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Chronic obstructive pulmonary disease

Triple therapy cuts exacerbations in COPD regardless of baseline reversibility

Research presented at the CHEST annual meeting shows that triple therapy with fluticasone furoate, umeclidinium and vilanterol reduces the number of moderate-to-severe exacerbations for people living with chronic obstructive pulmonary disease.

Triple therapy reduces the number of moderate-to-severe exacerbations in people with chronic obstructive pulmonary disease (COPD), regardless of whether their airway obstruction is bronchodilator-reversible, a study presented at the CHEST annual meeting (6–10 October 2018; San Antonio, Texas) has shown[1].

The 52-week trial involved 10,355 people with COPD with a history of moderate-to-severe exacerbations in the previous 12 months. They were randomly assigned to triple therapy with inhaled corticosteroid fluticasone furoate (FF)/long-acting muscarinic agonist (LAMA) umeclidinium (UMEC)/long-acting beta-agonist (LABA) vilanterol (VI) or dual therapy with FF/VI or UMEC/VI. Patients were tested at baseline for airway obstruction reversibility with salbutamol and defined as either reversible (18%) or non-reversible (82%). 

The researchers found that the rate of moderate-to-severe exacerbations was reduced by 40% in reversible patients and by 21% in non-reversible patients with triple therapy, compared with UMEC/VI dual therapy. Severe exacerbations were reduced by 44% and 31%, respectively.

Moderate-to-severe exacerbations were also significantly reduced compared with FF/VI in both reversible and non-reversible patients. Although, FF/UMEC/VI did not reduce the rate of severe exacerbations over FF/VI in reversible patients.

International guidelines recommend dual therapy (LABA/LAMA) for most patients with COPD, with the addition of inhaled corticosteroids only for those with frequent exacerbations. It was previously uncertain whether baseline reversibility, which indicates whether patients are bronchodilator-responsive, affects treatment response to triple therapy.

“Regardless of baseline reversibility, [triple therapy] showed statistically significant and clinically relevant improvements on a range of important outcomes,” the researchers concluded.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2018.20205754

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