Study: LABA-LAMA Combination Effectively Reduces COPD Exacerbations

A Long-acting β-agonist (LABA) plus a long-acting muscarinic agonist (LAMA) is superior to standard treatment with a LABA plus inhaled corticosteroid (ICS) for the treatment chronic obstructive pulmonary disease (COPD), according to the results of a recent trial.

Treatment guidelines recommend either a LABA plus an ICS or LAMA for the prevention of COPD exacerbations in high-risk patients, but the efficacy of a LABA-LAMA regimen is unclear.
_______________________________________________________________________________________________________________________________________________________________________

To compare the methods, the researchers conducted a 52-week randomized, double-blind, double-dummy, noninferiority trial of 3362 patients with a history of at least 1 COPD exacerbation in the previous year. The patients were randomly assigned to either LABA (110 μg) plus LAMA glycopyrronium (50 μg) once daily or to LABA salmeterol (50 μg) plus the the ICS fluticasone (500 μg) twice daily.

Overall, the LABA-LAMA combination was associated with an 11% lower rate of annual COPD exacerbations than the LABA-ICS combination. Those taking the LABA-LAMA combination had a longer time to first exacerbation than did the LABA-ICS group (71 days versus 51 days). The effect on the rate of exacerbations was independent of baseline blood eosinophil count, and rates of adverse events and death was similar in the 2 groups.

“In conclusion, we found that among patients with COPD who had a history of exacerbation during the previous year, indacaterol–glycopyrronium was consistently more effective than salmeterol–fluticasone in preventing exacerbations and was associated with no detectable increase in adverse events,” the researchers wrote.

—Michael Potts

Reference:

Wedzicha JA, Banerji D, Chapman KR, et al. Indacaterol–glycopyrronium versus salmeterol–fluticasone for COPD [published online May 15, 2016]. NEJM. doi:10.1056/NEJMoa1516385.