Effects of arformoterol twice daily, tiotropium once daily, and their combination in patients with COPD

Abstract

In this study, the combination of nebulized arformoterol 15microg BID plus tiotropium 18microg DPI QD was the most effective in improving pulmonary function and disease symptoms. Mono-therapy improvement with arformoterol or tiotropium was similar. All three treatments were well tolerated.

Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centred outcomes

“…All studies of tiotropium and formoterol/arformoterol combination therapy improved dyspnoea (assessed by the Transitional Dyspnoea Index (TDI)) to a greater extent than either monotherapy. 6,[15][16][17]19,20 Two further studies of tiotropium plus salmeterol (once or twice a day) also showed a marked improvement in dyspnoea with combination therapy over either monotherapy. 21,22 In a study by Aaron et al, 7 no significant difference in mean TDI total score was demonstrated between tiotropium plus salmeterol, tiotropium plus salmeterol/ fluticasone and tiotropium alone; however, it should be noted that a large number of patients discontinued during this study (61.0% completed), making it difficult to draw firm conclusions on efficacy between treatment groups.…”

“…Short-term (≤6 weeks) and longer-term (>12 weeks) studies demonstrated a decrease in rescue medication use with tiotropium and LABA (formoterol/arformoterol/salmeterol) combination therapy compared with either monotherapy, which may be associated with the improvements in symptoms observed with LABA/LAMA combination therapies in these studies. 2,8,15,17,[19][20][21][22][23] The reduction in rescue medication use in a 2-week and 6-week study of tiotropium plus formoterol compared with tiotropium is shown in Figure 2.…”

“…2,6,8,15,17,19,20,23 The most common adverse event with both treatments was COPD exacerbation, and the combination was not associated with any clinically relevant changes in laboratory variables. 2,6,8,15,17,19,20,23 Similar findings were recently reported in two large 12-week studies in which concurrent treatment with indacaterol and tiotropium did not increase the incidence of adverse events, serious adverse events, notable laboratory variables (plasma potassium and blood glucose), and ECG findings (QTc interval) compared with tiotropium alone. 18 In another recent study, QVA149, a fixed-dose combination of indacaterol and a LAMA (NVA237), was well tolerated in patients with COPD, with a cardiovascular safety profile and overall adverse event rate similar to placebo.…”

“…2,[15][16][17] In the first 2-week study, tiotropium with add-on formoterol once daily in the morning was shown to improve IC for >12 hrs compared with tiotropium alone, with further improvements in patients who received addon formoterol twice daily; however, the duration of improvement of IC was <10 hrs following the evening formoterol dose (Figure 1). 2 There was no significant difference in trough IC response among the three treatment groups.…”

“…15 The third 2-week study assessed the impact of tiotropium/formoterol combination therapy versus formoterol monotherapy on dynamic hyperinflation and exercise endurance in COPD patients. 16 IC was measured using constant-speed treadmill tests to the limit of tolerance (Tlim), or a maximum of 20 mins.…”