Aclidinium Bromide

Aclidinium Bromide is a long-acting antagonist of muscarinic (LAMAs) [1].

Aclidinium Bromide has been reported to inhibit the specific binding of [3H]-NMS to human M receptors in a dose-denpendent fasion with Ki values of 0.10±0.00nM,0.14±0.04nM, 0.14±0.02nM, 0.21±0.04nM and 0.16±0.01nM for M1, M2,M3,M4 and M5, respectively. In addition, Aclidinium Bromide has shown the great potency at endogenous M2 and M3 receptors with EC50 values of 17.4±1.1nM and 5.3±1.6nM, respectively. Apart from these, Aclidinium Bromide has been revealed to produce a concentration-dependent inhibition of acetylcholine-induced bronchoconstriction in vivo with an EC50 of ranging from 2.5 to 23.1μg/mL in anaesthetized guines pigs. Besides, Aclidinium Bromide has also been noted to inhibit the salivation in rat pilocarpine-induced sialorrhea model with an EC50 of 38μg/kg [1].

References:
[1] Gavaldà A1, Ramos I2, Carcasona C3, Calama E4, Otal R5, Montero JL6, Sentellas S7, Aparici M8, Vilella D9, Alberti J10, Beleta J11, Miralpeix M12. The in vitro and in vivo profile of aclidinium bromide in comparison with glycopyrronium bromide. Pulm Pharmacol Ther. 2014 Aug;28(2):114-21.

Effect of aclidinium bromide on cough and sputum symptoms in moderate-to-severe COPD in three phase III trials.[Pubmed:28074135]

BMJ Open Respir Res. 2016 Dec 8;3(1):e000148.

BACKGROUND: Cough and sputum are troublesome symptoms in chronic obstructive pulmonary disease (COPD) and are associated with adverse outcomes. The efficacy of Aclidinium Bromide 400 microg twice daily in patients with stable COPD has been established in two phase III studies (ACCORD COPD I and ATTAIN) and a phase IIIb active-comparator study. This analysis evaluated cough-related symptoms across these studies. METHOD: Patients were randomised to placebo, aclidinium 200 microg or 400 microg twice daily in ACCORD (12 weeks) and ATTAIN (24 weeks), or to placebo, aclidinium 400 microg twice daily or tiotropium 18 microg once daily (6-week active-comparator study). Analysed end points included changes from baseline in Evaluating Respiratory Symptoms (E-RS; formerly known as EXAcerbations of Chronic pulmonary disease Tool), total and cough/sputum scores and frequency/severity of morning and night-time cough and sputum symptoms. RESULTS: Data for 1792 patients were evaluated. E-RS cough/sputum domain scores were significantly reduced with aclidinium 400 microg versus placebo in ATTAIN (-0.7 vs -0.3, respectively; p<0.01) and the active-comparator study (-0.6 vs -0.2, respectively; p<0.01). In the active-comparator study, significantly greater improvements were observed with aclidinium versus placebo for severity of morning cough (-0.19 vs -0.02; p<0.01) and phlegm (-0.19 vs -0.02; p<0.05). In ACCORD, aclidinium reduced night-time cough frequency (-0.36 vs 0.1 for placebo; p<0.001) and severity (-0.24 vs -0.1 for placebo; p<0.05), and frequency of night-time sputum production (-0.37 vs 0.05 for placebo; p<0.001). CONCLUSIONS: Aclidinium 400 microg twice daily improves cough and sputum expectoration versus placebo in stable COPD. TRIAL REGISTRATION NUMBERS: NCT00891462; NCT01001494; NCT01462929.

Cost versus utility of aclidinium bromide 400 microg plus formoterol fumarate dihydrate 12 microg compared to aclidinium bromide 400 microg alone in the management of moderate-to-severe COPD.[Pubmed:27672337]

Clinicoecon Outcomes Res. 2016 Sep 12;8:445-56.

PURPOSE: Aclidinium-formoterol 400/12 microg is a long-acting muscarinic antagonist (LAMA) and a long-acting beta2-agonist in a fixed-dose combination used in the management of patients with COPD. This study aimed to assess the cost-effectiveness of aclidinium-formoterol 400/12 microg against the long-acting muscarinic antagonist Aclidinium Bromide 400 microg. MATERIALS AND METHODS: A five-health-state Markov transition model with monthly cycles was developed using MS Excel to simulate patients with moderate-to-severe COPD and their initial lung-function improvement following treatment with aclidinium-formoterol 400/12 microg or aclidinium 400 microg. Health states were based on severity levels defined by Global Initiative for Chronic Obstructive Lung Disease 2010 criteria. The analysis was a head-to-head comparison without step-up therapy, from the NHS Scotland perspective, over a 5-year time horizon. Clinical data on initial lung-function improvement were provided by a pooled analysis of the ACLIFORM and AUGMENT trials. Management, event costs, and utilities were health state-specific. Costs and effects were discounted at an annual rate of 3.5%. The outcome of the analysis was expressed as cost (UK pound) per quality-adjusted life-year (QALY) gained. The analysis included one way and probabilistic sensitivity analyses to investigate the impact of parameter uncertainty on model outputs. RESULTS: Aclidinium-formoterol 400/12 microg provided marginally higher costs ( pound41) and more QALYs (0.014), resulting in an incremental cost-effectiveness ratio of pound2,976/QALY. Sensitivity analyses indicated that results were robust to key parameter variations, and the main drivers were: mean baseline forced expiratory volume in 1 second (FEV1), risk of exacerbation, FEV1 improvement from aclidinium-formoterol 400/12 microg, and lung-function decline. The probability of aclidinium-formoterol 400/12 microg being cost-effective (using a willingness-to-pay threshold of pound20,000/QALY) versus aclidinium 400 microg was 79%. CONCLUSION: In Scotland, aclidinium-formoterol 400/12 microg can be considered a cost-effective treatment option compared to aclidinium 400 microg alone in patients with moderate-to-severe COPD.

Aclidinium Bromide(LAS 34273; LAS-W 330) is a long-acting, inhaled muscarinic antagonist as a maintenance treatment for chronic obstructive pulmonary disease (COPD).

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