Escalation Time to Open Triple Combination Therapy from the Initiation of LAMA versus ICS/LABA in COPD Management: Findings from Comparing the Incidence of Tiotropium and ICS/LABA in Real-World Use in South Korea (CITRUS) Study.

Doik Lee,Ye Jin Lee,Yong Il Hwang,Youlim Kim,Yong Bum Park,So Eun Lee,Chin Kook Rhee,Kwang Ha Yoo

doi:10.3390/jpm11121325

Abstract

Background: bronchodilators are the key treatment for chronic obstructive pulmonary disease (COPD), however, inhaled corticosteroids (ICSs)/long-acting β2-agonists (LABA) are widely prescribed. We compared the escalation time to open triple combination therapy between long-acting muscarinic receptor antagonists (LAMA) and ICS/LABA in COPD management. Methods: this retrospective study included COPD patients selected from the National Health Insurance Service of South Korea from January 2005 to April 2015. The primary outcome was the escalation time to triple therapy in patients who initially received LAMA or ICS/LABA. Other outcomes included risk factors predisposing escalation to triple combination therapy. Results: a total of 2444 patients were assigned to the LAMA or ICS/LABA groups. The incidences of triple combination therapy in the LAMA and ICS/LABA groups were 81.0 and 139.8 per 1000 person-years, respectively (p < 0.001); the median times to triple therapy escalation were 281 and 207 days, respectively (p = 0.03). Treatment with ICS/LABA showed a higher risk of triple therapy escalation compared to LAMA (hazard ratio (HR), 1.601; 95% confidence interval (CI), 1.402–1.829). The associated risk factor was male sex. (HR, 1.564; 95% CI, 1.352–1.809). Conclusions: the initiation of COPD treatment with LAMA is associated with a reduced escalation time to triple therapy compared with ICS/LABA.

Highlights

Introduction distributed under the terms andBronchodilator therapy, including a long-acting β2-agonist (LABA) or a long-acting muscarinic receptor antagonist (LAMA), is the key treatment for chronic obstructive pulmonary disease (COPD) [1,2]
For patients with a blood eosinophil count of >300/μL or frequent exacerbations of COPD, inhaled corticosteroids (ICSs) has a clinical role in COPD management, and several studies have confirmed that ICS/LABA is more effective than long-acting muscarinic receptor antagonists (LAMA) for exacerbation prevention [4–7]
A total of 9284 patients were defined as the crude population; 6352 (68.4%) and 2932 (31.6%) patients were classified in the LAMA and ICS/LABA treatment groups, respectively (Supplementary Materials, Table S1)

Summary

Introduction

Introduction distributed under the terms andBronchodilator therapy, including a long-acting β2-agonist (LABA) or a long-acting muscarinic receptor antagonist (LAMA), is the key treatment for chronic obstructive pulmonary disease (COPD) [1,2]. For patients with a blood eosinophil count of >300/μL or frequent exacerbations of COPD, ICS has a clinical role in COPD management, and several studies have confirmed that ICS/LABA is more effective than LAMA for exacerbation prevention [4–7]. Side effects such as pneumonia may occur in ICS-treated patients [7–9]. When patients with COPD experience frequent exacerbations, reduced lung function or worsening symptoms, physicians consider escalating the treatment regimen to a triple combination of LAMA + LABA, LAMA or ICS/LABA [10–13]. Uncontrolled symptoms can lead to hospitalization or emergency room visits, and the cost of triple therapy is higher than that of treatment with LAMA or ICS/LABA alone [14–17]

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