1. Tudorza Pressair®
(aclidinium bromide)
By Katrina Korn
3rd-Year Professional Pharmacy Student
kkorn@purdue.edu
2. Learning Objectives
State the mechanism of action for
Tudorza Pressair® (aclidinium bromide)
Provide information on indication, dosing
and side effects for aclidinium to patients
and professionals
Discuss advantages and disadvantages
of aclidinium with reference to clinical
trials results
Formulate an opinion regarding this
drug’s impact on clinical practice.
List important patient counseling points
for aclidinium
3. Background1,2
Dry-powder inhaler
Marketed by Forrest Labs, Inc.
Indication: FDA-approved in July 2012
for maintenance treatment of COPD
bronchospasms
4. Mechanism of Action1,2
Reversible, long-acting muscarinic
antagonist (anticholinergic)
Blocks M3 receptors in bronchiolar
smooth muscle
Leads to enhanced bronchodilation
Decreased bronchospasms
5. Dosing1
400 mcg twice daily via oral inhalation
Each puff delivers 400 mcg of
medicine
7. ACCORD COPD 13
Phase III, 12-week, double-
blind, randomized multicenter clinical trial
Compared twice-daily 200 mcg
aclidinium, daily 400 mcg aclidinium, and
placebo
Outcomes: change from baseline in
trough FEV1, COPD symptoms
Results: both active groups showed
improvement in FEV1, similar adverse
events compared to placebo
Comments: mean age 64 years, smoking
status unknown, longer studies needed
8. ATTAIN4
24-week, double-blind, placebo-controlled
trial
Compared twice-daily 200 mcg aclidinium vs.
twice-daily 400 mcg aclidinium vs. placebo
Outcomes: mean change in trough
FEV1, COPD symptoms
Significant improvement in FEV1 and
symptoms compared to placebo
SE were low and similar to placebo for both
groups
Comments: Smoking status unknown, not
comparative
9. Clinical trial comparing Spiriva®
(tiotropium) to aclidinium5
Phase IIa randomized, double-blind, double-
dummy crossover trial
Tiotropium 18 mcg vs. aclidinium 400 mcg vs.
placebo
15-day trial
Outcomes included change in peak FEV1 and
change in FEV1 AUC
Showed greater improvement in FEV1 AUC
values for aclidinium over tiotropium
COPD symptom scores improved with
aclidinium but not tiotropium
Comments: short, small study, symptom
scoring system unknown, FEV1 AUC not
standard
10. Clinical trial comparing
Spiriva® to aclidinium2,3,4,5
aclidinium Spiriva® ipratropium
Advantages Improved FEV1 more studies, Cost, well-
over Spiriva, currently first- studied and
lower line long-acting characterized,
incidence of cholinergic available in
Anticholinergic antagonist for combination with
side effects COPD, once albuterol
compared to daily dosing
both
Disadvantage cost ($261 for more anticholinergic
s one device), anticholinergic side effects, four
twice daily side effects times daily
dosing, 400 compared to dosing
mcg twice daily aclidinium
vs. 18 mcg
once daily for
11. Impact on Practice
Currently would argue against
formulary so it is not used as first-line
agent
Consider using in patients who are on
combo therapy including
corticosteroids who are not
experiencing relief
Consider using in patients who cannot
tolerate anticholinergic side effects
High cost, generic a possibility
12. Patient Counseling1
Inhalation technique – dry-powder
inhaler
Dose counter decreases by ten
Not a rescue inhaler – use twice every
day
Smoking cessation
Difficult urination, blurry vision,
bronchospasm
Discard after 45 days
Pregnancy category C
13. References
1. CenterWatch. Drug Information. Available at:
http://www.centerwatch.com/drug-information/fda-approvals/drug-
details.aspx?DrugID=1211. Accessed September 13, 2012.
2. TUDORZA PRESSAIR®. [package insert]. St. Louis, MO: Forrest Labs, Inc. ;
2012.
3. Kerwin EM, D’Urzo AD, Gelb AF, et al. Efficacy and safety of a twelve-week
treatment with twice-daily aclidinium bromide in COPD patients. (ACCORD
COPD 1). [abstract]. COPD 2012 Apr;9(2):90-101.
<http://www.ncbi.nlm.nih.gov.ezproxy.lib.purdue.edu/pubmed/2232014>.
Accessed September 15, 2012. PMID:22320148.
4. Jones PW, Singh D, Bateman ED, et al. Efficacy and safety of twice-daily
aclidinium bromide in COPD patients: The ATTAIN study. [abstract]. Eur Respir J
2012 Mar 22. [Epub ahead of print].
<http://www.ncbi.nlm.nih.gov.ezproxy.lib.purdue.edu/pubmed?term=efficacy%20
of%20aclidinium%20bromide%2024-week>. Accessed September 15, 2012.
PMID: 22441743.
5. Fuhr R, Magnussen H, Sarem K, et al. Efficacy of aclidinium bromide 400 μg
twice daily compared with placebo and tiotropium in patients with moderate to
severe COPD. [abstract]. Chest 2012 Mar;141(3):745-52.
<http://www.ncbi.nlm.nih.gov.ezproxy.lib.purdue.edu/pubmed/21903737>.