Clinical characteristics and factors associated with triple therapy use in newly diagnosed patients with COPD

Monteagudo, Mónica; Barrecheguren, Miriam; Solntseva, Iryna; Dhalwani, Nafeesa N.; Booth, Alison; Núñez, Alexa; Lambrelli, Dimitra; Miravitlles, Marc

doi:10.1038/s41533-021-00227-x

Cited by 8 publications

(12 citation statements)

References 25 publications

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“…Our results concur with other recent studies that confirmed the association between symptoms and ICS prescription. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

“…Our results concur with other recent studies that confirmed the association between symptoms and ICS prescription. 29,30 Understanding the role of eosinophils in COPD has increased over the last years. 31 Within our sample, blood eosinophils were not associated with ICS use, which in addition to the significant proportion of patient with missing eosinophil counts, could be suggesting a lack of awareness of the usefulness of eosinophil counts for the management of COPD within primary care.…”

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confidence: 99%

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Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain

Miravitlles

Román-Rodríguez

Ribera

et al. 2022

COPD

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Purpose Inhaled corticosteroids (ICS) are frequently used to treat chronic obstructive pulmonary disease (COPD) outside the current recommendations. Our aim was to describe ICS use in COPD patients and to identify factors associated with ICS use among COPD patients treated within primary care in Spain. Patients and Methods This was a cross-sectional, non-interventional and multicenter study of patients with COPD treated in primary care. Patient characteristics and exacerbations were described in terms of ICS use among the overall cohort, and among those with spirometry confirmed COPD (post-bronchodilator forced expiratory volume in 1 second [FEV 1 ]/forced vital capacity [FVC] ratio <70%). Multivariable logistic regression was used to identify factors associated with ICS use. Results A total of 901 patients were included, of which 47.9% (n = 432) were treated with ICS. A total of 240 patients (26.6%) experienced moderate/severe exacerbations in the prior year, while 309 (34.3%) during the previous two years. History of asthma totaled 11.6% (n = 105). The most frequent phenotype was non-exacerbator (51.6%), and the proportion of patient with moderate or severe exacerbations was significantly higher among ICS treated patients compared to non-treated: 37.5% versus 16.6% during the previous year (p < 0.001), and 46.8% versus 22.8% during the previous 2-years (p < 0.001), respectively. Patient characteristics were similar among spirometry confirmed patients and the overall population. Factors significantly associated with ICS use were a history of asthma (OR = 4.39, 95% CI: 2.67–7.26), the presence of moderate or severe exacerbations in the last year (OR = 2.52, 95% CI: 1.81–3.49), followed by higher mMRC and higher CAT score. Conclusion Nearly half of patients in primary care in Spain are treated with ICS, despite most of them being non-exacerbators. History of asthma, exacerbations, and worse dyspnea and CAT scores are associated with ICS use.

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“…Our results concur with other recent studies that confirmed the association between symptoms and ICS prescription. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain

Miravitlles

Román-Rodríguez

Ribera

et al. 2022

COPD

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“…In an international multicenter study, the median time from initial COPD diagnosis to the first prescription of triple therapy ranged from 16.9 (5.7–36.2) months in Australia to 42.5 (13.9–87.4) months in the UK [ 24 ]. The most common treatment pathways to triple therapy initiation are starting with ICS/LABA, no therapy, LAMA alone, [ 24 , 69 ] and LABA/LAMA [ 70 ]. A real-world study observed that patients who did not had exacerbations in the previous year often received ICS-containing therapy before escalation to triple therapy.…”

Section: Key Questions In Using Sitt In Oadmentioning

confidence: 99%

“…Current GOLD guidelines recommend TT for severe disease, frequent exacerbations and persistent symptoms who were not adequately controlled with LABA/LAMA or ICS/LABA therapy [ 19 ]. However, several real-world studies reported progression to TT even in patients with no exacerbations in the previous year [ 69 ]. L andis et al .…”

Section: Key Questions In Using Sitt In Oadmentioning

confidence: 99%

Use of single-inhaler triple therapy in the management of obstructive airway disease: Indian medical experts’ review

