title: The future of chronic obstructive pulmonary disease treatment--difficulties of and barriers to drug development.
abstract: Although chronic obstructive pulmonary disease (COPD) is a major global health problem with a rising incidence and morbidity, few pharmacotherapeutic advances have been made over the past several decades. The challenges of development of such agents are multifactorial and include rudimentary understanding of the biological genesis of human disease, inadequate in-vitro and in-vivo models, unvalidated biomarkers, inefficient physiological and clinical endpoints, and variable regulatory review worldwide. Blockade of various inflammatory pathways and mediators is a reasonable therapeutic strategy to alter the natural history of COPD. Substantial heterogeneity is evident with respect to clinical presentation, physiology, imaging, response to therapy, decline in lung function, and survival. Numerous endpoints have been proposed for clinical studies in COPD, with new approaches under study. The novel strategy that seems most promising is the use of biomarkers. We hope that with these approaches novel pharmacotherapies will be developed in the near future.
authors: Department of Internal Medicine and Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA. fmartine@umich.edu
authors: Fernando J
authors: FJ
authors: Martinez
authors: James F
authors: JF
authors: Donohue
authors: Stephen I
authors: SI
authors: Rennard
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D002626:Chemistry, Pharmaceutical; D006801:Humans; D058990:Molecular Targeted Therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers