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

Chronic obstructive pulmonary disease (COPD) is associated with major healthcare and socioeconomic burdens. International consortia recommend a personalized approach to treatment and management that aims to reduce both symptom burden and the risk of exacerbations. Recent clinical trials have investi...

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Autores principales: Bourbeau, Jean, Bafadhel, Mona, Barnes, Neil C, Compton, Chris, Di Boscio, Valentina, Lipson, David A, Jones, Paul W, Martin, Neil, Weiss, Gudrun, Halpin, David M G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935340/
https://www.ncbi.nlm.nih.gov/pubmed/33688176
http://dx.doi.org/10.2147/COPD.S291967
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author Bourbeau, Jean
Bafadhel, Mona
Barnes, Neil C
Compton, Chris
Di Boscio, Valentina
Lipson, David A
Jones, Paul W
Martin, Neil
Weiss, Gudrun
Halpin, David M G
author_facet Bourbeau, Jean
Bafadhel, Mona
Barnes, Neil C
Compton, Chris
Di Boscio, Valentina
Lipson, David A
Jones, Paul W
Martin, Neil
Weiss, Gudrun
Halpin, David M G
author_sort Bourbeau, Jean
collection PubMed
description Chronic obstructive pulmonary disease (COPD) is associated with major healthcare and socioeconomic burdens. International consortia recommend a personalized approach to treatment and management that aims to reduce both symptom burden and the risk of exacerbations. Recent clinical trials have investigated single-inhaler triple therapy (SITT) with a long-acting muscarinic antagonist (LAMA), long-acting β(2)-agonist (LABA), and inhaled corticosteroid (ICS) for patients with symptomatic COPD. Here, we review evidence from randomized controlled trials showing the benefits of SITT and weigh these against the reported risk of pneumonia with ICS use. We highlight the challenges associated with cross-trial comparisons of benefit/risk, discuss blood eosinophils as a marker of ICS responsiveness, and summarize current treatment recommendations and the position of SITT in the management of COPD, including potential advantages in terms of improving patient adherence. Evidence from trials of SITT versus dual therapies in symptomatic patients with moderate to very severe airflow limitation and increased risk of exacerbations shows benefits in lung function and patient-reported outcomes. Moreover, the key benefits reported with SITT are significant reductions in exacerbations and hospitalizations, with data also suggesting reduced all-cause mortality. These benefits outweigh the ICS-class effect of higher incidence of study-reported pneumonia compared with LAMA/LABA. Important differences in trial design, baseline population characteristics, such as exacerbation history, and assessment of outcomes, have significant implications for interpreting data from cross-trial comparisons. Current understanding interprets the blood eosinophil count as a continuum that can help predict response to ICS and has utility alongside other clinical factors to aid treatment decision-making. We conclude that treatment decisions in COPD should be guided by an approach that considers benefit versus risk, with early optimization of treatment essential for maximizing long-term benefits and patient outcomes.
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spelling pubmed-79353402021-03-08 Benefit/Risk Profile of Single-Inhaler Triple Therapy in COPD Bourbeau, Jean Bafadhel, Mona Barnes, Neil C Compton, Chris Di Boscio, Valentina Lipson, David A Jones, Paul W Martin, Neil Weiss, Gudrun Halpin, David M G Int J Chron Obstruct Pulmon Dis Review Chronic obstructive pulmonary disease (COPD) is associated with major healthcare and socioeconomic burdens. International consortia recommend a personalized approach to treatment and management that aims to reduce both symptom burden and the risk of exacerbations. Recent clinical trials have investigated single-inhaler triple therapy (SITT) with a long-acting muscarinic antagonist (LAMA), long-acting β(2)-agonist (LABA), and inhaled corticosteroid (ICS) for patients with symptomatic COPD. Here, we review evidence from randomized controlled trials showing the benefits of SITT and weigh these against the reported risk of pneumonia with ICS use. We highlight the challenges associated with cross-trial comparisons of benefit/risk, discuss blood eosinophils as a marker of ICS responsiveness, and summarize current treatment recommendations and the position of SITT in the management of COPD, including potential advantages in terms of improving patient adherence. Evidence from trials of SITT versus dual therapies in symptomatic patients with moderate to very severe airflow limitation and increased risk of exacerbations shows benefits in lung function and patient-reported outcomes. Moreover, the key benefits reported with SITT are significant reductions in exacerbations and hospitalizations, with data also suggesting reduced all-cause mortality. These benefits outweigh the ICS-class effect of higher incidence of study-reported pneumonia compared with LAMA/LABA. Important differences in trial design, baseline population characteristics, such as exacerbation history, and assessment of outcomes, have significant implications for interpreting data from cross-trial comparisons. Current understanding interprets the blood eosinophil count as a continuum that can help predict response to ICS and has utility alongside other clinical factors to aid treatment decision-making. We conclude that treatment decisions in COPD should be guided by an approach that considers benefit versus risk, with early optimization of treatment essential for maximizing long-term benefits and patient outcomes. Dove 2021-03-01 /pmc/articles/PMC7935340/ /pubmed/33688176 http://dx.doi.org/10.2147/COPD.S291967 Text en © 2021 Bourbeau et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Review
Bourbeau, Jean
Bafadhel, Mona
Barnes, Neil C
Compton, Chris
Di Boscio, Valentina
Lipson, David A
Jones, Paul W
Martin, Neil
Weiss, Gudrun
Halpin, David M G
Benefit/Risk Profile of Single-Inhaler Triple Therapy in COPD
title Benefit/Risk Profile of Single-Inhaler Triple Therapy in COPD
title_full Benefit/Risk Profile of Single-Inhaler Triple Therapy in COPD
title_fullStr Benefit/Risk Profile of Single-Inhaler Triple Therapy in COPD
title_full_unstemmed Benefit/Risk Profile of Single-Inhaler Triple Therapy in COPD
title_short Benefit/Risk Profile of Single-Inhaler Triple Therapy in COPD
title_sort benefit/risk profile of single-inhaler triple therapy in copd
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935340/
https://www.ncbi.nlm.nih.gov/pubmed/33688176
http://dx.doi.org/10.2147/COPD.S291967
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