Early triple combination COPD therapy decreases exacerbations, cardiopulmonary events
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Key takeaways:
- Starting COPD triple therapy within 1 month of an exacerbation was linked to the lowest future exacerbation rate.
- This treatment timing was also associated with a lower rate of future cardiopulmonary events.
Patients with COPD on budesonide/glycopyrrolate/formoterol fumarate within 30 days of an exacerbation had fewer future exacerbations and severe cardiopulmonary events, according to a study poster.
These findings were presented at the European Respiratory Society International Congress.
“This is particularly meaningful as an estimated one in five patients with COPD die within a year of their first hospitalization for an exacerbation,” Michael F. Pollack, MS, director of global epidemiology medical evidence at AstraZeneca, told Healio. “We also know that each exacerbation from COPD increases a patient’s risk of not only more lung events, but serious heart events, including heart attacks, stroke and event heart failure.
“This program underscores the need for optimized, comprehensive clinical management of COPD and prompt intervention with effective treatment options, even in newly diagnosed COPD patients,” Pollack said.
In the observational, retrospective MITOS EROS+CP study, Pollack and colleagues assessed 17,613 U.S. adults with COPD, no previous single inhaler triple therapy use and an acute COPD exacerbation ( 1 severe or 2 moderate or 1 moderate while receiving non-single inhaler triple therapy) to find out how timing of triple inhaled therapy combining budesonide, glycopyrrolate and formoterol fumarate (BGF; Breztri Aerosphere, AstraZeneca) after an exacerbation impacts future exacerbation and severe cardiopulmonary event rates.
According to the poster, several outcomes were recognized as cardiopulmonary events, such as “severe COPD exacerbation, acute heart failure, acute myocardial infarction, cardiac arrest or death.”
As Healio previously reported, a post-hoc analysis of the phase 3, randomized, double-blind, multicenter, parallel-group ETHOS trial found that patients with COPD on BGF had a lower risk for cardiopulmonary outcomes.
Within the MITOS EROS+CP population, 2,192 patients started receiving BGF within 30 days after an exacerbation (prompt), 7,230 started BGF 31 to 180 days after (delayed) and 8,191 started BGF 181 to 365 days after (very delayed).
At baseline, the three groups had comparable proportions of patients with zero, one, two, three and four or more CV-related comorbidities.
A severe exacerbation was the exacerbation type that made a patient eligible in around 20% of each timing group (prompt, 24.5%; delayed, 21.4%; very delayed, 18.2%), according to the poster.
Researchers found that patients who received prompt BGF had the lowest subsequent acute COPD exacerbation rate at 1.35 events per person-year (95% CI, 1.3-1.4), followed by patients who received delayed BGF at 1.77 events per person-year (95% CI, 1.74-1.79) and patients who received very delayed BGF at 1.98 events per person-year (95% CI, 1.95-2).
Similarly, the lowest subsequent severe cardiopulmonary event rate was observed in the prompt BGF group vs. the delayed BGF and very delayed BGF groups (0.34; 95% CI, 0.32-0.37 vs. 0.39; 95% CI, 0.38-0.4 and 0.38; 95% CI, 0.37-0.39), according to researchers.
“Preliminary descriptive data from MITOS EROS+CP provide clinical evidence that earlier use of Breztri may reduce the risk of severe cardiopulmonary events vs. delayed initiation,” Pollack told Healio.
“Together, [MITOS EROS+CP and post-hoc ETHOS] data add to the growing body of evidence supporting the need for more proactive intervention to improve outcomes in COPD and the need to proactively address cardiopulmonary risk to reduce mortality,” he added.
In the mean follow-up period of 495.8 days, researchers noted that 22.3% of the total cohort had at least one cardiopulmonary event, including 67.9% with one or more severe exacerbations and 58.5% with one or more hospitalizations for acute heart failure, acute myocardial infarction or cardiac arrest. Additionally, 23.9% of the patients with a cardiopulmonary event died.
“There is still a need for additional evidence to advance scientific understanding in this area and improve outcomes for patients,” Pollack told Healio. “To this end, AstraZeneca has recently initiated two additional clinical trials, including the first-ever cardiopulmonary outcomes trial in COPD, the THARROS phase 3 trial, investigating the potential of Breztri to improve cardiopulmonary outcomes in people with COPD, and the ATHLOS phase 3 trial assessing the impact of Breztri on integrated cardiopulmonary parameters associated with health status and survival in patients with COPD.”