Safety and efficacy of P2X3 receptor antagonist for the treatment of refractory or unexplained chronic cough: A systematic review and meta-analysis of 11 randomized controlled trials

Alaa Ramadan; Mohamed El-Samahy; Amr Elrosasy; Mohammed Al-Tawil; Ahmed Abdelaziz; Mostafa A Soliman; Mohamed Abouzid

doi:10.1016/j.pupt.2023.102252

Safety and efficacy of P2X3 receptor antagonist for the treatment of refractory or unexplained chronic cough: A systematic review and meta-analysis of 11 randomized controlled trials

Pulm Pharmacol Ther. 2023 Dec:83:102252. doi: 10.1016/j.pupt.2023.102252. Epub 2023 Sep 9.

Authors

Alaa Ramadan¹, Mohamed El-Samahy², Amr Elrosasy³, Mohammed Al-Tawil⁴, Ahmed Abdelaziz⁵, Mostafa A Soliman³, Mohamed Abouzid⁶

Affiliations

¹ Faculty of Medicine, South Valley University, Qena, Egypt. Electronic address: alaaramadan251@gmail.com.
² Faculty of Medicine, Zagazig University, Zagazig, Egypt.
³ Faculty of Medicine, Cairo University, Cairo, Egypt.
⁴ Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
⁵ Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
⁶ Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Poznan, Poland; Doctoral School, Poznan University of Medical Sciences, Poznan, Poland.

PMID: 37678663
DOI: 10.1016/j.pupt.2023.102252

Abstract

Background and objectives: Chronic refractory cough is a challenging condition that requires a thorough evaluation and management approach. P2X3 receptors that are ATP-dependent play an important part in nerve fiber sensitization and pathological pain pathways. We conducted this systematic review and meta-analysis to determine the long-term safety and efficacy of P2X3 receptor antagonist drugs in chronic cough.

Methods: We systematically searched PubMed, Scopus, Web of Science, and Embase to identify all relevant published studies through January 15, 2023 that assessed P2X3 antagonists in chronic cough. The protocol was registered in the PROSPERO database with ID: CRD42023422408. Efficacy outcomes were awake (daytime) cough frequency, night cough frequency, 24-h cough frequency, Cough Severity Diary, and total Leicester Cough Questionnaire score. We used the random-effect model to pool the data using RStudio and CMA software.

Results: A total of 11 randomized controlled trials comprising 1350 patients receiving a p2x3 antagonist compared to the placebo group were included in this meta-analysis. A significant decrease in 24-h cough frequency (MD = -4.99, 95% CI [-7.15 to -2.82], P < 0.01), awake (daytime) cough frequency (MD = -7.18, 95% CI [-9.98 to 4.37], P < 0.01), and total Leicester Cough Questionnaire score (MD = 1.74, 95% CI [1.02 to 2.46], P < 0.01) exhibited between the P2X3 antagonist and placebo groups. The frequency of the night cough showed an insignificant difference between the two groups. According to the safety, drug-related adverse events, dysgeusia, hypogeusia, and ageusia significantly increased between the P2X3 antagonist and placebo groups.

Conclusion: P2X3 receptor antagonists are promising drugs for treating chronic cough by significantly reducing the frequency, severity, and quality. Some potential side effects may include drug-related adverse events such as hypogeusia, ageusia, and dysgeusia.

Keywords: Chronic cough; Eliapixant; Gefapixant; P2X3 antagonist; Sivopixant.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Ageusia* / chemically induced
Ageusia* / drug therapy
Chronic Disease
Cough / drug therapy
Dysgeusia / chemically induced
Dysgeusia / drug therapy
Humans
Purinergic P2X Receptor Antagonists* / adverse effects
Randomized Controlled Trials as Topic

Substances

Purinergic P2X Receptor Antagonists