Patient considerations in the treatment of COPD: focus on the new combination inhaler umeclidinium/vilanterol

Abstract

Medication adherence among patients with chronic diseases, such as COPD, may be suboptimal, and many factors contribute to this poor adherence. One major factor is the frequency of medication dosing. Once-daily dosing has been shown to be an important variable in medication adherence in chronic diseases, such as COPD. New inhalers that only require once-daily dosing are becoming more widely available. Combination once-daily inhalers that combine any two of the following three agents are now available: 1) a long-acting muscarinic antagonist; 2) a long acting beta2 agonist; and 3) an inhaled corticosteroid. A new once-daily inhaler with both a long-acting muscarinic antagonist, umeclidinium bromide, and a long acting beta2 agonist, vilanterol trifenatate, is now available worldwide for COPD treatment. It provides COPD patients convenience, efficacy, and a very favorable adverse-effects profile. Additional once-daily combination inhalers are available or will soon be available for COPD patients worldwide. The use of once-daily combination inhalers will likely become the standard maintenance management approach in the treatment of COPD because they improve medication adherence.

<p>Medication adherence and persistence in chronic obstructive pulmonary disease patients receiving triple therapy in a USA commercially insured population</p>

“…Nonadherence to treatment may negatively influence the effectiveness of the triple therapy regimen and may result in the worsening of clinical symptoms or other poor health outcomes 29. Problems with medication adherence among patients with COPD have been well documented worldwide 35–39. Dhamane et al, using a large administrative claims database (N=14,117; mean age, 69.9 years), observed that 79.2% of patients were nonadherent to maintenance COPD medications with a mean PDC of 0.47 40.…”

Cardiovascular safety of new inhaled medications for asthma and chronic obstructive pulmonary disease: a critical review from pharmacist perspective

“…42 Among studies that investigate vilanterol/umeclidinium combination therapy, increased HR was observed in the treatment group (by 4.8 bpm). 39,56 A study by Donohue JF et al also observed some differences among subjects discontinued from the study, where abnormalities in ECG or Holter monitoring was twice as high in treatment than placebo groups. 39 However, a study by Hanania NA et al found that vilanterol monotherapy was not associated with significant changes in QTc interval or vital signs among COPD patients, even with increased doses.…”

“…[42][43][44] Studies have found that vilanterol has low bioavailability, where only 27% of vilanterol was absorbed when given as a combination product with umeclidinium. 56,57 After a once daily inhaled dose, C max was reached after 5-15 minutes, half-life was 11 hours, and steady state developed after 6 days. 57 The Vilanterol/fluticasone combination was found to be effective in reducing asthma exacerbations by 24% compared to fluticasone alone, whereas the once a day dosing was believed to be able to improve compliance and disease control.…”

A prospective study of salvational intervention with ICS/LABA for reducing chronic obstructive pulmonary disease exacerbation under severe air pollution (SIRCAP) in Beijing: protocol of a multi-center randomized controlled trial

“…Inhaled corticosteroids (ICS) play an essential role on anti-inflammation, and beta 2 -agonists stimulate beta 2 -adrenergic receptors in order to relax airway smooth muscle. Combination of ICS and long-acting beta 2 -agonists (LABA) such as budesonide/formoterol and fluticasone/ salmeterol has effective synergistic action on improving symptoms, lung function, and life quality, as well as reducing exacerbation of COPD [15, 16]. Compared with fluticasone/ salmeterol, short-term treatment of budesonide/formoterol have a more rapid onset of action and improves pulmonary function and morning activities more greatly [17].…”