From the Guidelines
Bevespi is preferred over Symbicort for COPD maintenance therapy in patients without significant inflammatory components, as it provides effective bronchodilation with a lower risk of steroid-related side effects, as supported by the most recent and highest quality study 1.
Key Differences Between Bevespi and Symbicort
- Bevespi (glycopyrrolate/formoterol) combines a long-acting muscarinic antagonist (LAMA) with a long-acting beta-agonist (LABA) and is primarily used for COPD maintenance therapy.
- Symbicort (budesonide/formoterol) combines an inhaled corticosteroid with a LABA and is used for both asthma and COPD.
Mechanism of Action and Indications
- Bevespi focuses on bronchodilation through two different mechanisms, making it suitable for COPD patients without significant inflammatory components.
- Symbicort contains an anti-inflammatory steroid component, making it more appropriate for conditions with significant inflammatory components like asthma.
Side Effects and Risks
- Both medications may cause throat irritation, headache, and potential cardiovascular effects.
- Symbicort carries additional risks associated with inhaled steroids, such as oral thrush and potential adrenal suppression with long-term use, as noted in the study 1.
Clinical Considerations
- The choice between Bevespi and Symbicort depends on the specific respiratory condition being treated and individual patient factors, as emphasized in the guideline 1.
- Patients with COPD and significant inflammatory components may benefit from Symbicort, while those without significant inflammation may prefer Bevespi, as suggested by the study 1.
Evidence-Based Recommendation
- Based on the most recent and highest quality study 1, Bevespi is recommended for COPD maintenance therapy in patients without significant inflammatory components, due to its effective bronchodilation and lower risk of steroid-related side effects.
From the Research
Comparison of Bevespi and Symbicort
- Bevespi is a triple therapy combination of budesonide, glycopyrrolate, and formoterol fumarate, while Symbicort is a combination of budesonide and formoterol fumarate.
- Studies have shown that triple therapy combinations like Bevespi can reduce the risk of exacerbations and improve lung function in patients with chronic obstructive pulmonary disease (COPD) compared to dual therapy combinations like Symbicort 2, 3.
- A network meta-analysis found that Bevespi had comparable efficacy to other triple combination therapies, including Symbicort, in reducing exacerbation rates and improving lung function, symptoms, and health-related quality of life in patients with moderate-to-very-severe COPD 3.
- Another study found that Bevespi improved trough forced expiratory volume in 1 second (FEV1) and FEV1 area under the curve from hours 0 to 4 (AUC0-4) change from baseline over 12-24 weeks, and reduced moderate/severe exacerbation rates, compared to Symbicort and other dual therapies in patients with COPD and phenotypic features of asthma 4.
- Real-world data analysis has shown that Bevespi is being initiated in patients with COPD who are experiencing symptoms and exacerbations despite current therapy, and who have various chronic comorbidities, most often cardiopulmonary-related 5.
- In contrast, Symbicort is a well-established dual therapy combination that has been shown to be effective in reducing exacerbations and improving lung function in patients with COPD, but may not be as effective as triple therapy combinations like Bevespi in patients with more severe disease or those who have not responded to dual therapy 6.