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Prabhudesai P, Singh BP, Agrawal G, Singh AK, Jadhav AY, Patil SR, Bhagat S, Patil S, Barkate H. Fluticasone Furoate/Vilanterol Use Trends and Characteristics in Patients With Obstructive Airway Disease: A Real-World Study of 10,374 Patients From India. Cureus 2023; 15:e34825. [PMID: 36919064 PMCID: PMC10008380 DOI: 10.7759/cureus.34825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
Introduction Obstructive Airway Diseases (OADs) are the leading cause of death among chronic respiratory diseases worldwide, and novel therapies are direly needed. Fluticasone furoate/vilanterol (FF/Vi) (100/25 µg) is the first once-daily ICS/uLABA marketed in India for COPD since 2021. Considering its limited real-world experience in OAD patients in Indian clinical settings, a large drug utilization study (DUS) was planned. Methodology We conducted a cross-sectional, observational DUS at 1900 outpatient clinics in India from October 2021 to March 2022. Prescription data and medical history of patients who were prescribed the FF/Vi combination were collected. Results It was observed that FF/Vi was prescribed in an almost equal number of patients with COPD (44.2%) and asthma (42.9%). The majority of the patients (74%) were switched from previous ICS/LABA to this ICS/uLABA, while 26% of patients were treatment naïve. The average CAT score was 19.5±7.8 (43.2% GOLD Group C and 32.2% GOLD Group B) in COPD patients, while the average ACQ-5 score was 2.6±1.3 (33.1% GINA Step 3, 29.5% GINA Step 2) in asthmatic patients. Most of the patients (63.9%) had raised biomarkers (Blood eosinophil count >300 cells/μl). Prior history of exacerbation was present in 65% of patients with annual exacerbation rates of 1.2 in COPD, 1.1 in asthma, and 1.2 in asthma-COPD overlap syndrome (ACOS). Leukotriene inhibitors (42%) and LAMAs (30.8%) were common add-on medications. Conclusion We observed a trend towards a shift to once-daily ICS/uLABA (FF/Vi) by physicians, especially in symptomatic and exacerbating OAD patients with underlying comorbidities.
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Affiliation(s)
| | | | | | | | - Amit Y Jadhav
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Saurabh R Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Sagar Bhagat
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Saiprasad Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
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Ružena Č, Jindra V, Renáta H. Chirality of β2-agonists. An overview of pharmacological activity, stereoselective analysis, and synthesis. OPEN CHEM 2020. [DOI: 10.1515/chem-2020-0056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Abstractβ2-Agonists (β2-adrenergic agonists, bronchodilatants, and sympathomimetic drugs) are a group of drugs that are mainly used in asthma and obstructive pulmonary diseases. In practice, the substances used to contain one or more stereogenic centers in their structure and their enantiomers exhibit different pharmacological properties. In terms of bronchodilatory activity, (R)-enantiomers showed higher activity. The investigation of stereoselectivity in action and disposition of chiral drugs together with the preparation of pure enantiomer drugs calls for efficient stereoselective analytical methods. The overview focuses on the stereoselectivity in pharmacodynamics and pharmacokinetics of β2-agonists and summarizes the stereoselective analytical methods for the enantioseparation of racemic beta-agonists (HPLC, LC-MS, GC, TLC, CE). Some methods of the stereoselective synthesis for β2-agonists preparation are also presented.
