Once-daily ICS-LABA-LAMA superior to ICS-LABA in improving lung function, research suggests

A study in The Lancet Respiratory Medicine indicates that a single-inhaler combination of inhaled corticosteroid, long-acting β2-adrenoceptor agonist, and long-acting muscarinic receptor antagonist works well to improve lung function in patients with asthma.

Woman using an asthma inhaler

A once-daily, single-inhaler combination of inhaled corticosteroid (ICS), long-acting β2-adrenoceptor agonist (LABA), and long-acting muscarinic receptor antagonist (LAMA) was superior to ICS–LABA in improving lung function in patients with inadequately controlled asthma, a study funded by Novartis has suggested[1]
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The researchers included 3,092 patients aged 18–75 years with symptomatic asthma despite treatment with medium-dose or high-dose ICS–LABA, at least one exacerbation in the previous year, and a percentage of predicted FEV1 of less than 80%.

Participants were randomised to receive one year of medium or high-dose mometasone–indacaterol–glycopyrronium (MF–IND–GLY) or mometasone–indacaterol (MF–IND) once daily, or twice daily fluticasone–salmeterol (FLU–SAL), a well-established ICS–LABA combination.

At week 26, the researchers found that medium and high-dose MF–IND–GLY showed superior improvement in trough FEV1, the mean volume of air that can be forced out in one second after taking a deep breath immediately before the next dose of study drug, compared with the corresponding doses of MF–IND. Medium and high-dose MF–IND–GLY also led to a greater improvement in trough FEV1 compared with high-dose FLU–SAL. Incidence of adverse events was balanced across the treatment groups.

In The Lancet Respiratory Medicine, the researchers said that the combination of ICS–LABA–LAMA containing a medium dose of ICS had the potential to offer similar or better disease control than ICS–LABA combinations containing high ICS doses.

“A once-daily dosage regimen and administration via a single inhaler might improve treatment adherence and, ultimately, asthma control in a real-world setting,” they added.

References

[1] Kerstjens H, Maspero J, Chapman K et al. Once-daily, single-inhaler mometasone–indacaterol–glycopyrronium versus mometasone–indacaterol or twice-daily fluticasone–salmeterol in patients with inadequately controlled asthma (IRIDIUM): a randomised, double-blind, controlled phase 3 study. Lancet Respir Med 2020. doi: 10.1016/S2213-2600(20)30190-9

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Citation
The Pharmaceutical Journal, PJ August 2020, Vol 305, No 7940;305(7940):DOI:10.1211/PJ.2020.20208267