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Efficacy and safety of twice-daily glycopyrrolate in patients with stable, symptomatic COPD with moderate-to-severe airflow limitation: the GEM1 study

Authors LaForce CF, Feldman G, Spangenthal S, Eckert JH, Henley M, Patalano F, D’Andrea P, Khanna V

Received 12 November 2015

Accepted for publication 1 February 2016

Published 8 June 2016 Volume 2016:11(1) Pages 1233—1243

DOI https://doi.org/10.2147/COPD.S100445

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell


Craig LaForce,1 Gregory Feldman,2 Selwyn Spangenthal,3 Joerg H Eckert,4 Michelle Henley,5 Francesco Patalano,4 Peter D’Andrea5

1North Carolina Clinical Research, Raleigh, NC, USA; 2South Carolina Pharmaceutical Research, Spartanburg, SC, USA; 3American Health Research, Charlotte, NC, USA; 4Novartis Pharma AG, Basel, Switzerland; 5Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

Background: The purpose of this study was to confirm the efficacy and safety of twice-daily glycopyrrolate 15.6 µg, a long-acting muscarinic antagonist, in patients with stable, symptomatic, chronic obstructive pulmonary disease (COPD) with moderate-to-severe airflow limitation.
Methods: The GEM1 study was a 12-week, multicenter, double-blind, parallel-group, placebo-controlled study that randomized patients with stable, symptomatic COPD with moderate-to-severe airflow limitation to twice-daily glycopyrrolate 15.6 µg or placebo (1:1) via the Neohaler® device. The primary objective was to demonstrate superiority of glycopyrrolate versus placebo in terms of forced expiratory volume in 1 second area under the curve between 0 and 12 hours post morning dose at week 12. Other outcomes included additional spirometric end points, transition dyspnea index, St George’s Respiratory Questionnaire, COPD Assessment Test, rescue medication use, and symptoms reported by patients via electronic diary. Safety was also assessed during the study.
Results: Of the 441 patients randomized (glycopyrrolate, n=222; placebo, n=219), 96% of patients completed the planned treatment phase. Glycopyrrolate demonstrated statistically significant (P<0.001) improvements in lung function versus placebo. Glycopyrrolate showed statistically significant improvement in the transition dyspnea index focal score, St George’s Respiratory Questionnaire total score, COPD Assessment Test score, rescue medication use, and daily total symptom score versus placebo at week 12. Safety was comparable between the treatment groups.
Conclusion: Significant improvement in lung function, dyspnea, COPD symptoms, health status, and rescue medication use suggests that glycopyrrolate is a safe and effective treatment option as maintenance bronchodilator in patients with stable, symptomatic COPD with moderate-to-severe airflow limitation.

Keywords: glycopyrronium, glycopyrrolate, lung function, chronic obstructive pulmonary disease, long-acting muscarinic antagonist, bronchodilator, twice daily

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