Profile of inhaled glycopyrronium bromide as monotherapy and in fixed-dose combination with indacaterol maleate for the treatment of COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. The cornerstone of pharmacological treatment for COPD is bronchodilation. Inhaled glycopyrronium bromide is a long-acting muscarinic antagonist developed as a maintenance treatment for patients with COPD. Phase III trials have shown that glycopyrronium produces rapid and sustained bronchodilation with an efficacy similar to tiotropium and is well tolerated, with a low incidence of muscarinic side effects in patients with moderate to severe COPD. A combination of glycopyrronium bromide with indacaterol maleate (QVA149) has recently been approved as a once-daily maintenance therapy in adult patients with COPD. Phase III trials (the IGNITE program) with QVA149 have demonstrated significant improvements in lung function versus placebo, glycopyrronium, and tiotropium in patients with moderate to severe COPD, with no safety concerns of note. Hence QVA149 is a safe treatment option for moderate to severe COPD patients in whom long-acting muscarinic antagonist monotherapy is inadequate.

Keywords:

• chronic obstructive pulmonary disease
• glycopyrronium bromide
• indacaterol maleate
• umeclidinium
• QVA149
• long-acting muscarinic antagonist

Author contributions

AP and JBM conceived the review and its content, including all interpretation of the studies described, based on discussions in September 2013. KSB reviewed and commented on the first draft and approved the final version. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

Aidan McManus and Ana Martins-Kaczor from Edge Medical Communications assisted JBM to write a first draft of the manuscript and provided subsequent editorial support as directed by JBM. This editorial assistance was funded by Novartis UK, which reviewed the manuscript for medical accuracy but not content. KSB has received honoraria for speaking and financial support to attend meetings held by Wyeth, Chiesi, and AstraZeneca. JBM has received honoraria for speaking and financial support to attend meetings/advisory boards organized by Wyeth, Chiesi, Pfizer, MSD, Boehringer Ingelheim, Teva, GSK/Allen and Hanburys, Napp, Almirall, AstraZeneca, and Novartis. AP reports no conflicts of interest in this work.