Key result
Once-daily fluticasone furoate/vilanterol fails to improve aortic pulse wave velocity versus placebo at 24 weeks.
Why the study?
Does once-daily inhaled fluticasone furoate/vilanterol or vilanterol improve arterial stiffness in patients with COPD?
RCT (n=430)
double-blind
stratified
Yes
Does once-daily inhaled fluticasone furoate/vilanterol or vilanterol improve arterial stiffness in patients with COPD?
Absolute Event Rate: -1.75% vs -1.97%
Inhaled fluticasone furoate/vilanterol or vilanterol alone did not significantly improve arterial stiffness compared to placebo in patients with COPD.
FF/VI does not reduce aPWV beyond placebo in COPD with elevated baseline stiffness; challenges prior non-placebo data and leaves open identification of potential responders.
Introduction: Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Elevated arterial stiffness, measured by aortic pulse wave velocity (aPWV), is a cardiovascular risk surrogate and is potentially modifiable by inhaled corticosteroid/long-acting beta 2 -agonist combinations in patients with COPD. Materials and methods: The effects of once-daily inhaled fluticasone furoate/vilanterol (FF/VI) 100/25 µg, VI 25 µg, versus placebo on arterial stiffness in patients with COPD and baseline aPWV ≥11.0 m/s were investigated in a 24-week, multicenter, double-blind, randomized, stratified (by COPD exacerbation history), parallel-group, placebo-controlled trial. Eligible patients were ≥40 years old, with ≥10 pack-year smoking history, forced expiratory volume in 1 s (FEV 1 )/forced vital capacity ≤0.70, and post-bronchodilator FEV 1 ≤70% of predicted. Patients with a major cardiovascular event in the previous 6 months/current severe heart failure/uncontrolled hypertension were excluded. Primary endpoint is change from baseline in aPWV after 24 weeks of treatment. Safety analyses included adverse events (AEs). Results: The intent-to-treat population included 430 patients: FF/VI (n=135), VI (n=154), and placebo (n=141). Patients were predominantly male (79%) and Asian or White (each 48%), with a mean age of 68.5 years (standard deviation [SD] =7.9), percentage predicted post-bronchodilator FEV 1 50.1% (SD =13.3), and aPWV 13.26 m/s (SD =2.22) at screening. At 24 weeks, mean (standard error [SE]) changes from baseline in aPWV were -1.75 m/s (SE =0.26, FF/VI), -1.95 m/s (SE =0.24, VI), and -1.97 m/s (SE =0.28, placebo). AEs occurred in 57% (FF/VI), 51% (VI), and 41% (placebo) of patients. Conclusion: No differences were observed in aPWV-adjusted mean change from baseline for FF/VI 100/25 µg, compared with placebo.
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Bhatt et al. (2017) conducted an RCT in Chronic obstructive pulmonary disease (COPD) (n=430). fluticasone furoate/vilanterol vs. placebo was evaluated on change from baseline in aPWV after 24 weeks of treatment. Once-daily fluticasone furoate/vilanterol did not significantly change aortic pulse wave velocity compared with placebo at 24 weeks (mean change -1.75 m/s vs -1.97 m/s).
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