Summary

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• Revefenacin (Yupelri) is indicated for the maintenance treatment of chronic obstructive pulmonary disease (COPD). It is generally well-tolerated with minimal adverse events at a dose of 175 µg, making it a suitable once-daily nebulized long-acting muscarinic antagonist for moderate to severe stable COPD.
• Two studies highlight that revefenacin does not significantly increase the risk of adverse events or serious adverse events compared to placebo, with its most frequently reported side effect being worsening/exacerbation of COPD.
• Revefenacin demonstrated significant improvement in lung function, measured by mean change in trough Forced Expiratory Volume in 1 second from baseline, particularly at the dose of 175 µg/day. This improvement was found to be dose-dependent starting at 88 µg/day.
• When comparing revefenacin's efficacy and safety with other long-acting muscarinic antagonists (LAMAs) such as tiotropium and ipratropium, it might be inferior in long-term efficacy to tiotropium, while its safety profile was not deemed superior based on very low-quality evidence suggesting that further high-quality studies are needed for accurate comparison.
• Indications suggest targeted use among those suffering from moderate-to-severe respiratory impairment due to COPD. Dose-dependency hints toward opportunities for tailored treatment plans based on individual response and tolerance levels, but this aspect requires more research.
• Despite being presented as a safe and effective option, especially considering its nebulized form which may offer advantages over other LAMAs available via different administrations, there is a need for higher quality comparative studies to clarify its standing against other LAMAs regarding long-term efficacy and safety, along with comprehensive subgroup analyses and outcome studies related specifically to management strategies involving revefenacin in the effective management of COPD patients' conditions.