Real-World Effectiveness of Inhalation Therapy Among Patients With Symptomatic COPD in China: A Multicenter Prospective Study

Cheng, Wei; Duan, Jia‐Xi; Zhou, Aiyuan; Zhao, Yiyang; Rong, Yi; Liu, Yi; Deng, Dingding; Li, Xin; Zeng, Yuqin; Peng, Yating; Song, Qing; Lin, Ling; Yang, Mao; Chen, Ping

doi:10.3389/fphar.2021.753653

Cited by 15 publications

(11 citation statements)

References 38 publications

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“…Interestingly, a similar responder rate of 49% was observed in a Chinese cohort, mainly including patients without prior inhalation treatment, who received either LAMA-monotherapy, dual-therapy consisting of LABA/LAMA, ICS/LABA or multiple inhaler therapy with ICS+LABA+LAMA over a period of 6 months. 33 Our results were also comparable to the mean change of −2.8 points and a CAT responder rate of 47% in previously treated COPD patients who were escalated to a single-inhaler triple therapy containing a ICS/LABA/LAMA composition different from efSITT for 24 weeks in a previous observational study. 30 In an Austrian cohort, a mean decrease in the CAT total score by −7.2 points was observed with efSITT after 12 months.…”

Section: Discussionsupporting

confidence: 86%

“…Although the efficacy and safety of a single-inhaler ICS/LABA/LAMA triple therapy was demonstrated in several randomized controlled trials, 2,3,[14][15][16]28,29 important issues of every day care such as patient adherence to therapy were rarely addressed. [30][31][32][33][34][35] Hence, our results contribute to address the gap between evidence from controlled trials and routine clinical care.…”

Section: Discussionmentioning

confidence: 78%

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Effectiveness of Extrafine Single Inhaler Triple Therapy in Chronic Obstructive Pulmonary Disease (COPD) in Germany – The TriOptimize Study

Geßner¹,

Javan²,

Hövelmann³

et al. 2022

COPD

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Purpose Real-word evidence on the effectiveness of switching from dual therapies or triple therapies (multiple inhalers) to extrafine single-inhaler triple therapy (efSITT), which consists of the inhaled corticosteroid (ICS) beclomethasone, the long-acting β 2 -agonist (LABA) formoterol and the long-acting muscarinic antagonist (LAMA) glycopyrronium, in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) is limited. The impact of switching to efSITT on health-related quality of life (HRQoL), COPD specific symptoms, lung function and treatment adherence were assessed in routine clinical care. Patients and Methods Patients were recruited at 148 sites in Germany between 2017 and 2020 in this multicenter, non-interventional observational study. Demographics, clinical data and treatment history were collected at baseline. HRQoL (measured by COPD Assessment Test [CAT]), lung function and adherence (measured by Test of Adherence to Inhalers [TAI]) were assessed at baseline and after six months. Descriptive analyses were conducted by prior treatment and GOLD groups as well as for the overall population. Results 55.1% of the 2623 included patients were male. Mean age was 65.8 years. 57.5% of the patients were previously treated with ICS+LABA+LAMA (multiple inhalers), 23.9% with ICS/LABA (single or two inhalers) and 18.6% with LAMA/LABA (single or two inhalers). After six months, largest mean improvements in the total CAT score were observed in the ICS/LABA (−3.9) and LAMA/LABA (−3.9) prior treatment groups as well as in patients in GOLD group B (−2.9). In the overall population, the CAT items for cough, phlegm, and dyspnea decreased on average by −0.4 points each. After six months, FEV 1 increased by 2.0 percentage points in relation to predicted values. The percentages of measured sRtot and RV of predicted values decreased by 24.5 and 4.4 percentage points, respectively. The percentage of patients with good adherence increased from 67.8% to 76.5%. Conclusion Treatment switch to efSITT resulted in an improvement of HRQoL, COPD specific symptoms, lung function parameters and adherence under real-world conditions.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 78%

Effectiveness of Extrafine Single Inhaler Triple Therapy in Chronic Obstructive Pulmonary Disease (COPD) in Germany – The TriOptimize Study

Geßner¹,

Javan²,

Hövelmann³

et al. 2022

COPD

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“…Inhalation drugs were the main treatment that could reduce symptoms and risk of exacerbation and mortality, as well as improve health status for stable COPD patients. Currently, LAMA, LABA + LAMA, LABA + ICS and LABA + LAMA + ICS were the top four inhalation drugs [18][19][20]. We have found that the low BMI patients had a poor treatment response, but which inhalation drugs would be better for low BMI patients was uncertain.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: The clinical characteristics and treatment response of patients with chronic obstructive pulmonary disease with low body mass index

