ADRB2 polymorphisms and budesonide/formoterol responses in COPD

Background: Effects of β₂ -adrenergic receptor gene (ADRB2) polymorphism on therapeutic responses to long-acting β₂ -adrenergic agonists have not been evaluated in long-term COPD trials. We aimed to investigate the effects of the ADRB2 Gly16Arg polymorphism on response to formoterol alone or in combination with the inhaled corticosteroid budesonide in patients with COPD. Methods: Patients ≥ 40 years of age with moderate to very severe COPD from the 12-month trial I (NCT00206167) or the 6-month trial II (NCT00206154) were randomly assigned to bid budesonide/formoterol pressurized metered-dose inhaler (pMDI) 320/9 μg or 160/9 μg, budesonide pMDI 320 μg 1 formoterol dry powder inhaler 9 μg (trial II), budesonide pMDI 320 μg (trial II), formoterol dry powder inhaler 9 μg, or placebo. The effect of Gly16Arg on predose FEV₁ and 1-h postdose FEV₁, exacerbations, diary variables, and adverse events were analyzed. Results: No significant interaction between genotype and treatment response was observed for predose (P ≥ .197) or postdose FEV₁ (P ≥ .125) in either pharmacogenetic study (n = 2,866). The number of COPD exacerbations per patient-treatment year was low and similar across genotypes for the active treatment groups (both studies). Percentages of patients with adverse events were similar across Gly16Arg genotype groups for each treatment. Conclusion: Therapeutic response and tolerability to long-term treatment with formoterol alone or in combination with budesonide was not modified by ADRB2 Gly16Arg genotype in two large independent pharmacogenetic studies in patients with moderate to very severe COPD. Trial registry: ClinicalTrials.gov; Nos.: NCT00206167, NCT00206154; URL: clinicaltrials.gov.