Long-acting muscarinic antagonist and long-acting β-agonist combination for the treatment of maintenance therapy–naïve patients with chronic obstructive pulmonary disease: a narrative review
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Faster lung function impairment occurs earlier in the disease, particularly in mild-to-moderate COPD, highlighting the need for early and effective targeted interventions. The Global Initiative for...
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SAGE Publishing
2024-10-01
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| Series: | Therapeutic Advances in Respiratory Disease |
| Online Access: | https://doi.org/10.1177/17534666241279115 |
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| author | Roland Buhl Marc Miravitlles Antonio Anzueto Stephen Brunton |
| author_facet | Roland Buhl Marc Miravitlles Antonio Anzueto Stephen Brunton |
| author_sort | Roland Buhl |
| collection | DOAJ |
| description | Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Faster lung function impairment occurs earlier in the disease, particularly in mild-to-moderate COPD, highlighting the need for early and effective targeted interventions. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024 report recommends initial pharmacologic treatment with a long-acting muscarinic antagonist (LAMA) and long-acting β 2 -agonist (LABA) combination in group B (0 or 1 moderate exacerbation not leading to hospitalization, modified Medical Research Council score of ⩾2, and COPD Assessment Test™ score of ⩾10) and E (⩾2 moderate exacerbations or ⩾1 exacerbation leading to hospitalization and blood eosinophil count <300 cells/µL) patients. In randomized controlled trials (RCTs), LAMA/LABA combination therapy improved lung function, St. George’s Respiratory Questionnaire (SGRQ) total score, and Transitional Dyspnea Index (TDI) focal score and reduced the use of rescue medications, exacerbation risk, and risk of first clinically important deterioration (CID), compared with LAMA or LABA monotherapy. However, there is limited evidence regarding the efficacy and safety of LAMA/LABA combination therapy versus LAMA or LABA monotherapy in maintenance therapy–naïve patients. This review discusses the rationale for the early initiation of LAMA/LABA combination therapy in maintenance therapy–naïve patients with COPD. In post hoc analyses of pooled data from RCTs, compared with LAMA or LABA monotherapy, LAMA/LABA combination therapy improved lung function and quality of life and reduced COPD symptoms, risk of first moderate/severe exacerbation, risk of first CID, and use of rescue medication, with no new safety signals. In a real-world study, patients initiating LAMA/LABA had significantly reduced risk of COPD-related inpatient admissions and rate of on-treatment COPD-related inpatient admissions over 12 months than those initiating LAMA. Consequently, LAMA/LABA combination therapy could be considered the treatment of choice in maintenance therapy–naïve patients with COPD, as recommended by the GOLD 2024 report. |
| format | Article |
| id | doaj-art-e29b061b70944356a690b148c1c8cbf4 |
| institution | Kabale University |
| issn | 1753-4666 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Respiratory Disease |
| spelling | doaj-art-e29b061b70944356a690b148c1c8cbf42024-11-16T13:03:34ZengSAGE PublishingTherapeutic Advances in Respiratory Disease1753-46662024-10-011810.1177/17534666241279115Long-acting muscarinic antagonist and long-acting β-agonist combination for the treatment of maintenance therapy–naïve patients with chronic obstructive pulmonary disease: a narrative reviewRoland BuhlMarc MiravitllesAntonio AnzuetoStephen BruntonChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Faster lung function impairment occurs earlier in the disease, particularly in mild-to-moderate COPD, highlighting the need for early and effective targeted interventions. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024 report recommends initial pharmacologic treatment with a long-acting muscarinic antagonist (LAMA) and long-acting β 2 -agonist (LABA) combination in group B (0 or 1 moderate exacerbation not leading to hospitalization, modified Medical Research Council score of ⩾2, and COPD Assessment Test™ score of ⩾10) and E (⩾2 moderate exacerbations or ⩾1 exacerbation leading to hospitalization and blood eosinophil count <300 cells/µL) patients. In randomized controlled trials (RCTs), LAMA/LABA combination therapy improved lung function, St. George’s Respiratory Questionnaire (SGRQ) total score, and Transitional Dyspnea Index (TDI) focal score and reduced the use of rescue medications, exacerbation risk, and risk of first clinically important deterioration (CID), compared with LAMA or LABA monotherapy. However, there is limited evidence regarding the efficacy and safety of LAMA/LABA combination therapy versus LAMA or LABA monotherapy in maintenance therapy–naïve patients. This review discusses the rationale for the early initiation of LAMA/LABA combination therapy in maintenance therapy–naïve patients with COPD. In post hoc analyses of pooled data from RCTs, compared with LAMA or LABA monotherapy, LAMA/LABA combination therapy improved lung function and quality of life and reduced COPD symptoms, risk of first moderate/severe exacerbation, risk of first CID, and use of rescue medication, with no new safety signals. In a real-world study, patients initiating LAMA/LABA had significantly reduced risk of COPD-related inpatient admissions and rate of on-treatment COPD-related inpatient admissions over 12 months than those initiating LAMA. Consequently, LAMA/LABA combination therapy could be considered the treatment of choice in maintenance therapy–naïve patients with COPD, as recommended by the GOLD 2024 report.https://doi.org/10.1177/17534666241279115 |
| spellingShingle | Roland Buhl Marc Miravitlles Antonio Anzueto Stephen Brunton Long-acting muscarinic antagonist and long-acting β-agonist combination for the treatment of maintenance therapy–naïve patients with chronic obstructive pulmonary disease: a narrative review Therapeutic Advances in Respiratory Disease |
| title | Long-acting muscarinic antagonist and long-acting β-agonist combination for the treatment of maintenance therapy–naïve patients with chronic obstructive pulmonary disease: a narrative review |
| title_full | Long-acting muscarinic antagonist and long-acting β-agonist combination for the treatment of maintenance therapy–naïve patients with chronic obstructive pulmonary disease: a narrative review |
| title_fullStr | Long-acting muscarinic antagonist and long-acting β-agonist combination for the treatment of maintenance therapy–naïve patients with chronic obstructive pulmonary disease: a narrative review |
| title_full_unstemmed | Long-acting muscarinic antagonist and long-acting β-agonist combination for the treatment of maintenance therapy–naïve patients with chronic obstructive pulmonary disease: a narrative review |
| title_short | Long-acting muscarinic antagonist and long-acting β-agonist combination for the treatment of maintenance therapy–naïve patients with chronic obstructive pulmonary disease: a narrative review |
| title_sort | long acting muscarinic antagonist and long acting β agonist combination for the treatment of maintenance therapy naive patients with chronic obstructive pulmonary disease a narrative review |
| url | https://doi.org/10.1177/17534666241279115 |
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