From the Guidelines
Revefenacin is indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD) as a once-daily, nebulized long-acting muscarinic antagonist (LAMA) bronchodilator. The standard dosage is 175 mcg (3 mL of the solution) administered once daily via a standard jet nebulizer connected to an air compressor 1. Revefenacin works by blocking muscarinic receptors in the airways, which reduces bronchoconstriction and improves airflow. According to the 2023 Canadian Thoracic Society guideline, LAMA monotherapy is recommended for patients with stable COPD who are at low risk of exacerbations 1.
Key Points
- Revefenacin is not indicated for the relief of acute bronchospasm or for asthma treatment.
- Patients should administer the medication at the same time each day to maintain consistent blood levels.
- Common side effects include cough, headache, upper respiratory tract infection, and back pain.
- Revefenacin should be used with caution in patients with narrow-angle glaucoma, urinary retention, or severe hypersensitivity to the drug or its components.
- The 2017 GOLD strategy document recommends either a LAMA or a combination LABA/LAMA for patients with either two or more exacerbations per year or one or more exacerbations requiring hospitalisation 1.
Recommendations
- Revefenacin offers an alternative delivery method for patients who may have difficulty using handheld inhalers or who prefer nebulized therapy for their COPD maintenance treatment.
- The choice of treatment should be based on the individual patient's needs and medical history, as well as the potential benefits and risks of the treatment 1.
- Patients with COPD should be treated with a step-wise approach, starting with monotherapy and adding additional medications as needed to control symptoms and prevent exacerbations 1.
From the Research
Revefenacin Indications
- Revefenacin is indicated for the maintenance treatment of patients with moderate to very severe chronic obstructive pulmonary disease (COPD) 2, 3, 4.
- It is a once-daily, long-acting muscarinic antagonist that can be delivered via a standard jet nebulizer 2, 3, 4.
- Revefenacin has been shown to improve lung function and health outcomes in patients with COPD, including those with concomitant use of long-acting β-agonists (LABA) or LABA with inhaled corticosteroids (ICS) 3, 5.
- The approved dose of revefenacin is 175 μg, which has been demonstrated to be safe and well-tolerated in clinical trials 2, 3, 6.
Patient Population
- Revefenacin is suitable for patients with COPD who require nebulized therapy, including those who may have difficulty using traditional handheld inhalers 2, 4.
- It can be used in patients with moderate to very severe COPD, regardless of airflow obstruction severity 3, 5.
- Revefenacin has been shown to be effective and safe in patients taking concomitant LABA or LABA with ICS 5.
Clinical Benefits
- Revefenacin has been demonstrated to improve trough forced expiratory volume in 1 second (FEV1) and peak FEV1 in patients with COPD 3.
- It has also been shown to improve clinical health outcomes, as measured by the St. George's Respiratory Questionnaire (SGRQ) 5.
- Revefenacin has a similar safety profile to tiotropium, with no significant difference in rates of adverse events 2.