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Fears over Combivent phase-out

By Nigel Praities

GPs are faced with thousands of patients with COPD having to make a difficult switch to alternative treatments, after the manufacturer of Combivent announced it had stopped producing the inhaler.

There are enough supplies in pharmacy wholesalers to last until the summer but over 190,000 patients still remain on the ipratropium and salbutamol combined inhaler, according to data from Cegedim Strategic Data.

Boehringer Ingelheim admitted no direct switch is available for these patients but they had stopped production as part of an agreement to phase-out CFC containing products.

‘At current usage levels, stock should be available until about the middle of this year, however, I must stress this is only an estimate,' a spokesperson told Pulse.

Red stickers have been placed on packets to warn patients and encourage them to consult a healthcare professional. But GPs have warned switching patients to alternative treatments will increase costs, workload and adversely affect patient care.

Dr John Haughney, a GP in East Kilbride and member of the General Practice Airways Group, said Combivent was the mainstay of COPD treatment for many years and switching patients would have serious workload implications.

‘There is no question that there are a lot of people benefiting from Combivent and it could be quite awkward keeping those patients as well as possible after Combivent is withdrawn,' he said.

NICE recommends anticholinergic treatments, such as ipratropium, should be used to control symptoms and improve exercise capacity in patients who continue to experience problems despite the use of short-acting drugs.

Dr Rupert Jones, a GP in Plymouth, Devon, and a clinical research fellow at Peninsula Medical School, said GPs had been put in an impossible situation and should consider switching patients to separate inhalers for ipratropium and salbutamol, although there were adherence concerns in older patients.

‘For the older patients who are on multiple therapies to give them two instead of one adds a layer of complexity, which in some individuals is not great,' he said.

Dr Haughney recommended GPs either stepped down therapy with sole use of ipratropium or a short-acting beta-agonist, or stepped up by switching to tiotropium or a regular bronchodilator, despite the cost implications.

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