A multicenter, randomized, double-blind dose-ranging study of glycopyrrolate/formoterol fumarate fixed-dose combination metered dose inhaler compared to the monocomponents and open-label tiotropium dry powder inhaler in patients with moderate-to-severe COPD

Respir Med. 2016 Nov:120:16-24. doi: 10.1016/j.rmed.2016.09.012. Epub 2016 Sep 17.

Abstract

Background: This study formed part of the dose selection for a glycopyrrolate (GP)/formoterol fumarate (FF) fixed-dose combination formulated using novel Co-Suspension™ Delivery Technology and delivered via a metered dose inhaler (GFF MDI). The study aimed to confirm the optimal dose of GP to formulate with FF 9.6 μg in the fixed-dose combination product, GFF MDI.

Methods: This multicenter, randomized, double-blind, chronic-dosing, balanced incomplete block, crossover study (NCT01587079) compared five doses of GFF MDI (18/9.6, 9/9.6, 4.6/9.6, 2.4/9.6 and 1.2/9.6 μg, twice daily [BID]) with its monocomponents FF MDI 9.6 μg and GP MDI 18 μg (both BID) and open-label tiotropium (18 μg once daily) as the active control. The primary efficacy endpoint was change from baseline in forced expiratory volume in 1 s area under the curve from 0 to 12 h (FEV1 AUC0-12) on Day 7.

Results: In total, 159 patients were randomized to treatment and 132 patients (52.2% male, mean age 62.8 years) were included in the intent-to-treat population. All doses of GFF MDI (except 1.2/9.6 μg) resulted in statistically significant improvements in FEV1 AUC0-12 versus monocomponents and open-label tiotropium. GFF MDI 18/9.6 μg consistently showing the greatest improvement over monocomponents and open-label tiotropium. Adverse events for each GFF MDI dose were similar versus GP MDI 18 μg, FF MDI 9.6 μg and open-label tiotropium.

Conclusions: These findings further support selection of GP 18 μg as the optimal dose to combine with FF MDI 9.6 μg for advancement into Phase III clinical trials of GFF MDI.

Keywords: Bronchodilators; COPD maintenance therapy; Co-Suspension™ Delivery Technology; Fixed-dose combinations; LABA; LAMA.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Inhalation
  • Adrenergic beta-2 Receptor Agonists / administration & dosage
  • Cholinergic Antagonists / administration & dosage
  • Cross-Over Studies
  • Double-Blind Method
  • Drug Combinations
  • Dry Powder Inhalers / methods*
  • Female
  • Forced Expiratory Volume / drug effects
  • Formoterol Fumarate / administration & dosage*
  • Formoterol Fumarate / adverse effects
  • Formoterol Fumarate / pharmacology
  • Glycopyrrolate / administration & dosage*
  • Glycopyrrolate / adverse effects
  • Glycopyrrolate / pharmacology
  • Humans
  • Male
  • Metered Dose Inhalers / statistics & numerical data*
  • Middle Aged
  • Muscarinic Antagonists / administration & dosage
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Tiotropium Bromide / administration & dosage*
  • Tiotropium Bromide / adverse effects
  • Tiotropium Bromide / pharmacology
  • Treatment Outcome

Substances

  • Adrenergic beta-2 Receptor Agonists
  • Cholinergic Antagonists
  • Drug Combinations
  • Muscarinic Antagonists
  • Glycopyrrolate
  • Formoterol Fumarate
  • Tiotropium Bromide