense of the overlying disease state that affect your symptoms. Again, most of us have been in situations that are very stressful, and the first thing you notice is your breathing rate becomes short and shallow.

It seems like that can be a situation that perpetuates a worsened state of anxiety and breathing.

Goodin: There was a small study that showed when they took out patients aged 20-25, with anxiety and depression at the same level as COPD, they measured some blood levels to see how well the patient oxygenates. They took 1 group of patients and gave them treatment for anxiety and depression, then gave the other group COPD treatment. For almost 6 months, the group treated for their anxiety and depression showed improvement in their COPD lung and oxygen parameters.

So, there is some evidence showing that treating this makes the difference.

The study, “Improvement in Lung Function and Patient-Reported Outcomes in Patients with Chronic Obstructive Pulmonary Disease with Comorbid Anxiety and Depression Receiving Nebulized Glycopyrrolate in the GOLDEN 3 and 4 Studies,” was published online.