title: Inhaled Umeclidinium in COPD Patients: A Review and Meta-Analysis.
abstract: A number of new agents for the management of chronic obstructive pulmonary disease (COPD) are at different stages of development, including several inhaled long-acting antimuscarinics (LAMA). Long-acting bronchodilators are considered to be central to the management of COPD due to the evidence supporting their efficacy and safety. Umeclidinium, a LAMA, has recently been approved for the maintenance treatment of moderate to very severe COPD in a number of countries. This comprehensive review and pooled meta-analysis provides detailed information about the efficacy and safety of this agent. The pharmacokinetics and pharmacodynamics of umeclidinium observed in phase I and II studies support its once-daily administration. Umeclidinium is rapidly cleared from blood, and renal or hepatic impairment do not lead to significant changes in drug disposition. A pooled analysis of phase III and comparative studies of umeclidinium in patients with moderate to very severe COPD showed significant improvement in lung function measures, including trough forced expiratory volume in 1 s (FEV1), as well as in acute exacerbations of COPD, dyspnea, and quality of life. Adverse effects, including known anticholinergic effects, were uncommon with umeclidinium. Limited data suggest the efficacy of umeclidinium is similar to that of tiotropium. Umeclidinium is administered as a dry powder inhaler, provides adequate lung delivery in patients with moderate to very severe airflow obstruction, and appears to be easily used by patients. Umeclidinium provides a safe and effective option as an inhaled LAMA for the management of COPD.
authors.affiliation: Duke University Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Asthma, Allergy, and Airways Center, 1821 Hillandale Rd Suite 25A, Durham, NC, 27705, USA. roy.pleasants@duke.edu.
authors.forename: Roy A
authors.initials: RA
authors.lastname: Pleasants
authors.affiliation: Department of Pharmacy Administration and Clinical Pharmacy, Peking University Health Science Center, Beijing, China.
authors.forename: Tiansheng
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Respiratory Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Jinming
authors.initials: J
authors.lastname: Gao
authors.affiliation: Department of Pharmacy, Peking University Third Hospital, Beijing, China.
authors.forename: Huilin
authors.initials: H
authors.lastname: Tang
authors.affiliation: Division of Pulmonary Diseases and Critical Care Medicine, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Donohue
mesh_terms: D000280:Administration, Inhalation; D017321:Clinical Trials, Phase I as Topic; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D004334:Drug Administration Schedule; D058995:Dry Powder Inhalers; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D009129:Muscle Tonus / Q000187:drug effects; D009130:Muscle, Smooth / Q000187:drug effects; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D011812:Quinuclidines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: C573971:GSK573719; D018727:Muscarinic Antagonists; D011812:Quinuclidines