Is Stiolto (tiotropium and olodaterol) suitable for treating acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Stiolto is not suitable for treating acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) as it is a maintenance medication designed for long-term control of chronic symptoms, not for quick relief during flare-ups. According to the global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report 1, the goal for treatment of exacerbations is to minimize the negative impact of the current exacerbation and to prevent subsequent events, and short-acting inhaled β2-agonists, with or without short-acting anticholinergics, are recommended as the initial bronchodilators to treat an acute exacerbation.

Key Points to Consider

• Stiolto (tiotropium/olodaterol) is a combination of a long-acting muscarinic antagonist (LAMA) and a long-acting beta-agonist (LABA), designed to provide sustained bronchodilation over 24 hours, which is not suitable for the immediate relief needed during an exacerbation.
• The prevention of acute exacerbations of COPD guideline 1 suggests that long-acting muscarinic antagonists, such as tiotropium, may reduce the rate of acute exacerbations, but this does not make Stiolto suitable for treating acute exacerbations.
• Systemic corticosteroids and antibiotics are typically the mainstay treatments for COPD exacerbations, and patients experiencing an acute exacerbation should continue their maintenance medications like Stiolto while adding appropriate rescue treatments.

Treatment Recommendations

• For acute exacerbations, short-acting bronchodilators like albuterol or ipratropium are more appropriate as rescue medications because they work rapidly to open airways.
• Systemic corticosteroids (such as prednisone 40mg daily for 5 days) and antibiotics (if infection is suspected) are typically the mainstay treatments for COPD exacerbations.
• Patients experiencing an acute exacerbation should continue their maintenance medications like Stiolto while adding appropriate rescue treatments, but Stiolto alone would not adequately address the urgent needs of an acute flare-up.

From the Research

Stiolto (Tiotropium and Olodaterol) for Treating Acute Exacerbation of COPD

• The provided studies do not directly address the suitability of Stiolto (tiotropium and olodaterol) for treating acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) 2, 3, 4, 5, 6.
• However, the studies suggest that the combination of tiotropium and olodaterol is effective in improving lung function, reducing exacerbations, and improving health-related quality of life in patients with COPD 2, 3, 4, 5, 6.
• The combination of tiotropium and olodaterol has been shown to reduce the rate of moderate-to-severe exacerbations by approximately 10% compared to tiotropium alone 5.
• The studies also suggest that the combination of tiotropium and olodaterol is well-tolerated and has a similar safety profile to the individual components 3, 6.

Efficacy of Tiotropium and Olodaterol in COPD

• The combination of tiotropium and olodaterol has been shown to significantly improve lung function, including trough FEV1, compared to the individual components and other active comparators 6.
• The combination has also been shown to improve patient-reported outcomes, such as dyspnea, use of rescue medication, and health status 5, 6.
• The studies suggest that the combination of tiotropium and olodaterol is effective in reducing the use of rescue medication and improving exercise capacity and physical activity in patients with COPD 5, 6.

Safety of Tiotropium and Olodaterol in COPD

• The studies suggest that the combination of tiotropium and olodaterol is well-tolerated and has a similar safety profile to the individual components 3, 6.
• The combination has been shown to have no significant differences in frequency of general and serious adverse events compared to the individual components and other active comparators 6.