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Affiliation(s)
- Čižmáriková Ružena
- Department of Chemical Theory of Drugs, Faculty of Pharmacy, Comenius University in Bratislava, Odbojárov 10, 832 32 Bratislava, Slovakia
| | - Valentová Jindra
- Department of Chemical Theory of Drugs, Faculty of Pharmacy, Comenius University in Bratislava, Odbojárov 10, 832 32 Bratislava, Slovakia
| | - Horáková Renáta
- Department of Chemical Theory of Drugs, Faculty of Pharmacy, Comenius University in Bratislava, Odbojárov 10, 832 32 Bratislava, Slovakia
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Ramadan WH, Al Masri S, Rizk J. Fixed-dose combination of umeclidinium and vilanterol for patients with chronic obstructive pulmonary disease: A systematic review. CLINICAL RESPIRATORY JOURNAL 2019; 13:663-673. [PMID: 31389190 DOI: 10.1111/crj.13073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 06/24/2019] [Accepted: 07/19/2019] [Indexed: 12/11/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that is predicted to be one of the leading causes of death worldwide. Pharmacologic treatment options of COPD are bronchodilators, using either long-acting β2-agonists (LABAs), or long-acting muscarinic antagonists (LAMAs), or a combination of two. Anoro Ellipta (umeclidinium + vilanterol) dry powder inhaler, a fixed-dose combination of LAMA and LABA, was Food and Drug Administration (FDA) approved in 2013 for COPD. The objective of this study is to evaluate the efficacy and safety of once daily umeclidinium/vilanterol (62.5 mcg/25 mcg) in COPD patients, focusing on pharmacodynamic and pharmacokinetic characteristics, efficacy and safety in clinical studies and cost. Literature search was done through PubMed (2004-2017) using the terms umeclidinium, vilanterol, COPD, LABA and LAMA. Recent and significant clinical trials about the monocomponents and their combination were identified, in addition to reviews, guidelines for COPD, data from manufacturer and FDA product labels. The search was limited to English language studies on human subjects. Clinical data published on the combination of umeclidinium/vilanterol in patients with COPD have shown greater improvements in lung function compared to monotherapies. However, further studies comparing umeclidinium/vilanterol FDC (ANORO) to other LABA/LAMA combinations are needed.
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Affiliation(s)
- Wijdan H Ramadan
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | | | - John Rizk
- Bellevue Medical Center, Mansourieh, Lebanon
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4
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Albertson TE, Bowman WS, Harper RW, Godbout RM, Murin S. Evidence-based review of data on the combination inhaler umeclidinium/vilanterol in patients with COPD. Int J Chron Obstruct Pulmon Dis 2019; 14:1251-1265. [PMID: 31239659 PMCID: PMC6559138 DOI: 10.2147/copd.s191845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/25/2019] [Indexed: 01/10/2023] Open
Abstract
The use of inhaled, fixed-dose, long-acting muscarinic antagonists (LAMA) combined with long-acting, beta2-adrenergic receptor agonists (LABA) has become a mainstay in the maintenance treatment of chronic obstructive pulmonary disease (COPD). One of the fixed-dose LAMA/LABA combinations is the dry powder inhaler (DPI) of umeclidinium bromide (UMEC) and vilanterol trifenatate (VI) (62.5 µg/25 µg) approved for once-a-day maintenance treatment of COPD. This paper reviews the use of fixed-dose combination LAMA/LABA agents focusing on the UMEC/VI DPI inhaler in the maintenance treatment of COPD. The fixed-dose combination LAMA/LABA inhaler offers a step beyond a single inhaled maintenance agent but is still a single device for the COPD patient having frequent COPD exacerbations and persistent symptoms not well controlled on one agent. Currently available clinical trials suggest that the once-a-day DPI of UMEC/VI is well-tolerated, safe and non-inferior or better than other currently available inhaled fixed-dose LAMA/LABA combinations for COPD.
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Affiliation(s)
- Timothy E Albertson
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, UC Davis, Sacramento, CA, USA
- Department of Veterans Affairs, Northern California Health Care System, Mather, CA, USA
| | - Willis S Bowman
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, UC Davis, Sacramento, CA, USA
- Department of Veterans Affairs, Northern California Health Care System, Mather, CA, USA
| | - Richart W Harper
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, UC Davis, Sacramento, CA, USA
- Department of Veterans Affairs, Northern California Health Care System, Mather, CA, USA
| | - Regina M Godbout
- Department of Veterans Affairs, Northern California Health Care System, Mather, CA, USA
- Department of Internal Medicine, Division of General Medicine, UC Davis, Sacramento, CA, USA
| | - Susan Murin
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, UC Davis, Sacramento, CA, USA
- Department of Veterans Affairs, Northern California Health Care System, Mather, CA, USA
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Malerba M, Foci V, Patrucco F, Pochetti P, Nardin M, Pelaia C, Radaeli A. Single Inhaler LABA/LAMA for COPD. Front Pharmacol 2019; 10:390. [PMID: 31105560 PMCID: PMC6494943 DOI: 10.3389/fphar.2019.00390] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/29/2019] [Indexed: 01/04/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common disabling disease characterized by progressive airflow obstruction. Great efforts were spent in the development of drugs able to improve symptoms, quality of life, reduce exacerbations, hospitalizations and the frequency of death of patients with COPD. The cornerstones of treatment are bronchodilator drugs of two different classes: beta agonists and muscarinic antagonists. Currently the Global initiative for COPD suggests the use of long acting beta agonists (LABAs) and long acting muscarinic antagonists (LAMAs) in combination for the majority of COPD patients, thus great interest is associated with the developing of LAMA/LABA fixed combination in the maintenance treatment of stable COPD. Many LAMA/LABA fixed dose combinations have been licensed in different countries and the clinical use of these drugs stimulated the performance of many clinical trials. The purpose of this review is a complete criticism of pharmacological and clinical aspects related to the use of LAMA/LABA single inhalers for the maintenance treatment of stable COPD, with particular mention to the most debated topics and future prospects in the field.
