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

From the Guidelines

Stiolto is not recommended for acute exacerbations of COPD. According to the most recent and highest quality study 1, the management of acute exacerbations of COPD should focus on symptom resolution and recovery from the exacerbation episode via improving airflow and gas exchange, as well as reducing lung inflammation. The study suggests that systemic corticosteroids and antibiotics are the mainstay treatments for exacerbations, and that short-acting bronchodilators like albuterol or ipratropium are typically used as rescue medications.

Key Points for Acute COPD Exacerbation Management

• Systemic corticosteroids, such as prednisone 40mg daily for 5 days, are recommended to improve symptom resolution and reduce hospitalization duration 1
• Antibiotics should be used if a bacterial infection is suspected, as they can reduce the risk of early relapse, treatment failure, and hospitalization duration 1
• Short-acting bronchodilators, such as albuterol or ipratropium, are typically used as rescue medications to provide rapid relief during an acute episode 1
• Maintenance therapy with long-acting bronchodilators, such as Stiolto, should be continued during an acute exacerbation, but it is not sufficient to treat the exacerbation on its own 1

Rationale for Not Using Stiolto for Acute Exacerbations

• Stiolto is a maintenance therapy designed for long-term daily use to control stable COPD symptoms, not for treating sudden worsening of symptoms during an exacerbation 1
• The combination of a long-acting muscarinic antagonist (tiotropium) and a long-acting beta-agonist (olodaterol) in Stiolto provides bronchodilation over 24 hours, but does not deliver the rapid relief needed during an acute episode 1
• Patients experiencing an acute COPD exacerbation should continue their maintenance medications like Stiolto while adding appropriate acute treatments under medical supervision 1

From the Research

Suitability of Stiolto for Treating Acute Exacerbation of COPD

• Stiolto (tiotropium and olodaterol) is a fixed-dose combination of two long-acting bronchodilators, which has been shown to be effective in managing COPD symptoms and reducing exacerbations 2, 3, 4, 5, 6.
• The combination of tiotropium and olodaterol has been demonstrated to improve lung function, health status, and dyspnea severity compared to tiotropium alone 3, 5.
• Tiotropium/olodaterol has been shown to reduce the rate of moderate-to-severe exacerbations by approximately 10% compared to tiotropium alone 2.
• A pooled analysis of four clinical trials found that tiotropium/olodaterol resulted in significant improvements in trough FEV1, St. George's Respiratory Questionnaire score, and Transition Dyspnea Index focal score compared to tiotropium alone 3.
• Another study found that tiotropium/olodaterol decreased the rate of moderate/severe exacerbations and exacerbations leading to hospitalization compared to tiotropium alone 5.

Efficacy in Reducing Exacerbations

• Tiotropium/olodaterol has been shown to be effective in reducing exacerbations in patients with COPD, including those with a history of exacerbations and those without 5.
• The combination of tiotropium and olodaterol has been demonstrated to reduce the rate of moderate/severe exacerbations in patients with GOLD 2 and GOLD 3 COPD 5.
• Tiotropium/olodaterol has also been shown to reduce the number of exacerbations leading to hospitalization compared to tiotropium alone 5.

Patient-Reported Outcomes

• Tiotropium/olodaterol has been shown to improve patient-reported outcomes, including breathlessness, health status, and night-time rescue medication use 6.
• A greater proportion of patients responded positively to tiotropium/olodaterol compared to monotherapy or placebo 6.