Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Ther Clin Risk Manag. 2013;9:341-53. doi: 10.2147/TCRM.S30317. Epub 2013 Aug 19.
Progressive airflow limitation is a hallmark feature of chronic obstructive pulmonary disease (COPD) that ultimately leads to breathlessness, impaired quality of life, and reduced exercise capacity. Pharmacotherapy is used in patients with COPD to prevent and control symptoms, reduce both the frequency and severity of exacerbations, improve health status, and increase exercise tolerance. These strategies are intended to address management issues which promote both current disease control and a reduction in the risk of disease deterioration in the future. At the present time, long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are available for maintenance therapy in patients with persistent symptoms. Tiotropium was the first LAMA to be approved for management of COPD, and many studies have described its beneficial effects on multiple clinically relevant outcomes. Glycopyrronium bromide (NVA237), a new LAMA, has been developed and received regulatory approval for management of COPD in a number of countries around the world. Results from pivotal Phase III trials suggest that NVA237 is safe and well tolerated in patients with moderate to severe COPD, and provides rapid and sustained improvements in lung function. Further, these changes are associated with statistically and clinically meaningful improvements in dyspnea, health-related quality of life, and exercise tolerance. Treatment with NVA237 also results in a significant reduction in risk of exacerbations and the need for rescue medication, and has been comparable with tiotropium with respect to safety and efficacy outcomes. Finally, emerging data indicate that NVA237 is efficacious both as monotherapy and in combination with indacaterol.
渐进性气流受限是慢性阻塞性肺疾病（COPD）的一个显著特征，最终导致呼吸困难、生活质量受损和运动能力下降。在 COPD 患者中，药物治疗用于预防和控制症状，减少恶化的频率和严重程度，改善健康状况，并提高运动耐量。这些策略旨在解决管理问题，既促进当前疾病控制，又降低未来疾病恶化的风险。目前，长效β2-激动剂（LABAs）和长效抗胆碱能拮抗剂（LAMAs）可用于持续症状患者的维持治疗。噻托溴铵是第一个被批准用于 COPD 管理的 LAMA，许多研究描述了它对多种临床相关结局的有益影响。溴化 Glycopyrronium（NVA237），一种新的 LAMA，已被开发并在世界许多国家获得监管批准用于 COPD 的管理。关键的 III 期试验结果表明，NVA237 在中重度 COPD 患者中安全且耐受良好，可迅速持续改善肺功能。此外，这些变化与呼吸困难、健康相关生活质量和运动耐量的统计学和临床意义上的改善相关。NVA237 治疗还可显著降低恶化风险和需要抢救药物的风险，并且在安全性和疗效方面与噻托溴铵相当。最后，新出现的数据表明，NVA237 作为单药治疗和与茚达特罗联合治疗均有效。
