STEPS

New Drug Reviews

Revefenacin (Yupelri) for the Treatment of Chronic Obstructive Pulmonary Disease

 

Am Fam Physician. 2020 Jan 15;101(2):121-122.

Revefenacin (Yupelri) is a once-daily, nebulized, long-acting muscarinic antagonist labeled for the treatment of moderate to severe chronic obstructive pulmonary disease (COPD).

Safety

Revefenacin is generally safe with minimal systemic adverse effects.1 As with other long-acting treatments, revefenacin should not be used to treat acute symptoms. Similar to other inhaled therapies, it has a theoretic risk of immediate hypersensitivity reaction and acute bronchospasm. Revefenacin is anticholinergic and may induce narrow-angle glaucoma or worsen urinary retention. Revefenacin has not been studied in pregnant women or breastfed infants. The manufacturer recommends against its use in patients with hepatic impairment or those taking rifampin or cyclosporine (Sandimmune).

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DrugDosageDose formCost*

Revefenacin (Yupelri)

175 mcg once daily

175 mcg per 3 mL aqueous solution via nebulizer

$1,000


*—Estimated retail price for one month of treatment based on information obtained at https://www.goodrx.com (accessed November 22, 2019).

DrugDosageDose formCost*

Revefenacin (Yupelri)

175 mcg once daily

175 mcg per 3 mL aqueous solution via nebulizer

$1,000


*—Estimated retail price for one month of treatment based on information obtained at https://www.goodrx.com (accessed November 22, 2019).

Tolerability

Revefenacin was shown to be well tolerated in clinical trials. In two 12-week placebo-controlled trials of 1,225 patients with moderate to severe COPD, adverse effects leading to discontinuation were more common in patients receiving placebo (19%) than revefenacin (13%).2

Effectiveness

Revefenacin is superior to placebo in improving forced expiratory volume in one second (FEV1) for patients with moderate to severe COPD. A 28-day randomized, double-blind study compared placebo and revefenacin in 355 patients with COPD, a mean age of 62 years, and a mean FEV1 of 44% of predicted. Patients were

Author disclosure: No relevant financial affiliations.

Address correspondence to Joanne Wilkinson, MD, MSc, at jwilkmd@gmail.com. Reprints are not available from the authors.

References

show all references

1. DailyMed. Drug label information. Yupelri —revefenacin solution. Accessed May 16, 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6dfebf04-7c90-436a-9b16-750d3c1ee0a6...

2. Ferguson G, Pudi KK, Feldmann G, et al. Efficacy and safety of revefenacin (REV), a long-acting muscarinic antagonist for nebulization: results of replicate randomized, double-blind, placebo-controlled, parallel-group phase 3 trials in participants with moderate to very severe COPD. Eur Respir J. 2017;50(suppl 61):1812.

3. Pudi KK, Barnes CN, Moran EJ, et al. A 28-day, randomized, double-blind, placebo-controlled, parallel group study of nebulized revefenacin in patients with chronic obstructive pulmonary disease. Respir Res. 2017;18(1):182.

4. Ferguson GT, Feldman G, Pudi KK, et al. Improvements in lung function with nebulized revefenacin in the treatment of patients with moderate to very severe COPD: results from two replicate phase III clinical trials. Chronic Obstr Pulm Dis. 2019;6(2):154–165.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, MMedEd, assistant medical editor.

A collection of STEPS published in AFP is available at https://www.aafp.org/afp/steps.

 

 

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