PMID- 34744701
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211110
IS  - 1663-9812 (Print)
IS  - 1663-9812 (Electronic)
IS  - 1663-9812 (Linking)
VI  - 12
DP  - 2021
TI  - The Efficacy and Safety of Revefenacin for the Treatment of Chronic Obstructive 
      Pulmonary Disease: A Systematic Review.
PG  - 667027
LID - 10.3389/fphar.2021.667027 [doi]
LID - 667027
AB  - Background Revefenacin (REV) is a novel once-daily long-acting muscarinic 
      antagonist (LAMA) in the treatment of moderate to very severe chronic obstructive 
      pulmonary disease (COPD). This systematic review incorporating a dose-response 
      meta-analysis aimed to assess the efficacy and safety of REV. Methods PubMed, 
      Embase, Cochrane Library, China National Knowledge Infrastructure, VIP database, 
      and Wanfang database were searched from their inception to April 2020. We 
      included randomized controlled trials (RCTs) which evaluated the efficacy and 
      safety of REV in COPD patients. Two reviewers independently performed study 
      screening, data extraction, and risk of bias assessment. Outcomes consisted of 
      the mean change in trough Forced Expiratory Volume in 1 second (FEV(1)) from 
      baseline, adverse events (AEs), and serious adverse events (SAEs). A 
      dose-response meta-analysis using the robust error meta-regression method was 
      conducted. We used Grading of Recommendations, Assessment, Development and 
      Evaluation (GRADE) approach to assess the quality of evidence. Results Nine RCTs 
      (3,121 participants) were included in this systematic review. The meta-analyses 
      indicated that 175 mug/day REV could significantly improve the trough FEV(1) 
      (MD=143.67, 95%CI: 129.67 to 157.68; I(2)=96%; 809 participants; studies=4; low 
      quality) without increasing the risk of AEs (OR=0.98, 95%CI: 0.81 to 1.18; 
      I(2)=34%; 2,286 participants; studies=7; low quality) or SAEs (OR=0.89, 95%CI: 
      0.55 to 1.46; I(2)=0%; 2,318 participants; studies=7; very low quality) compared 
      to placebo. Furthermore, the effect of REV in increasing trough FEV(1) was 
      dose-dependent with an effective threshold of 88 mug/day (R(2) = 0.7017). 
      Nevertheless, only very low-quality to low-quality evidence showed that REV at a 
      dose of 175 mug/day was inferior to tiotropium regarding the long-term efficacy, 
      and its safety profile was not superior to tiotropium or ipratropium. Conclusion 
      Current evidence shows that REV is a promising option for the treatment of 
      moderate to very severe COPD. Due to most evidence graded as low quality, further 
      studies are required to compare the efficacy, long-term safety and 
      cost-effectiveness between REV and other LAMAs in different populations. Clinical 
      Trial Registration: [PROSPERO], identifier [CRD42020182793].
CI  - Copyright (c) 2021 Zhang, Xie, Kwong, Ge, He, Zheng, Han, Zhang, Zhao, He and Li.
FAU - Zhang, Jiaxing
AU  - Zhang J
AD  - Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China.
FAU - Xie, Yihong
AU  - Xie Y
AD  - Department of Pharmacy, Hospital of Chengdu Office of People's Government of 
      Tibetan Autonomous Region, Chengdu, China.
FAU - Kwong, Joey Sum-Wing
AU  - Kwong JS
AD  - Global Health Nursing, Graduate School of Nursing Science, St. Luke's 
      International University, Tokyo, Japan.
FAU - Ge, Long
AU  - Ge L
AD  - Evidence Based Social Science Research Centre, School of Public Health, Lanzhou 
      University, Lanzhou, China.
FAU - He, Rui
AU  - He R
AD  - Department of Laboratory Medicine, Experimental Cancer Medicine, Karolinska 
      Institute, Stockholm, Sweden.
FAU - Zheng, Wenyi
AU  - Zheng W
AD  - Department of Laboratory Medicine, Experimental Cancer Medicine, Karolinska 
      Institute, Stockholm, Sweden.
FAU - Han, Jing
AU  - Han J
AD  - Department of Respiratory, Guizhou Provincial People's Hospital, Guiyang, China.
FAU - Zhang, Rui
AU  - Zhang R
AD  - Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China.
FAU - Zhao, Huaye
AU  - Zhao H
AD  - Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China.
FAU - He, Yuru
AU  - He Y
AD  - Department of Pharmacy, Hospital of Chengdu Office of People's Government of 
      Tibetan Autonomous Region, Chengdu, China.
FAU - Li, Xiaosi
AU  - Li X
AD  - Department of Pharmacy, Hospital of Chengdu Office of People's Government of 
      Tibetan Autonomous Region, Chengdu, China.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20211020
PL  - Switzerland
TA  - Front Pharmacol
JT  - Frontiers in pharmacology
JID - 101548923
PMC - PMC8564370
OTO - NOTNLM
OT  - chronic obstructive pulmonary disease
OT  - dose-response meta-analysis
OT  - long-acting muscarinic antagonist
OT  - revefenacin
OT  - systematic review
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/11/09 06:00
MHDA- 2021/11/09 06:01
PMCR- 2021/10/20
CRDT- 2021/11/08 06:34
PHST- 2021/02/11 00:00 [received]
PHST- 2021/10/06 00:00 [accepted]
PHST- 2021/11/08 06:34 [entrez]
PHST- 2021/11/09 06:00 [pubmed]
PHST- 2021/11/09 06:01 [medline]
PHST- 2021/10/20 00:00 [pmc-release]
AID - 667027 [pii]
AID - 10.3389/fphar.2021.667027 [doi]
PST - epublish
SO  - Front Pharmacol. 2021 Oct 20;12:667027. doi: 10.3389/fphar.2021.667027. 
      eCollection 2021.