Position of the Aclidinium-Bromide/Formoterol-Fumarate Combination in COPD Treatment According to Current Recommendations
Dual bronchodilator therapy, which combines long-acting muscarinic antagonists (LAMA) and long-acting β-agonists (LABA), has become an integral part of the treatment for chronic obstructive pulmonary disease (COPD). Growing evidence of the efficacy and safety of the fixed combination of aclidinium-bromide/formoterol-fumarate demonstrates that this treatment meets patient needs and the current GOLD recommendations from 2019.
Current GOLD Recommendations
The 2019 update of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations more clearly defines initial and subsequent treatments and introduces biomarker-based therapy for the first time. The new emphasis is on reducing the use of inhaled corticosteroids (ICS) unless necessary. Greater attention is given to the utilization of dual bronchodilation LAMA/LABA. This combination is recommended as the initial treatment for patients in group D, who, besides being at risk of exacerbations, have a high burden of symptoms, and for patients in group B with severe dyspnea. Additionally, for patients who do not show an adequate response to the initial treatment, subsequent treatment according to the predominant therapeutic goal, i.e., reducing dyspnea or decreasing the occurrence of exacerbations, is recommended. The LAMA/LABA combination is a key component of both of these treatment strategies.
Overview of Studies with AB/FF
Evidence from studies with AB/FF in the treatment of moderate to severe COPD shows a rapid onset of action, improvement in lung function, symptom control, and reduction in the occurrence of exacerbations compared to placebo and monotherapy, with good safety and tolerability and minimal cost increase compared to monotherapy. These results align well with patient needs and current GOLD recommendations. Improvements in lung function with AB/FF compared to monotherapy have been demonstrated regardless of symptom burden or concurrent ICS use. Administering 2× daily may also improve control of nighttime COPD symptoms.
Conclusion
In light of current GOLD recommendations and clinical study results, AB/FF 400/12 μg administered 2× daily should be considered an effective therapeutic option for patients with moderate to severe COPD.
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Source: D'Urzo A. D., Singh D., Donohue J. F., Chapman K. R. Aclidinium bromide in fixed-dose combination with formoterol fumarate in the management of COPD: an update on the evidence base. Ther Adv Respir Dis 2019; 13: 1753466619850725, doi: 10.1177/1753466619850725.
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