Aclidinium bromide delays COPD exacerbation without increased MACE risk

Treating patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and concomitant cardiovascular risk factors with aclidinium bromide improved lung function, lowered the exacerbation rates, and delayed the onset of first COPD exacerbation. Furthermore, these at-risk patients did not have an increased risk for all-cause mortality or major adverse cardiovascular event (MACE) occurrence [1].

Prof. Kenneth Chapman (University of Toronto, Canada) presented this post-hoc analysis of the ASCENT-COPD study. The study included 3,589 participants; 35.4% (n=1,269) of whom used beta-blockers at baseline and 64.6% (n=2,320) of whom did not. Participants were randomly assigned 1:1 to twice daily aclidinium or placebo, both of which were administered by a dry powder inhaler for ≤3 years. Among beta-blocker users, 627 used aclidinium and 642 used a placebo; whereas among beta-blocker nonusers, 1,164 used aclidinium and 1,156 used a placebo. Outcomes included time to first MACE and all-cause mortality within the 3-year period, rate of moderate-to-severe COPD exacerbation, time to first moderate-to-severe COPD exacerbation within the first year, and change in morning trough forced expiratory volume in 1 second (FEV1) from baseline between weeks 4 and 52. More men than women (64.4% vs 55.5%) used beta-blockers and had ≥1 previous cardiovascular event (67.9% vs 36.7%); otherwise, characteristics at baseline did not differ significantly.

Beta-blocker users and nonusers did not experience significantly different treatment effects on MACE or all-cause mortality, nor did those receiving aclidinium vs placebo. However, aclidinium was associated with longer time to first moderate-or-severe COPD exacerbation in both beta-blocker users and nonusers and a reduction in exacerbation rate (25% and 21% reduction, respectively). Patients who used beta-blockers and aclidinium bromide also showed more improvement in morning trough FEV1 than nonusers using aclidinium bromide (99 mL; 95% CI, 76-122 vs 69 mL; 95% CI, 52-86, respectively; P=0.041).

Prof. Chapman concluded that “aclidinium bromide treatment did not increase the risk of MACE or all-cause mortality vs placebo in patients with moderate-to-very severe COPD and cardiovascular risk factors, regardless of baseline beta-blocker use. Aclidinium reduced the rate of moderate/severe COPD exacerbations, prolonged the time to first COPD exacerbation, and improved lung function vs placebo irrespective of beta-blocker use.”

1. 
   
   1. Chapman KR et al. Aclidinium bromide treatment in patients receiving beta-blockers: effects on MACE, moderate/severe COPD exacerbations, and lung function in patients with moderate-to-very severe COPD and cardiovascular risk factors (ASCENT-COPD). A2443. ATS 2019, 17-22 May, Dallas, USA.

Posted on 23 July, 201924 March, 2021