US study names COPD therapy Anoro Elipta top choice for new patients
Once-daily dry powder inhaler worked better than 2 alternatives at reducing flares
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For people with chronic obstructive pulmonary disease (COPD), characterized by cough and shortness of breath, Anoro Elipta (umeclidinium-vilanterol) may work better than other approved COPD medications at reducing the risk of disease flares.
That’s according to a new federally funded study that used U.S. insurance data to compare treatment outcomes among thousands of COPD patients nationwide.
The researchers found that Anoro Elipta is generally better than Bevespi Aerosphere (glycopyrrolate-formoterol) or Stiolto Respimat (tiotropium-olodaterol) at lowering flare risk among people with COPD. The team examined outcomes from patients newly treated with LAMA-LABA inhalers, a class of COPD-approved treatments that includes these three medications.
“This cohort study found that [Anoro Elipta] was associated with improved clinical outcomes compared with [Bevespi Aerosphere] and [Stiolto Respimat],” the researchers wrote.
As a key point, the team added: “Patients, prescribers, and health systems may consider once-daily [Anoro Elipta] dry powder inhalers over alternatives among new users of LAMA-LABA therapy.”
The study, “Comparative Effectiveness and Safety of LAMA-LABA Inhalers in Chronic Obstructive Pulmonary Disease,” was published in the journal JAMA Internal Medicine. The work was funded by a grant from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.
LAMA-LABA inhalers contain a combination of two types of medications that promote airway widening in the lungs: long-acting muscarinic antagonists (LAMAs) and long-acting beta2-agonists (LABAs).
Anoro Elipta, Bevespi Aerosphere, and Stiolto Respimat are three LAMA-LABA inhalers approved for the long-term maintenance treatment of COPD. Although they work through the same basic mechanisms, there are important differences. Most notably, although all are inhaled, the specific devices used to administer each therapy differ.
‘Largest real-world study’ to compare COPD treatments
GlaxoSmithKline’s Anoro Elipta is administered once daily via a dry powder inhaler. Meanwhile, Boehringer Ingelheim’s Stiolto Respimat is taken once daily via a soft mist inhaler, and AstraZeneca’s Bevespi Aerosphere is administered twice daily using a metered-dose inhaler.
“Despite the push for wider adoption of dry powder and soft mist inhalers to mitigate the effects of climate change, scant large-scale data are available directly comparing LAMA-LABA inhalers to one another,” the researchers wrote.
To address this knowledge gap, a team of scientists used information compiled through U.S. insurance databases to compare the effectiveness of these three therapies in people with COPD. The team identified thousands of COPD patients who started using each of three therapies, then carefully matched individuals with similar characteristics to compare outcomes.
“The current study, to our knowledge, is the largest real-world study to date testing for potential [within-class] differences among LAMA-LABAs,” the researchers wrote.
A total of 9,479 patient pairs were involved in the Anoro Elipta versus Bevespi Aerosphere analysis. The Stiolto Respimat versus Bevespi Aerosphere analysis involved 9,598 pairs of patients. The Anoro Elipta versus Stiolto Respimat analysis was by far the largest, involving 36,740 patient pairs.
The researchers specifically focused on how well each therapy was able to prevent moderate or severe COPD exacerbations, which are episodes when lung symptoms suddenly worsen. Follow-up data for up to one year showed that Anoro Elipta was generally better than either of the other two medicines at reducing the risk of COPD exacerbations.
Specifically, Anoro Elipta was significantly linked to a 14% lower risk of first moderate or severe COPD exacerbation compared with Bevespi Aerosphere and a 3% lower chance relative to Stiolto Respimat. The risk of first moderate or severe COPD exacerbation was 6% lower with Stiolto Respimat than with Bevespi Aerosphere; with the differences reaching the borderline of statistical significance.
Similar findings were obtained when the team looked at the annual rate of moderate to severe COPD exacerbations. Subgroup analyses showed that Anoro Elipta performed better than Bevespi Aerosphere regardless of disease severity at study’s start. It also worked better in patients with co-occurring asthma.
Safety findings showed no notable differences between the three therapies.
Researchers: Once-daily Anoro Elipta is easiest of 3 inhalers to use
The researchers postulated that one potential explanation for Bevespi Aerosphere’s poor performance is that it must be taken twice daily, whereas the other two therapies are once-daily meds. The need for more frequent doses may lead more patients to accidentally miss doses needed for the therapy to be maximally effective.
Differences in administration also might explain the better performance of Anoro Elipta relative to Stiolto Respimat. The team said Anoro Elipta’s dry powder inhaler is generally simpler to use than other types of inhalers, which could mean more patients are taking their medications correctly and getting the maximum possible benefit from treatment.
This study found that once-daily [Anoro Elipta] dry powder inhalers were associated with lower risk of moderate or severe COPD exacerbations compared with twice-daily [Bevespi Aerosphere] metered-dosed inhalers and once-daily [Stiolto Respimat] soft mist inhalers in patients with COPD treated in routine clinical practice.
In addition to being more effective, the researchers also highlighted that Anoro Elipta’s dry powder inhaler is more environmentally friendly than other devices, as it doesn’t use propellant gases that can also act as powerful greenhouse gases.
Despite these findings, the scientists emphasized that Anoro Elipta won’t be the right choice for everyone with COPD. As one example, people who have trouble taking a deep breath may struggle to use the dry powder inhaler and may benefit more from other devices.
Still, it was the most effective, the team noted.
“This study found that once-daily [Anoro Elipta] dry powder inhalers were associated with lower risk of moderate or severe COPD exacerbations compared with twice-daily [Bevespi Aerosphere] metered-dosed inhalers and once-daily [Stiolto Respimat] soft mist inhalers in patients with COPD treated in routine clinical practice,” the researchers wrote.
Further, the therapy may appeal on environmental grounds.
“Patients, prescribers, payers, and health systems seeking to reduce greenhouse gas emissions may favor the once-daily [Anoro Elipta] dry powder inhaler over other LAMA-LABA inhalers for new users without compromising clinical outcomes,” the team wrote.
