Dreifachfixkombinationen (LAMA/LABA/ICS) zur inhalativen Dauertherapie der schwergradigen COPD

Zusammenfassung

COPD (chronic obstructive pulmonary disease) ist durch eine persistierende Atemwegsobstruktion charakterisiert, die durch eine meist jahrzehntelange Exposition gegenüber inhalativen Noxen wie Zigarettenrauch, Stäuben oder Gasen hervorgerufen wird. Langwirksame Beta-2-Mimetika und langwirksame Anticholinergika (LABA/LAMA), getrennt oder in einem Inhalationsdevice, sind gegenwärtig die wichtigste Grundlage in der COPD-Therapie. LABA/ICS- (inhalatives Kortikosteroid) Kombinationen haben ihren Stellenwert im Rahmen der Eskalation v. a. bei Patienten mit ≥ 2 Exazerbationen/Jahr. Neuere Studien zu Dreifachfixkombinationen, die entweder Fluticason/Vilanterol/Umeclidinium oder Beclometason/Formoterol/Glycopyrronium enthalten, haben unser Wissen zur ICS-basierten Therapie der COPD erweitert. Die inhalativen Triple-Therapien reduzierten im Vergleich zu LABA/ICS, zur LAMA-Monotherapie und zur LABA/LAMA-Kombination signifikant sowohl die Exazerbationsrate, als auch die Dyspnoe und verbesserten die Lungenfunktion (FEV1) sowie die Lebensqualität. Ende 2017 wurde eine Kombination aus Beclometason/Formoterol/Glycopyrronium und Anfang 2018 eine Kombination aus Fluticasonfuroat/Umeclidinium/Vilanterol als fixe Triple-Präparate für die inhalative COPD-Therapie zugelassen. Die Domäne für die LABA/LAMA/ICS-Kombinationen ist die schwere COPD der Gruppen C + D.

Abstract

COPD (chronic obstructive pulmonary disease) is characterised by persistent airflow obstruction caused by exposure to irritants including cigarette smoke dust, and fumes. Long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) in fixed-dose combination inhalers are the pillars of modern COPD therapy. LABA/inhaled corticosteroids (ICS) inhalers have been proved to be particularly efficient in patients with ≥ 2 exacerbations per year. Until recently, although recommended in guidelines for severe and unstable COPD patients, the clinical usefulness of the LABA/LAMA/ICS combination was a matter of debate. Recent trials with fixed-dose combination inhalers containing fluticasonfuroate/vilanterol/umeclidinium or beclometasone/formoterol/glycopyrronium significantly reduced exacerbation rates and dyspnea scores and improved lung function as well as quality of life better than the LABA/ICS, LABA/LAMA comparators or the single compounds in selected COPD trial patients. Beclometasone/formoterol/glycolpyrronium and fluticasonfuroate/umeclidinium/vilanterol are the first triple combination therapies approved in a fixed-dose inhaler for COPD patients. The domains of triple fixed-dose formulations are COPD patients in groups C and D.

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