The clinical implications of triple therapy in fixed-dose combination in COPD: from the trial to the patient

Lόpez-Campos, José Luís; Carrasco‐Hernández, Laura; Rodríguez, Lucas Román; Quintana‐Gallego, Esther; Bernal, C. Carmona; Navarrete, Bernardino Alcázar

doi:10.1016/j.arbr.2020.02.002

Cited by 12 publications

(10 citation statements)

References 31 publications

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“…These results support the ATS and particularly the ERS guidelines that recommend discontinuation of ICS in patients without a history of frequent exacerbations and blood eosinophils < 300 cells/μL [14,15]. Despite the published studies and recommendations, ICS withdrawal is very infrequent in real life in primary care [31,32]. In our study, only 2% of patients on TT discontinued ICS during 1 year, which is similar to the 2% to 3.5% rates of discontinuation of ICS observed between 2014 and 2018 in another large primary care study in the UK [33].…”

Section: Discussionsupporting

confidence: 66%

Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study

Magnussen

Lucas²,

Lapperre³

et al. 2021

Respir Res

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Background Inhaled corticosteroids (ICS) are indicated for prevention of exacerbations in patients with COPD, but they are frequently overprescribed. ICS withdrawal has been recommended by international guidelines in order to prevent side effects in patients in whom ICS are not indicated. Method Observational comparative effectiveness study aimed to evaluate the effect of ICS withdrawal versus continuation of triple therapy (TT) in COPD patients in primary care. Data were obtained from the Optimum Patient Care Research Database (OPCRD) in the UK. Results A total of 1046 patients who withdrew ICS were matched 1:4 by time on TT to 4184 patients who continued with TT. Up to 76.1% of the total population had 0 or 1 exacerbation the previous year. After controlling for confounders, patients who discontinued ICS did not have an increased risk of moderate or severe exacerbations (adjusted HR: 1.04, 95% confidence interval (CI) 0.94–1.15; p = 0.441). However, rates of exacerbations managed in primary care (incidence rate ratio (IRR) 1.33, 95% CI 1.10–1.60; p = 0.003) or in hospital (IRR 1.72, 95% CI 1.03–2.86; p = 0.036) were higher in the cessation group. Unsuccessful ICS withdrawal was significantly and independently associated with more frequent courses of oral corticosteroids the previous year and with a blood eosinophil count ≥ 300 cells/μL. Conclusions In this primary care population of patients with COPD, composed mostly of infrequent exacerbators, discontinuation of ICS from TT was not associated with an increased risk of exacerbation; however, the subgroup of patients with more frequent courses of oral corticosteroids and high blood eosinophil counts should not be withdrawn from ICS. Trial registration European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (EUPAS30851).

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Section: Discussionsupporting

confidence: 66%

Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study

Magnussen

Lucas²,

Lapperre³

et al. 2021

Respir Res

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“…At present, patient-tailored treatments are available, improving the disease prognosis [7][8][9]. Personalized care, based on the individualized management of patients based on their clinical characteristics and certain biological factors, makes it possible to maximize the benefits and minimize the side effects at a reasonable cost [10,11].…”

Section: Introductionmentioning

confidence: 99%

Variability of blood eosinophil count and prognosis of COPD exacerbations

Martínez-Gestoso¹,

García-Sanz²,

Calvo-Álvarez

et al. 2021

Annals of Medicine

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Background: Eosinophils in peripheral blood are one of the emerging biomarkers in chronic obstructive pulmonary disease (COPD) patients. However, when analysing the relationship between peripheral eosinophilia and COPD prognosis, highly variable results are obtained. The aim of our study is to describe the serum eosinophilia levels in COPD patients and to analyse their relationship to prognosis following hospital admission. Methods: A prospective observational study was conducted from 1 October 2016 to 1 October 2018 in the following Spanish centres: Saln es County Hospital in Vilagarc ıa de Arousa, Arquitecto Marcide Hospital in Ferrol and the University Hospital Complex in Santiago de Compostela. The patients were classified using three cut-off points of blood eosinophil count (BEC): 150 cells/mL, 300 cells/mL, and 400 cells/mL; in addition, the peripheral BEC was analysed on admission. Results: 615 patients were included in the study, 86.2% male, mean age 73.9 years, and mean FEV1 52.7%. The mean stay was 8.4 days, and 6% of all patients were readmitted early. No significant relationship was observed between the BEC, neither in the stable phase nor in the acute phase, and hospital stay, readmissions, deaths during admission, the need for intensive care, or the condition of frequent exacerbator. Conclusion:The results of our study do not seem to support the usefulness of BEC as a COPD biomarker. KEY MESSAGES1. There is evidence that BEC participates in pathophysiological mechanisms of the COPD. 2. BEC may be useful as a biomarker in COPD for aspects such as the optimization of treatments. 3. We did not find any relationship between BEC levels and prognosis following hospital admission for AECOPD.

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“…The benefits of triple therapy have been extensively studied, and there is a greater effect on lung function and a decrease in exacerbations and hospitalizations in severe patients compared to other alternatives of treatment, in particular in patients with high blood eosinophil counts. 34 However, some high-risk patients may still not have good disease control despite receiving triple therapy, as seen in the results of this and previous studies. [35][36][37] All this reflects that there are still unmet needs in treatment of patients with COPD.…”

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confidence: 54%

Burden of Disease Among Exacerbating Patients with COPD Treated with Triple Therapy in Spain

Alcázar¹,

García‐Río²,

Sánchez³

et al. 2021

COPD

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Background:The cost of chronic obstructive pulmonary disease (COPD) in Spain has been studied from different perspectives, but parameters such as the patient's phenotype have seldom been considered. Our aim was to describe the disease burden of COPD patients with frequent exacerbator phenotype, treated with triple therapy. Methods: An observational, multicenter study was carried out from December 2017 to November 2018 in pulmonology services among patients ≥40 years with COPD confirmed diagnosis receiving triple therapy (ICS/LAMA/LABA) and history of ≥2 moderate or ≥1 severe exacerbation in the 12 months prior to the inclusion visit. COPD-related healthcare resources were collected over a 12-months period prior to the inclusion visit: pharmacological and non-pharmacological treatments, medical and ER visits, hospitalizations, tests and productivity loss. Costs were updated to €2019. Patients were classified according to blood eosinophil levels: <150 cells/µL and ≥150 cells/µL. Results: A total of 306 patients were included (77.1% men), with mean age of 69.9 years. Mean COPD exacerbation rate was 2.5/patient/year and 51.3% of patients had ≥150 cells/µL eosinophil level. On average, for the total population, COPD-related visits/patients/year were 6.2. Resource use in moderate exacerbation was higher in patients with eosinophils ≥150 cells/µL, whereas in severe exacerbation was higher in patients with eosinophils <150cells/ µL. According to eosinophil levels, total annual mean (SD) costs/patient accounted for €8382 (9863) and €5144 (5444) for patients with eosinophils <150 cells/µL and ≥150 cells/µL, respectively. Conclusion:The impact of exacerbating COPD patients treated with triple therapy in Spain is large, especially among those with eosinophils <150 cells/µL.

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The clinical implications of triple therapy in fixed-dose combination in COPD: from the trial to the patient

Cited by 12 publications

References 31 publications

Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study

Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study

Variability of blood eosinophil count and prognosis of COPD exacerbations

Burden of Disease Among Exacerbating Patients with COPD Treated with Triple Therapy in Spain

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