Incruse® is a new inhalation product of the type of long-acting muscarinic antagonists (LAMA) approved for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). The treatment is given once daily, and the registered dose is 55 micrograms (µg) of umeclidinium per 24 hours.
Compared to placebo, Incruse® has demonstrated statistically significant and clinically meaningful improvements in lung function, dyspnoea and quality of life (1). In randomised studies, Incruse® has been established to be comparable to two other LAMA inhalation agents. Compared to other LAMA inhalation agents, umeclidinium is assessed to have comparable efficacy (2) and adverse reactions (1).
Incruse® is supplied in the same inhaler device (Ellipta) as Anoro® and Relvar®, which have previously been reviewed by IRF (3,4). Anoro® combines umeclidinium and the long-acting beta 2 agonist (LABA) vilanterol (LAMA+LABA). Relvar® combines the inhaled corticosteroid fluticasone furoate and vilanterol (ICS+LABA).
It is IRF's overall assessment that the effect of Incruse® is comparable to other LAMAs, but that the experience base of older LAMA products, tiotropium primarily (5), is significantly greater. Since there is presumably a class effect within the group of LAMA products, the choice of treatment should be based on experience, device manageability as well as price. Incruse® may be relevant for patients in triple treatment (ICS/LAMA/LABA) in which it is considered appropriate to use as few devices as possible. Today, the price of Incruse® is comparable to the other LAMA products (Table 3).
1. EPAR Incruse: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/002809/WC500167431.pdf
2. Comparative efficacy of long-acting muscarinic antagonist monotherapies in COPD: a systematic review and network meta-analysis. Ismaila AS, Huisman EL, Punekar YS, Karabis A. Int J Chron Obstruct Pulmon Dis. 2015 Nov 16;10:2495-517.
3. IRF’s præparatanmeldelser af Anoro, 28/1-2015: http://www.irf.dk/dk/anmeldelser/praeparatanmeldelser/anoro-umeclidinium-vilanterol.htm
4. IRF’s præparatanmeldelser af Relvar, 11/7-2014: http://www.irf.dk/dk/anmeldelser/praeparatanmeldelser/arkiv/relvar_ellipta_fluticasonfuroatvilanterol.htm
5. Tiotropium versus placebo for chronic obstructive pulmonary disease. Karner C, Chong J, Poole P.Cochrane Database Syst Rev. 2014 Jul 21;7:CD009285.