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Affiliation(s)
- Mario Malerba
- Respiratory Medicine, Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
- Respiratory Unit, Sant’Andrea Hospital, Vercelli, Italy
| | - Valentina Foci
- Respiratory Medicine, Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
- Respiratory Unit, Sant’Andrea Hospital, Vercelli, Italy
| | - Filippo Patrucco
- Respiratory Medicine, Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
- Respiratory Unit, Sant’Andrea Hospital, Vercelli, Italy
| | - Patrizia Pochetti
- Respiratory Medicine, Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
- Respiratory Unit, Sant’Andrea Hospital, Vercelli, Italy
| | - Matteo Nardin
- Department of Medicine, Spedali Civili di Brescia, Brescia, Italy
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
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Sliwka A, Jankowski M, Gross‐Sondej I, Storman M, Nowobilski R, Bala MM. Once-daily long-acting beta₂-agonists/inhaled corticosteroids combined inhalers versus inhaled long-acting muscarinic antagonists for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2018; 8:CD012355. [PMID: 30141826 PMCID: PMC6513478 DOI: 10.1002/14651858.cd012355.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Three classes of inhaler medication are used to manage chronic obstructive pulmonary disease (COPD): long-acting beta₂-agonists (LABA); long-acting muscarinic antagonists (LAMA); and inhaled corticosteroids (ICS). To encourage patient adherence, two classes of medication are often combined in a single medication device; it seems that once-daily dosing offers greatest convenience to patients and may markedly influence adherence. OBJECTIVES To compare a once-daily combination of inhaled corticosteroid and long-acting beta₂-agonist inhalers (ICS/LABA) versus inhaled long-acting muscarinic antagonists alone (LAMA) for people with chronic obstructive pulmonary disease (COPD). SEARCH METHODS We performed an electronic search of the Specialised Register of the Cochrane Airways Group (14 May 2018), ClinicalTrials.gov (14 May 2018), and the World Health Organization International Clinical Trials Registry Platform (20 September 2017), then a search of other resources, including reference lists of included studies and manufacturers' trial registers (10 October 2017). Two pairs of review authors screened and scrutinised selected articles. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing once-daily administered ICS/LABA and LAMA in adults with COPD. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias in each study. We analysed dichotomous data as random-effects odds ratios (ORs) and continuous data as mean differences (MDs), both with 95% confidence intervals (95% CIs), using Review Manager 5. MAIN RESULTS We included two studies with 880 participants. We identified one ongoing trial with planned recruitment of 80 participants. Included studies enrolled participants with both partially reversible and non-reversible COPD and baseline mean per cent predicted (%pred) forced expiratory volume in one second (FEV₁) of 43.4 to 49.6. Both studies lasted 12 weeks. Both studies used the same combination of inhaled ICS/LABA (fluticasone furoate and vilanterol 100/25 mcg once daily; FF/VI) versus LAMA (18 mcg tiotropium; TIO). They were published as full articles, and neither study was at low risk of bias in all domains.Compared to the TIO arm, results for pooled primary outcomes for the FF/VI arm were as follows: mortality: OR 0.20, 95% CI 0.02 to 1.73, 880 participants (deaths reported only in the TIO arm), very low-quality evidence; COPD exacerbation (requiring short-burst oral corticosteroids or antibiotics, or both): OR 0.72, 95% Cl 0.35 to 1.50, 880 participants, very low-quality evidence; pneumonia: reported in both studies only during treatment with FF/VI: OR 6.12, 95% Cl 0.73 to 51.24, 880 participants, very low-quality evidence; and total serious adverse events: OR 0.96, 95% Cl 0.50 to 1.83, 880 participants, very low-quality evidence. None of the pneumonias were fatal. Compared to the TIO arm, we found no statistically significant difference for pooled secondary outcomes, including St George's Respiratory Questionnaire (SGRQ) mean total score change; hospital admissions (all-cause); disease-specific adverse events; mean weekly rescue medication use (results available from only one of the studies); and mean weekly percentage of rescue-free days for FF/VI. We found no statistically significant differences between ICS/LABA and LAMA for improvement in symptoms measured by the COPD Assessment Test (CAT score) nor for FEV₁ (change from baseline trough in 24-hour weighted mean on treatment day 84). Many pooled estimates lacked precision. Data for other endpoints such as exacerbations leading to intubation and physical activity measures were not available in included trials. AUTHORS' CONCLUSIONS Based on analysis of primary and secondary outcomes, we are uncertain whether once-daily ICS/LABA, combined in one inhaler, has a different efficacy or adverse effect profile compared to LAMA for treatment of people with COPD. However, the current review is based on only two trials with the main focus on primary outcomes other than those considered in this review. The short follow-up period and the very low quality of evidence limit our confidence in the result and increase uncertainty. Further trials of longer duration are needed. Current evidence is not strong enough to demonstrate important differences between inhalers in terms of effects, nor to establish that once-daily fluticasone/vilanterol 100/25 mcg and tiotropium 18 mcg are equivalent.
