The primary safety database consisted of pooled data from the four 48-week double-blind, active and placebo-controlled, parallel
group confirmatory clinical trials. These trials included 3104 adult COPD patients (77% males and 23% females) 40 years of age and
older. Of these patients, 876 and 883 patients were treated with STRIVERDI RESPIMAT 5 mcg and 10 mcg once-daily, respectively.
The STRIVERDI RESPIMAT groups were composed of mostly Caucasians (66%) with a mean age of 64 years and a mean percent
predicted FEV1 at baseline of 44% for both the 5 mcg and 10 mcg treatment groups. Control arms for comparison included placebo in
all four trials plus formoterol 12 mcg in two trials.
In these four clinical trials, seventy-two percent (72%) of patients exposed to any dose of STRIVERDI RESPIMAT reported an
adverse reaction compared to 71% in the placebo group. The proportion of patients who discontinued due to an adverse reaction was
STRIVERDI RESPIMAT was not teratogenic in rats at inhalation doses approximately 2,731 times the maximum recommended
human daily inhalation dose (MRHDID) on an AUC basis (at a rat maternal inhalation dose of 1,054 mcg/kg/day). Placental transfer
of STRIVERDI RESPIMAT was observed in pregnant rats.
STRIVERDI RESPIMAT has been shown to be teratogenic in New Zealand rabbits at inhalation Beta-adrenoceptors are divided into three subtypes: beta1-adrenoceptors predominantly expressed on cardiac smooth muscle, beta2
adrenoceptors predominantly expressed on airway smooth muscle, and beta3-adrenoceptors predominantly expressed on adipose
tissue. Beta2-agonists cause bronchodilation. Although the beta2-adrenoceptor is the predominant adrenergic receptor in the airway
smooth muscle, it is also present on the surface of a variety of other cells, including lung epithelial and endothelial cells and in the
heart. The precise function of beta2-receptors in the heart is not known, but their presence raises the possibility that even highly
selective beta2-agonists may have cardiac effects. .