Song

Zhou

et al. 2022

Preprint

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Background This study aimed to analyze the clinical characteristics and treatment response of patients with chronic obstructive pulmonary disease (COPD) with low body mass index (BMI). Methods This cross-sectional study enrolled stable COPD patients from database setup by Second Xiangya Hospital of Central South University. According to the BMI, the patients were classified into three groups: low BMI (BMI < 18.5 kg/m2), normal BMI (18.5 ≤ BMI < 24.0 kg/m2) and high BMI (BMI ≥ 24 kg/m2) groups. Clinically important deterioration (CID) was defined as attaining CAT scores increased ≥ 2, minimum clinically important difference (MCID) was defined as attaining CAT scores decreased ≥ 2 during six months of follow up. Exacerbation and mortality were recorded during one year of follow up. Results A total of 910 stable COPD patients were included and 144 (15.8%) patients in low BMI, 475 (52.2%) patients in normal BMI and 291 (32.0%) patients in high BMI groups. The patients with low BMI had a worse pulmonary function, higher symptoms score and exacerbations in the past year compared with normal and high BMI groups (P < 0.05). Logistic regression analysis revealed that age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 3 and 4, hospitalizations in the past year were the independent risk factors for low BMI (P < 0.05). After followed up for one year, the low BMI patients had higher mortality and number of hospitalizations. Patients with low BMI more likely to attain CID, while less likely to attain MCID compared with high BMI group (P < 0.05). In addition, the low BMI patients treated with long-acting β2-agonist (LABA) + long-acting muscarinic antagonist (LAMA) and LABA + LAMA + inhaled corticosteroid (ICS) more likely attain MCID than treated with LABA + ICS and LAMA (P < 0.05). Conclusion COPD patients with low BMI had worse pulmonary function, higher symptoms scores, higher risk of future hospitalizations and mortality, as well as less likely to attain MCID and more likely to attained CID. It was worth noting that low BMI patients treated with LABA + LAMA and LABA + LAMA + ICS more likely attain MCID than treated with LABA + ICS and LAMA.

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“…Currently, most randomized controlled trials (RCTs) or meta-analyses on the effectiveness of single, double, or triple inhaled drugs has just focused on all patients with COPD rather than examining drug effectiveness according to the GOLD groups [ 16–17 ]. In addition, more symptomatic patients with COPD have accounted for the majority of the study populations [ 8 , 18 ], and studies have shown that more symptomatic patients with COPD treated with LABA + LAMA or LABA + LAMA + ICS are more likely to attain a minimum clinically important difference than patients treated with a LAMA [ 19 ]. In fact, in China, patients with COPD typically do not go to the hospital until they have severe respiratory symptoms.…”

Section: Discussionmentioning

confidence: 99%

The effects of different inhalation therapies on less symptomatic chronic obstructive pulmonary disease patients in a Chinese population: a real-world study

et al. 2023

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Background The Global Initiative for Chronic Obstructive Lung Disease (GOLD) document suggests that patients with chronic obstructive pulmonary disease (COPD) should be divided into a less symptomatic group. Moreover, single-inhaled drugs are recommended as initial inhalation therapy for them. However, many less symptomatic patients are provided double or triple-inhaled drugs as initial therapy in the real world. This study aimed to describe the inhalation prescriptions and compare the effects of different inhalation therapies on less symptomatic COPD patients. Patients and methods This was an observational study. Stable COPD patients were recruited and divided into a less symptomatic group including Groups A and C based on the GOLD 2019 document. We collected the data of inhalation therapies prescriptions. Then, the patients were classified into long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS groups. All the patients were followed up for 1 year to collect exacerbation and mortality data. Results We found that only 45.4% of patients in Group A and 43.6% of patients in Group C received reasonable inhalation therapy in reference to the GOLD document. In addition, the LAMA group had a higher forced expiratory volume in one second (FEV1), FEV1%pred, FEV1/forced vital capacity and peak expiratory flow compared with LABA + ICS, LABA + LAMA and LABA + LAMA + ICS groups. However, we did not find any significant differences of exacerbation, hospitalization and mortality during the follow-up among different inhalation therapies groups on less symptomatic COPD patients. Conclusion Over half of the less symptomatic patients received inhalation therapy that were inconsistent with the GOLD document recommendations in a Chinese population in the real world. In fact, the single inhaled drug of LAMA should be recommended and pulmonary function is not a good indicator for the choice of initial inhalation therapy in less symptomatic COPD patients. KEY MESSAGES Over half of the less symptomatic COPD patients received inhalation therapy that were inconsistent with the GOLD document recommendations in a Chinese population in the real world. The clinicians should offer a single inhaled drug of LAMA to less symptomatic COPD patients and pulmonary function is not a good indicator for the choice of initial inhalation therapy.

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Real-World Effectiveness of Inhalation Therapy Among Patients With Symptomatic COPD in China: A Multicenter Prospective Study

Cited by 15 publications

References 38 publications

Effectiveness of Extrafine Single Inhaler Triple Therapy in Chronic Obstructive Pulmonary Disease (COPD) in Germany – The TriOptimize Study

Effectiveness of Extrafine Single Inhaler Triple Therapy in Chronic Obstructive Pulmonary Disease (COPD) in Germany – The TriOptimize Study

WITHDRAWN: The clinical characteristics and treatment response of patients with chronic obstructive pulmonary disease with low body mass index

The effects of different inhalation therapies on less symptomatic chronic obstructive pulmonary disease patients in a Chinese population: a real-world study

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