In this issue of JAMA, Kum and colleagues report the results of a high-quality systematic review and dose-response meta-analysis that evaluated the efficacy and tolerability of gefapixant for the treatment of adults with refractory or unexplained chronic cough. Gefapixant, a P2X3 receptor antagonist that blocks the adenosine triphosphate–gated ion channel on chemically sensitive airway C-fibers, has the potential to decrease cough by reducing activation of airway C-fibers that transmit action potentials to the brain. Kum et al rated their certainty as to whether patients would perceive the treatment effects as important by comparing their results with the minimal important difference (MID) of the outcome measures that have been reported in the literature as well as surveying a small number (n = 5) of their own patients with refractory or unexplained chronic coughs for MIDs related to adverse effects. The MID is the smallest difference in scores of an outcome measure perceived by patients as beneficial or harmful and which would lead a clinician to consider a change in treatment.
Source: JAMA Online First