A phase IIb randomized, chronic-dosing, incomplete block, cross-over study of glycopyrronium, delivered via metered dose inhaler, compared with a placebo and an active control in patients with moderate-to-severe COPD.

BACKGROUND: Long-acting muscarinic antagonist (LAMA) and long-acting ß2-agonist (LABA) bronchodilators are key to the pharmacologic treatment of chronic obstructive pulmonary disease (COPD). This Phase IIb study investigated the safety and efficacy of four doses of the LAMA glycopyrronium (GP) delivered using co-suspension delivery technology via metered dose inhaler (MDI). The study was part of a wider clinical trial program performed to determine the optimal dose of GP MDI, the LABA formoterol fumarate dihydrate (FF) MDI, and glycopyrronium/formoterol fumarate dihydrate (GFF) MDI fixed-dose combination to be taken forward into Phase III studies. METHODS: In this randomized, double-blind, 7-day chronic-dosing, three-period incomplete block, cross-over study, patients with moderate-to-severe COPD received two of the four doses of GP MDI (28.8 µg, 14.4 µg, 7.2 µg, and 3.6 µg) twice daily (BID), and either placebo MDI BID or open-label ipratropium MDI 34 µg four times daily. The primary efficacy endpoint was forced expiratory volume in 1 s (FEV1) area under the curve from 0 to 12 h (AUC0-12) relative to baseline on Day 7. Secondary and exploratory efficacy endpoints were assessed on Days 1 and 7. Safety and tolerability were evaluated throughout the study. RESULTS: All GP MDI treatments were superior to placebo MDI for the primary efficacy endpoint (all p < 0.0001). However, only GP MDI 28.8 µg and 14.4 µg demonstrated statistical superiority to placebo MDI for all secondary efficacy endpoints analyzed in this study, with the exception of GP MDI 14.4 µg versus placebo MDI for the proportion of patients achieving ≥12% improvement in FEV1. No nominally significant differences were observed between GP MDI 28.8 µg and GP MDI 14.4 µg for any of the endpoints. All doses of GP MDI were well tolerated, with no unexpected safety findings. CONCLUSIONS: This study indicated that there was no advantage of GP MDI 28.8 µg compared with GP MDI 14.4 µg. It therefore added to the evidence from the Phase I/II clinical trial program, which identified GP MDI 14.4 µg as the most appropriate dose for use in the Phase III clinical studies. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01350128). Registered May 09, 2011.

Meta-analysis of the efficacy of a single dose of phenylephrine 10 mg compared with placebo in adults with acute nasal congestion due to the common cold.

BACKGROUND: Although nonprescription oral phenylephrine 10 mg has been judged "generally recognized as safe and effective" by the US Food and Drug Administration (FDA), its efficacy as a nasal decongestant has been questioned. OBJECTIVE: This study assessed available data on the efficacy of oral phenylephrine 10 mg as a nasal decongestant. METHODS: Three sources were used to identify potentially relevant publications--the bibliography of the phenylephrine section of the 1976 FDA monograph on over-the-counter cold, cough, allergy, bronchodilator, and antiasthmatic products; a 2004 Cochrane Review of nasal decongestants for the common cold; and a search of MEDLINE from 1966 through January 2007 using the term phenylephrine nasal. To be included in the analyses, studies had to have a single-dose, randomized, placebo-controlled design; involve an orally administered product in which phenylephrine 10 mg was the sole active ingredient; enroll patients with acute nasal congestion due to the common cold; evaluate nasal airway resistance (NAR) as the efficacy end point; and have sufficient data in the study report to allow reanalysis and/or meta-analysis of phenylephrine 10 mg versus placebo. Reanalysis of individual studies and fixed-effects and random-effects meta-analyses were performed. Statistical significance at 30 and 60 minutes after dosing (the primary time points) and a >or=20% reduction in NAR from baseline were considered indicative of a clinically meaningful difference. RESULTS: Fifteen potentially relevant studies were identified, of which 8 met the inclusion criteria. Data from 7 crossover studies involving a total of 113 subjects were reanalyzed and then pooled for meta-analysis; results from the initial phase of the eighth study, a parallel-group trial involving 50 subjects, were included in the reanalysis of individual studies but not in the meta-analyses. Significant differences in favor of phenylephrine were seen in 4 of the 8 studies (P or=20% with phenylephrine. CONCLUSION: These meta-analyses of 7 crossover studies and the reanalysis of a parallel-group study support the effectiveness of a single oral dose of phenylephrine 10 mg as a decongestant in adults with acute nasal congestion associated with the common cold.