LABA+LAMA+ICS associated with greater decline in all-cause mortality than LABA+LAMA in patients with severe COPD (IMPACT)

Référence

Lipson DA, Crim C, Criner GJ, et al. Reduction in all-cause mortality with fluticasone furoate/umeclidinium/vilanterol in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2020;201(12):1508-1516.

Sommaire

To allow gathering vital status on the participants, these authors conducted a secondary analysis of the IMPACT study, which enrolled 10,355 patients with severe chronic obstructive pulmonary disease (COPD) based on spirometry who also had at least 1 moderate or severe exacerbation in the previous year or with moderate COPD plus 2 or more moderately severe exacerbations or 1 severe exacerbation in the preceding year. Following a 2-week run-in period during which the patients continued their usual treatment, the researchers randomized patients to receive once-daily triple therapy (n = 4151) or 1 of 2 types of dual therapy. Triple therapy consisted of an ICS (fluticasone furoate) plus a LAMA (umeclidinium) plus a LABA (vilanterol), commercially available in the United States as Trelegy. The 2 forms of dual therapy were a combination of an ICS plus a LABA (Breo; n = 4134) or a LAMA plus a LABA (Anoro; n = 2070). As near as I can tell, the authors put each combination into the same delivery device. After 1 year, they report that 98 (2.4%) patients who received triple therapy died compared with 109 (2.6%) patients who received ICS plus LABA, and 66 (3.2%) of those receiving LAMA plus LABA.