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Affiliation(s)
- Agnieszka Sliwka
- Jagiellonian University Medical CollegeInstitute of Physiotherapy, Faculty of Health ScienceKrakowPoland
| | - Milosz Jankowski
- Jagiellonian University Medical CollegeDepartment of Anaesthesiology and Intensive Care, The University Hospital in Krakow; II Department of Internal Medicine; Systematic Reviews Unit ‐ Polish Cochrane Branch,KrakowPoland
| | | | - Monika Storman
- Systematic Reviews Unit Polish Cochrane Branch (Cochrane Poland)KrakowPoland
| | - Roman Nowobilski
- Jagiellonian University Medical CollegeFaculty of Health ScienceKrakowPoland
| | - Malgorzata M Bala
- Jagiellonian University Medical CollegeChair of Epidemiology and Preventive Medicine; Department of Hygiene and Dietetics; Systematic Reviews Unit ‐ Polish Cochrane BranchKopernika 7KrakowPoland31‐034
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7
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Malerba M, Nardin M, Santini G, Mores N, Radaeli A, Montuschi P. Single-inhaler triple therapy utilizing the once-daily combination of fluticasone furoate, umeclidinium and vilanterol in the management of COPD: the current evidence base and future prospects. Ther Adv Respir Dis 2018; 12:1753466618760779. [PMID: 29537340 PMCID: PMC5941662 DOI: 10.1177/1753466618760779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/31/2018] [Indexed: 12/13/2022] Open
Abstract
Maintenance pharmacological treatment for stable chronic obstructive pulmonary disease (COPD) is based on inhaled drugs, including long-acting muscarinic receptor antagonists (LAMA), long-acting β2-adrenoceptor agonists (LABA) and inhaled corticosteroids (ICS). Inhaled pharmacological treatment can improve patients' daily symptoms and reduce decline of pulmonary function and acute exacerbation rate. Treatment with all three inhaled drug classes is reserved for selected, more severe, patients with COPD when symptoms are not sufficiently controlled by dual LABA/LAMA therapy and exacerbations are frequent. This review focuses on the role of single-inhaler triple therapy with once-daily fluticasone furoate/umeclidinium/vilanterol fixed-dose combination, which is in phase III clinical development for maintenance treatment of severe-to-very severe COPD. In this review, we summarize evidence providing the rationale for its use in COPD and discuss the gaps to be filled in this pharmacotherapeutic area.
