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?