New Combined Treatment for COPD & Asthma


Vol. 15 •Issue 10 • Page 22
New Combined Treatment for COPD&Asthma

Think of the great teams in action: Abbott and Costello, Batman and Robin, Lois and Clark. With any character missing in action, the team is destined to fail. Drug companies realized “two heads are better than one” when they began to combine two drugs to create more powerful super drugs.

This concept of combo drugs may be especially beneficial in treating patients with asthma and COPD. Combo drugs provide patients with an easier regimen of medications to increase adherence, using a simple philosophy geared on the concept that if patients adhere to a simple medication regimen, they will get better faster and stay better longer.

Gaining popularity in the pediatric asthma market is GlaxoSmithKline’s Advair™ Diskus.® Advair combines two drugs—salmeterol and fluticasone—used for adolescent patients. “Advair is a combination product that is useful in patients that require more than just an inhaled steroid to control their symptoms,” said Joseph Spahn, MD, associate professor of pediatrics in the Health Sciences Center at the University of Colorado and a staff physician in the department of pediatrics at National Jewish Medical and Research Center in Denver.

Advair is not approved for use in children under 12. Its two components (Flovent and Serevent) are approved starting with children four years of age, and studies in younger children are currently being performed.

Late last month, GlaxoSmithKline announced Advair is being widely used to treat COPD, even though the drug is still awaiting final U.S. approval for that use. “Some specialists are using Advair in COPD, and a high percent are getting very good results,” said Jean-Pierre Garnier, CEO of GlaxoSmithKline. Garnier estimated 20Ð30 percent of Advair sales were already accounted for in the treatment of COPD, even though the company is not officially advocating this use.

BENEFITS

Convenience is the primary factor for patients when medication is concerned. “It’s a lot easier to use one inhaler than two,” Spahn said. A patient can get the same medication by using two puffs a day of Advair than with eight puffs a day with two other inhalers. “Advair is one inhaler with fewer puffs,” he noted.

For asthmatics, one of the benefits of the combo drugs is the adherence with inhaled steroid components will probably go up. “Patients underutilize their inhaled steroids because they do not perceive a real benefit,” Spahn said.

Patients are more likely to take a medication if they feel better and notice a difference after taking it. “Patients are more prone to use a beta agonist rather than an inhaled steroid,” Spahn said. “If a medication combines a inhaled steroid with the long-acting beta-agonists, every time patients take the drug, they will get their inhaled steroid, he added.

COPD COMBOS

“Combination drugs are also used in COPD. Among the combo drugs being used by COPDers is Combivent® Metered-Dose Inhaler (ipratropium bromide and albuterol sulfate), manufactured by Boehringer Ingleheim,” said Barry Make, MD, director of the Emphysema Center at the National Jewish Medical Research Center and professor of medicine at the University of Colorado School of Medicine.

The principal behind combo drugs is that when the combinations of these agents work well together, using lower doses may avoid side effects from using high doses of a single agent. In addition, the combination often yields greater effectiveness than one drug working alone. “We use a lot of these agents together, at the same time, in the same patient,” Make said, “But they are not all commercially available as combinations. For example, we use long-acting beta agonists and anticholinergics at the same time, but they are not available as a combination.” The only FDA-approved combination drug for COPD is ipratropium and albuterol, which is available both as a metered-dose inhaler and an aerosol solution.

ISSUES

With every single drug on the market, there are pros and cons involved in their use. The same is true for combo drugs where the medication doses are uniform. “A fixed combination does not allow clinicians to add or subtract individual components,” Make said. This fact along might benefit certain patient populations.

Combo drugs may also work to limit the number of medications a patient takes because the combo drug is confined to one package. “It is easier for a patient to take one drug that is a mixture of two, rather than to take two separate drugs,” Make said. It all boils down to patient adherence. “If it is an advantage for the patient to take one compared to two different drugs at the same time, it may improve adherence and compliance,” he said.

Adherence is a big issue for everyone taking a medication.

Another advantage for patients is the cost. “It may be cheaper for the patient to take one drug rather than two,” Make said. Packaging one drug instead of two saves money.

One major disadvantage of using combo drugs for treating COPDers is the limited number of drugs available in the first place.

Combo drugs are not new by any means. “Twenty years ago there were a lot of combination drugs,” Make said.

Caroline Crispino can be reached at ccrispino@merion.com

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