| Reference | 1. Int J Chron Obstruct Pulmon Dis. 2017 Oct 6;12:2917-2928. doi:
10.2147/COPD.S146822. eCollection 2017.
<br>
Triple therapy in COPD: new evidence with the extrafine fixed combination of
beclomethasone dipropionate, formoterol fumarate, and glycopyrronium bromide.
<br>
Singh D(1), Corradi M(2), Spinola M(3), Papi A(4), Usmani OS(5), Scuri M(3),
Petruzzelli S(3), Vestbo J(1).
<br>
Author information:<br>
(1)Division of Infection, Immunity and Respiratory Medicine, University of
Manchester, Manchester, UK.<br>
(2)Department of Medicine and Surgery, University of Parma, Parma, Italy.
(3)Chiesi Farmaceutici SpA, Parma, Italy.<br>
(4)Department of Medical Sciences, Research Centre on Asthma and COPD,
University of Ferrara, Ferrara, Italy.<br>
(5)National Heart and Lung Institute, Imperial College London, London, UK.
<br>
The goals of COPD therapy are to prevent and control symptoms, reduce the
frequency and severity of exacerbations, and improve exercise tolerance. The
triple combination therapy of inhaled corticosteroids (ICSs), long-acting beta2
agonists (LABAs), and long-acting muscarinic antagonists (LAMAs) has become an
option for maintenance treatment of COPD and as a “step-up” therapy from single
or double combination treatments. There is evidence that triple combination
ICS/LABA/LAMA with different inhalers improves lung function, symptoms, and
health status and reduces exacerbations. A new triple fixed-dose combination of
extrafine beclomethasone dipropionate (100 µg/puff)/formoterol fumarate (6
µg/puff)/glycopyrronium bromide (12.5 µg/puff) has been developed as a
hydrofluoroalkane pressurized metered dose inhaler. Two large pivotal studies
showed that this extrafine fixed ICS/LABA/LAMA triple combination is superior to
fixed ICS/LABA combined therapy and also superior to the LAMA tiotropium in
terms of lung function and exacerbation prevention in COPD patients at risk of
exacerbation. This review considers the new information provided by these
clinical trials of extrafine triple therapy and the implications for the
clinical management of COPD patients.
<br><br>
2. Expert Opin Pharmacother. 2016;17(7):1023-30. doi:
10.1517/14656566.2016.1165207. Epub 2016 Apr 12.
<br>
Budesonide + formoterol fumarate dihydrate for the treatment of asthma.
<br>
Wolthers OD(1).
<br>
Author information:<br>
(1)a Asthma and Allergy Clinic , Children´s Clinic Randers , Randers , Denmark.
<br>
INTRODUCTION: One of the most widely used fixed combinations in asthma
management is dry powder budesonide+formoterol fumarate dihydrate which is
commercially available as Symbicort Turbuhaler(®) (and generic products),
Easyhaler Bufomix(®) and DuoRespSpiromax(®) inhaler. The aim of this paper was
to review the fixed dry powder combination of inhaled budesonide+formoterol
fumarate dihydrate for asthma treatment in adolescents and adults.
AREAS COVERED: A literature search using relevant search terms, reference lists
for reviews and meta-analyses was performed.<br>
EXPERT OPINION: In symptomatic adolescent and adult patients with asthma
maintenance and reliever therapy with a single-inhaler fixed combination of dry
powder budesonide+formoterol fumarate dihydrate is an evidenced option. The
combination treatment is convenient to patients. It reduces the number of
exacerbations requiring treatment with oral corticosteroids. In some patients
the strategy may also reduce the total intake of inhaled corticosteroids over
time. Whether important outcome measures of asthma treatment, such as hospital
admission and emergency room visit rates, may be reduced is less well documented
since the published studies may have been influenced by publication bias.
Non-pharmaceutical company-sponsored research evaluating such measures is
needed. There is no evidence for the use of single inhaler fixed combinations of
inhaled corticosteroids+long-acting β(2)-agonists in children (<12 years of
age), and budesonide+formoterol fumarate dihydrate should not be prescribed to
the age group.
<br><br>
3. Ther Adv Respir Dis. 2019 Jan-Dec;13:1753466619850725. doi:
10.1177/1753466619850725.
<br>
Aclidinium bromide in fixed-dose combination with formoterol fumarate in the
management of COPD: an update on the evidence base.
<br>
D’Urzo AD(1), Singh D(2), Donohue JF(3), Chapman KR(4).
<br>
Author information:<br>
(1)Department of Family and Community Medicine, Faculty of Medicine, University
of Toronto, Toronto, ON 12354, Canada.<br>
(2)Medicines Evaluation Unit, Manchester University NHS Foundations Trust,
Manchester, UK.<br>
(3)Division of Pulmonary Diseases and Critical Care Medicine, University of
North Carolina Pulmonary Critical Medicine, Chapel Hill, NC, USA.
(4)Asthma and Airway Center, Toronto Western Hospital, Toronto, ON, Canada.
<br>
Aclidinium bromide/formoterol fumarate (AB/FF) 400/12 µg is a twice-daily
long-acting muscarinic receptor antagonist and long-acting β2 agonist
(LAMA/LABA) dual-bronchodilator maintenance therapy used to relieve symptoms and
reduce future risk of exacerbations in adults with chronic obstructive pulmonary
disease (COPD). To date, there have been several clinical studies and post hoc
analyses of AB/FF, assessing treatment outcomes in patients with
moderate-to-severe COPD. These studies have looked at a range of outcomes,
including lung function parameters, patient-reported symptom scores,
quality-of-life measures assessing impaired health and perceived well-being, and
the frequency, duration, and severity of exacerbations. In light of the major
2017 revision to the Global initiative for chronic Obstructive Lung Disease
(GOLD) recommendations, and the subsequent updates, we present an update on the
latest evidence supporting the efficacy and safety of AB/FF. This review
discusses the clinical relevance of the improvements in lung function, symptoms,
quality of life, and exacerbations in patients with COPD reported in the phase
III and IV trials of AB/FF. Given the current concerns over unnecessary inhaled
corticosteroid (ICS) use in COPD, we also touch briefly on the use of blood
eosinophils as a biomarker for identifying those patients with COPD already
using LAMA/LABA therapy for whom the addition of ICS might be of benefit.
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