What is it?

Daliresp is a medicine that contains the active substance roflumilast. It is available as yellow, D-shaped tablets (500 micrograms).

This medicine is the same as Daxas, which is already authorised in the European Union (EU). The company that makes Daxas has agreed that its scientific data can be used for Daliresp (?informed consent?).

Table of Contents
What is it used for?
How is it used?
How does it work?
How has it been studied?
What benefits has it shown during the studies?
What is the risk associated?
Why has it been approved?

What is it used for?

Daliresp 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.

Daliresp 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 it used?

The recommended dose of Daliresp is one tablet once a day. The tablets should be swallowed with water at the same time each day. Patients may need to take Daliresp for several weeks before it starts to have an effect.

How does it work?

The active substance in Daliresp, 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 it been studied?

The effects of Daliresp were first tested in experimental models before being studied in humans.

Daliresp 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 benefits has it shown during the studies?

Daliresp 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 Daliresp had an average increase of 40 ml while those given placebo had an average decrease of 9 ml. In addition, the patients who took Daliresp 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?

The most common side effects with Daliresp (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 Daliresp may lose weight, they are advised to weigh themselves on a regular basis. The doctor may stop treatment with Daliresp if the patient loses too much weight. For the full list of all side effects reported with Daliresp, see the package leaflet.

Daliresp 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. Daliresp 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 Daliresp feeling suicidal, the medicine is also not recommended in patients who have had depression with suicidal thoughts.

Why has it been approved?

The CHMP noted that there was a need for new COPD treatments and that the main studies showed a modest benefit of Daliresp 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 Daliresp?s benefits are greater than its risks and recommended that it be given marketing authorisation.

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