What are examples of LAMA (Long-Acting Muscarinic Antagonist) therapy for Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

LAMA-LABA therapy is a recommended treatment for patients with moderate to severe COPD who remain symptomatic on single bronchodilator therapy, as it provides effective bronchodilation through complementary mechanisms, resulting in improved lung function, reduced symptoms, decreased exacerbations, and better quality of life compared to monotherapy. The most recent and highest quality study, 1, supports the use of LAMA-LABA therapy in patients with COPD, as it reduces symptoms, exacerbations, and mortality. Some common LAMA-LABA combinations include:

• Anoro Ellipta (umeclidinium/vilanterol, 62.5/25 mcg once daily)
• Stiolto Respimat (tiotropium/olodaterol, 5/5 mcg, two inhalations once daily)
• Utibron Neohaler (glycopyrrolate/indacaterol, 15.6/27.5 mcg, one capsule twice daily)
• Bevespi Aerosphere (glycopyrrolate/formoterol, 9/4.8 mcg, two inhalations twice daily)
• Duaklir Pressair (aclidinium/formoterol, 400/12 mcg, one inhalation twice daily) These medications work by relaxing airway smooth muscles through different pathways, with LAMAs blocking acetylcholine receptors and LABAs stimulating beta-2 receptors. Patients should be instructed on proper inhaler technique, advised to rinse their mouth after use to prevent thrush, and monitored for potential side effects, including dry mouth, urinary retention, tachycardia, and tremors, as noted in 1 and 1. Additionally, the 2023 Canadian Thoracic Society guideline, 1 and 1, recommends LAMA-LABA therapy as a step-up treatment for patients with moderate to severe COPD who remain symptomatic on single bronchodilator therapy, and suggests that it can be used in combination with other therapies, such as pulmonary rehabilitation, to improve symptoms and health status.

From the FDA Drug Label

STIOLTO RESPIMAT is a combination of tiotropium bromide, an anticholinergic and olodaterol, a long-acting beta2-adrenergic agonist (LABA) indicated for the long-term, once-daily maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). ANORO ELLIPTA contains both umeclidinium and vilanterol. The mechanisms of action described below for the individual components apply to ANORO ELLIPTA. These drugs represent 2 different classes of medications (an anticholinergic and a LABA) each having different effects on clinical and physiological indices

Examples of LAMA-LABA therapy for COPD:

• STIOLTO RESPIMAT: a combination of tiotropium bromide (LAMA) and olodaterol (LABA)
• ANORO ELLIPTA: a combination of umeclidinium (LAMA) and vilanterol (LABA) 2 3

From the Research

LAMA-LABA Therapy for COPD

• The combination of long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) is a common therapy for chronic obstructive pulmonary disease (COPD) 4.
• This combination is thought to leverage different pathways to induce bronchodilation using submaximal drug doses, increasing the benefits and minimizing receptor-specific side effects 4.
• Examples of LAMA-LABA combinations include:
  • Umeclidinium/vilanterol, which is approved for use in stable COPD in the USA and Europe 4, 5.
  • Indacaterol/glycopyrronium, which is approved in Europe and numerous locations outside the USA 4.
  • Aclidinium/formoterol, which is approved in Europe and numerous locations outside the USA 4, 6.

Benefits of LAMA-LABA Therapy

• The benefits of LAMA-LABA combinations include improved pulmonary function, dyspnea, and health-related quality of life, and in some cases, reduced exacerbations 4, 6.
• A study found that LAMA-LABA combinations such as aclidinium/formoterol, glycopyrronium/indacaterol, and umeclidinium/vilanterol provided clinical benefits in lung function, quality of life, and early morning COPD symptoms in a broad cohort of COPD patients under routine medical practice conditions 6.
• The American Thoracic Society recommends the use of LAMA-LABA combination therapy over LAMA or LABA monotherapy in patients with COPD and dyspnea or exercise intolerance 7.

Treatment Guidelines

• The Global Initiative for Chronic Obstructive Lung Disease assigns patients with COPD into four groups based on the degree of airflow restriction, symptom score, and number of exacerbations in one year, and recommends different treatment options for each group 8.
• For patients with COPD who are not controlled with one therapy, triple therapy with an inhaled corticosteroid, long-acting beta2 agonist, and anticholinergic may be considered 8.