COPD Exacerbation Risk May Be Increased by Delayed Start of Triple Therapy

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How does a delay in initiating triple therapy affect patients with COPD with a history of several moderate COPD exacerbations during a 1-year period?

Delaying the initiation of triple therapy (TT) after a second moderate event among patients with chronic obstructive pulmonary disease (COPD) is associated with an increased number of future exacerbations, according to study results presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting, held from October 16 to 19, 2022, in Nashville, Tennessee.

Although moderate COPD exacerbations are linked to a risk for future exacerbations, many patients may not receive timely escalation of therapy after moderate events. Researchers therefore analyzed data from the PRIMUS study to assess whether patients who immediately began TT after a second moderate COPD exacerbation within 12 months experienced a lower risk for future exacerbations.

The PRIMUS study involved at least 40 years of age with a diagnosis of COPD who were identified from the IBM MarketScan database from January 1, 2010, to December 31, 2019. Eligible participants had open or closed TT, at least 2 moderate COPD exacerbation events within 12 months before the index treatment, 12 months of continuous enrollment before or after the index exacerbation (the second moderate event), and did not have select respiratory diseases and cancer.

In the current analysis, 17,998 patients were stratified into 3 groups according to the timing of their TT prescription after their index exacerbation: (1) prompt (within 30 days; n=4609 [25.6%]); (2) delayed (31-180 days; n=7678 [42.7%]); and (3) very delayed (181+ days; n=5711 [31.7%]). Patients included in the analysis had a mean (SD) age of 61.3 (10.9) years, 61.5% were women, and 98% had received baseline monotherapy or dual therapy.

The proportion of patients who had 1 or more exacerbations was 66.6%, 81.3%, and 88.5% for the prompt, delayed, and very delayed TT groups, respectively (P <.001). The mean number of moderate or severe exacerbations that occurred was 1.5 (1.7), 2.1 (1.8), and 2.9 (2.2) for the prompt, delayed, and very delayed TT groups, respectively (P <.001).

In addition, the proportion of patients having a severe exacerbation increased by 8.4%, 12.6%, and 17.2% in the prompt, delayed, and very delayed TT groups, respectively (P <.001).

“Delays in starting TT may introduce avoidable risks of future exacerbations including hospitalizations,” concluded the investigators. “These results support a more proactive approach to the management of COPD following moderate exacerbation events, particularly initiation of TT.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Evans KA, Pollack M, Tkacz J, et al. Promptly initiating triple therapy following second moderate exacerbation among patients with COPD in the United States: analysis of the PRIMUS study. Abstract presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN.