Effects of a single long-acting muscarinic antagonist agent and a long-acting muscarinic antagonist/long-acting β2-adrenoceptor agonist combination on lung function and symptoms in untreated COPD patients in Japan

Abstract

BackgroundA large body of evidence suggests that long-acting β2-adrenoceptor agonist (LABA)/long-acting muscarinic antagonist (LAMA) combinations induce a strong synergistic bronchodilatory effect in human isolated airways. Moreover, a recent post hoc analysis demonstrated clinical synergism between LABAs and LAMAs, which induces a synergistic improvement not only in lung function but also in dyspnea in COPD patients.AimThe aim of this study is to examine the baseline factors related to improvement in lung function or clinical symptoms that results from the administration of LAMA or LAMA/LABA and to compare the differences in improvement in lung function or clinical symptoms between LAMA and LAMA/LABA.MethodsAmong 829 patients with COPD who were treated with LAMA or LAMA/LABA in our hospital, 112 patients (aged 40–89 years) matched the criteria. Of these 112 patients, 71 received LAMA (LAMA group) and 41 received LAMA/LABA (LAMA/LABA group) as the initial treatment. Various examination results such as lung function test values, symptom change, and frequency of exacerbations were compared between the two groups.ResultsCompared with the monotherapy, the combination therapy significantly improved the FEV1, inspiratory capacity (IC), and total COPD assessment test (CAT) scores. Comparing the improvement in each domain of the CAT produced by the combination therapy with that of the monotherapy, larger improvements were found for the domains of going out and sleeping. The frequency of exacerbations during the 24 weeks was significantly lower in the combination therapy group than in the LAMA monotherapy group (P=0.034). Although no relationship was found between improvement in FEV1 and any pretreatment factors in the LAMA/LABA group, the improvement in the CAT score was strongly related to the baseline CAT score, smoking index, and air trapping index (P-value <1×10−4).ConclusionIn this study of clinical practice, we found that LAMA/LABA combination therapy improved the clinical symptoms of COPD and IC and that the effects of the combination therapy were consistent with those observed in previous clinical trials.

Effectiveness of Tiotropium/Olodaterol in the Real World: A Post Hoc Subgroup Analysis After the First Year of Use

“…In particular, the ‘sleep’ and ‘confident leaving home’ items were reduced significantly at all time points in treatment-naive patients, and the magnitude of change was greater than that in the previously treated patients. The effects seen in our analysis are consistent with a comparison of LAMA/LABA versus LAMA monotherapy in Japanese patients with untreated COPD, which showed a significant improvement in FEV 1 , inspiratory capacity and CAT scores with the combination compared with LAMA monotherapy and that the CAT items of ‘sleep’ and ‘confident leaving home’ were significantly improved compared with LAMA monotherapy [ 12 ]. The improvement in inspiratory capacity may have resulted in an improvement in these CAT items.…”

A randomized controlled trial of long-acting muscarinic antagonist and long-acting β2 agonist fixed-dose combinations in patients with chronic obstructive pulmonary disease

“…This difference might have influenced the preferences such as "Actual feeling of being able to inhale". Finally, compared to global reports, the proportion of women with COPD in Japanese COPD studies is small (8.0-14.5%) [31][32][33]; the proportion of women in this study was also small (8.0%). These differences in sex ratios between various countries might have influenced results such as preference.…”

Effect of timing of bronchodilator therapy initiation on exacerbations in patients with chronic obstructive pulmonary disease: a retrospective cohort study

“…S5). LAMA + LABA combinations are more effective than the individual components because of their distinct mechanisms [31][32][33]. Use of LAMA + LABA may have been responsible for the difference in the prolonged time to first exacerbation between the overall population and those with an index date after LAMA + LABA launch.…”