Compared to dual therapy, Triple therapy doesn`t improve survival in COPD: Study
Recent research reveals that no differences in mortality between LAMA+LABA and triple therapy in patients with moderate-to-very severe COPD and predominantly low risk of exacerbations.
The study was presented at the American Thoracic Society (ATS) 2021 International Conference, held virtually from May 14 to May 19, 2021.
Recent studies report a possible mortality benefit of treatment with long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA)/inhaled corticosteroid (ICS) versus LAMA/LABA combinations in patients with highly symptomatic COPD and a history of exacerbations.
Hence, M. Miravitlles and colleagues from the Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain compared the time to all-cause mortality with LAMA/LABA/ICS versus LAMA+LABA in a population of patients with predominantly moderate-to-severe COPD and a predominantly lower exacerbation risk.
Data were pooled from patients who participated in six phase 3/4 randomized controlled trials and received treatment with either LAMA/LABA/ICS (n=11,891) or LAMA+LABA (n=3,156). There was no withdrawal of prior treatment at randomization in either arm, and the LAMA/LABA/ICS group were receiving ICS prior to study entry.
The analysis was on-treatment and all data were censored at 52 weeks. To address any imbalance in characteristics between treatment arms, analyses were performed in a propensity score (PS)-matched cohort with age, sex, geographical region, smoking status, post-bronchodilator forced expiratory volume in 1 second (FEV1) percent predicted, exacerbation history, body mass index and time since diagnosis as covariates.
Patients were PS-matched to those who received LAMA+LABA during the treatment period and had not previously received ICS. Cox proportional hazard regression models adjusting for covariates were used to assess time to all-cause mortality.
The following findings were seen-
- After propensity score matching, there were 3,133 patients in both the LAMA+LABA and LAMA/LABA/ICS treatment groups.
- Baseline characteristics and comorbidities were well balanced between groups (LAMA+LABA vs. LAMA/LABA/ICS: male: 71.7% vs. 72.0%; age, mean±SD: 65.5±8.8 years vs. 65.5±8.7 years; FEV1% predicted [post-bronchodilator], mean±SD: 48.6±13.2% vs. 48.4±13.3%).
- Groups were composed mostly of infrequent exacerbators (patients with ≥2 COPD exacerbation in prior year: 19.1% vs. 19.0%).
- Overall, there were 41 (1.3%) deaths in the LAMA+LABA group and 45 (1.4%) in the LAMA/LABA/ICS group.
- No statistically significant difference in the time to death was observed between treatment groups (; hazard ratio 1.06; 95% confidence intervals 0.68, 1.64; P=0.806).
- Sensitivity analyses using three additional models with different covariates showed similar results.
Therefore, the authors concluded that "this pooled analysis of over 6,000 PS-matched patients showed no differences in mortality between LAMA+LABA and triple therapy in patients with moderate-to-very severe COPD and predominantly low risk of exacerbations."