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Affiliation(s)
- Mario Malerba
- Department of Translational Medicine-Respiratory Medicine, University of Piemonte Orientale, Novara/Vercelli, Italy
| | - Matteo Nardin
- Department of Internal Medicine, University of Brescia, Brescia, Italy
| | - Giuseppe Santini
- Department of Pharmacology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation, Rome, Italy
| | - Nadia Mores
- Department of Pharmacology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation, Rome, Italy
| | - Alessandro Radaeli
- Department of Emergency Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Agostino Gemelli, University Hospital Foundation, Largo Francesco Vito, 1 – 00168, Rome, Italy
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8
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Shaikh N, Johnson M, Hall DA, Chung KF, Riley JH, Worsley S, Bhavsar PK. Intracellular interactions of umeclidinium and vilanterol in human airway smooth muscle. Int J Chron Obstruct Pulmon Dis 2017; 12:1903-1913. [PMID: 28721035 PMCID: PMC5501633 DOI: 10.2147/copd.s134420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Intracellular mechanisms of action of umeclidinium (UMEC), a long-acting muscarinic receptor antagonist, and vilanterol (VI), a long-acting β2-adrenoceptor (β2R) agonist, were investigated in target cells: human airway smooth-muscle cells (ASMCs). Materials and methods ASMCs from tracheas of healthy lung-transplant donors were treated with VI, UMEC, UMEC and VI combined, or control compounds (salmeterol, propranolol, ICI 118.551, or methacholine [MCh]). Cyclic adenosine monophosphate (cAMP) was measured using an enzyme-linked immunosorbent assay, intracellular free calcium ([Ca2+]i) using a fluorescence assay, and regulator of G-protein signaling 2 (RGS2) messenger RNA using real-time quantitative polymerase chain reaction. Results VI and salmeterol (10−12–10−6 M) induced cAMP production from ASMCs in a concentration-dependent manner, which was greater for VI at all concentrations. β2R antagonism by propranolol or ICI 118.551 (10−12–10−4 M) resulted in concentration-dependent inhibition of VI-induced cAMP production, and ICI 118.551 was more potent. MCh (5×10−6 M, 30 minutes) attenuated VI-induced cAMP production (P<0.05), whereas pretreatment with UMEC (10−8 M, 1 hour) restored the magnitude of VI-induced cAMP production. ASMC stimulation with MCh (10−11–5×10−6 M) resulted in a concentration-dependent increase in [Ca2+]i, which was attenuated with UMEC pretreatment. Reduction of MCh-induced [Ca2+]i release was greater with UMEC + VI versus UMEC. UMEC enhanced VI-induced RGS2 messenger RNA expression. Conclusion These data indicate that UMEC reverses cholinergic inhibition of VI-induced cAMP production, and is a more potent muscarinic receptor antagonist when in combination with VI versus either alone.
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Affiliation(s)
- Nooreen Shaikh
- Experimental Studies, National Heart and Lung Institute, Imperial College London.,Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London
| | | | - David A Hall
- Fibrosis and Lung Injury Development Planning Unit, GlaxoSmithKline, Stevenage
| | - Kian Fan Chung
- Experimental Studies, National Heart and Lung Institute, Imperial College London.,Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London
| | - John H Riley
- Respiratory Global Franchise, GlaxoSmithKline, Uxbridge
| | - Sally Worsley
- Respiratory Research & Development, GlaxoSmithKline, Uxbridge, UK
| | - Pankaj K Bhavsar
- Experimental Studies, National Heart and Lung Institute, Imperial College London.,Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London
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Abstract
Evidence-based guidelines recommend inhaled long-acting anti-muscarinic agents (LAMAs) as first-line maintenance therapy for symptomatic patients with COPD. Several LAMAs are now available for use either as monotherapy or in combination with other COPD medications, including long-acting β2-agonists (LABAs) or inhaled corticosteroids (ICS). The efficacy and long-term safety of these medications have been evaluated in multiple clinical trials and real-life studies. This review evaluates the evidence available on the safety of existing LAMAs alone or in combination with LABAs and ICS in patients with COPD.
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Affiliation(s)
- Nicola A Hanania
- a Section of Pulmonary and Critical Care Medicine , Baylor College of Medicine , Houston , TX , USA
| | - Suzanne C Lareau
- b College of Nursing , University of Colorado Denver , Aurora , CO , USA
| | - Barbara P Yawn
- c Department of Family and Community Health , University of Minnesota , Minneapolis , MN , USA
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10
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Babu KS, Morjaria JB. Umeclidinium in chronic obstructive pulmonary disease: latest evidence and place in therapy. Ther Adv Chronic Dis 2017; 8:81-91. [PMID: 28491268 PMCID: PMC5406010 DOI: 10.1177/2040622317700822] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/01/2017] [Indexed: 12/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality and health care expenditure throughout the world. COPD guidelines recommend the use of long-acting muscarinic antagonist (LAMA) either alone or in combination with a long-acting β2 agonist (LABA). For over 10 years, tiotropium was the only LAMA that was used in the management of COPD. Over the past few years, various new drugs have been identified that act on the muscarinic receptors and β2 receptors. Umeclidinium (Umec) is a new LAMA currently approved for use in patients with COPD either as monotherapy or in combination with vilanterol (Vil). Both Umec alone and in combination with Vil delivered through a multi-dose dry powder Ellipta™ device have shown improvement in lung function, health-related quality of life and exacerbation frequency in patients with COPD. This review provides an overview of the pharmacology, pharmacodynamics and pharmacokinetics of Umec, and evaluates the clinical efficacy and safety studies in patients with COPD.
