From the Guidelines
Ultibro is a combination medication of indacaterol and glycopyrronium, used for the treatment of chronic obstructive pulmonary disease (COPD).
Key Components
- Indacaterol: a long-acting β-agonist (LABA)
- Glycopyrronium: a long-acting muscarinic antagonist (LAMA)
Evidence
The combination of indacaterol and glycopyrronium has been studied in the context of COPD management, with a randomized, double-blind, multicenter, parallel-group study (SUNSET) examining the long-term triple therapy de-escalation to indacaterol/glycopyrronium in patients with COPD 1.
Clinical Use
This combination is used as a once-daily inhalation therapy, offering a convenient treatment option for patients with COPD. The use of LABA and LAMA combinations, such as indacaterol and glycopyrronium, has been associated with improved lung function and reduced exacerbations in patients with COPD 1.
Mechanism of Action
The LABA component (indacaterol) works by stimulating β2-adrenergic receptors in the lungs, causing bronchodilation and increased airflow. The LAMA component (glycopyrronium) works by blocking muscarinic receptors, reducing bronchospasm and increasing airflow.
Treatment Guidelines
The use of indacaterol and glycopyrronium in combination is supported by guidelines for the management of COPD, which recommend the use of LABA and LAMA combinations as a treatment option for patients with moderate to severe COPD 1.
From the Research
Definition and Composition of Ultibro
- Ultibro, also known as QVA149, is an inhaled fixed-dose combination of indacaterol (a long-acting selective β2-adrenergic receptor agonist [LABA]) and glycopyrronium (a long-acting muscarinic receptor antagonist [LAMA]) 2.
- It is approved in the EU and Japan for the symptomatic control of chronic obstructive pulmonary disease (COPD) in adults 2, 3.
Mechanism of Action and Effects
- The combination of indacaterol and glycopyrronium in Ultibro provides dual bronchodilation, which improves lung function, dyspnea, health status, and reduces COPD exacerbation risk 2, 4.
- Ultibro has been shown to improve bronchodilation, symptoms, and reduce exacerbations in patients with COPD, with a rapid onset of action and maintained effects during long-term treatment 2, 4, 5.
Clinical Trials and Comparisons
- Clinical trials, such as the SHINE and ILLUMINATE studies, have demonstrated the efficacy of Ultibro in improving lung function and symptoms in patients with COPD, compared to other treatments like tiotropium and salmeterol/fluticasone 2.
- A study comparing Ultibro to nebulized short-acting dual bronchodilator (salbutamol/ipratropium) found no significant difference in bronchodilating effects over 6 hours, although the nebulization had a faster onset of action 6.
- Another study using magnetic resonance imaging (MRI) found that Ultibro improved lung ventilation and perfusion in patients with COPD, providing mechanistic support for its clinical benefits 5.
Safety and Tolerability
- Ultibro is generally well-tolerated, with no new safety signals identified compared to its monocomponents 2.
- The safety and efficacy of Ultibro have been evaluated in several randomized controlled trials, which have shown good safety profiles and improved bronchodilator effects compared to placebo or other inhaled medications 3.