Aclidinium and Tiotropium Reduce Sedentary Behavior in Patients With COPD

Using bronchodilators early on in patients with chronic obstructive pulmonary disease (COPD) is increasingly understood to be an important therapeutic intervention to improve quality of life, inhibit disease progression, and allow for greater physical activity.

A recent paper, published in BMJ Open, sought to compare 2 treatment options with respect to their impact on pulmonary function, health-related quality of life, and physical activity: twice-daily inhalation therapy with aclidinium and once-daily inhalation therapy with tiotropium.

The study, conducted at 4 centers in Japan from 2015 to 2016, enrolled 44 patients with grade 2 or grade 3 COPD. Patients were randomized to either receive aclidinium 2 times per day at a dose of 400 mcg in the morning and at night, or tiotropium at a dose of 5 mcg once per day at night, for 8 weeks.

The study’s primary outcome was forced expiratory volume in 1 second, area under the curve (FEV₁AUC_0-3), in the continuous respiratory function test. Secondary outcomes were patient-reported health-related quality of life based on St George’s Respiratory Questionnaire (SGRQ) and the 8-item Short-Form Health Survey (SF-8). Patients also wore accelerometers to measure physical activity.

At week 8, mean (SD) FEV₁AUC_0-3, in terms of L/hour, was 4.62 (1.43 ) in the aclidinium group and 4.73 (1.60)  in the tiotropium group, for a mean difference of −0.11 L/hour (95% CI, −1.04 to 0.83).

Mean (SD) change in the SGRQ score from week 0 to week 8 significantly improved in the aclidinium group (−4.11 [11.77] points) versus the tiotropium group (3.67 [10.33] points). There was also greater improvement in the role of physical domain of the SF-8 score in the aclidinium group versus the tiotropium group at weeks 4 and 8.

Objectively measured physical activity showed no significant differences in sedentary behavior or light behavior between groups. However, the duration of sedentary behavior in the morning hours significantly decreased in the aclidinium group, whereas sedentary behavior in the afternoon significantly decreased in the tiotropium group.

The researchers concluded that there was no significant difference between twice-daily aclidinium and once-daily tiotropium in terms of the primary outcome, which suggests that the bronchodilating effect of the 2 therapies is similar. And while the 2 therapies reduced sedentary behavior, aclidinium demonstrated superiority “in terms of the subjective but pertinent measures of activity.”

Reference

Kamei T, Nakamura H, Nanki N, Minakata Y, Matsunga K, Mori Y. Clinical benefit of two-times-per-day aclidinium bromide compared with once-a-day tiotropium bromide hydrate in COPD: a multicenter, open-label, randomized study. BMJ Open. 2019;9:e024114. doi: 10.1136/bmjopen-2018-024114.