Real-World Experience of Treating Chronic Obstructive Pulmonary Disease with Triple Therapy

Overview

Journal Int J Chron Obstruct Pulmon Dis

Publisher Dove Medical Press

Specialty Pulmonary Medicine

Date 2023 Jun 13

PMID 37309394

Authors

Kuang-Ming Liao

Jhi-Joung Wang

Chung-Han Ho

Affiliations

Soon will be listed here.

Abstract

Background: Double-blind randomized controlled trials have compared patients with chronic obstructive pulmonary disease (COPD) taking triple therapy, which can improve lung function, dyspnea, and quality of life and reduce acute exacerbation and mortality, with those taking long-acting muscarinic antagonist/long-acting β2-agonist; however, the real-word treatment scenario may be different from that of a strict and well-designed study. The aim of our study was to assess long-term outcomes among patients with COPD who received triple therapy in real-world practice.

Methods: Data from Taiwan's National Health Insurance Research Database (NHIRD) from 2005 and 2016 were used to identify COPD patients who were over 40 years of age with diagnosis codes 490-492, 496 (ICD-9-CM) or J41-44 (ICD-10-CM). After matching for age, sex, and COPD exacerbations, COPD patients who did and did not receive triple therapy were enrolled in this study. Cox proportional regression was used to estimate the mortality risk between smoking status and COPD patients with and without triple therapy.

Results: A total of 19,358 patients with COPD who did or did not receive triple therapy were enrolled in this study. The prevalence rates of some comorbidities were higher among patients with COPD who received triple therapy than among those who did not receive triple therapy. These comorbidities included lung cancer, thoracic malignancies, bronchiectasis, and heart failure. The risk of mortality was higher among patients who received triple therapy than among those who did not receive triple therapy after matching for age, sex, and COPD exacerbations, with a crude hazard ratio, fully adjusted model hazard ratio and stepwise approach reduced hazard ratio of 1.568 (95% CI, 1.500-1.639), 1.675 (95% CI, 1.596-1.757), and 1.677 (95% CI, 1.599-1.76), respectively.

Conclusion: Over 5 years of observation, patients with COPD who received triple therapy did not show a survival benefit compared with those who did not receive triple therapy in a real-world scenario.

Citing Articles

Impact of Triple Inhaler Therapy on COPD Patients with Non-Small Cell Lung Cancer After Radical Surgery: A Single-Centre Retrospective Analysis.

Bertuccio F, DAgnano V, Cordoni S, Tafa M, Novy C, Baio N J Clin Med. 2025; 14(1.

PMID: 39797331 PMC: 11722558. DOI: 10.3390/jcm14010249.

References

Bang K, Gergen P, Kramer R, Cohen B . The effect of pulmonary impairment on all-cause mortality in a national cohort. Chest. 1993; 103(2):536-40. DOI: 10.1378/chest.103.2.536. View

Traver G, Cline M, Burrows B . Predictors of mortality in chronic obstructive pulmonary disease. A 15-year follow-up study. Am Rev Respir Dis. 1979; 119(6):895-902. DOI: 10.1164/arrd.1979.119.6.895. View

Lipson D, Barnhart F, Brealey N, Brooks J, Criner G, Day N . Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD. N Engl J Med. 2018; 378(18):1671-1680. DOI: 10.1056/NEJMoa1713901. View

Lipson D, Barnacle H, Birk R, Brealey N, Locantore N, Lomas D . FULFIL Trial: Once-Daily Triple Therapy for Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2017; 196(4):438-446. DOI: 10.1164/rccm.201703-0449OC. View

Rabe K, Hurd S, Anzueto A, Barnes P, Buist S, Calverley P . Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007; 176(6):532-55. DOI: 10.1164/rccm.200703-456SO. View

Suissa S, DellAniello S, Ernst P . Comparative Effects of LAMA-LABA-ICS vs LAMA-LABA for COPD: Cohort Study in Real-World Clinical Practice. Chest. 2019; 157(4):846-855. DOI: 10.1016/j.chest.2019.11.007. View

