Efficacy and safety of LABA/LAMA fixed-dose combinations approved in the US for the management of COPD.

Introduction: Long-acting beta(2)- agonists [LABAs] and long-acting muscarinic antagonists [LAMAs]) are primary therapies for chronic obstructive pulmonary disease (COPD). Despite improvements in lung function and patient-reported outcomes (PROs) with these therapies, there is room to optimize outcomes further. Combined use of LABAs and LAMAs is recommended when symptoms are not improved with a single agent, and LABA/LAMA fixed-dose combinations (FDCs) are at the forefront of drug development in COPD. Areas covered: This review focusses on the three LABA/LAMA FDCs (indacaterol/glycopyrrolate(1) [IND/ GLY] 27.5/ 15.6 mu g twice daily, umeclidinium/ vilanterol [UMEC/ VI] 62.5/ 25 mu g once daily and tiotropium/ olodaterol [Tio/ Olo] 5/ 5 mu g once daily approved in the US. Phase III clinical trials have shown benefits in lung function, dyspnea and health status with FDCs of IND/ GLY, UMEC/ VI and Tio/ Olo versus placebo and monotherapies. Expert commentary: Data from recent studies of three LABA/LAMA combinations, reviewed here, indicate that dual bronchodilation may be beneficial above and beyond both the monotherapies and LABA/ICS combinations, in providing improvements in lung function and PROs for patients with COPD, which may encourage a shift away from the use of ICS in COPD management, in particular for non-exacerbating patients.