Tiotropium/Olodaterol: A Review in COPD

This article reviews the efficacy of a new inhaler for COPD (chronic obstructive pulmonary disease) that was approved by the FDA in May 2015 and has since been out on the market. This new inhaler is named Stiolto Respimat (tiotropium/olodaterol), and it was developed by the company Boehringer Ingelheim.

For a quick review, COPD is an overarching term that describes a group of diseases that affect the lungs. People with COPD have difficulty breathing and receiving necessary airflow through their lungs. Patients who receive treatment for COPD typically use long-acting inhalers that are used to improve their chronic state of limited breathing along with “rescue” inhalers that are used to treat acute asthma attacks as needed. Some examples of common, long-acting inhalers already on the market are Advair and Symbicort, and some examples of commonly used “rescue” inhalers already on the market are albuterol inhalers sold under the brand names of Ventolin, ProAir, and Proventil.

Stiolto Respimat is a long-acting inhaler that is a combination of 2 drugs used to treat respiratory problems, which are tiotropium and olodaterol. Tiotropium (bromide) is a long-acting antimuscarinic agent (LAMA), so it works by blocking muscarinic acetylcholine receptors to dilate the bronchioles. Olodaterol is the new drug in this inhaler that has allowed Boehringer Ingelheim to patent and manufacture Stiolto Respimat. Olodaterol is an ultra long-acting beta 2-adrenoreceptor agonist (LABA) that works on beta 2 receptors in the lungs to dilate the bronchioles.

 

This article reviewed clinical trial data and compared Stiolto Respimat to the commonly used inhaler, Advair (fluticasone/salmeterol), that is also a long-acting inhaler for the treatment of COPD. The article determined that Stiolto Respimat seems to be a relatively safe inhaler that has minimal side effects when used correctly and does not have any adverse cardiovascular side effects. It was found to work more efficiently than Advair over a 24 hour period for bronchodilation and lung functioning. The article determined that the combination of tiotropium and olodaterol was more effective when used in combination compared to using the two drug components monotherapeutically. This inhaler can be used once daily, which is convenient in comparison to other long-acting inhalers that must be administered twice daily. Stiolto Respimat was also found to increase exercise capacity in COPD patients and the amount of gas they can inhale into their lungs.

In conclusion, this article has shed a positive light on Stiolto Respimat as it makes it way into the medical world through the new few years. It seems to be a great addition to current therapies for COPD, and could be a good alternative to COPD patients who are allergic to drugs in some of the other inhalers. I find it interesting how drug developers have combined drugs with different mechanism of actions in inhalers to maximize the efficacy of inhaled therapies. These newer combination therapies have been very popular in the treatment of COPD since they came out a few years ago (I’m thinking of inhalers such as Advair, Symbicort, and Ventolin). I am thinking that I want to become a community pharmacist, so I am interested in learning more about the treatment options for COPD and all of the side effects that come with these treatments.

My question posed to colleagues: How are the mechanism of action between Advair (fluticasone/salmeterol) and Stiolto Respimat (tiotropium/olodaterol) different?

Dhillon, S. Tiotropium/olodaterol: A review in COPD. Drugs. 2016;76:135-146.

 

2 thoughts on “Tiotropium/Olodaterol: A Review in COPD”

  1. Interesting article, thanks for posting! As you mentioned, Advair must be used twice daily whereas Stiolto is used once daily, which would likely improve patient adherence, and I believe this may be the first long-acting inhaler that combines two bronchodilators (most include a long-acting bronchodilator and an inhaled steroid). Because the active ingredients in Advair and Stiolto include medications in different classes, they target different pathophysiological processes of COPD. Do you think this would affect patients’ long-term outcomes? It will be interesting to see how this medication plays out in practice. Perhaps we will start seeing development of three-drug inhalers that include two bronchodilators and an inhaled steroid!

    1. I think that Stiolto having 2 bronchodilators will improve patients’ long-term outcomes because it will hopefully target the faulty mechanisms in COPD patients’ lungs more effectively than an inhaler that has 1 steroid and 1 bronchodilator. Steroids act to reduce inflammation and mucus production in the lungs, but not all COPD patients need to be taking a steroid because they might not have excessive swelling and mucus production. Instead, the 2 bronchodilators in Stiolto will work by different mechanisms to open up the airways in COPD patients and allow their lungs to work more effectively. I would think that the second bronchodilator in Stiolto will make patients’ airways open better than an inhaler that has just 1 bronchodilator over the long-term. Like you said, maybe there will be inhalers that incorporate 2 bronchodilators and 1 steroid developed in upcoming years. This type of inhaler would be great for COPD patients who need the steroid to reduce swelling and mucus production in their lungs and who also need a powerful combination of 2 bronchodilators to really open up their airways. It will be interesting to see if Stiolto becomes a great innovation for COPD treatment. Thanks for commenting on my post!

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