Efficacy and safety of umeclidinium added to fluticasone furoate/vilanterol in chronic obstructive pulmonary disease: Results of two randomized studies

Objective: The aim of these studies (NCT01957163; NCT02119286) was to evaluate the efficacy and safety of umeclidinium (UMEC 62.5 mu g and 125 mu g) added to fluticasone furoate/vilanterol (FF/VI, 100/25 mu g) 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 mu g (delivering 55 mu g), UMEC 125 mu g (delivering 113 mu g) or placebo (PBO) added to open-label FF/VI (delivering 92/22 mu g; 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 mu g and 125 mu g) 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 mu g 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 mu g and 125 mu g) to FF/VI (100/25 mu g) 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. (C) 2015 The Authors. Published by Elsevier Ltd.