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Miejsce złożonych leków rozszerzających oskrzela LAMA/LABA w leczeniu przewlekłej obturacyjnej choroby płuc

Michał Rogacki, Szczepan Cofta

Data publikacji online: 2017/12/28
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W artykule opisano znaczenie stosowania leków łączących długo działających antagonistów receptorów muskarynowych z długo działającymi agonistami receptorów beta 2 (long-acting antimuscarinic/long-acting beta2-agonists – LAMA/LABA) w leczeniu przewlekłej obturacyjnej choroby płuc (POChP). Przedstawiono krótką charakterystykę choroby oraz jej epidemiologię. Omówiono podstawy działania leków z grupy LAMA/LABA. Na podstawie zaleceń GOLD 2017 określono wskazania do leczenia tymi preparatami. Przytoczono badania porównujące leczenie LAMA/LABA z monoterapią LAMA lub LABA. Wymieniono różne preparaty łączone wraz z badaniami oceniającymi ich skuteczność. Wyszczególniono trudności dla pacjentów związane z inhalacją leków. Leki LAMA/LABA zostały opisane z perspektywy medycyny opartej na fenotypowaniu chorych oraz personalizacji leczenia. Wyciągnięto wnioski dotyczące ewentualnej dodatkowej terapii wziewnymi glikokortykosteroidami (inhaled corticosteroid – ICS) oraz przyszłości tej grupy leków.

The article describes the importance of using drugs that combine long-acting muscarinic receptor antagonists with long-acting beta2-agonists (LAMA/LABA) in the treatment of chronic obstructive pulmonary disease (COPD). A brief description of the disease and its epidemiology are presented. The mechanism of LAMA/LABA drugs are discussed. Based on the recommendations of GOLD 2017, indications for treatment with these bronchodilators were defined. The studies comparing the LAMA/LABA treatment with the LAMA or LABA monotherapy were cited. Various combinations have been listed together with clinical tests assessing their effectiveness. The article lists the difficulties for patients associated with drug inhalation. LAMA/LABA drugs are described from the perspective of medicine based on phenotyping patients and personalisation of treatment. Conclusions regarding possible additional therapy with inhaled corticosteroids (ICS) and the future of this group of drugs are presented.
słowa kluczowe:

przewlekła obturacyjna choroba płuc (POChP), LAMA/LABA, leki rozszerzające oskrzela, leczenie POChP, GOLD 2017, nebulizacja, fenotypowanie w medycynie, leki wziewne

