Sanjay Sethi, MD: Adding LAMA/LABA Options to the Market

Today while at the CHEST 2019 Annual Meeting in New Orleans, Circassia Pharmaceuticals announced the US launch of aclidinium/formoterol (DUAKLIR PRESSAIR) for patients with chronic obstructive pulmonary disease (COPD).

The combination inhaler therapy—a pairing of long-acting muscarinic antagonist (LAMA) and long-acting beta agonist (LABA)—is the newest among a trend of dual inhaled therapies for patients with respiratory disease. But the LAMA/LABA combination’s benefit for COPD is more distinct, and well-evidenced.

In an interview with MD Magazine® while at CHEST, Sanjay Sethi, MD, professor of Medicine at the University of Buffalo, discussed the introduction of aclidinium/formoterol to US patients with COPD, and what the drug class’ known benefit is in the space.

Sethi: So we have the introduction of a LAMA/LABA combination—aclidinium bromide is the LAMA, and formoterol fumarate muscarinic agent is the LABA. So, there's a combination that has not become available to use in patients with COPD for the maintenance treatment of COPD.

It's given by the inhaled route, it's given twice a day, and it's got a different device. There are other LAMA/LABA combinations available, but this has got a different device, and therefore we have more choices now in terms of delivery and drugs for our patients with COPD.

MD Mag: What is the currently understood benefit of LAMA/LABA in COPD?

Sethi: So basically what's happened is that the LAMA/LABA act by different mechanisms—and they’re complementary mechanisms. So when you combine the 2, you generally always tend to get more bronchodilation. And we're getting levels of bronchodilation that we could not achieve with 1 of those agents. So, combining them gives you more bronchodilation, and so that's of course the one big advantage—bronchodilation relates to their ability, to their exercise capacity and may also relate to a lot of other outcomes, like health status and quality of life.

So I think because of that, achieving the bronchodilation is very important. So giving the 2 agents together in 1 device, you know it ensures that they will comply, that they will take both the medications.

There may be some additional benefit of giving the 2 together, in terms of interactions that may be beneficial. And what's interesting is what the data is showing with these LAMA/LABA combinations is that in terms of safety, there's not much of a change or difference from the single-agent safety.

The baseline drugs are safe enough and giving the 2 together doesn't seem to really have an impact on the safety. So essentially, you're getting more benefit with very little difference in safety, and so why not? A lot of COPD patients are very limited and dyspnea is their major complaint, major symptom. The dyspnea clearly relates to airflow obstruction and hyperinflation.

So if you can relieve that early, why go halfway? Let's go the full way with this, and do the best we can for these patients.