New Drugs and Devices From 2011 – 2012 That Might Change Your Practice

Joe Lex, MD


Western J Emerg Med. 2013;14(6):619-628. 

In This Article

Tudorza® (Aclidinium Bromide)

We've known for many years that inhaled anti-cholinergic agents work as bronchodilators, and they are recommended as an option with beta-agonist therapy in most treatment algorithms for chronic obstructive pulmonary disease (COPD) and emphysema. Ipratropium bromide (Atrovent®), a shortacting quaternary ammonium compound, was standard therapy for many years, but its 4-time-daily dosing had fallen out of favor recently with the addition of once-daily tiotropium (Spiriva®) to the armamentarium. At first, aclidinium bromide (Tudorza®) seems like a step backward with its twice-daily dosing schedule.

There have been several published placebo-controlled trials of aclidinium, but very few head-to-head trials of aclidinium and another inhaled anticholinergic. The studies looked at data-oriented results – for instance, a 10% increase in FEV1 30 minutes after treatment; this improvement was noted in 49.5% treated with aclidinium, 51.8% treated with tiotropium, and 13.8% treated with placebo. Interestingly, a COPD symptom score was improved at night in users of the twice-daily aclidinium. This was thought due to the second, night-time dose. No attempt was made to compare twice-daily aclidinium to twice-daily tiotropium.

Many users of the tiotropium HandiHaler find it cumbersome, as it involves placing an intact capsule in a chamber, piercing it, and inhaling the contents. Aclidinium is a breath-actuated multi-dose dry powder inhaler, similar to the familiar Advair® Discus.

Lower cost is not an issue, as aclidinium costs $220 per monthly inhaler compared to $240 per month for tiotropium. Perhaps patients without dexterity to manage the somewhat tedious task of placing a capsule in the tiotropium dispenser would benefit with a switch to aclidinium, but there is no other clear reason for someone to switch.