Effect of Combination vs Triple Therapy on COPD Exacerbations

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Combination therapy with LABA and LAMA yielded a lower annualized rate of COPD exacerbations compared with triple therapy.

This article is part of Pulmonology Advisor‘s coverage of the American Thoracic Society’s International Conference, taking place in San Diego, California. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2018.

SAN DIEGO — Patients who received a free or fixed-dose combination of a long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) experienced a lower risk for chronic obstructive pulmonary disease (COPD) exacerbations compared with patients who received triple therapy, according to research presented at the 2018 American Thoracic Society International Conference, held May 18-23 in San Diego, California.

DACCORD is an ongoing, longitudinal noninterventional study within the German COPD National Prospective Registry that collects data from patients with COPD who are recruited from primary and secondary care throughout Germany with a change of maintenance therapy at baseline.

Researchers matched patients for age, gender, body mass index, baseline COPD Assessment Test, baseline FEV1% predicted, and exacerbation history. A total of 2885 patients received LABA and LAMA therapy and 1311 patients received triple therapy with LABA, LAMA, and inhaled corticosteroids. The researchers matched 1046 pairs who were on the two treatment regimens.

During a 1-year follow-up, patients who were given combination therapy of LABA and LAMA had a lower annualized rate of exacerbations compared with the patients in the triple therapy group (0.184; 95% CI, 0.156-0.216 vs 0.364; 95% CI, 0.320-0.414; P <.001).

In a subgroup analysis based on prior therapy, researchers found that 376 patients in the LABA and LAMA group had added a bronchodilator at baseline (exacerbation rate, 0.189; 95% CI, 0.145-0.248) and 201 had a received LABA and LAMA combination before study entry (exacerbation rate, 0.196; 95% CI, 0.135-0.287). In the triple therapy group, 468 patients had added a bronchodilator at baseline (exacerbation rate, 0.352; 95% CI, 0.291-0.427) and 400 had received triple therapy before study entry (exacerbation rate, 0.418; 95% CI, 0.340-0.248).

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The researchers concluded that the patients who received LABA and LAMA combination therapy may have experienced fewer COPD exacerbations because of differences in treatment regimens prior to study inclusion and because of the effectiveness of long-acting bronchodilators used in both treatment groups.

“The greatest benefit from the COPD maintenance therapy change on entry to DACCORD was in patients who added a second bronchodilator to a single bronchodilator. This benefit was greater than in patients who added another bronchodilator to an inhaled corticosteroid plus a bronchodilator,” stated lead author Dr Buhl. Study patients who remained on triple therapy, in contrast, were at the highest risk of experiencing exacerbations.

“The results suggest a potential impact of prior medication on study results, something to consider when interpreting the results of controlled trials,” added Dr Buhl.

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Buhl R, Criee CP, Kardos P, et al. Dual bronchodilation vs triple therapy in the real-life DACCORD study. Presented at: American Thoracic Society 2018 International Conference; May 18-23, 2018; San Diego, CA. Abstract 1012.