Early triple combination COPD therapy lowers rate of future exacerbations

Key takeaways:

• More time between an exacerbation and start of COPD triple therapy increased rate of future exacerbations.
• Starting the therapy within 1 month of an exacerbation was linked to the lowest rate.

WASHINGTON — Patients with COPD on budesonide/glycopyrrolate/formoterol fumarate within 30 days of an exacerbation had fewer future exacerbations, according to data presented at the American Thoracic Society International Conference.

Charlie Strange

“Exacerbations and Real-world Outcomes [EROS] informs us that triple therapy begun immediately after both moderate and severe exacerbations improved outcomes compared to all combinations of inhalers that were used in the month before the index exacerbation,” Charlie Strange, MD, professor of pulmonary and critical care medicine at Medical University of South Carolina and investigator in the EROS study, told Healio. “When we try and match the right patient with the right inhaler, the move to triple therapy earlier after exacerbations is supported by real world evidence.”

In a retrospective analysis of the MORE² Registry database, Strange and colleagues evaluated 2,409 adults (mean age, 61.8 years; 63.4% women) with COPD to determine if there was a difference in risk for future exacerbations based on the time of initiation of budesonide/glycopyrrolate/formoterol fumarate (BGF; Breztri Aerosphere, AstraZeneca), a single inhaler triple therapy.

According to the abstract, included patients had to meet one of the following criteria: at least one severe exacerbation, at least two moderate exacerbations or at least one moderate exacerbation while receiving another maintenance treatment.

Researchers determined each patient’s first qualifying exacerbation and grouped them according to when they started BGF in relation to that exacerbation (up to 1 year after).

Of the total cohort, 434 patients received BGF within 30 days of their qualifying exacerbation (prompt), 1,187 patients received it within 31 to 180 days (delayed) and 788 patients received it within 181 to 365 days (very delayed).

Researchers found that more time between a patient’s exacerbation and starting BGF meant a higher rate of total exacerbations. The annualized rate in patients who received BGF promptly was 1.52 exacerbations per person-year (95% CI, 1.39-1.66), whereas the rate increased to 2 exacerbations per person-year (95% CI, 1.92-2.09) in patients who received BGF within the delayed timeframe and 2.3 per person-year (95% CI, 2.2-2.4) in the very delayed timeframe.

When only evaluating severe exacerbations, which involved being hospitalized for COPD or alternatively, respiratory failure with a secondary diagnosis of COPD, researchers again found that more time from qualifying exacerbation to receiving BGF heightened the rate. Patients who started BGF promptly had a severe exacerbation rate of 0.06 per person-year (95% CI, 0.04-0.09), which went up in patients who had a delayed start (0.08 per person-year; 95% CI, 0.06-0.1) and a very delayed start (0.16 per person-year; 95% CI, 0.14-0.19).

“COPD is a growing global health emergency and deserves special attention from the medical community, as the third leading cause of death globally with no improvement in mortality in 20 years,” Strange told Healio. “COPD management has historically been reactive and underprioritized, but there is new momentum building toward more prompt intervention to prevent exacerbations and address cardiopulmonary risk to prevent premature death.”

Reference:

• New AstraZeneca data presented at ATS 2023 strengthen the body of evidence supporting early intervention with BREZTRI in COPD. https://www.astrazeneca-us.com/media/press-releases/2023/new-astrazeneca-data-presented-at-ats-2023-strengthen-the-body-of-evidence-supporting-early-intervention-with-breztri-in-copd.html. Published May 23, 2023. Accessed May 26, 2023.