Boehringer Ingelheim Pharmaceuticals, Inc. and Pfizer Inc. announced that the US Food and Drug Administration (FDA) has approved SPIRIVA HandiHaler (tiotropium bromide inhalation powder) for the reduction of exacerbations in patients with chronic obstructive pulmonary disease (COPD). SPIRIVA HandiHaler is already FDA-approved as a once-daily maintenance treatment for breathing problems associated with COPD, which includes chronic bronchitis, emphysema, or both.

Reducing exacerbations is a key goal of COPD disease management, according to treatment guidelines. In the clinical trials that served as the basis for this approval, COPD exacerbations were defined as a new onset or increase of symptoms (including cough, sputum, wheezing or difficulty breathing) lasting for at least three days and which required a change in treatment (antibiotics or steroids), which could include hospitalization. COPD exacerbations may be caused by viral or bacterial infections, as well as environmental irritants.

“Exacerbations of COPD are serious events that can negatively impact the lives of patients,” said Dr. Donald P. Tashkin, emeritus professor of medicine, David Geffen School of Medicine at UCLA, Los Angeles. “People with COPD now have a once-daily treatment option that not only helps them manage the debilitating symptoms of COPD, but also can help them reduce the chance of an exacerbation.”

The new indication is supported by data from two clinical trials: the landmark UPLIFT (Understanding the Potential Long-term Impacts on Function with Tiotropium) study and a six-month study conducted in the Veterans Affairs setting, which together involved nearly 8,000 people with COPD. While the UPLIFT trial did not meet its primary endpoint (slowing the rate of decline in lung function versus placebo), it provided relevant and important clinical information regarding the effect of SPIRIVA HandiHaler on COPD exacerbations.

“With today’s approval, SPIRIVA HandiHaler is now the first steroid-free maintenance treatment that has been shown to reduce COPD exacerbations,” said Dr. Christopher Corsico, vice president, drug regulatory affairs, Boehringer Ingelheim Pharmaceuticals, Inc. “We also are pleased that the product label will now include data from the landmark UPLIFT trial, which provides important information for physicians to consider when making treatment decisions.”

Along with the new indication, the SPIRIVA HandiHaler product label now includes clinical trial data from the UPLIFT study. In this trial, COPD patients in both treatment groups were allowed to use all of their respiratory medications with the exception of inhaled anticholinergics in order to simulate a real-world environment. The clinical data demonstrated that SPIRIVA HandiHaler sustained improved lung function over four years when compared with placebo and reduced COPD exacerbations, even with the use of these medications. Additionally, the inclusion of the safety data reaffirmed the established safety profile of SPIRIVA HandiHaler.

The safety profile of SPIRIVA HandiHaler has been well-established in clinical studies involving more than 17,000 COPD patients, 11,000 of whom were treated with SPIRIVA HandiHaler, and in post-marketing experience involving more than 16 million patient-years of exposure since its European approval in 2002. SPIRIVA HandiHaler was approved in the United States in 2004.

SPIRIVA HandiHaler is a prescription medicine used once every day (a maintenance medicine) to control symptoms of chronic obstructive pulmonary disease (COPD) by relaxing your airways and keeping them open. COPD includes chronic bronchitis, emphysema, or both.

SPIRIVA HandiHaler also reduces the likelihood of flare-ups and worsening of COPD symptoms (COPD exacerbations). A COPD exacerbation is defined as an increase or new onset of more than one COPD symptom such as cough, mucus, shortness of breath, and wheezing that requires medicine beyond your rescue medicine.