New Data Shows Benefits of Combination Treatment

New data, presented at the American College of Chest Physicians Annual Meeting on October 25, 2016, has indicated that LAMA/LABA combination treatment for COPD has a positive edge on conventional LABA/ICS (inhaled corticosteroids) medications.

LAMA stands for a long-acting muscarinic antagonist. It serves to shut down or slow down the activity of the muscarinic receptors in the body. These receptors are linked with acetylcholine, among many other things, and when blocked by LAMA, will block the effects of the parasympathetic nervous system, which is the opposite of the body’s fight or flight response. This means that when the parasympathetic nervous system’s effects are reduced, individuals will have increased bronchodilation and an easier time breathing fully.

LABA (long-acting βagonists), on the other hand, stimulates receptors that function with smooth muscles in the airway. Similar to LAMA, these will also allow for increased bronchodilation by relaxing muscles in the respiratory tract that we use to breathe fully. Previously, LABA has been used in combination with ICS (inhaled corticosteroid), however, there are many side effects and risks with ICS, such as hoarse voice, fungal infections of the mouth and throat, and an increased risk of developing pneumonia, type 2 diabetes, and tuberculosis. Because of these risks, many individuals with COPD have been seeking other effective treatments.

The presenters of this study have concluded that a LAMA/LABA combination may be the answer these individuals are looking for.

The data presented came from a review of two studies centering on treatment options for COPD, the FLAME and LANTERN studies. The FLAME study included 3362 individuals with previous history of COPD exacerbations in the past year, while the LANTERN study included 744 similar individuals. A fixed-dose combination of indacaterol and glycopyrronium (LAMA/LABA treatment) was compared to the combination of salmeterol and fluticasone (LABA/ICS treatment) for effectiveness. For all subgroups, the LAMA/LABA combination treatment reduced moderate to severe COPD exacerbations annually, as well as showed improvement in the time elapsed until the first moderate or severe exacerbation after beginning treatment.

The authors of the data, including Francesco Patalano, MD, Senior Global Program Head—Inhaled Respiratory Portfolio, Novartis, have spoken highly of their results, saying,

This may come as a surprise to some clinicians, who have looked to LABA/ICS to reduce exacerbations. Our results show clear benefit from the LABA/LAMA, without the sort of risks you would see with an inhaled corticosteroid-containing regimen.”

Treatment for COPD is generally considered on a case by case basis, with LAMA/LABA typically being used for COPD without significant inflammation, and LABA/ICS being used for individuals with COPD and asthma overlap. These results could be indicative of a shift in treatment regiments, however, many predict that future research will lead to the development of a treatment combining all three components (LAMA, LABA, and ICS). More research will need to be performed to determine the efficacy of a combination treatment like this, and time will tell if it out-performs it’s dual-combination counterparts!

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