Umeclidinio/vilanterolo nel trattamento farmacologico della BPCO.

A solid pharmacological rationale, a documented strong synergism of action on the human airway in vitro, and excellent clinical efficacy revealed by randomized controlled trials and real-world observational studies support the use of umeclidinium (UMEC)/vilanterol (VIL) combination in a single inhaler (Ellipta) in the treatment of chronic obstructive pulmonary disease (COPD). Robust evidence indicates that it is consistently more effective than UMEC or VIL alone in improving lung function, dyspnoea, and quality of life. There is also a signal, albeit not a very strong one, indicating the ability of UMEC/VIL to prevent or reduce the risk of COPD exacerbations. Several mechanisms explain why this combination may decrease the frequency of COPD exacerbations. Both UMEC and VIL, like all drugs that antagonise muscarinic receptors or stimulate β2-adrenergic receptors, have the potential to impact cardiac activity. However, UMEC/VIL combination has an acceptable cardiovascular safety profile, at least in the COPD population enrolled in randomized controlled trials. It has even been reported that it may exert a protective role against serious cardiovascular adverse events compared to its mono-components. Unfortunately, there are very few head-to-head studies comparing UMEC/VIL and the other LAMA/LABA combinations, but the available data seem to suggest that it should be understood as the most effective LAMA/LABA combination currently available. [ABSTRACT FROM AUTHOR]