Updates in Pharmaceutical Therapies for Asthma …...Updates in Pharmaceutical Therapies for Asthma...
Transcript of Updates in Pharmaceutical Therapies for Asthma …...Updates in Pharmaceutical Therapies for Asthma...
Updates in Pharmaceutical Therapies for Asthma Treatment
Dr. Marla M Woods, PharmD, BCPS, CDE, AE-C
Director of Pharmacy Memorial Healthcare
Owosso, MI
Pharmacy Systems Inc
Objective/Outline
• Participants will be able to describe new pharmaceutical entities and delivery products for the treatment of asthma
• Overview of new pharmaceutical therapies
• New delivery products
Vasodilation Bronchoconstriction
Short-Acting β2 Agonists
Onset: 5-15 minutes; Duration: 2-6 hours
Long-Acting β2 Agonists
Onset: 30-50 minutes; Duration: 10-12 hours
Ultra Long Acting Beta Agonist (LABA)
• Carmoterol
• Indacaterol-Arcapta-
• Vilanterol- Breo Ellipta-
• Oldaterol- Striverdi Respimat – (cartridge separate from inhaler)
Ultra Long Acting Beta Agonist (LABA)
• Carmoterol
• Indacaterol-Arcapta- COPD only
• Vilanterol- Breo Ellipta- COPD only
• Oldaterol- Striverdi Respimat – (cartridge separate from inhaler) COPD –chronic bronchitis, emphysema
Inflammation and Autacoids
Inhaled Corticosteroids
•Onset: 4-8 weeks •Products Available:
• *Budesonide (Pulmicort) • *Fluticasone propionate (Flovent) • *Triamcinolone acetate (Azmacort) • *Mometasone (Asmanex) • *Ciclesonide (Alvesco) • Flunisolide (AeroBid) • Beclomethasone dipropionate (QVAR)
New?
• Arnuity Ellipta (fluticasone furoate inhalation powder) Company: GlaxoSmithKline Approval Status: Approved August 2014 Treatment Area: asthma
• General Information
• Arnuity Ellipta contains the active component fluticasone furoate, a synthetic trifluorinated corticosteroid with anti-inflammatory activity
Combinations
• LABA and IHC Combinations: • salmeterol + fluticasone (Advair) • formoterol + budesonide (Symbicort) • Formoterol + mometasone (Dulera) • Vilanterol + fluticasone (Breo Ellipta)
• LA anti-cholinergic and LABA Combination: • Umeclidinium + vilanterol (Anoro Ellipta)
Vasodilation Bronchoconstriction
IgE monoclonal antibody
IgE modulators
• Omalizumab- Xolair- neutralizes IgE in the blood 1-3 injects Q2-4 weeks
• Caused by year round allergens in the air
• Quilizumab- keeps IgE from being produced
• inhalation every 3 months
IgE monoclonal antibody
•Product available • Omalizumab (Xolair)
•Administration • Subcutaneous injection only!
• Dose determined by serum IgE concentrations and body weight.
• 150-375mg given q 2 or 4 weeks.
• Anaphylaxis!
•Cost/dose: $541.25
Omalizumab (Xolair®)
• Clinical Pearls—Cost-effectiveness
Figure from O
ba et al, 2004.
What Now??
Administration of respiratory drugs
Aerosol Dosage Forms
• Site-specific • More drug, fewer side effects
• Quicker effect
• Ban on CFCs → new HFA devices • Benefits
MDIs (Metered Dose Inhalers)
• Most common(?)
• Pressurized canister with metering valve
• Factors to consider: • Inspiratory flow
• Breath holding
• Coordination
• Priming/shaking
• Device cleanliness
Holding Chambers/Spacers • Use with MDI
• Decrease oropharyngeal
deposition and enhance lung
delivery
• Factors to consider: • Inspiratory flow
• Time between actuation and inhalation <5s.
• Required less coordination
• Clean to reduce static
• Holding chamber vs. open ended spacer
DPIs (Dry Powder Inhalers)
• May use a powder-filled capsule that must be punctured, or may have powder contained within device.
• Factors to consider:
• Inspiratory flow (breath actuated)
• Tilt head back
• Maintain parallel to ground once primed
• Humidity
Jet Nebulizers • Produce aerosol from a liquid in a cup, creating
a cloud that is inhaled.
• Factors to consider:
• Inspiratory flow
• Breath holding
• Mouthpiece vs. facemask
• Tapping nebulizer to increase dose
Ultrasonic Nebulizers
• Produce aerosol by vibrating liquid, which is then inhaled.
• Factors to consider:
• Inspiratory flow
• Breath holding
• Mouthpiece vs. facemask
New Technology
• Aeroneb
• OnQ™ Vibrating Mesh Technology
Questions?