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Long-term safety of tiotropium/olodaterol Respimat® in patients with moderate-to-very severe COPD and renal impairment in the TONADO® studies

Authors LaForce C, Derom E, Bothner U, Kloer IM, Trampisch M, Buhl R

Received 4 January 2018

Accepted for publication 22 February 2018

Published 1 June 2018 Volume 2018:13 Pages 1819—1831

DOI https://doi.org/10.2147/COPD.S161489

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


Video abstract presented by Craig LaForce.

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Craig LaForce,1 Eric Derom,2 Ulrich Bothner,3 Isabel M Kloer,3 Matthias Trampisch,4 Roland Buhl5

1NC Clinical Research, Raleigh, NC, USA; 2Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; 3Pharmacovigilance, Boehringer Ingelheim International GmbH, Ingelheim, Germany; 4Biostatistics & Data Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany; 5Pulmonary Department, Mainz University Hospital, Mainz, Germany

Introduction: The safety, lung function efficacy, and symptomatic benefits of combined tiotropium and olodaterol in patients with COPD were established in the 1-year TONADO® studies (NCT01431274; NCT01431287). As tiotropium is predominantly excreted by the kidneys, the long-term safety profile of tiotropium/olodaterol was investigated in patients with renal impairment in a prespecified safety analysis of the TONADO studies.
Methods: These were 2 replicate, randomized, double-blind, parallel-group, 52-week Phase III studies that assessed tiotropium/olodaterol compared with tiotropium or olodaterol alone (all via Respimat®) in patients with moderate-to-very severe COPD. In this analysis, renal impairment was defined as mild (creatinine clearance [CLcr] 60–89 mL/min), moderate (CLcr 30–59 mL/min) or severe (CLcr 15–29 mL/min). Adverse events (AEs) were pooled from both studies.
Results: Of 3,041 patients included in this analysis, 1,333 (43.8%) had mild, 404 (13.3%) had moderate, and 5 (0.2%) had severe renal impairment; these were distributed equally between treatment groups. Almost one-quarter of all treated patients (23.4%) had a history of cardiac disorder, 45.6% had hypertension, and 13.3% had glucose metabolism disorders, including diabetes. AEs with olodaterol, tiotropium, and tiotropium/olodaterol occurred in 75.1%, 70.8%, and 72.0% of patients with no renal impairment, 75.7%, 74.0%, and 73.3% with mild renal impairment, and 84.3%, 79.5%, and 79.7% with moderate renal impairment, respectively. There was no notable effect of renal impairment on the proportion of patients with an AE, and no differences were observed between tiotropium/olodaterol versus the monocomponents. There was no difference in the incidence of major adverse cardiac events, renal and urinary tract AEs, or potential anticholinergic effects with increasing severity of renal impairment.
Conclusion: Over half the patients enrolled in the TONADO studies had renal impairment, and there was a high level of pre-existing cardiovascular comorbidity. The safety and tolerability of tiotropium/olodaterol is comparable to the monocomponents, irrespective of the level of renal impairment.

Keywords: COPD, renal impairment, comorbidities, tiotropium, olodaterol, safety

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