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Efficacy and safety of ipratropium bromide/salbutamol sulphate administered in a hydrofluoroalkane metered-dose inhaler for the treatment of COPD

Authors Bhattacharya A, Bhargava S, Singh V, Talwar D, Whig J, Rebello CJ, Purandare S, Gogtay J

Received 5 June 2015

Accepted for publication 21 December 2015

Published 30 June 2016 Volume 2016:11(1) Pages 1469—1476


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Glenda Ernst

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Amal Bhattacharya,1 Salil Bhargava,2 Virendra Singh,3 Deepak Talwar,4 Jagdeep Whig,5 Juliet Rebello,6 Shrinivas Purandare,6 Jaideep Gogtay6

1Department of Medicine, MP Shah Medical College, Jamnager, Gujarat, 2Tuberculosis and Chest Diseases, MGM Medical College, Indore, Madhya Pradesh, 3Pulmonary Division, SMS Hospital, Jaipur, Rajasthan, 4Respiratory Diseases, Metro Hospital and Heart Institute, Noida, Uttar Pradesh, 5Department of Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, 6Clinical Research Department, Cipla Ltd, Mumbai, Maharashtra, India

Background: The use of chlorofluorocarbons (CFCs) has contributed to the depletion of the stratospheric ozone layer resulting in serious health concerns. Ipratropium bromide/salbutamol sulphate CFC-pressurized metered-dose inhalers (IB/SAL-CFC pMDI) have been in widespread use for many years without any apparent ill consequences. This combination has now been reformulated using the hydrofluoroalkane (HFA) propellant. This study sought to establish the clinical noninferiority of a new HFA-containing IB/SAL pMDI to the conventional IB/SAL-CFC pMDI in subjects with mild/moderate COPD.
Methods: This was a randomized, double-blind, parallel-group, multicenter study in two consecutive periods: a 14-day run-in period followed by a 85-day treatment period. Eligible mild-to-moderate stable COPD subjects aged 40-75 years were enrolled into the study and entered the run-in period during which subjects withdrew all the bronchodilators, except for salbutamol as rescue medication. Subjects were randomized to 85 days treatment with either IB/SAL-HFA or IB/SAL-CFC, 20 µg qid.
Results: Of the 290 randomized patients, 249 completed the study. The primary efficacy variable was the change in forced expiratory volume in one second from predose to 60 minutes after dosing on day 85. At the end of the treatment period, the adjusted mean change in forced expiratory volume in one second at 60 minutes was 123 mL in the IB/SAL-HFA pMDI group and 115 mL in the IB/SAL-CFC pMDI group. Because the lower limit of the 95% confidence interval for the between-group difference (-62 mL) was well within the noninferiority margin (-100 mL), the HFA formulation was deemed clinically noninferior to the CFC formulation. This finding was supported by secondary efficacy assessments. Both formulations of IB/SAL were well tolerated during the prolonged multiple dosing.
Conclusion: It is concluded that IB/SAL-HFA pMDI provides effective bronchodilation of similar degree to that achieved with IB/SAL-CFC pMDI. Therefore, IB/SAL-HFA pMDI is a valuable alternative to IB/SAL-CFC pMDI.

ipratropium/salbutamol, pressurized metered-dose inhaler, noninferiority, FEV1, hydrofluoroalkane, COPD

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