Does Umeclidinium Monotherapy Help Asthma Patients Without ICS?
the MPR take:
Umeclidinium is an anticholinergic indicated for the long-term, once-daily maintenance treatment of airflow obstructions in patients with chronic obstructive pulmonary disease (COPD). However, no studies have assessed a long-acting muscarinic antagonist in the absence of inhaled corticosteroids (ICS) for asthma patients. A new study in Respiratory Medicine reports on a double-blind, three-period crossover study of 350 asthma patients ≥18 years of age randomized to a sequence of 3–8 inhaled treatments: umeclidinium bromide (UMEC) 15.6mcg, 31.25mcg, 62.5mcg, 125mcg, or 250mcg once daily, UMEC 15.6mcg or 31.25mcg twice daily, or placebo. All patients received the medications or placebo for 14 days, with a 12–14 day washout. Trough forced expiratory volume in one second (FEV1), 0–24-hour weighted mean (WM) FEV1, and safety were the study outcomes. Although significant improvements in change from baseline trough FEV1 were observed for UMEC 15.6mcg and 125mg once daily vs. placebo, these were not observed in other once daily and twice daily doses. Although modest improvements in trough FEV1 with umeclidinium monotherapy were promising, they were not dose-related or consistent and do not support a therapeutic benefit in patients with asthma not requiring ICS treatment.
To our knowledge, no studies in patients with asthma have assessed a long-acting muscarinic antagonist in the absence of inhaled corticosteroids (ICS).
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