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. http://bit.ly/StieC

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 (http://goo.gl/3RJyu).

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 http://bit.ly/8behH

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 http://bit.ly/StieC

QVA149 is an inhaled fixed dose combination of NVA237 (LAMA) and indacaterol (LABA) for the treatment of COPD http://bit.ly/1M92hI

References:


Anticholinergic (Tiotropium) Plus a Low-Dose Glucocorticoid May Effectively Control Asthma http://goo.gl/OGEr
QVA149 (LABA plus LAMA) demonstrates superior bronchodilation compared with indacaterol in COPD - Thorax http://goo.gl/OHSW0
The Risks and Benefits of Indacaterol - NEJM review and 16-min podcast. NEJM, 2011.

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