Risk of Exacerbation and Pneumonia with Single-Inhaler Triple versus Dual Therapy in IMPACT

Crim, Courtney; Criner, Gerard J.; Day, Nicola C.; Halpin, David; Han, Mei Lan K.; Jones, Christine; Kilbride, Sally; LaFon, David C.; Lipson, David A.; Lomas, David A.; Martin, Neil; Martínez, Fernando J.; Singh, Dave; Wise, Robert A.; Lange, Peter

doi:10.1513/annalsats.202002-096oc

Cited by 24 publications

(15 citation statements)

References 23 publications

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“…Поскольку ИГКС-содержащая терапия снижает частоту обострений при некотором повышении риска пневмонии, особенный интерес представляет определение композитной конечной точки -времени до первого неблагоприятного события, которым может быть как обострение ХОБЛ, так и пневмония. В исследовании IMPACT время до первого среднетяжелого/тяжелого обострения или пневмонии было достоверно дольше у пациентов на тройной терапии в сравнении с двой ной бронходилатацией; кроме того, также достоверно различалось время до первого тяжелого события (обострение или пневмония с госпитализацией) [20].…”

Section: Discussionunclassified

Triple therapy in a single inhaler for chronic obstructive pulmonary disease: clinical studies and case report (real practice)

et al. 2021

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Algorithms for de-escalation of basic therapy, including the abolition of inhaled corticosteroids (ICS), in patients with chronic obstructive pulmonary disease (COPD), as well as the development of clear criteria for prescribing triple therapy in clinical practice remain the subject of numerous studies and discussions. The given case report of managing a patient with a long experience of smoking and severe COPD demonstrated an unsuccessful experience of de-escalation of therapy with the abolition of ICS due to concerns about the fact of pneumonia. The dual bronchodilator therapy prescribed in accordance with modern recommendations was insufficiently effective in preventing exacerbations, and the stabilization of the patient’s condition was observed after the appointment of a fixed triple combination of drugs in a single inhaler (VI/UMEC/FF), which contains vilanterol (VI), umeclidinium bromide (UMEC) and ICS fluticasone furoate (FF). An additional contribution to ensuring clinical success was made by such factors as strict compliance with medical prescriptions by the patient, smoking cessation and compliance with recommendations for maintaining physical activity, compliance with a strict self-isolation regime during the pandemic, which reduced the risks of respiratory viral infections. Additional clinical predictors of the effectiveness of ICS in COPD were the bronchitis type, the persistence of symptoms and the recurrence of exacerbations of the disease after discontinuation of the drug, the level of blood eosinophilia. When deciding whether to prescribe or cancel triple therapy, it is recommended to take into account the data on the effect of ICS on improving the functional parameters and clinical course of the disease with a decrease in symptoms, on reducing the risk of exacerbations, on increasing patient survival and a positive prognosis during COPD.

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Section: Discussionunclassified

Triple therapy in a single inhaler for chronic obstructive pulmonary disease: clinical studies and case report (real practice)

et al. 2021

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“…[58][59][60][61] Both hospitalization due to severe exacerbations and pneumonia have a profound impact on patient outcomes, supporting the idea that clinical trials should evaluate these events together as a composite outcome of hospitalized respiratory events, as recently reported for the IMPACT trial. 62 In that trial, triple therapy with FF/UMEC/VI resulted in a significant 17% reduction in the risk of a severe exacerbation or hospitalized pneumonia compared with UMEC/VI (P=0.011). 62 Ultimately, the key is to identify patients with COPD who will have a favorable benefit/risk ratio with triple therapy.…”

Section: Benefit Versus Risk With Sittmentioning

confidence: 94%

“…62 In that trial, triple therapy with FF/UMEC/VI resulted in a significant 17% reduction in the risk of a severe exacerbation or hospitalized pneumonia compared with UMEC/VI (P=0.011). 62 Ultimately, the key is to identify patients with COPD who will have a favorable benefit/risk ratio with triple therapy.…”

Section: Benefit Versus Risk With Sittmentioning

confidence: 94%

Benefit/Risk Profile of Single-Inhaler Triple Therapy in COPD

Bourbeau¹,

Bafadhel²,

Barnes³

et al. 2021

COPD

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“…Важными для понимания профиля польза / риск являются результаты подобного анализа данных исследования IMPACT. Показано, что при трехкомпонентной иГКС-содержащей терапии ФФ / УМЕК / ВИ достоверно на 17 % снижался риск госпитализации по поводу тяжелого обострения ХОБЛ или пневмонии по сравнению с режимом двойной бронходилатации УМЕК / ВИ (р = 0,011) [45].…”

Section: соотношение пользы и риска применения трехкомпонентной терапии единым ингалятором у больных хронической обструктивной болезнью лunclassified

Benefit/risk ratio profile of single inhaler triple therapy for сhronic obstructive pulmonary disease patients

Овчаренко

Белевский

2021

Pulʹmonologiâ (Mosk.)

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Chronic obstructive pulmonary disease (COPD) is associated with significant healthcare and socioeconomic burden. International guidelines recommend a personalized approach to treatment and management that aims to reduce symptom burden and exacerbation risk. Numerous recently published clinical trials have investigated efficacy and safety of single-inhaler triple therapy (SITT) with a long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA), and an inhaled corticosteroid (ICS) for patients with COPD.Aim of the publication: to review the findings of randomized controlled trials that showed the benefit of single-inhaler triple therapy and compare this benefit with the known risk of pneumonia associated with ICSs.Conclusion. The key benefits reported with SITT are significant reductions in exacerbations and hospitalizations; the trials also suggest reduced all-cause mortality. The benefits of SITT outweigh the known risk of pneumonia with ICS use that is reported as the class-effect in COPD patients.

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Risk of Exacerbation and Pneumonia with Single-Inhaler Triple versus Dual Therapy in IMPACT

Cited by 24 publications

References 23 publications

Triple therapy in a single inhaler for chronic obstructive pulmonary disease: clinical studies and case report (real practice)

Triple therapy in a single inhaler for chronic obstructive pulmonary disease: clinical studies and case report (real practice)

Benefit/Risk Profile of Single-Inhaler Triple Therapy in COPD

Benefit/risk ratio profile of single inhaler triple therapy for сhronic obstructive pulmonary disease patients

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