Extract
Suissaand Ariel[1] performed apost hocanalysis of TRIBUTE and IMPACT [2, 3], by “digitising” the figures to obtain values over each month of the cumulative incidence curves. They concluded that the lower rate of a first exacerbation with triple long-acting muscarinic antagonist/long-acting β2-agonist/inhaled corticosteroid (LAMA/LABA/ICS) therapy was exclusively due to a lower rate in the first month of treatment, while the rates were comparable to LAMA/LABA in the subsequent 11 months. They argue that this pattern of “depletion of susceptible individuals” might identify a small group of patients and suggest that only these patients could benefit from triple therapy, whereas the majority could be treated with LAMA/LABA without risk. They also found that the 42% lower mortality with triple therapy in IMPACT was localised in the first 4 months of follow-up, with no difference in the following 8 months. Based on these observations, they speculate that the subgroup who may benefit from triple therapy could be represented by patients with a history of asthma or eosinophilia, and they could be identifieda priori.
Abstract
In keeping with the latest international recommendations, we suggest using triple therapy in all patients with severe symptomatic COPD at increased risk of exacerbation who are not adequately treated by LAMA/LABA or LABA/ICS, independent of asthma historyhttp://ow.ly/Bbsr30nXffO
Acknowledgements
Writing support was provided by David Young (Young Medical Communications and Consulting Ltd, Horsham, UK). This support was funded by Chiesi Farmaceutici SpA.
Footnotes
Conflict of interest: A. Papi reports grants, personal fees, non-financial support and other from Chiesi, AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Menarini, Novartis, Zambon, Mundipharma and TEVA, and grants from Sanofi, outside the submitted work.
Conflict of interest: S. Petruzzelli is employed by Chiesi Farmaceutici SpA, the sponsor of the studies.
Conflict of interest: S. Vezzoli is employed by Chiesi Farmaceutici SpA, the sponsor of the studies.
Conflict of interest: G. Georges reports other support from Chiesi USA, Inc., during the conduct of the study; and other support from Chiesi USA, Inc., outside the submitted work.
Conflict of interest: L.M. Fabbri reports personal fees and non-financial support from AstraZeneca, GSK, Novartis, Menarini, Boehringer Ingelheim, Zambon and Pearl Therapeutics, non-financial support from Dompe, and grants, personal fees and non-financial support from Chiesi, outside the submitted work.
Support statement: This study was funded by Chiesi Farmaceutici. Funding information for this article has been deposited with theCrossref Funder Registry.
- ReceivedJanuary 21, 2019.
- AcceptedFebruary 3, 2019.
- Copyright ©ERS 2019
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