Better Combination Therapy Appears More Effective for COPD Exacerbations, Study Finds

Better Combination Therapy Appears More Effective for COPD Exacerbations, Study Finds

Results from a recent clinical trial demonstrated that treatment with the combination bronchodilator and inhaled medicine therapy indacaterol/glycopyrronium is better for treating chronic obstructive pulmonary disorder (COPD) exacerbations.

The study, “Indacaterol-Glycopyrronium versus Salmeterol-Fluticasone for COPD,” was published in the New England Journal of Medicine.

Serevent (salmaterol) is also a bronchodilator used for COPD and asthma attacks. Flonase (fluticasone) is a nasal spray used to treat congestion, sneezing, and runny nose caused by allergies.

COPD exacerbations are associated with an accelerated decline in lung function, impaired quality of life, hospitalization, and increased mortality, so prevention of exacerbations is a key goal in the management of COPD.

Inhaled long-acting bronchodilators not only control symptoms but also prevent COPD exacerbations. Inhaled glucocorticoids are also known to reduce the frequency of exacerbations, and have been studied in combination with inhaled long-acting beta-agonists (LABAs).

In one trial, the combination of a LABA with an inhaled glucocorticoid (salmeterol-fluticasone) in fixed doses and the inhaled long-acting muscarinic antagonist (LAMA) Spiriva (tiotropium) had similar effects on the rate of COPD exacerbations among patients with a history of exacerbations.

Therefore, treatment guidelines have recommended that either a LABA plus an inhaled glucocorticoid or a LAMA can be used to prevent COPD exacerbations in high-risk patients. But until now, a combination of the two regimens had not been compared to find the best results for patients.

According to a news release, Prof. Wisia Wedzicha at England’s National Heart and Lung Institute (NHLI) and her colleagues conducted a 52-week trial (funded by Novartis; FLAME ClinicalTrials.gov, NCT01782326). The trial was randomized, double-blind, and double-dummy.

Patients who had COPD with a history of at least one exacerbation in the previous year were randomly assigned to receive either the inhaled LABA indacaterol (110 micrograms, or mcg) plus the LAMA glycopyrronium (50 mcg) once daily (1,680 patients), or the LABA salmeterol (50 mcg) plus the inhaled glucocorticoid Flonase (500 mcg) twice daily (1,682 patients).

The primary outcome was the annual rate of all COPD exacerbations, and its assessment involved the methodology developed by Wedzicha’s research team and used in the COPD exacerbation cohort based at Imperial College London.

The results demonstrated that the combination indacaterol/glycopyrronium (LABA/LAMA) was superior to the current recommended treatment for the entire spectrum of exacerbation symptoms tested, with a good safety profile and fewer episodes of pneumonia.

The findings of the study have major implications for the treatment of COPD patients, and the authors believe that the guidelines will need to be revised to help improve the healthcare and quality of life for these patients.

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