BACKGROUND:Dual phosphodiesterase (PDE) 3 and 4 inhibitors have emerged as a novel therapeutic strategy for COPD, but their applicability remains limited to specific treatment contexts. To our knowledge, TQC3721 is a novel inhaled dual PDE3 and PDE4 inhibitor with synergistic bronchodilator and antiinflammatory effects.
RESEARCH QUESTION:Does TQC3721 improve lung function and symptoms in patients with COPD receiving background therapy with single or dual long-acting bronchodilators?
STUDY DESIGN AND METHODS:This phase 2, randomized, double-anonymized, placebo-controlled trial (A Clinical Trial of TQC3721 Suspension for Inhalation in Patients With Moderate to Severe Chronic Obstructive Pulmonary Disease [PACER-II]) was conducted at 27 tertiary centers in China. Participants with after bronchodilator FEV1 30% to 70% of predicted and FEV1/FVC < 0.7 were enrolled and randomized 1:1:1 to receive TQC3721 (3 or 6 mg) or placebo twice daily for 4 weeks. The primary end point was change of peak FEV1 from baseline over 4 weeks.
RESULTS:A total of 240 patients were randomized and treated, with 28.8% and 71.2% receiving concomitant long-acting muscarinic antagonists (LAMAs) or long-acting β2-agonists (LABAs)/LAMAs, respectively. These results show that TQC3721 significantly improved peak FEV1 at week 4 (3 mg group, 100 mL [95% CI, 41 to 159; P = .0011]; 6 mg group, 147 mL [95% CI, 93 to 201; P < .0001]) compared with placebo. Treatment with 6 mg TQC3721 significantly improved average FEV1 area under the curve at 0 to 12 hours (87 mL; 95% CI, 43 to 131; P < .0001) and symptoms (St George's Respiratory Questionnaire score, -5.09; 95% CI, -8.44 to -1.74; P = .0031) vs placebo. Improvement of peak FEV1 at week 4 in the LAMA (239 mL; 95% CI, 130 to 348; P < .0001) and LABA/LAMA (109 mL; 95% CI, 47 to 170; P = .0006) subgroups was superior to placebo following treatment with 6 mg TQC3721. The safety profile of TQC3721 was similar to that of placebo.
INTERPRETATION:Our results show that TQC3721 significantly improved lung function and symptoms compared with placebo in patients with COPD receiving concomitant single or dual long-acting bronchodilators, with good tolerability. The study supports further development of TQC3721 in COPD.
CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov; No.: NCT06527144; URL: www.