Dropping ICS from triple therapy may improve outcomes of COPD patients: Study

Germany: Recent randomized controlled trials (RCTs) by C. Vogelmeier and colleagues showed that selected chronic obstructive pulmonary disease (COPD) patients may benefit from an inhaled corticosteroid (ICS) cessation. Researchers have found that among patients with chronic obstructive pulmonary disease (COPD) switching from so-called triple therapy to a two-drug product dropping inhaled corticosteroid (ICS) component had improved symptom control, as well as fewer adverse effects.

The findings of this study were presented at the American Thoracic Society annual meeting, in 2022.

In patients with COPD, randomized controlled studies evaluated a step-down from inhaled triple treatment, which included inhaled corticosteroid, long-acting muscarinic antagonist (LAMA), and long-acting 2-agonists (LABA), to a LABA/LAMA combination. Although the results of such RCTs can affect treatment decisions, there is a lack of information on ICS discontinuation in 'real-life' populations. The primary goal of the prospective, non-interventional DACCORD trial was to collect data on COPD development in real-life settings. Previous DACCORD cohort 1 and 2 analyses suggested that many patients in Germany may be receiving ICS needlessly and hence be candidates for switching to a LABA/LAMA combination.

The third cohort of DACCORD patients who had been taking inhaled triple treatment for at least 6 months before enrollment were enrolled for this trial. The purpose of this study was to evaluate the efficacy and safety of a LABA/LAMA fixed-dose combination (FDC) in COPD patients following ICS withdrawal solely at the discretion of the treating physician, with the primary goal being time to COPD worsening (= moderate/severe exacerbation or deterioration of 2 or more in COPD Assessment Test [CAT] score). The researchers present 1-year follow-up data from both groups in this paper.

The key findings of this study were as follows:

1. 30% of the 967 patients in the third DACCORD cohort with relevant post-baseline data were transferred to a LABA/LAMA FDC upon admission.

2. Disease characteristics and baseline demographics were similar between groups, and the most common reasons for quitting and maintaining triple treatment were "patient's request" and "COPD symptom management," respectively.

3. During the follow-up period, patients in the LABA/LAMA FDC group had significantly superior results, with a reduced percentage of COPD worsening and exacerbations, a longer time to worsening, a reduction in exacerbation incidence, and an increase in median CAT scores.

4. In the LABA/LAMA FDC group, a reduced proportion of patients experienced non-serious and serious side effects.

In conclusion, the third DACCORD cohort confirms these findings in a real-world population, demonstrating that switching from inhaled triple treatment to a LABA/LAMA FDC did not aggravate COPD but rather improved health status.

Reference: Vogelmeier C, et al "Stepping down from triple inhaled therapy to a LABA/LAMA fixed-dose combination: data from the German real-life DACCORD COPD cohort" American Thoracic Society 2022.