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?
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