Long-acting antimuscarinic therapy in patients with chronic obstructive pulmonary disease receiving beta-blockers.

Abstract

BACKGROUND:

Beta-blocker therapies for cardiovascular comorbidities are often withheld in patients with chronic obstructive pulmonary disease (COPD) due to potential adverse effects on airway obstruction. We carried out a post hoc analysis to determine the efficacy and safety of aclidinium in patients with moderate-to-very severe COPD and increased cardiovascular risk receiving beta-blockers at baseline versus non-users.

METHODS:

ASCENT-COPD was a Phase 4, multicenter, double-blind, randomized, placebo-controlled, parallel-group study. Patients were randomized 1:1 to aclidinium or placebo twice-daily for up to 3 years. Outcomes included risk of (time to first) major adverse cardiovascular events (MACE), all-cause mortality, and lung function over 3 years, and exacerbations over 1 year.

RESULTS:

Of 3589 patients, 1269 (35.4%) used beta-blockers and 2320 (64.6%) were non-users at baseline. Aclidinium did not statistically increase the risk of MACE (beta-blocker user: hazard ratio 1.01 [95% CI 0.62-1.64]; non-user: 0.80 [0.51-1.24]; interaction P = 0.48) or all-cause mortality (beta-blocker user: 1.13 [0.78-1.64]; non-user: 0.89 [0.62-1.26]; interaction P = 0.35), in patients using beta-blockers. Aclidinium reduced annualized rate of moderate-to-severe COPD exacerbation (beta-blocker user: rate ratio 0.75 [95% CI 0.60-0.94, P = 0.013]; non-user: 0.79 [0.67-0.93, P = 0.005]), delayed time to first exacerbation, and improved lung function versus placebo. There was greater trough FEV1 benefit in beta-blocker users versus non-users (least squares mean difference at 52 weeks: 111 mL [95% CI 74 mL-147 mL] versus 69 mL [42 mL-97 mL]; interaction P = 0.041).

CONCLUSIONS:

This post hoc analysis supports long-acting anti-muscarinic use with concomitant beta-blockers in patients with moderate-to-very severe COPD and cardiovascular comorbidity.

TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01966107, Registered 16 October 2013, https://clinicaltrials.gov/ct2/show/NCT01966107 .

• Authors: Kenneth R Chapman, Robert A Wise, Benjamin M Scirica, Deepak L Bhatt, Sami Z Daoud, Dan Lythgoe, Esther Garcia Gil
• Journal: Respiratory research (Respir Res) Vol. 22 Issue 1 Pg. 272 (Oct 22 2021) ISSN: 1465-993X [Electronic] England
• PMID: 34686204 (Publication Type: Clinical Trial, Phase IV, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: © 2021. The Author(s).

Chemical References

• Adrenergic beta-Antagonists
• Muscarinic Antagonists
• Tropanes
• aclidinium bromide

Topics

• Adrenergic beta-Antagonists (adverse effects, therapeutic use)
• Aged
• Canada
• Disease Progression
• Double-Blind Method
• Drug Therapy, Combination
• Female
• Forced Expiratory Volume
• Humans
• Lung (drug effects, physiopathology)
• Male
• Middle Aged
• Muscarinic Antagonists (adverse effects, therapeutic use)
• Pulmonary Disease, Chronic Obstructive (diagnosis, drug therapy, mortality, physiopathology)
• Recovery of Function
• Severity of Illness Index
• Time Factors
• Treatment Outcome
• Tropanes (adverse effects, therapeutic use)
• United States
• Vital Capacity