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Gary T Ferguson,1 Edward M Kerwin,2 Tara Rheault,3 Thomas Bengtsson,4 Kathleen Rickard3 1Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA; 2Altitude Clinical Consulting, Medford, OR, USA; 3Verona Pharma, Plc, Raleigh, NC, USA; 4Stat Mind AB, Lund, SwedenCorrespondence: Tara RheaultVerona Pharma, 8045 Arco Corporate Drive, Suite 130, Raleigh, NC, 27617, USATel +1 646-530-2126Email tara.rheault@veronapharma.comPurpose: Ensifentrine is an inhaled dual inhibitor of phosphodiesterase (PDE) 3 and 4 that has shown bronchodilatory effects and symptom improvement in clinical studies in patients with chronic obstructive pulmonary disease (COPD), and anti-inflammatory effects in healthy volunteers in a model of COPD-like inflammation. This manuscript reports on the results of the clinical study examining if ensifentrine provides meaningful improvements in lung function when added on to tiotropium over 4 weeks in patients with COPD who have impaired lung function and symptoms despite treatment with tiotropium.Patients and Methods: This randomized, double-blind, placebo-controlled, parallel-group, dose-ranging study recruited patients with moderate-to-severe COPD. Patients were randomized to open-label tiotropium once daily (QD) plus (+) blinded escalating doses of ensifentrine or placebo twice daily (BID). Effects on lung function, symptoms and quality of life (QoL) were assessed over 4 weeks.Results: A total of 416 COPD patients were randomized and 413 received at least one dose of blinded study medication + tiotropium. All ensifentrine doses produced a significant and dose-dependent increase in peak forced expiratory volume in 1 second (FEV1) from baseline to Week 4, with placebo-corrected differences of 77.5 mL when added to tiotropium (0.375 mg; 95% CI: 4.8, 150.1 mL; p=0.037) to 124.2 mL (3 mg; 95% CI: 51.0, 196.8 mL; p< 0.001). A significant increase in average FEV1 (0– 12h) was shown at Week 4 with the 3 mg dose (87.3 mL; 95% CI: 20.0, 154.5 mL; p=0.011). Clinically meaningful and statistically significant improvements in the St. George’s Respiratory Questionnaire – COPD (SGRQ-C) additive to tiotropium were observed at Week 4, exceeding the minimally clinically important difference of 4 units with the 1.5 and 3 mg doses. Adverse events were similar in frequency between the ensifentrine and placebo arms.Conclusion: This clinical study demonstrated that nebulized ensifentrine added on to tiotropium produced clinically important improvements in lung function and QoL over 4 weeks in COPD patients receiving tiotropium who demonstrated symptoms and lung function impairment, with a safety profile similar to placebo.Keywords: dual PDE3 and 4 inhibitor, phosphodiesterase, COPD, tiotropium, bronchodilation |
