Abstract
In the article, we describe the pathophysiological basis for synergistic effect of beta2-mimetics and anticholinergics together with the results of clinical studies evaluating the effectiveness of the two medication groups, both short- and long-acting. The dual combination of ultra-long acting beta2-mimetic indacaterol and a new anticholinergic glycopyrronium bromide is being referred to QVA 149 so far (registered as Ultibro Breezhaler).
This combination was evaluated from many aspects in 4 studies published in the past 2 years. In the SHINE study, the effectiveness of the combination was compared (trough FEV1) with that of its individual components used in monotherapy, of tiotropium, and of placebo; in the ILLUMINATE study, the above combination was compared with ICS/LABA (with respect to both effectiveness and safety).
The main aim of the SPARK study was to demonstrate the ability of QVA149 to lower the rate of exacerbations compared with glycopyrronium or tiotropium monotherapy while in the BEACON study, the authors aimed to compare the effectiveness and safety profiles of QVA 149 applied once daily with those of the concurrent administration of its monocomponents using Breezhaler. This article comments on the results of the above studies, on the role of QVA 149 in the treatment of stabile COPD, and on the significance of once-daily application of the medication for the compliance of patients with therapy.