NPS MedicineWise has published a new edition of RADAR, including a review of glycopyrronium (Seebri Breezhaler), a new medicine for the treatment of chronic obstructive pulmonary disease (COPD).
The publication provides information for health professionals to put the new once-daily long-acting anticholinergic bronchodilator into clinical context.
This independent review of glycopyrronium shows that the medicine offers a long-acting effect over 24 hours with a rapid onset of action, within five minutes of inhalation. It has a comparable activity profile and rate of adverse events to the other currently listed product in the class, tiotropium. Administration requires the use of the Breezhaler inhaler device.
The RADAR review explains that improvements in lung function and symptom control with glycopyrronium treatment vary between patients. Prescribers should choose a maintenance therapy that provides the best relief of symptoms. As an anticholinergic, use this medicine with caution in people with risk factors for angle-closure glaucoma or prostatic symptoms.
Efficacy and safety of glycopyrronium 50 micrograms once daily have been demonstrated in three multicentre, randomised, double blind placebo-controlled trials, but the review highlights that the long-term clinical side effects of glycopyrronium are unknown, as there are no data beyond use for 64 weeks.
Prescribers are advised to instruct patients in the correct use of the inhaler device before prescribing and ensure correct technique is being followed during follow up appointments. Glycopyrronium is not indicated for the initial treatment of acute exacerbations of COPD.
A corresponding issue of Medicine Update has also been published for consumers about this medicine. Health professionals are encouraged to download and share this with patients who are taking or are thinking about taking glycopyrronium. This consumer-friendly information is available for download from the NPS website at www.nps.org.au/medicine-update.
The latest issue of RADAR also includes an In Brief article which details four new fixed-dose combination therapies of metformin and gliptin listed on the PBS for patients with type 2 diabetes:
metformin with alogliptin (Nesina Met);
metformin XR with saxagliptin (Kombiglyze XR);
linagliptin with metformin (Trajentamet); and metformin XR; and
sitagliptin (Janument XR).
All four products are listed as Authority Required (STREAMLINED) benefit for treatment of patients whose HbA1c is greater than 7% before starting gliptin therapy, despite treatment with metformin. As with the other PBS-listed gliptins these can now be prescribed for second line treatment in patients whose diabetes remains poorly controlled despite life-style intervention and treatment with metformin or a sulfonylurea.