Large controlled trials of the two available ICS/LABA/LAMA triple combinations in a single inhaler showed significant benefits not only on exacerbations, but also on lung function, health status, rescue medication use, and importantly, potentially the risk of death compared to LAMA mono-therapy, ICS/LABA, or LAMA/LABA. 1 However, recent studies in patients with moderate-to-very severe airflow limitation, most of whom had an exacerbation history, show otherwise. 2 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) suggested that the addition of ICS to dual bronchodilation was to be reserved primarily for patients with symptomatic disease and a history of frequent exacerbations (two or more in the previous year), or one or more exacerbations leading to hospitalization.
#Laba lama inhalers plus
1 The role of inhaled corticosteroids (ICSs) in the maintenance treatment of COPD came under scrutiny, in part following a single study showing the benefit on exacerbation frequency of dual bronchodilation of a long-acting β 2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), over a LABA plus ICS. Ongoing studies are examining the role of triple therapy in less severe symptomatic patients with COPD and asthma–COPD overlap.Ĭurrent recommendations are that the pharmacological treatment of COPD should take a “personalized” approach, based around the use of either single therapy or a combination of medications with different or complementary mechanisms of action. The evidence suggests that triple therapy is the most effective treatment in moderate/severe symptomatic patients with COPD at risk of exacerbations, with marginal if any risk of side effects including pneumonia.
Furthermore, triple therapy showed a promising signal in terms of improved survival. Overall, compared to LAMA, ICS/LABA, or LAMA/LABA, triple therapy decreased the risk of exacerbations and improved lung function and health status, with a favorable benefit-to-harm ratio. Of the five main fixed triple studies completed so far, three evaluated the efficacy and safety of an extrafine formulation of beclometasone dipropionate, formoterol fumarate, and glycopyrronium the other two studies evaluated fluticasone furoate, vilanterol, and umeclidinium. This review presents the clinical evidence that led to the approval of these triple therapies, discusses the role of ICS in patients with COPD, and presents data on the relative efficacy of “fixed triple” (ICS/LAMA/LABA) therapy vs LAMA, ICS/LABA, and LAMA/LABA combinations, and summarizes studies in which ICS/LABAs were combined with LAMAs to form “open triple” combinations.
Recently, two “fixed triple” single-inhaler combinations of an inhaled corticosteroid (ICS), a long-acting β 2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA) have become available for patients with COPD.
0 kommentar(er)
