Peter Dicpinigaitis, MD, professor of medicine at the Albert Einstein College of Medicine, director of the Montefiore Cough Center, and editor-in-chief of LUNG, addresses the lack of approved treatments for chronic cough in the United States, current off-label remedies, and the prospect of future approvals.
Chronic refractory cough suffers from a marked lack of approved treatments in the United States, and the 2 remedies used on an off-label basis—amitriptyline and gabapentin—have adverse effects many patients find intolerable, noted Peter Dicpinigaitis, MD, professor of medicine at the Albert Einstein College of Medicine, director of the Montefiore Cough Center, and editor-in-chief of LUNG.
Without any drugs on the market in the United States, how is chronic cough treated?
When I lecture about cough, I spend a lot of time talking about trying to find these underlying treatable causes of cough—because once we get to the stage of refractory chronic cough, we unfortunately do not have any approved treatments for refractory chronic cough. There's never been a chronic cough drug approved in the United States. Hopefully that'll change next year with the approval of gefapixant.
What we have now, unfortunately, at our disposal once we've made the diagnosis of refractory chronic cough, is really just off-label treatments. Narcotics are used, but of course, those are not a very palatable option for what is going to be chronic treatment. So most of us are left with the 2 drugs that are referred to as neuromodulators, trying to suppress this hypersensitive cough reflex that we deal with. Those are an old antidepressant, amitriptyline, and gabapentin.
We use those, but unfortunately in my experience, I've had very little success with these drugs in terms of their efficacy against cough. But oftentimes even if there is a benefit for cough, often the side effects—mainly sedation—are just intolerable to the patient. So we really don't have any good, safe, effective, well-tolerated options for chronic cough, and that's why we're so excited that we have multiple pipeline programs now, which will hopefully render chronic cough drugs in the near future.