Dhar

Talwar²,

Salvi³

et al. 2022

ERJ Open Res

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Obstructive airway disease (OAD), which includes COPD and asthma, is the leading cause of morbidity and mortality in India. Long-acting bronchodilators (long-acting β2 agonists (LABAs) and/or long-acting muscarinic antagonists (LAMAs)) and inhaled corticosteroids (ICS) have a vital role in the management of patients with OAD. While symptom burden and exacerbations are common amongst treated patients, poor adherence to inhaler therapy is a frequent challenge. Better treatment options that optimise symptom control, improve quality of life, reduce exacerbation risk and improve adherence are desired. Triple therapy (ICS/LABA/LAMA) is recommended in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021 guidelines for symptomatic COPD patients on ICS/LABA or LABA/LAMA, and who are at increased risk for frequent or severe exacerbations. Similarly, add-on LAMA is recommended in uncontrolled asthma patients on medium- to high-dose ICS/LABA by the Global Initiative for Asthma (GINA) 2021 guideline. In the real world, high-risk and overlapping phenotypes exist, which necessitate early initiation of triple therapy. We aim to provide an expert review on the use of single-inhaler triple therapy (SITT) for OAD management in global and Indian settings, knowledge from which can be extrapolated for appropriate treatment of Indian patients. The OAD population in India may benefit from early optimisation to SITT characterised by a high burden of exacerbating OAD, nonsmoker COPD and asthma–COPD overlap.

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“… 9 Nevertheless, it remains surprising that many general practitioners prescribe triple therapy shortly after or even before an established COPD diagnosis. 10 , 11 Variables associated with ICS/LABA/LAMA therapy initiation in newly diagnosed patients with COPD were FEV 1 , exacerbations, male sex, increased age, current or previous smoking, and some comorbid lung conditions in US 10 and male sex, older age, previous exacerbations, asthma-COPD overlap, a previous treatment regimen containing an ICS, previous pneumonia, and history of lung cancer in Spain. 11 However, the transition to triple therapy in those already on regular treatment for COPD, which is not necessarily a LABA/LAMA combination, follows pathways that are influenced by many different factors that vary both within and between countries probably due to differences in prescribing practices.…”

Section: Introductionmentioning

confidence: 99%

Beyond Dual Bronchodilation – Triple Therapy, When and Why

Cazzola¹,

Rogliani²,

Laitano³

et al. 2022

COPD

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Although pharmacological treatment of COPD is codified in different guidelines and strategy documents, there is abundant evidence of discrepancy between what they suggest and what health professionals prescribe, especially in low-risk groups where there is widespread overprescription of triple therapy. It is therefore necessary to clarify when the use of triple therapy is indicated in COPD patients and when it is preferable to maintain treatment with dual bronchodilation. In this article, we discuss our views based on our experience and what is reported in the literature and try to give answers to these two questions. The evidence generated by pivotal RCTs supports the use of triple therapy in patients who present for the first time and have severe airway obstruction, are symptomatic, have had frequent moderate or severe exacerbations in the previous year, and have peripheral eosinophilia. However, it is difficult to determine whether step-up is useful in all other cases because the available data are quite conflicting. It is likely that the inconsistency in the information generated by the various available studies may explain the prescribing behaviour of many physicians who do not adhere to recommendations of guidelines and strategies. However, it is necessary to establish whether and when the addition of an ICS to the LAMA/LABA combination is effective, to determine whether triple therapy can induce an additional clinical benefit over dual bronchodilation, irrespective of a preventive effect on COPD exacerbations, to establish its value, and to examine whether cost differences can support the use of triple therapy over combined LAMA/LABA therapy in real life.

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Clinical characteristics and factors associated with triple therapy use in newly diagnosed patients with COPD

Cited by 8 publications

References 25 publications

Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain

Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain

Use of single-inhaler triple therapy in the management of obstructive airway disease: Indian medical experts’ review

Beyond Dual Bronchodilation – Triple Therapy, When and Why

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