Szczeklik A. Choroby wewnętrzne. Medycyna Praktyczna, Kraków 2011.
McDonough JE, Yuan R, Suzuki M i wsp. Small-airway obstruction and emphysema in chronic obstructive pulmonary disease. N Engl J Med 2011; 365: 1567-1575.
Casanova C, Cote C, de Torres JP i wsp. Inspiratory-total lung capac­ity ratio predicts mortality in patients with chronic obstructive pulmo­nary disease. Am J Respir Crit Care Med 2005; 171: 591-597.
The Global Strategy for the Diagnosis, Management, and Prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017; http://www.goldcopd.org.
Qaseem A, Wilt TJ, Weinberger SE i wsp. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and Euro­pean Respiratory Society. Ann Intern Med 2011; 155: 179-191.
Cazzola M, Page CP, Calzetta L, Matera MG. Pharmacology and therapeutics of bronchodilators. Pharmacol Rev 2012; 64: 450-504.
Bateman ED, Ferguson GT, Barnes N i wsp. Dual bronchodilation with QVA149 versus single bronchodilator therapy: the SHINE study. Eur Respir J 2013; 42: 1484-1494.
Dutkowska A, Antczak A. Standardy leczenia POCHP. Medycyna po Dyplomie 2016.
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD (2017 report). Available at: http://www.sppneumologia.pt/uploads/files/ comissoestrabalho/Fisiopatologia%20e%20DPOC/wms-GOLD-2017-FINAL.pdf.
Feldman GJ, Sousa AR, Lipson DA i wsp. Comparative Efficacy of Once-Daily Umeclidinium/Vilanterol and Tiotropium/Olodaterol Therapy in Symptomatic Chronic Obstructive Pulmonary Disease: A Randomized Study. Adv Ther 2017; 34: 2518-2533.
Feldman G, Maltais F, Khindri S i wsp. A randomized, blinded study to evaluate the efficacy and safety of umeclidinium 62.5 mcg compared with tiotropium 18 mcg in patients with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11: 719-730.
Calzetta L, Rogliani P, Matera MG, Cazzola M. A systematic review with meta-analysis of dual bronchodilation with LAMA/LABA for the treatment of stable COPD. Chest 2016; 149: 1181-1196.
Oba Y, Sarva ST, Dias S. Efficacy and safety of long-acting -agonist/long-acting muscarinic antagonist combinations in COPD: a network meta-analysis. Thorax 2016; 71: 15-25.
Mahler DA, Kerwin E, Ayers T i wsp. FLIGHT: efficacy and safety of QVA149 (indacaterol/glycopyrrolate) versus its monocomponents and placebo in patients with COPD. Am J Respir Crit Care Med 2015; 192: 1068-1079.
Decramer M, Anzueto A, Kerwin E i wsp. Efficacy and safety of umeclidinium plus vilanterol versus tiotropium, vilanterol, or umeclidinium monotherapies over 24 weeks in patients with chronic obstructive pulmonary disease: results from two multicentre, blinded, randomised controlled trials. Lancet Respir Med 2014; 2: 472-486.
CHMP – Committee for Medicinal Products for Human Use. Initial authorisation of Ultibro Breezhaler (indacaterol/glycopyrroniumbro­mide).2013.Availablefrom: http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/002679/WC500146589.pdf.
Mahler DA, Decramer M, D’Urzo A i wsp. Dual bronchodilation with QVA149 reduces patient-reported dyspnoea in COPD: the BLAZE study. Eur Respir J 2014; 43: 1599-1609.
Indacaterol FDA approval information. Available from: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.DrugDetails
Cazzola M, Page CP, Calzetta L, Matera MG. Pharmacology and thera­peutics of bronchodilators. Pharmacol Rev 2012; 64: 450-504.
D’Urzo A, Mergel V, Leselbaum A, Caracta C. Efficacy and safety of fixed-dose combination aclidinium bromide/formoterol fumarate in patients with COPD: results from the AUGMENT COPD trial. Chest 2013; 144 (4 Meeting Abstracts): 1025A.
Singh D, Jones PW, Bateman ED i wsp. Efficacy and safety of aclidinium bromide/formoterol fumarate fixed-dose combinations compared with individual components and placebo in patients with COPD (ACLIFORM-COPD): a multicentre, randomised study. BMC Pulm Med 2014; 14: 178.
U.S. Food and Drug Administration. Department of Health and Human Services. Stiolto Respimat (tiotropium bromide and olodaterol inhalation spray) approval letter. 2015. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/appletter/2015/206756Orig1s000ltr.pdf.
Derom E, Westerman J, Grönke L i wsp. P258 the 24-hour lung function profile of once-daily tiotropium and olodaterol fixed-dose combination compared with placebo and monotherapies in chronic obstructive pulmonary disease. Thorax 2014; 69 (Suppl 2): A190-A191.
Buhl R, Maltais F, Abrahams R i wsp. Tiotropium and olodaterol fixed-dose combination versus mono-components in COPD (GOLD 2–4). Eur Respir J 2015; 45: 969-979.
Miravitlles M, Urrutia G, Mathioudakis AG, Ancochea J. Efficacy and safety of tiotropium and olodaterol in COPD: a systematic review and meta-analysis. Respir Res 2017; 18: 196.
Reisner C, St Rose E, Strom S i wsp. Fixed combination of glycopyr­rolate and formoterol MDI (GFF-MDI) demonstrates superior inspiratory capacity (IC) compared to tiotropium DPI (Tio) following 7 days dosing, in a randomized, double-blind, placebo-controlled phase 2b study in patients with COPD. Eur Respir J 2011; 38 (Suppl 55): 879.
Magnussen H, Disse B, Rodriguez-Roisin R i wsp. Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N Engl J Med 2014; 371: 1285-1294.
Pistolesi M, Camiciottoli G, Paoletti M i wsp. Identification of a predominant COPD phenotype in clinical practice. Respir Med 2008; 102: 367e76.
Barnes PJ. Glucocorticosteroids: current and future directions. Br J Pharmacol 2011; 163: 29-43.
Hizawa N. Pharmacogenetics of chronic obstructive pulmonary disease. Pharmacogenomics 2013; 14: 1215-1225.
Rabe KF, Fabbri LM, Israel E i wsp. Effect of ADRB2 polymorphisms on the efficacy of salmeterol and tiotropium in preventing COPD exacerbations: a prespecified substudy of the POET-COPD trial. Lancet Respir Med 2014; 1: 44-53.
Rossi A, Guerriero M, Corrado A i wsp. Withdrawal of inhaled corti­costeroids can be safe in COPD patients at low risk of exacerbation: a real-life study on the appropriateness of treatment in moderate COPD patients (OPTIMO). Respir Res 2014; 15: 77.
Rossi A, van der Molen T, Olmo RD i wsp. INSTEAD: a randomized switch trial of indacaterol versus salmeterol/fluticasone in moderate COPD. Eur Respir J 2014; 44: 1548-1556.
Siva R, Green RH, Brightling CE i wsp. Eosinophilic airway inflam­mation and exacerbations of COPD: a randomised controlled trial. Eur Respir J 2007; 29: 906-913.
Jamieson DB, Matsui EC, Belli A i wsp. Effects of allergic pheno­type on respiratory symptoms and exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 188: 187-192.
Gershon A, Croxford R, Calzavara A i wsp. Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease. JAMA Intern Med 2013; 173: 1175-1185.
Decramer ML, Chapman KR, Dahl R i wsp. Once-daily indacaterol versus tiotropium for patients with severe chronic obstructive pulmonary disease (INVIGORATE): a randomised, blinded, parallel-group study. Lancet Respir Med 2013; 1: 524-533.
Singh D, Brooks J, Hagan G i wsp. Superiority of ‘triple’ therapy with salmeterol/fluticasone propionate and tiotropium bromide versus individual components in moderate to severe COPD. Thorax 2008; 63: 592-598.
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