Placing Novel, Fixed-Dose Dual Bronchodilators within the nice Guidelines for Chronic Obstructive Pulmonary Disease -Reflections on the Past, Present and Future

John O'Reilly*

The  current  National  Institute  for  Health  and  Care  Excellence  (NICE)  chronic  obstructive pulmonary disease (COPD) guidelines were updated in 2010, reflecting clinical evidence available at that time. Since the guidelines were written, a growing body of evidence has demonstrated enhanced Bronchodilation with LABA/LAMA in fixed-dose combinations (FDCs) versus single component agents (the  standard  of  care)  in  moderate  to  severe  COPD.  Studies  to  date  indicate  that  the  indacaterol/glycopyrronium (QVA149)  and  umeclinidium/vilanterol  (UMEC/VI)  can  optimize  Bronchodilation  and may lead to improvements in patient-reported outcomes beyond lung function. The evidence for LABA/LAMA  FDC,  in  particular  glycopyrronium/indacaterol,  and  also  umeclidinium/vilanterol,  supported by meta-analysis, shows that dual Bronchodilation provides superior efficacy compared with LAMA monotherapy  (glycopyrronium  or  tiotropium),  and  suggests  the  appropriateness  of  progression  to LABA/LAMA combinations after LAMA mono therapy rather than escalation to LABA/ICS in patients with persistent breathlessness. The debate regarding the benefits and risks of LABA/ICS is on-going, with data now more firmly showing an association with inhaled ICS use and pneumonia. In patients with moderate or severe airflow obstruction and no history of exacerbations in the past year, randomised data showed that glycopyrronium/indacaterol was superior to LABA/ICS in improving lung function and breathlessness score. How to quantify the benefits of LABA/LAMA FDC over Mono therapy will be an ongoing debate, and consideration of other parameters such as a responder analysis of the proportion of patients that did achieve a threshold, may be better suited to establish clinically relevant differences between active agents and placebo. This review highlights the need to consider revisions to the current NICE COPD guidelines to reflect the recently published evidence demonstrating a role for LABA/LAMA FDC in the treatment of moderate to severe COPD

Keywords: Chronic obstructive pulmonary disease(COPD); National Institute for Health and Care Excellence (NICE); long-acting β2-agonist (LABA);long-acting muscarinic antagonist (LAMA); fixed-dose combination (FDC)

Published on: Jun 9, 2015 Pages: 1-8

Full Text PDF Full Text HTML DOI: 10.17352/aprc.000001
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