Are inhalers containing umeclidinium bromide effective and safe for people with COPD?


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Review question

We reviewed the effectiveness and safety of umeclidinium inhalers compared with placebo (dummy) inhalers in people with chronic obstructive pulmonary disease (COPD).

Background

People with COPD are often breathless and have poor quality of life. Symptoms may worsen during flare-ups, increasing healthcare expenses and reducing life span. Medications that widen the airways (bronchodilators), which act for 12 to 24 hours, are the treatments generally given to improve symptoms. Umeclidinium is a new treatment of this sort. We wanted to discover whether umeclidinium was better or worse than placebo.

Study characteristics

We included four studies involving 3798 people with COPD. Most were men in their 60s who were moderate to heavy smokers. When they started treatment, they had moderate to severe symptoms of COPD. Studies ranged from three months to one year long. Studies were well designed and were funded by the drug manufacturer. Neither people in the study nor people doing the research knew which treatment participants were getting. People in the studies took either umeclidinium or placebo through an inhaler each morning.

The conclusions of this review are current to April 2017.

Key results

We determined the number of people who had a moderate flare-up. A moderate flare-up is treated with short-term oral steroids or antibiotics, or both. People who took umeclidinium were less likely than those given placebo to have a moderate flare-up. Eighteen people with COPD would need to be treated with umeclidinium to prevent one of these flare-ups.

People taking umeclidinium probably had a better quality of life, and their lung function was better. People taking umeclidinium were less breathless and took fewer puffs of their reliever inhaler.

Results showed little or no difference with umeclidinium in other outcomes, such as risk of dying during the study period, side effects, or the need to be admitted to hospital because of severe flare-ups.

Quality of the evidence

We are confident that umeclidinium inhalers are more likely than dummy inhalers to reduce moderate flare-ups and improve symptoms and lung function. However, we are less certain about effects of umeclidinium on quality of life, side effects, and serious side effects. We have limited confidence in terms of hospital admissions due to flare-ups, but this was a rare event.

Conclusions

In people with COPD, umeclidinium inhalers improve symptoms, lung function, and quality of life compared with dummy inhalers. They also reduce the use of quick-relief medications and decrease flare-ups that need additional medication. However, no convincing evidence indicates that umeclidinium is better than dummy inhalers in terms of hospitalisations, side effects, serious side effects, or deaths.