Efficacy and safety of umeclidinium added to fluticasone furoate/vilanterol in chronic obstructive pulmonary disease: Results of two randomized studies. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Siler, Thomas M.; Kerwin, Edward; Sousa, Ana R.; Donald, Alison; Ali, Rehan; Church, Alison
• Is Part Of: Respiratory medicine. Volume 109:Issue 9(2015)
• Page Start: 1155
• Page End: 1163
• Publication Date: 2015-09
• Subjects: Long-acting muscarinic antagonist -- Inhaled corticosteroid -- Long-acting beta2 agonist -- Bronchodilation; AE adverse event -- ASE all subjects enrolled -- CAT COPD Assessment Test -- CI confidence interval -- COPD chronic obstructive pulmonary disease -- FEV1 forced expiratory volume in one second -- FF fluticasone furoate -- FVC forced vital capacity -- GOLD Global Initiative for Chronic Obstructive Lung Disease -- HRQoL health-related quality of life -- ICS inhaled corticosteroid -- ITT intent-to-treat -- LABA long-acting beta2 agonist -- LAMA long-acting muscarinic agonist -- LS least squares -- MedDRA Medical Dictionary for Regulatory Activities -- PBO placebo -- PRO patient-reported outcome -- QoL quality of life -- RI run-in -- SAE serious adverse event -- SGRQ St George's Respiratory Questionnaire -- UMEC umeclidinium -- VI vilanterol -- WM weighted mean; 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.2015.06.006
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Objective: The aim of these studies (NCT01957163; NCT02119286) was to evaluate the efficacy and safety of umeclidinium (UMEC 62.5 μg and 125 μg) added to fluticasone furoate/vilanterol (FF/VI, 100/25 μg) in chronic obstructive pulmonary disease (COPD). Methods: These were 12-week, double-blind, placebo-controlled, parallel-group, multicenter studies. Eligible patients were randomized 1:1:1 to treatment with once-daily blinded UMEC 62.5 μg (delivering 55 μg), UMEC 125 μg (delivering 113 μg) or placebo (PBO) added to open-label FF/VI (delivering 92/22 μg; N = 1238 [intent-to-treat population]). The primary endpoint was trough forced expiratory volume in one second (FEV1 ) on Day 85; the secondary endpoint was 0–6 h post-dose weighted mean (WM) FEV1 at Day 84. Health-related quality of life was reported using St George's respiratory questionnaire (SGRQ). Adverse events (AEs) were also assessed. Results: In both studies, trough FEV1 was significantly improved with UMEC + FF/VI (62.5 μg and 125 μg) versus PBO + FF/VI (range: 0.111–0.128 L, all p < 0.001 [Day 85]), as was 0–6 h post-dose WM FEV1 (range: 0.135–0.153 L, all p < 0.001 [Day 84]). SGRQ results were inconsistent, with statistically significant improvements with UMEC + FF/VI versus PBO + FF/VI in one study only and with UMEC 62.5 μg only (difference in SGRQ total score from baseline between treatments: −2.16, p < 0.05). Across all treatment groups, the overall incidences of AEs were similar (30–39%), as were cardiovascular AEs of special interest (<1–3%) and pneumonia AEs (0–1%). Conclusion: Overall, the addition of UMEC to FF/VI therapy resulted in significant improvements in lung function compared with PBO + FF/VI in patients with COPD, with similar safety profiles, though SGRQ results were inconsistent. Clinical relevance: The results from these two studies demonstrate that the addition of umeclidinium (62.5 μg and 125 μg) to FF/VI (100/25 μg) provides statistically significant and clinically meaningful improvements in lung function compared with placebo + FF/VI in patients with COPD. Statistically significant improvements in quality of life with UMEC + FF/VI versus placebo + FF/VI were reported in one study only. Safety profiles were consistent across all treatment groups in both studies. These studies support the use of triple therapy in COPD, providing physicians with an alternative treatment option. Highlights: Umeclidinium (UMEC) is a long-acting muscarinic antagonist indicated for the treatment of COPD. Fluticasone furoate/vilanterol (FF/VI) is a corticosteroid/long acting beta agonist for COPD. These data show that triple therapy with UMEC + FF/VI significantly improves lung function vs FF/VI. Safety profiles were consistent across all treatment groups in both studies.