Alternative to Advair (Fluticasone-Salmeterol) inhaler?

From the Guidelines

Alternative to Advair (Fluticasone-Salmeterol) inhaler is a combination of a Long-Acting Beta-Agonist (LABA) and a Long-Acting Muscarinic Antagonist (LAMA).

Key Points

• The combination of a LABA and a LAMA has been shown to be effective in reducing exacerbations and improving lung function in patients with COPD 1.
• The LABA/ICS combination is sometimes given either instead of a long-acting inhaled bronchodilator alone or in addition to a LAMA, and has been shown to improve health-related quality of life and reduce the risk of a COPD exacerbation 1.
• Tiotropium, a LAMA, has been shown to statistically significantly reduce hospitalizations for COPD exacerbations compared with placebo 1.
• The choice of alternative therapy should be based on individual patient factors, such as severity of disease, symptoms, and response to previous treatments.

Alternative Options

• Salmeterol and Tiotropium: This combination has been shown to be effective in reducing exacerbations and improving lung function in patients with COPD 1.
• Formoterol and Tiotropium: This combination has also been shown to be effective in reducing exacerbations and improving lung function in patients with COPD 1.
• Indacaterol and Glycopyrrolate: This combination has been shown to increase lung function to a greater degree than a LAMA alone 1.

Important Considerations

• The primary adverse effect attributed to the LABA/ICS combination is an increased risk of pneumonia, although this effect may not be present to the same degree with all formulations of a LABA/ICS 1.
• Adherence to inhaled medications has a significant impact on patient-centred outcomes, including mortality and hospital admissions 1.

From the FDA Drug Label

In 15 healthy subjects, systemic exposure to fluticasone propionate from 4 inhalations of ADVAIR HFA 230/21 (fluticasone propionate 230 mcg and salmeterol 21 mcg) Inhalation Aerosol (920/84 mcg) and 2 inhalations of fluticasone propionate and salmeterol inhalation powder 500 mcg/50 mcg (1,000 mcg/100 mcg) was similar between the 2 inhalers (i.e., 799 versus 832 pg•h/mL, respectively)

An alternative to Advair (Fluticasone-Salmeterol) inhaler is fluticasone propionate and salmeterol inhalation powder.

• The systemic exposure to fluticasone propionate from this alternative inhaler is similar to that of ADVAIR HFA.
• Peak plasma concentrations of fluticasone propionate are also comparable between the two inhalers. 2

From the Research

Alternative Options to Advair (Fluticasone-Salmeterol) Inhaler

• Wixela Inhub is a generic equivalent to Advair Diskus, containing the combination of fluticasone propionate and salmeterol, and has been shown to be bioequivalent to Advair Diskus 3, 4.
• Budesonide/formoterol (Symbicort) is another combination product that can be used for both maintenance and relief of asthma symptoms, and has been endorsed as an effective treatment by the Global Initiative for Asthma 5.
• Salmeterol/fluticasone propionate (Seretide or Advair) can also be used as a combination product for maintenance treatment of asthma and COPD 6, 7.

Key Features of Alternative Options

• Wixela Inhub has been shown to be robust and easy to use, and may provide an alternative option to Advair Diskus for patients with asthma or COPD requiring intervention with an ICS/LABA 3.
• Budesonide/formoterol (Symbicort) has a rapid onset of bronchodilator effect, making it suitable for use as both a maintenance and reliever medication 5.
• Salmeterol/fluticasone propionate (Seretide or Advair) has been shown to improve lung function and symptoms in patients with asthma and COPD, and is a well-established treatment option 6, 7.

Efficacy and Safety of Alternative Options

• Wixela Inhub has been shown to be bioequivalent to Advair Diskus in terms of therapeutic effects in the lung 4.
• Budesonide/formoterol (Symbicort) has been shown to improve asthma outcomes and reduce the risk of severe exacerbations 5.
• Salmeterol/fluticasone propionate (Seretide or Advair) has been shown to improve lung function and symptoms in patients with asthma and COPD, and is generally well-tolerated 6, 7.