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Affiliation(s)
- Kesavan Suresh Babu
- Department of Respiratory Medicine, Queen Alexandra Hospital, Cosham, Portsmouth, UK
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11
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Malerba M, Radaeli A, Montuschi P, Babu KS, Morjaria JB. Investigational beta-2 adrenergic agonists for the treatment of chronic obstructive pulmonary disease. Expert Opin Investig Drugs 2017; 26:319-329. [PMID: 28117615 DOI: 10.1080/13543784.2017.1287172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Long-acting bronchodilators are pivotal in the therapeutic management of COPD patients with moderate-to-severe airflow obstruction. New ultra-long-acting β2-agnoists (ultra-LABAs) have been developed, some of which have been licensed for use as monotherapy and/or in combination with other bronchodilators or inhaled corticosteroids, for use in COPD patients with persistent symptoms and worsening airflow limitation. These new agents are faster in onset and have a prolonged duration of action, with a similar safety profile to the traditional twice-daily bronchodilators which may have an impact on patient concordance. Areas covered: A number of these ultra-LABAs are still under development and bi-functional hybrid molecules containing regions functioning as β2-agonists, and as muscarinic agonists (MABAs) has been developed. This review summarizes these (excluding the licensed ultra-LABAs) with attention on phase II studies data available to-date on their pharmacological profiles, clinical efficacy and safety, and future perspectives. Expert opinion: Despite all the new agents' available, the challenges that persist include any differences in efficacy and safety between the various possible LAMA/LABA combinations, relative advantages of MABAs over fixed-dose LAMA/LABAs, and the impact of these new molecules in terms of long term safety, especially in certain populations in co-morbidities frequently associated with COPD.
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Affiliation(s)
- Mario Malerba
- a Department of Internal Medicine , University of Brescia and ASST Spedali Civili , Brescia , Italy
| | | | - Paolo Montuschi
- c Department of Pharmacology, Faculty of Medicine , University Hospital Agostino Gemelli Foundation Catholic University of the Sacred Heart, Pharmacology , Rome , Italy
| | - Kesavan S Babu
- d Department of Respiratory Medicine , Queen Alexandra Hospital, Cosham , Portsmouth , UK
| | - Jaymin B Morjaria
- e Department of Respiratory Medicine , Royal Brompton & Harefield NHS Trust, Harefield Hospital , Harefield , UK
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12
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Chang V, Gray EL, Thomas PS. Phamacology of fluticasone furoate and vilanterol trifenatate combination therapy for asthma. Expert Rev Respir Med 2016; 10:1069-78. [PMID: 27599692 DOI: 10.1080/17476348.2016.1227245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Fluticasone furoate (FF) is a novel inhaled corticosteroid (ICS). Vilanterol trifenate (VI) is a new inhaled, selective, long - acting β2 adrenergic agonist (LABA). It is now also marketed as a novel once daily combined ICS/LABA indicated for treatment of moderate and severe asthma. AREAS COVERED FF has a highly specific, fast association and slow dissociation from the glucocorticoid receptor, with a 24 hr duration of action. This, combined with a slow transport out of respiratory cells, creates a long tissue retention period. Vilanterol trifenate (VI) is a new inhaled, selective, long - acting β2 adrenergic agonist, also with a rapid onset of action with a maximal effect within 6 mins and prolonged lung retention with effects on lung function over 24 hours. Expert commentary: Multiple Phase I-III efficacy studies performed on FF and VI have shown an improvement in spirometry as well as symptom control in asthma. The development of once daily ICS/LABA combinations may potentially improve adherence to asthma therapy, but this has yet to be demonstrated.
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Affiliation(s)
- Vicky Chang
- a Department of Respiratory Medicine , Prince of Wales Hospital , Randwick , Australia
| | - Emma L Gray
- a Department of Respiratory Medicine , Prince of Wales Hospital , Randwick , Australia
| | - Paul S Thomas
- a Department of Respiratory Medicine , Prince of Wales Hospital , Randwick , Australia.,b Inflammation and Infection Research Centre, School of Medical Sciences, and Prince of Wales Clinical School , University of New South Wales , Randwick , Australia
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