LAMA (long-acting muscarinic antagonist) treatments may be more beneficial to people with stable chronic obstructive pulmonary disease (COPD) than those with LABA (long-acting beta2-agonist), especially in patients at risk of frequent exacerbations, according to results of a recent review study.
Both LAMA and LABA are long-lasting bronchodilators, widely used as first-line treatments to improve lung function and ease symptoms in patients with stable COPD.
The review, titled “Long-acting beta2-agonists versus long-acting muscarinic antagonists in patients with stable COPD: A systematic review and meta-analysis of randomized controlled trials,” was published in the journal Respirology.
Treatments for COPD include long-acting bronchodilators, that is, drugs that dilate and relax the bronchi tissue to ease the flow of air in the lungs. LAMA medications include tiotropium, glycopyrronium, aclidinium and umeclidinium, whereas LABA includes formoterol, salmeterol, indacaterol and olodaterol.
“[A]ccording to the 2017 revised Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, a single LAMA or LABA is still recommended as the first or alternative choice of therapy in group A and B COPD patients,” researchers wrote. “However, given the increased number of new treatment options, the initial choice of agent remains under debate.”
The study compared the efficacy and safety of LAMA and LABA in patients with stable COPD. To do so, researchers analyzed data from 16 previous clinical trials investigating these treatments in 22,872 patients. Data included several patient outcomes, such as forced expiratory volume in 1 second (FEV1; a measure of lung function), acute exacerbations, transitional dyspnea index (TDI) score, St George’s Respiratory Questionnaire (SGRQ) score, and adverse events.
Results showed that patients treated with LAMA drugs were 84 percent less likely to have acute exacerbations and 92 percent less likely to experience side effects, compared to those on LABA therapy.
Other outcome measures, such as trough FEV1, TDI and SGRQ scores were not found to be different between LAMA or LABA therapies.
“In conclusion, our meta-analysis suggests that LAMA are associated with a lower risk of acute exacerbations and lower incidence of adverse events compared with LABA,” the researchers wrote. “There were no significant differences between LAMA and LABA in terms of lung function, symptom score and health status. These findings indicate that LAMA may be preferable to LABA in patients with stable COPD, especially in those at risk or frequent exacerbations.”