From the Guidelines
The main therapeutic substitutions for Anoro Ellipta inhaler are other long-acting combination inhalers containing a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), such as Stiolto Respimat (tiotropium/olodaterol), Bevespi Aerosphere (glycopyrrolate/formoterol), and Utibron Neohaler (glycopyrrolate/indacaterol), as recommended by the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1.
Therapeutic Substitutions
The following are specific alternatives to Anoro Ellipta inhaler:
- Stiolto Respimat (tiotropium/olodaterol)
- Bevespi Aerosphere (glycopyrrolate/formoterol)
- Utibron Neohaler (glycopyrrolate/indacaterol) These inhalers are typically used once or twice daily for maintenance treatment of COPD.
Rationale for Substitutions
The rationale for these substitutions is that they all contain a LABA and LAMA, which work synergistically to improve airflow in COPD patients, as supported by the 2023 Canadian Thoracic Society guideline 1. LABAs relax airway smooth muscle, while LAMAs reduce mucus secretion and bronchial constriction. Using both classes together provides greater bronchodilation than either alone.
Important Considerations
When substituting, ensure the patient is instructed on proper use of the new device, as inhaler technique varies between products. Additionally, monitor the patient for any changes in symptom control or side effects, as individual responses to different medications can vary 1. The choice of therapy should be determined based on the risk of future exacerbations and the goal of preventing exacerbations is to significantly minimize all the negative impacts of exacerbations, including symptom burden, health status worsening, hospital admission, and mortality 1.
From the Research
Therapeutic Substitutions for Anoro (Umeclidinium/Vilanterol) Ellipta Inhaler
The following are potential therapeutic substitutions for Anoro (Umeclidinium/Vilanterol) Ellipta inhaler:
- Tiotropium/Olodaterol (Stiolto® Respimat® or Spiolto® Respimat®) 2, 3, 4, 5, 6
- Indacaterol/Glycopyrronium (Ultibro® Breezhaler®) 5, 6
- Aclidinium bromide + formoterol fumarate (Duaklir® Genuair®) 5
- Tiotropium + salmeterol (free-dose combination) 5
Comparison of Therapeutic Substitutions
Studies have compared the efficacy of these therapeutic substitutions:
- Umeclidinium/Vilanterol was superior to Tiotropium/Olodaterol in improving trough FEV1 at week 8 4
- Tiotropium/Olodaterol was more effective than Umeclidinium/Vilanterol in improving lung function and reducing acute exacerbations 6
- Indacaterol/Glycopyrronium and Umeclidinium/Vilanterol had similar efficacy to Tiotropium/Olodaterol in terms of quality-adjusted life years and costs 5
- Aclidinium bromide + formoterol fumarate and Tiotropium + salmeterol were dominated by Tiotropium/Olodaterol in terms of cost-effectiveness 5
Key Findings
Key findings from the studies include:
- Tiotropium/Olodaterol is a valuable option for the treatment of COPD patients who remain symptomatic under monotherapy 2, 3
- Umeclidinium/Vilanterol is superior to Tiotropium/Olodaterol in improving trough FEV1 at week 8 4
- Tiotropium/Olodaterol demonstrates higher therapeutic effects compared to Umeclidinium/Vilanterol or Indacaterol/Glycopyrronium 6