Revefenacin for the treatment of chronic obstructive pulmonary disease

ABSTRACT

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by irreversible or incompletely reversible airflow limitation. Long-acting bronchodilators, including β₂ agonists (LABA) and muscarinic antagonists (LAMA), serve as the standard of care for maintenance therapy in COPD. Individualizing therapy to optimize selection of delivery device has the potential to improve medication adherence and clinical outcomes among COPD patients.

Areas covered: Revefenacin (Yupelri) is the only LAMA approved for once-daily administration via standard jet nebulizer for the maintenance therapy in patients with COPD. Revefenacin has a unique biphenyl carbamate tertiary amine structure, differing from the quaternary amine structure of previously approved LAMAs. Here we summarize the available clinical data for this new agent and discuss its potential place in the treatment of COPD.

Expert opinion: Based on available clinical trial data, revefenacin appears to be an effective and safe option for long-term maintenance therapy of COPD. Revefenacin offers a once-daily option for LAMA therapy for patients who prefer or require nebulized drug delivery. The availability of this agent can allow patients to combine nebulized therapies that could improve clinical outcomes in appropriately selected patients with COPD.

KEYWORDS:

• Chronic obstructive pulmonary disease
• long-acting muscarinic antagonists
• revefenacin

Article highlights

• Revefenacin is the first, once-daily, LAMA approved for the treatment of COPD that is administered via a standard jet nebulizer.

• Clinical trial data show that revefenacin is safe and effective for long-term maintenance therapy in patients with moderate to very severe COPD.

• Nebulized drug delivery may help address issues in drug delivery in patients with low PIFR; however, additional studies are needed to assess if revefenacin (and other nebulized medications) will provide additional benefit in this sub-population.

• Triple therapy with a LAMA, LABA, and inhaled corticosteroids is now possible through nebulized medication delivery with once-/twice-daily dosing.

Declaration of interest

S Sethi discloses Research Grants from Glaxo Smith Kline, Sanofi, Cipla and Consultant fees/Honoraria from Astra Zeneca, Boehringer Ingelheim, Pulmotect, GSK, Pumonx. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Information resources

** www.yupelrihcp.com – provides information regarding revefenacin for US healthcare providers.

Additional information

Funding

This paper was not funded