Three’s a crowd for triple therapy in COPD

A German registry study reported that patients with chronic obstructive pulmonary disease (COPD) who dropped the inhaled corticosteroid (ICS) component from their so-called triple-therapy regimen reported improved symptom control while experiencing fewer adverse effects.

Triple therapy is a common standard-of-care for COPD maintenance, consisting of a long-acting β-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an ICS. However, after achieving symptom control with triple therapy, it was unknown whether the ICS maintenance was really necessary or whether a LABA/LAMA combination is sufficient. This was the rationale for a real-world study, presented by Prof. Claus Vogelmeier (Philipps-University Marburg, Germany) [1].

The study included 340 patients who switched from triple therapy to a fixed-dose LABA/LAMA product and 784 who remained on triple therapy. The study was not randomised; as a result, some baseline differences between the groups were identified. Those remaining on triple therapy consisted of more men, participants had experienced longer average duration of disease, and they had worse lung function than those who switched (58% of predicted forced expiratory volume in 1 second vs 67%). The study's primary endpoint was time to first COPD exacerbation.

The data showed that the 1-year risk was twice as high among participants remaining on triple therapy than those who had stepped down to dual therapy (HR 2.00; 95% CI 1.60–2.51). By month 12, nearly 60% of the triple-therapy group had experienced an exacerbation versus about 35% of those on dual therapy.

In addition, more participants in the step-down group obtained clinically relevant improvements in COPD Assessment Test (CAT) score. At baseline, those who remained on triplet therapy had an average CAT score of 20.0 compared with an average of 21.0 in the group who stepped down from their ICS therapy. At 1-year, improvement was seen in both groups, although the score dropped by 2 points (indicating a better outcome) for those who had stepped down to doublet therapy and by only 1 point for participants remaining on triple therapy. Of those who had stepped down, 58% had scores indicating clinically relevant improvement compared with 49% of those on triple therapy (P<0.001).

With regard to safety, dual therapy was safer during the 1-year follow-up. Not only was the total of all adverse events reduced, but also the number of those rated as serious. Even when exacerbations were discounted as adverse events, these results held steady.

1. Vogelmeier C, et al. Stepping Down from Triple Inhaled Therapy to a LABA/LAMA Fixed-Dose Combination: Data from the German Real-Life DACCORD COPD Cohort. Session C93, ATS International Conference 2022, San Francisco, CA, USA, 13–18 May.

 

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Posted on 18 July 2022