What Can Be Done to Promote the Development and Testing of Novel Agents for the Treatment of COPD?
Several factors impede the development and testing of novel treatments for COPD. First, because the key pathogenetic pathways are not established, financial incentives for pharmaceutical companies favor trials of drugs already used for other diseases, rather than de novo development of targeted agents for COPD. Second, the unavailability of validated surrogate markers of COPD makes studies to establish proof of principle or appropriate dosage both complex and expensive. Third, the slow progression of COPD requires that efficacy trials be of long duration. Fourth, the heterogeneity of COPD requires large numbers of subjects for clinical trials of therapeutics. Efforts that may reduce these barriers to the development of novel agents include basic research on COPD pathogenesis; investigations of surrogate endpoints and indices for therapeutic stratification; exploration of alternative outcome measures; and greater cooperation among research institutions, funding agencies, health care pro
