Riarify (previously CHF 5993 Chiesi Farmaceutici S.p.A.)

Riarify is available as a liquid in a portable inhaler device. The recommended dose is two inhalations twice a day.

Patients should be shown how to use the inhaler correctly by a doctor or another healthcare professional, who should also regularly check that the patient’s inhalation technique is correct.

The medicine can only be obtained with a prescription. For more information about using Riarify, see the package leaflet or contact your doctor or pharmacist.

The three active substances in Riarify work in different ways to reduce inflammation and keep the airways open, allowing the patient to breathe more easily.

Beclometasone belongs to anti-inflammatory medicines known as corticosteroids. It works in a similar way to naturally occurring corticosteroid hormones, reducing the activity of the immune system. This leads to a reduction in the release of substances involved in the inflammation process, such as histamine, thereby helping to keep the airways clear and allowing the patient to breathe more easily.

Formoterol is a long-acting beta-2 agonist. It attaches to receptors (targets) known as beta-2 receptors in the muscles of the airways. By attaching to these receptors, it causes the muscles to relax, which keeps the airways open and helps with the patient’s breathing.

Glycopyrronium bromide is a long-acting muscarinic receptor antagonist. It opens the airways by blocking muscarinic receptors in muscle cells in the lungs. Because these receptors help control the contraction of the airway muscles, blocking them causes the muscles to relax, helping to keep the airways open and allowing the patient to breathe more easily.

Riarify has been shown to be effective at relieving symptoms of COPD in three main studies involving over 5,500 patients whose symptoms were not controlled well enough either by combinations of two other COPD medicines or by a muscarinic receptor antagonist alone.

In the first study lasting a year, after 26 weeks of treatment Riarify improved patients’ FEV1 (the maximum volume of air a person can breathe out in one second) by 82 ml before a dose and 261 ml after a dose. By comparison, the FEV1 increased by 1 and 145 ml before and after dosing in patients treated with a medicine containing only 2 of the active substances found in Riarify (beclometasone plus formoterol).

In the second study lasting a year, patients treated with Riarify had 20% fewer exacerbations (flare-ups of symptoms) per year than patients treated with tiotropium (a long-acting muscarinic receptor antagonist). In this study, Riarify was as effective as tiotropium plus a combination of beclometasone and formoterol at reducing the number of exacerbations.

In the third study lasting a year, patients treated with Riarify had 15% fewer exacerbations a year than patients treated with a combination of indacaterol (a long-acting beta-2 agonist) and glycopyrronium bromide.

Side effects with Riarify include oral candidiasis (a fungal infection of the mouth caused by a yeast called Candida), muscle spasms and dry mouth.

For the full list of side effects and restrictions with Riarify, see the package leaflet.

Riarify is effective at reducing the frequency of exacerbations and improving lung function of patients with COPD. No major safety concerns have been reported with Riarify, with side effects being manageable and similar to other COPD medicines. The European Medicines Agency therefore decided that Riarify’s benefits are greater than its risks and it can be authorised for use in the EU.

Recommendations and precautions to be followed by healthcare professionals and patients for the safe and effective use of Riarify have been included in the summary of product characteristics and the package leaflet.

As for all medicines, data on the use of Riarify is continuously monitored. Side effects reported with Riarify are carefully evaluated and any necessary action taken to protect patients.

Riarify received a marketing authorisation valid throughout the EU on 23 April 2018.