COPD Study Supports Concomitant Beta-Blocker Use in Moderate to Severe Disease

Adults with moderate to severe chronic obstructive pulmonary disease (COPD) prescribed beta blockers may not experience differences in lung function, safety, or overall respiratory status compared with individuals with COPD not treated with beta-blockers, according to a study published by Chest.

Researchers identified 5162 individuals from the phase 3 TONADO 1 and 2 studies (ClinicalTrials.gov identifiers: NCT01431274 and NCT01431287), which were designed to assess lung function and patient-reported outcomes in individuals prescribed long-acting bronchodilator treatment (a combination of tiotropium/olodaterol) for >1 year for moderate to severe COPD. Individuals prescribed beta-blockers during the 1-year study (n=557) were identified and evaluated to assess differences in patient-reported outcomes, lung function, and safety in this population. Cardioselective beta-blockers were used in 80% of the individuals treated with a beta-blocker.

The 2 multinational, replicate, phase 3, multicenter, randomized, double-blind, active-controlled, 5-arm, parallel-group studies measured lung function using forced expiratory volume in 1 second and forced vital capacity in individuals treated with beta-blockers. Results were similar for both patients treated with beta-blockers and those not treated with beta-blockers, with a between-group difference at 24 weeks of 0.010 L (95% CI, –0.009 to –0.028) and –0.010 L (95% CI, –0.048 to 0.028), respectively, and at 52 weeks of –0.005 L and –0.008 L, respectively.

Patient-reported symptoms were found to have improved in both treatment groups, with a treatment difference in St. George’s Respiratory Questionnaire scores at 24 and 52 weeks of –1.39 (95% CI, –2.581 to –0.207) and –0.60 (95% CI, –1.810 to –0.602), respectively. Dyspnea scores appeared to improve slightly in those treated with beta-blockers, but without a significant difference.

Finally, the rate of adverse events in both treatment groups was similar, with a slightly higher incidence of respirator adverse events occurring in the group not treated with beta-blockers. The overall rates of serious adverse events in individuals treated with and without beta-blockers were 19.4% and 16.0%, respectively.

The rate of COPD exacerbations was lower in individuals treated with beta-blockers (26.9%) compared with those not treated with beta-blockers (30.8%). However, the time to first COPD exacerbation was not different between treatment groups (271 and 236 days, respectively; adjusted hazard ratio, 0.878; 95% CI, 0.732-1.053; P =.1604). In the beta-blocker indication subgroup, the total number of respiratory events was lower in individuals who received beta-blockers compared with individuals who did not receive beta-blockers.

Clinicians may safely consider the concomitant use of beta-blockers in individuals with moderate to severe COPD who have an indication for their use.

Disclosures: The funding source, Boehringer Ingelheim, was involved in the study design and conduct, data collection and analysis, and the manuscript preparation, review, and approval.

Reference

Maltais F, Buhl R, Koch A, et al. β-blockers in chronic obstructive pulmonary disease: a cohort study from the TONADO research programme [published online January 2, 2018]. Chest.  doi:10.1016.j.chest.2018.01.008