Triple Therapy Is Also Effective in Real-World When Used in Chronic Obstructive Pulmonary Disease Patients Who Are Frequent Exacerbators

Cazzola, Mario; Celli, Bartolomé R.

doi:10.1159/000512728

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…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%

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: 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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“…Patients treated in real life differ from those enrolled in studies and this is a cause for concern about the external validity of RCT data and the ability to broadly extrapolate these data to real-world patients. 68 …”

Section: Triple Therapy In Real-worldmentioning

confidence: 99%

“…Possibly, deflation resulting from triple therapy may have improved cardiac function, and this, together with increased alveolar ventilation, enhanced the perfusion/ventilation ratio, but this information is not available. 68 …”

Section: Triple Therapy In Real-worldmentioning

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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A single inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol for the treatment of COPD

Cazzola

Rogliani

Calzetta

et al. 2022

Expert Review of Clinical Pharmacology

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Triple Therapy Is Also Effective in Real-World When Used in Chronic Obstructive Pulmonary Disease Patients Who Are Frequent Exacerbators

Cited by 4 publications

References 30 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

Beyond Dual Bronchodilation – Triple Therapy, When and Why

A single inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol for the treatment of COPD

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