Abstract
Introduction In patients with chronic obstructive pulmonary disease (COPD), dual bronchodilator (long-acting muscarinic antagonist (LAMA)/long-acting beta2-agonist (LABA)) and triple therapy (inhaled corticosteroid (ICS)/LAMA/LABA) reduce risk of exacerbations and lung function decline in short-mid-term, but their long-term impact is unknown. This modelling study explores long-term impact of these therapies on lung function decline, quality of life (QoL) and all-cause mortality.
Methods This modelling approach used a longitudinal non-parametric superposition model using published data regarding exacerbations, QoL (assessed by St. George's Respiratory Questionnaire (SGRQ)), and mortality. The model simulated disease progression from 40 to 75 years of age and assessed the impact of initiating dual bronchodilator at age 45 years (“LAMA/LABA only” group) and escalation to triple therapy at age 50 years (“Escalation to triple” group) on forced expiratory volume in 1 s (FEV1) decline, QoL, and mortality.
Results Model simulation predicted that by 75 years of age: “LAMA/LABA only” preserves 159.1 mL of FEV1 versus no treatment, “Escalation to triple” preserves an additional 376.5 mL and 217.3 mL of FEV1 versus no pharmacotherapy and “LAMA/LABA only”, respectively. In “LAMA/LABA only”, SGRQ score reduces (−3.2) versus no treatment, which further reduces to −7.5 therapy in “Escalation to triple”. In “LAMA/LABA only”, mortality reduces by 5.4% by 75 years versus no treatment, while the “Escalation to triple” shows further decrease in mortality by 12.0%.
Conclusion Early pharmacotherapy initiation and escalation from dual bronchodilator to triple therapy could slow disease progression by preserving lung function and improving QoL and survival in patients with COPD.
Footnotes
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Conflict of interest: Dave Singh has received consultancy fees from Aerogen, AstraZeneca, BIAL, Boehringer Ingelheim, Chiesi, Cipla, CSL Behring, EpiEndo, Genentech, GlaxoSmithKline, Glenmark, Gossamer Bio, Kinaset Therapeutics, Menarini, Novartis, Orion, Pulmatrix, Sanofi, Teva, Theravance Biopharma, and Verona Pharma.
Conflict of interest: Diego Fabian Litewka has received speaker fees from GSK, Novartis, Astra Zeneca, Sanofi, Boehringer Ingelheim and Tuteur and has participated in advisory boards by GSK.
Conflict of interest: Joan B Soriano and Hakan Günen declare no conflicts of interest in this work.
Conflict of interest: Adrian Rendon has received consulting and speaker fees and participated in advisory board from GSK, Boehringer Ingelheim, AstraZeneca, Chiesi, Sanofi, has received travel support from Chiesi and GSK.
Conflict of interest: Frederico Leon Arrabal Fernandes has received consulting fees and travel support from GSK, Boehringer Ingelheim, AstraZeneca, speaker fees from Abbott, GSK, AstraZeneca, Boehringer Ingelheim, Sanofi, Chiesi, and has participated in advisory boards by GSK, Boehringer Ingelheim and Sanofi and is a part of Brasilian Respiratory Society.
Conflict of interest: Rafael Páramo has received consulting fees, grants/contracts and travel support from GSK, speaker fees from GSK, AstraZeneca, Silanes, holds royalties/licenses from GSK, AstraZeneca, Lopmont and was a part of Sociedad Mexicana de Neumologia.
Conflict of interest: Tim Trinidad has received consulting fees from Orient Euro Pharmaceutical Philippines, speaker fees and travel support from GSK, Orient Euro Pharmaceutical Philippines, United American Philippines and served on the advisory of Department of Health Philippines (Clinical Practice Guideline for COPD).
Conflict of interest: Sudeep Acharya, Bhumika Aggarwal, Gur Levy, Chris Compton and Abdelkader El Hasnaoui are employees of GSK and hold GSK shares.
Conflict of interest: Peter Daley-Yates received consulting fees from GSK for data analysis related to this modelling study.
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- Received April 29, 2024.
- Accepted August 8, 2024.
- Copyright ©The authors 2024
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