Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
LAMA/LABA Fixed-Dose Combinations for Treatment of COPD
Chest; ePub 2016 Mar 3; Calzetta, Rogliani, et al
Dual bronchodilation with Long-acting Muscarinic Antagonists/Long-acting Beta Agonists (LAMA/LABA) for the treatment of stable chronic obstructive pulmonary disease (COPD) is more effective than a LAMA or a LABA alone, regardless of the drugs used. This according to a review and meta-analysis of 23,168 COPD patients (combinations n=10,328; monocomponents n=12,840) who participated in trials that lasted at least 3 months. Researchers found:
• All LAMA/LABA combinations were always more effective than the LAMA or LABA alone in terms of improvement in trough FEV1.
• There was a gradient of effectiveness among the currently available LAMA/LABA fixed-dose combinations, although there was not a significant difference among them.
• LAMA/LABA combinations also improved both quality of life scores, and did not increase the cardiovascular risk when compared with monocomponents.
Citation: Calzetta L, Rogliani P, Matera MG, Cazzola M. A systematic review with meta-analysis of dual bronchodilation with LAMA/LABA for the treatment of stable chronic obstructive pulmonary disease. [Published online ahead of print March 3, 2016]. Chest. doi:10.1016/j.chest.2016.02.646.
• Umeclidinium bromide and vilanterol (Anoro-GSK).
• Glycopyrronium bromide and indacaterol (Ultibro-Novartis).
• Tiotropium and olodaterol (Stiolto Respimat-Boehringer Ingelheim Pharmaceuticals).
It is clear from the meta-analysis above that LAMA/LABA combination therapy improves lung function as measured by FEV-1 better than either of the bronchodilator components alone. In the 2015 Gold Guidelines for COPD, for stage B disease (the second in severity of the four severity stages), the recommended first choice for treatment is a long-acting bronchodilator, either a LABA or a LAMA, with an alternative listed as a LAMA/LABA. For stage C disease (the third in severity of the four severity stages), the recommended first choice is a combination Inhaled Corticosteroid/Long-acting Beta Agonist with an alternative given to use a LAMA/LABA.1 It appears that LAMA/LABA may have greater bronchodilator activity compared to ICS/LABAs, but the precise place of dual bronchodilator therapy in the treatment of COPD still needs to be refined and we are just gaining clinical experience with this class of agents.2 —Neil Skolnik, MD
1. GOLD Guidelines for COPD 2015. http://www.goldcopd.org. Accessed April 1, 2016.
2. Vogelmeier CF, Bateman ED, Pallante J, et al. Efficacy and safety of once-daily QVA149 compared with twice-daily salmeterol-fluticasone in patients with chronic obstructive pulmonary disease (ILLUMINATE): a randomised, double-blind, parallel group study. Lancet Respir Med. 2013;1:51–60. doi:10.1016/S2213-2600(12)70052-8.