LABA plus LAMA combination products for COPD and asthma

COPD is a large and fast expanding market estimated to be worth $6 billion (2007) and expected to double by 2011. The LAMA tiotropium (Spiriva) recorded sales of $2.77 billion in 2008.

Once-daily beta2-agonists or ultra long-acting beta2-agonists (LABAs) are under development for asthma and COPD.
Ultra-LABAs include carmoterol, indacaterol, and several GSK molecules that are under development for treatment of asthma and COPD. Arcapta Neohaler (indacaterol) is the only once-daily ultra-LABA approved for COPD maintenance (

New long-acting antimuscarinic agents (LAMAs): aclidinium, LAS-35201, 2 GSK products, NVA-237 (glycopyrrolate), and OrM3.

Several options for once-daily dual-action ultra LABA plus LAMA combination products are currently being evaluated.
Dimer molecule in which both LABA and LAMA are present is called M3 antagonist-beta2 agonist (MABA) bronchodilators

NVA237 is an anti-muscarinic agent glycopyrronium bromide which is currently registered for IV use during surgery. Dry-powder inhaler device with NVA237 produced a bronchodilation that was maintained for at least 32 hour. NVA237 demonstrated a 24-hour bronchodilation efficacy comparable to tiotropium and potentially faster onset of action

QVA149 is an inhaled fixed dose combination of NVA237 (LAMA) and indacaterol (LABA) for the treatment of COPD


Anticholinergic (Tiotropium) Plus a Low-Dose Glucocorticoid May Effectively Control Asthma
QVA149 (LABA plus LAMA) demonstrates superior bronchodilation compared with indacaterol in COPD - Thorax
The Risks and Benefits of Indacaterol - NEJM review and 16-min podcast. NEJM, 2011.

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