Spiolto Respimat® (tiotropium/olodaterol)
Spiolto Respimat® (tiotropium/olodaterol) combines a long-acting muscarinic antagonist (LAMA) with a long-acting beta agonist (LABA) and is approved for maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). The LAMA component, tiotropium (Spiriva®), and the LABA component, olodaterol (Striverdi®), each have the same indication as Spiolto Respimat®.
Despite statistically significant differences in several patient-specific measures of effectiveness (e.g. quality of life) favouring Spiolto Respimat® over the individual components, the efficacy is assessed to have limited clinical relevance in patients not yet started on relevant symptom-alleviating pharmacological treatment. For patients who have not achieved adequate effect from treatment with either olodaterol or tiotropium alone, a switch to Spiolto Respimat® could be relevant.
It is IRF's overall assessment that if combination therapy is indicated in adults with COPD, Spiolto Respimat® does not have significant therapeutic advantageous over other LABA/LAMA combination products. In addition, cheaper alternatives are presently available through a combination of LAMA and LABA in separate inhalers (Table 2). IRF assesses that there are class effects between LAMA and LABA agents, and COPD patients should therefore always be treated with the cheapest analogue agents in the cheapest inhaler device.