Triple vs Dual Therapy Outcomes in Reversible, Nonreversible COPD

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2018 meeting, taking place in San Antonio, Texas. Our staff will report on medical research related to COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2018.

SAN ANTONIO — Triple therapy with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) demonstrated significant improvements in chronic obstructive pulmonary disease (COPD) outcomes compared with dual therapy with umeclidinium/vilanterol (UMEC/VI) independent of reversibility, according to findings presented at the CHEST Annual Meeting 2018, held October 6-10, in San Antonio, Texas.

Researchers conducted a randomized double-blind parallel-group study (Informing the Pathway of COPD Treatment; IMPACT; ClinicalTrials.gov Identifier: NCT02164513) to determine the effect of baseline reversibility on treatment response. A total of 10,355 symptomatic patients with COPD who had a history of moderate or severe exacerbations during the previous 12 months were included. Patients were defined as “reversible” when there was a ≥12% and ≥200 mL difference in forced expiratory volume in 1 second (FEV₁) between pre- and post-albuterol assessment. At screening, 18% of patients were considered reversible. 

FF/UMEC/VI demonstrated a statistically significant reduction in the rate of on-treatment moderate or severe exacerbations compared with UMEC/VI in reversible and nonreversible patients (percentage reduction in rate for reversible patients, 40%; 95% CI, 28%-50%, and for nonreversible patients, 21%; 95% CI, 14%-28%). Severe exacerbation rates were reduced by 44% (95% CI, 14%-63%) with FF/UMEC/VI vs UMEC/VI in reversible patients and 31% (95% CI, 17%-44%) in nonreversible patients.

The risk in time to first moderate or severe exacerbation was also reduced (25.6%; 95% CI, 11.0%-37.9% and 13.6%; 95% CI, 6.2%-20.5%, respectively) as was the risk of having a severe exacerbation (32.8%; 95% CI, 2.8%-53.5% and 23.5%; 95% CI, 9.7%-35.2%, respectively). In addition, lung function (change from baseline trough FEV1 at week 52) and quality of life as assessed by St. George’s Respiratory Questionnaire improved in patients who received FF/UMEC/VI vs UMEC/VI, regardless of reversibility status (all P <.05).

“Statistically significant improvements of triple therapy over FF/VI were observed [in] all end points in nonreversible patients and [in] the moderate/severe exacerbate rate and lung function end points for reversible patients,” the researchers concluded.

However, FF/UME/VI did not reduce severe exacerbation rates compared with FF/VI in reversible patients.