Anthonisen N, Wright E, Hodgkin J . Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis. 1986; 133(1):14-20. DOI: 10.1164/arrd.1986.133.1.14. View

Mannino D, Buist A, Petty T, Enright P, Redd S . Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax. 2003; 58(5):388-93. PMC: 1746680. DOI: 10.1136/thorax.58.5.388. View

Kim H, Lee S, Kim J . Real-world Evidence versus Randomized Controlled Trial: Clinical Research Based on Electronic Medical Records. J Korean Med Sci. 2018; 33(34):e213. PMC: 6097073. DOI: 10.3346/jkms.2018.33.e213. View

10.

Suissa S, DellAniello S, Ernst P . Triple Inhaler versus Dual Bronchodilator Therapy in COPD: Real-World Effectiveness on Mortality. COPD. 2021; 19(1):1-9. DOI: 10.1080/15412555.2021.1977789. View

11.

Ashdown H, Smith M, McFadden E, Pavord I, Butler C, Bafadhel M . Blood eosinophils to guide inhaled maintenance therapy in a primary care COPD population. ERJ Open Res. 2022; 8(1). PMC: 8819252. DOI: 10.1183/23120541.00606-2021. View

12.

Papi A, Vestbo J, Fabbri L, Corradi M, Prunier H, Cohuet G . Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet. 2018; 391(10125):1076-1084. DOI: 10.1016/S0140-6736(18)30206-X. View

13.

Frith P, Thompson P, Ratnavadivel R, Chang C, Bremner P, Day P . Glycopyrronium once-daily significantly improves lung function and health status when combined with salmeterol/fluticasone in patients with COPD: the GLISTEN study, a randomised controlled trial. Thorax. 2015; 70(6):519-27. PMC: 4453631. DOI: 10.1136/thoraxjnl-2014-206670. View

14.

Pascoe S, Barnes N, Brusselle G, Compton C, Criner G, Dransfield M . Blood eosinophils and treatment response with triple and dual combination therapy in chronic obstructive pulmonary disease: analysis of the IMPACT trial. Lancet Respir Med. 2019; 7(9):745-756. DOI: 10.1016/S2213-2600(19)30190-0. View

15.

McGarvey L, John M, Anderson J, Zvarich M, Wise R . Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax. 2007; 62(5):411-5. PMC: 2117197. DOI: 10.1136/thx.2006.072348. View

16.

Rabe K, Martinez F, Ferguson G, Wang C, Singh D, Wedzicha J . Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD. N Engl J Med. 2020; 383(1):35-48. DOI: 10.1056/NEJMoa1916046. View

17.

Siler T, Kerwin E, Singletary K, Brooks J, Church A . Efficacy and Safety of Umeclidinium Added to Fluticasone Propionate/Salmeterol in Patients with COPD: Results of Two Randomized, Double-Blind Studies. COPD. 2015; 13(1):1-10. PMC: 4778542. DOI: 10.3109/15412555.2015.1034256. View

18.

Singh D, Papi A, Corradi M, Pavlisova I, Montagna I, Francisco C . Single inhaler triple therapy versus inhaled corticosteroid plus long-acting β2-agonist therapy for chronic obstructive pulmonary disease (TRILOGY): a double-blind, parallel group, randomised controlled trial. Lancet. 2016; 388(10048):963-73. DOI: 10.1016/S0140-6736(16)31354-X. View

19.

Vestbo J, Papi A, Corradi M, Blazhko V, Montagna I, Francisco C . Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial. Lancet. 2017; 389(10082):1919-1929. DOI: 10.1016/S0140-6736(17)30188-5. View

20.

Rogliani P, Calzetta L . Mortality in ETHOS: A Question of "Power". Am J Respir Crit Care Med. 2021; 203(7):926-927. PMC: 8017584. DOI: 10.1164/rccm.202012-4328LE. View