Benefits reported for formoterol over ipratropium in
COPD
The long acting beta2-agonist formoterol
is more effective than ipratropium in the treatment of chronic obstructive
pulmonary disease (COPD), a head-to-head study has shown.
Dr Ronald Dahl of University Hospital Aarhus, Denmark,
and colleagues (on behalf of the Formoterol in Chronic Obstructive Pulmonary
Disease Study Group) compared the two therapies in a placebo-controlled
trial. They found that although both formoterol and ipratropium were better
than placebo at increasing lung function, the bronchodilator effect of
formoterol was greater than that seen with ipratropium.
“The improvement in pulmonary function by formoterol
was associated with reductions in daily symptoms, use of rescue medication
and frequency of bad days, whereas ipratropium had no significant effect
on these parameters,” they say.
The researchers randomised 780 patients with COPD
to receive formoterol dry powder inhalation 12 or 24µg twice daily, ipratropium
bromide 40µg four times daily, or placebo. Patients on stable inhaled
corticosteroid treatment were allowed to remain on that treatment throughout
the trial.
After 12 weeks of treatment, the researchers found
that the primary efficacy measure (the area under the curve for forced
expiratory volume exhaled in 1 second following the morning dose of study
medicine) was superior for both formoterol 12 and 24µg and for ipratropium
40µg compared with placebo (P<0.001 for all three comparisons).
In addition, patients who received formoterol therapy showed significant
improvements over those who received ipratropium for this measure (P=0.001
for 12µg formoterol). The researchers found that the bronchodilator effect
of formoterol did not diminish during the treatment period and note that
the drug gave better 24-hour coverage than ipratropium, despite being
given only twice a day.
The researchers conclude: “The twice-daily dosing
schedule of formoterol, its fast onset of action, and the perception of
benefit by the patients should enhance compliance and minimise the possibility
of overdosage.” They add that this observation indicates that formoterol
12 or 24µg twice daily could be used as the first-line therapy for stable,
symptomatic COPD.
The study is published in the American Journal
of Respiratory and Critical Care Medicine (2001;164:778).
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