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Bronchodilator efficacy of extrafine glycopyrronium bromide: the Glyco 2 study

Authors Singh D, Scuri M, Collarini S, Vezzoli S, Mariotti F, Muraro A, Acerbi D

Received 22 March 2017

Accepted for publication 20 May 2017

Published 7 July 2017 Volume 2017:12 Pages 2001—2014

DOI https://doi.org/10.2147/COPD.S137659

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 4

Editor who approved publication: Dr Richard Russell

Dave Singh,1 Mario Scuri,2 Sara Collarini,2 Stefano Vezzoli,2 Fabrizia Mariotti,2 Annamaria Muraro,2 Daniela Acerbi2

1Medicines Evaluation, University Of Manchester, University Hospital of South Manchester, Manchester, UK; 2Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy

Abstract: An extrafine formulation of the long-acting muscarinic antagonist glycopyrronium bromide (GB) is in development for chronic obstructive pulmonary disease (COPD), in combination with beclometasone dipropionate and formoterol fumarate – a “fixed triple”. This two-part study was randomized, double blind, placebo controlled in patients with moderate-to-severe COPD: Part 1: single-dose escalation, GB 12.5, 25, 50, 100 or 200 µg versus placebo; Part 2: repeat-dose (7-day), four-period crossover, GB 12.5, 25 or 50 µg twice daily (BID) versus placebo, with an open-label extension in which all patients received tiotropium 18 µg once daily. On the morning of Day 8 in all five periods, patients also received formoterol 12 µg. In study Part 1, 27 patients were recruited. All GB doses significantly increased from baseline forced expiratory volume in 1 second (FEV1) area under the curve (AUC0–12h) and peak FEV1, with a trend toward greater efficacy with higher GB dose. All adverse events were mild–moderate in severity, with a lower incidence with GB than placebo and no evidence of a dose–response relationship. In study Part 2, of 38 patients recruited, 34 completed the study. Adjusted mean differences from placebo in 12 h trough FEV1 on Day 7 (primary) were 115, 142 and 136 mL for GB 12.5, 25 and 50 µg BID, respectively (all P<0.001). GB 25 and 50 µg BID were superior (P<0.05) to GB 12.5 µg BID for pre-dose morning FEV1 on Day 8. For this endpoint, GB 25 and 50 µg BID were also superior to tiotropium. Compared with Day 7, addition of formoterol significantly increased Day 8 FEV1 peak and AUC0–12h with all GB doses and placebo (all P<0.001). All adverse events were mild–moderate in severity and there was no indication of a dose-related relationship. This study provides initial evidence on bronchodilation, safety and pharmacokinetics of extrafine GB BID. Overall, the results suggest that GB 25 µg BID is the optimal dose in patients with COPD.

Keywords: glycopyrronium, COPD, bronchodilator, dose-ranging

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