Single vs. multiple inhaler COPD triple therapy decreases risk of cardiopulmonary events
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Key takeaways:
- The single inhaler combined budesonide, glycopyrrolate and formoterol fumarate.
- The risk for cardiopulmonary events dropped by 12% with use of this single inhaler vs. multiple inhaler triple therapy.
BOSTON — Patients with COPD faced a decreased risk of severe cardiopulmonary events if treated with single inhaler vs. multiple inhaler triple therapy, according to data presented at the CHEST Annual Meeting.
“These data continue to support the optimization of using single inhaler triple therapy with Breztri to proactively address cardiopulmonary risk to improve outcomes in COPD and reduce avoidable deaths and enhance Breztri’s robust, competitive profile amongst fixed-dose combination therapies,” Michael F. Pollack, MS, director of global epidemiology medical evidence at AstraZeneca, told Healio.
In the real-world SKOPOS-MAZI study, Pollack and colleagues evaluated U.S. adults with at least two separate diagnoses for COPD and no previous use of triple therapy to find out how treatment with a single inhaler combining budesonide, glycopyrrolate and formoterol fumarate (BGF; Breztri Aerosphere, AstraZeneca) impacts severe cardiopulmonary event incidence at 1 year and risk vs. treatment with multiple-inhaler triple therapy (MITT).
According to the abstract, acute hospitalizations for COPD exacerbation, cardiac arrest, heart failure, myocardial infarction or all-cause mortality were all the conditions recognized as cardiopulmonary events.
As Healio previously reported, patients with COPD on BGF had a lower risk for cardiopulmonary outcomes, and those who started BGF within 30 days of an exacerbation had fewer future exacerbations and severe cardiopulmonary events.
Within the SKOPOS-MAZI study population, 11,988 patients (mean age, 70.9 years; 44.8% men) started receiving BGF, and 10,650 patients (mean age, 71.7 years; 42.3% men) started receiving MITT.
At baseline, significantly more patients in the MITT group had at least one exacerbation than the BGF group. Researchers also reported that the MITT group had a significantly higher mean Charlson Comorbidity Index score.
The full cohort experienced 10,786 cardiopulmonary events during mean follow-up periods of 348.5 days in the BGF group and 394.2 days in the MITT group.
The most frequent cardiopulmonary event was COPD exacerbation (31.9%), followed by all-cause mortality (18.9%), acute heart failure (18.4%) and arrhythmias (18.2%).
“Just one COPD exacerbation doubles the risk of a heart attack and increases risk of a stroke, hospitalisation and cardiopulmonary-related death,” Pollack told Healio. “A COPD exacerbation can also contribute to lung function decline and accelerate progression of the disease. Further, approximately 1 in 5 patients with COPD will die within a year of their first hospitalisation for an exacerbation.”
Researchers achieved balanced BGF and MITT groups in terms of baseline characteristics with inverse propensity of treatment weighting (IPTW).
Patients receiving BGF vs. MITT had a significantly lower IPTW weighted 1-year cumulative incidence of cardiopulmonary events (22.8% vs. 24.85%; P < .001).
Additionally, researchers observed that the risk for cardiopulmonary events was decreased by 12% in the BGF vs. MITT group (HR = 0.88; 95% CI, 0.83-0.93). After adding arrythmias, emergency coronary revascularization and ischemic stroke to the outcomes considered as cardiopulmonary events, the risk was still lower with BGF vs. MITT (HR = 0.87; 95% CI, 0.83-0.92), according to the abstract.
Notably, sensitivity analysis included 7,604 patients from the BGF group and 6,943 patients from the MITT group, all with the characteristic of remaining on therapy past initial prescription. Similar to above, the BGF group in this analysis had a lower IPTW weighted 1-year cumulative incidence of cardiopulmonary events than the MITT group (20.58% vs. 23.08%), as well as a reduced cardiopulmonary event risk (HR = 0.87; 95% CI, 0.81-0.94).
“These results are significant in that they add to the growing evidence demonstrating the need for the prioritization of COPD and proactive approach to addressing cardiopulmonary risk, which is increasingly recognised across the clinical community,” Pollack told Healio.
Looking ahead, Pollack said two trials from AstraZeneca will continue to study BGF and expand the understanding of the effect of cardiopulmonary events.
“AstraZeneca has recently initiated the THARROS phase 3 trial, a first-of-its-kind, landmark phase 3 trial that will investigate the potential of Breztri to reduce the risk of cardiopulmonary outcomes, including death from respiratory and cardiac causes, in patients COPD,” Pollack told Healio.
“We have also initiated the ATHLOS phase 3 trial assessing Breztri on integrated cardiopulmonary parameters associated with health status and survival in patients with COPD,” Pollack added.