Long-term safety of glycopyrrolate: A randomized study in patients with moderate-to-severe COPD (GEM3). (June 2016)

• Record Type: Journal Article
• Authors: Mahler, Donald A.; Gifford, Alex H.; Satti, Aditi; Jessop, Nicola; Eckert, Joerg H.; D'Andrea, Peter; Mota, Fernando; Banerjee, Rudrani
• Is Part Of: Respiratory medicine. Volume 115(2016)
• Page Start: 39
• Page End: 45
• Publication Date: 2016-06
• Subjects: Bronchodilator -- Chronic obstructive pulmonary disease -- Safety -- Glycopyrrolate -- Long-acting muscarinic antagonist -- Indacaterol; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2016.03.015
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the United States. Long-acting muscarinic antagonists (LAMAs) are a class of medications used as maintenance therapy for COPD. The GEM3 (G lycopyrrolateE ffect on syM ptoms and lung function) study assessed the long-term safety and efficacy of a LAMA, glycopyrrolate (GLY) 15.6 μg twice daily (b.i.d.), compared with an approved long-acting β2 -agonist (LABA), indacaterol (IND) 75 μg once daily (q.d.) in patients with stable, symptomatic COPD with moderate-to-severe airflow limitation. Methods: This 52-week, multicenter, double-blind, parallel-group study randomized patients (1:1) of the United States to receive GLY 15.6 μg b.i.d. or IND 75 μg q.d. both delivered via the Neohaler ® device. The primary objective was to assess the safety and tolerability in terms of adverse event (AE) reporting rates over 52 weeks. Safety was also determined by evaluating multiple secondary endpoints, including vital signs, electrocardiograms (ECGs), and time to first moderate or severe exacerbation. Efficacy-related secondary endpoints included pre-dose forced expiratory volume in one second (FEV1 ) and forced vital capacity (FVC). Results: Of the 511 randomized patients (GLY, n = 254; IND, n = 257), 81.6% completed the study. The overall incidences of AEs (GLY, 77.3%; IND, 77.0%) and serious AEs (GLY, 13.1%; IND, 13.3%) were comparable between the groups. The incidence of major adverse cardiovascular events was low and comparable between the groups. No clinically relevant differences for vital signs or ECG parameters were observed between the treatment groups. The three sudden deaths reported within 30 days of the treatment (GLY, n = 2; IND, n = 1) were adjudicated as unrelated to the study medication. In terms of efficacy, GLY 15.6 μg b.i.d. showed improvements in pre-dose FEV1 and FVC from baseline, which was comparable to those with IND 75 μg q.d., with no statistically significant differences. No significant differences were observed between the treatment groups in the time to first moderate or severe COPD exacerbation. Conclusion: GLY 15.6 μg b.i.d. showed a long-term safety profile comparable to that of IND 75 μg q.d. and provided rapid and sustained bronchodilation over 52 weeks in patients with COPD with moderate-to-severe airflow limitation. Clinical trial registration number: NCT01697696 . Highlights: GEM3 was a long-term safety (52 weeks) study in patients with COPD. Long-term safety of glycopyrrolate 15.6 μg b.i.d. was comparable to indacaterol 75 μg q.d. Incidence of AEs, SAEs and MACE was comparable between groups. Time to first moderate or severe COPD exacerbation was comparable between groups. Efficacy was comparable between groups.