GLYCOPYRRONIUM-BASED TRIPLE (ICS/LABA/LAMA) NEBULIZATION IN PATIENTS HOSPITALIZED WITH ACUTE EXACERBATING OBSTRUCTIVE AIRWAY DISEASE: DRUG UTILIZATION STUDY IN INDIA

Abstract

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Nebulization therapy plays an essential role in hospitalized AEOAD patients. Primary bronchodilators used in the management are salbutamol/levosalbutamol (SABA) and ipratropium bromide (SAMA) requiring frequent dosing and with heightened cardiovascular risk. Glycopyrronium has more potent, quicker and long lasting bronchodilatory action compared to ipratropium, also it has better cardiac safety leading to its off label use for AEOAD in Indian clinical setting. Objective: To evaluate the real world use of glycopyrronium based triple nebulization in hospitalized AEOAD cases in terms of patient characteristics, treatment pattern, dosing, duration. METHODS: Retrospective drug utilization study (DUS) was conducted in 100 consecutive hospitalized AEOAD patients who received glycopyrronium based triple nebulization from single Indian centre after independent ethics committee approval. Medical records from Oct 2020 – Feb 2021 were analyzed to capture details about demography, diagnosis, co-morbidities, existing OAD treatment, nebulization therapy, discharge medications. RESULTS: Average age of 100 consecutive AEOAD patients was 64.5 + 14.5 yrs with 4:1 M:F ratio. 44% were smokers. 67% had comorbidities, commonest being DM (49%), CVD (42%) & HTN (22%) . Most common OAD diagnosis was COPD (70%), followed by asthma (27%) & ACO (3%); Median duration of OAD was 12 yrs(1-40 yrs). 21% were diagnosed of OAD during current hospitalization. Prior OAD medications included ICS-LABA(27%), SABA-SAMA(27%), ICS-LABA-LAMA(4%). None were on LABA-LAMA therapy. 35% didn’t receive any prior therapy. Adherence to OAD treatment was 52%. 49% had ≥ 1 exacerbation in the last 1 yr, with 28% requiring hospitalization. Commonest presentation of AEOAD included dyspnea(90%), cough(69%), fever(47%) with SpO2 (93.3 ± 5.6), RR (28.8 ± 8) & eosinophil count (412.9 ± 706.9). All patients were treated with triple nebulization of Budesonide/Formoterol/Glycopyrronium (500/20/25 mcg) by Jet nebulizer for median duration of 5 days (1-17 days). Most (94%) were prescribed concomitant antibiotics for median duration of 4 days (1-11 days). 45% needed respiratory support in form of NIV (40%), MV (28%) or ECMO (1%). Median duration of hospitalization was 6 days (1-11 days). On discharge, therapies like ICS-LABA(46%), ICS (39%), SAMA-SABA (24%), LAMA (10%) were prescribed. Majority (55%) were prescribed home Nebulization treatment. CONCLUSIONS: Though traditionally SABA/SAMA combination is preferred for AEOAD, we observed growing use of Glycopyrronium/formomterol/Budesonide triple nebulization. Testing this strategy in controlled clinical trials will further validate the role of glycopyrronium based nebulization in AECOPD patients. CLINICAL IMPLICATIONS: Owing to its faster onset of action & cardiovascular safety, Glycopyrronium based Triple nebulization can be a potential alternative clinical strategy for management of hospitalized AEOAD patients. DISCLOSURES: Employee relationship with Glenmark Pharmaceuticals Ltd Please note: since last42 months Added 04/27/2021 by HANMANT VENKATRAO BARKATE, source=Web Response, value=Salary Employee relationship with Glenmark Pharmaceuticals Ltd Please note: since last 42 months Added 04/28/2021 by HANMANT VENKATRAO BARKATE, source=Web Response, value=Salary No relevant relationships by SAGAR PANCHAL, source=Web Response No relevant relationships by NIRANJANA PANIGRAHI, source=Web Response Employee relationship with Glenmark Pharmaceuticals Ltd Please note: 8 years Added 04/27/2021 by Saiprasad Patil, source=Web Response, value=Salary