The choice of treatment for a person with COPD depends on drug efficacy, tolerability to treatment, possible adverse events and the suitability of different inhaler devices to the person. Inhaled long-acting bronchodilators have an important role to play in managing COPD.
Published trial data for the alternative maintenance treatments, LABAs and the established LAMA tiotropium, show they significantly reduce the risk of patient-orientated outcomes, such as COPD exacerbations. Similar data from clinical outcome trials comparing glycopyrronium bromide (and the other recently marketed LAMA, aclidinium bromide) with active comparators are needed for local decision makers to be able to determine their place in therapy.
Glycopyrronium bromide is less expensive than tiotropium and aclidinium bromide, at £27.50 for 30 days treatment, compared with between £33.50 and £35.50 for tiotropium and £28.60 for aclidinium bromide. Glycopyrronium bromide and tiotropium are administered once daily, compared with twice daily for aclidinium bromide. Although the once-daily dose has demonstrated efficacy, the EMA highlighted a dose-finding study of glycopyrronium bromide that seemed to suggest that a twice-daily regimen could be more effective for this drug. The CHMP has requested a post-authorisation clinical study to further characterise the optimal dosing schedule.
It is difficult to provide estimated usage based on the available data. However, during the financial year 2011–2012, over 4 million items of tiotropium were prescribed in primary care in England, at a cost of nearly £155 million. The manufacturer estimates that glycopyrronium bromide will make up 1.3% of total LAMA usage in the UK in 2013, rising to 6.7% by 2017.
 Chong J, Karner C, Poole P (2012) Tiotropium versus long-acting beta-agonists for stable chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews issue 9: CD009157
 European Medicines Agency (2012) European public assessment report: Seebri Breezhaler
 NHS Business Services Authority: personal communication December 2012