LABA/LAMA Fixed-dose Combinations in Patients with COPD: a Systematic Review

Overview

Journal Int J Chron Obstruct Pulmon Dis

Publisher Dove Medical Press

Specialty Pulmonary Medicine

Date 2018 Oct 17

PMID 30323582

Citations 17

Authors

Paola Rogliani

Luigino Calzetta

Fulvio Braido

Mario Cazzola

Enrico Clini

Girolamo Pelaia

Andrea Rossi

Nicola Scichilone

Fabiano Di Marco

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of this study was to assess the current evidence for long-acting β-agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations (FDCs) in the treatment of COPD.

Materials And Methods: A systematic literature search of randomized controlled trials published in English up to September 2017 of LABA/LAMA FDCs vs LABA or LAMA or LABA/inhaled corticosteroid (ICS) FDCs in COPD patients was performed using PubMed, Embase, Scopus, and Google Scholar. Outcomes including forced expiratory volume in 1 second (FEV), Transition Dyspnea Index (TDI) scores, St George's Respiratory Questionnaire (SGRQ) scores, exacerbations, exercise tolerance (endurance time [ET]), inspiratory capacity (IC), and rescue medication use were evaluated.

Results: In total, 27 studies were included in the review. LABA/LAMA FDCs significantly improved lung function (FEV) at 12 weeks compared with LABA or LAMA or LABA/ICS. These effects were maintained over time. Significant improvements with LABA/LAMA FDCs vs each evaluated comparator were also observed in TDI and SGRQ scores, even if significant differences between different LABA/LAMA FDCs were detected. Only the LABA/LAMA FDC indacaterol/glycopyrronium has shown superiority vs LAMA and LABA/ICS for reducing exacerbation rates, while olodaterol/tiotropium and indacaterol/glycopyrronium have been shown to improve ET and IC vs the active comparators. Rescue medication use was significantly reduced by LABA/LAMA FDCs vs the evaluated comparators. LABA/LAMA FDCs were safe, with no increase in the risk of adverse events with LABA/LAMA FDCs vs the monocomponents.

Conclusion: Evidence supporting the efficacy of LABA/LAMA FDCs for COPD is heterogeneous, particularly for TDI and SGRQ scores, exacerbation rates, ET, and IC. So far, indacaterol/glycopyrronium is the LABA/LAMA FDC that has the strongest evidence for superiority vs LABA, LAMA, and LABA/ICS FDCs across the evaluated outcomes. LABA/LAMA FDCs were safe; however, more data should be collected in a real-world setting to confirm their safety.

Citing Articles

Comparing Costs and Healthcare Resource Utilization (HCRU) Using LAMA versus LABA/ICS at Treatment Initiation for COPD: Findings from CITRUS (Comparing the Incidence of Tiotropium and ICS/LABA in Real-World Use in South Korea) Study.

Choi K, Kim H, Rhee C, Yoo K, Park Y, Kim Y Int J Chron Obstruct Pulmon Dis. 2024; 19:1661-1671.

PMID: 39050737 PMC: 11268597. DOI: 10.2147/COPD.S448492.

Clinical and Functional Effects of Inhaled Dual Therapy Umeclidinium/Vilanterol in Patients with Chronic Obstructive Pulmonary Disease: A Real-Life Study.

Pelaia C, Ferrante Bannera A, Rotundo F, Tropea F, Armentaro G, Maglio A Int J Chron Obstruct Pulmon Dis. 2023; 18:995-1002.

PMID: 37260547 PMC: 10228585. DOI: 10.2147/COPD.S407238.

Fluticasone Furoate/Vilanterol Use Trends and Characteristics in Patients With Obstructive Airway Disease: A Real-World Study of 10,374 Patients From India.

Prabhudesai P, Singh B, Agrawal G, Singh A, Jadhav A, Patil S Cureus. 2023; 15(2):e34825.

PMID: 36919064 PMC: 10008380. DOI: 10.7759/cureus.34825.

Comparative efficacy and safety of glycopyrronium/formoterol fixed-dose combination versus glycopyrronium monotherapy in patients with moderate-to-severe COPD.

Salvi S, Jain M, Krishnamurthy S, Balki A, Kodgule R, Tandon M Lung India. 2023; 39(6):517-524.

PMID: 36629230 PMC: 9746267. DOI: 10.4103/lungindia.lungindia_136_22.

LABA/LAMA as First-Line Therapy for COPD: A Summary of the Evidence and Guideline Recommendations.

Miravitlles M, Kawayama T, Dreher M J Clin Med. 2022; 11(22).

PMID: 36431099 PMC: 9692772. DOI: 10.3390/jcm11226623.

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