TY - JOUR T1 - Prognostic value of clinically important deterioration in COPD: IMPACT trial analysis JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00663-2020 VL - 7 IS - 1 SP - 00663-2020 AU - MeiLan K. Han AU - Gerard J. Criner AU - Mark T. Dransfield AU - David M.G. Halpin AU - Christine E. Jones AU - Sally Kilbride AU - Peter Lange AU - Sally Lettis AU - David A. Lipson AU - David A. Lomas AU - Neil Martin AU - Fernando J. Martinez AU - Robert A. Wise AU - Ian P. Naya AU - Dave Singh Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/7/1/00663-2020.abstract N2 - Introduction Clinically important deterioration (CID) is a multicomponent measure for assessing disease worsening in chronic obstructive pulmonary disease (COPD). This analysis investigated the prognostic value of a CID event on future clinical outcomes and the effect of single-inhaler triple versus dual therapy on reducing CID risk in patients in the IMPACT trial.Methods IMPACT was a phase III, double-blind, 52-week, multicentre trial. Patients with symptomatic COPD and at least one moderate/severe exacerbation in the prior year were randomised 2:2:1 to fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 µg, FF/VI 100/25 µg or UMEC/VI 62.5/25 µg. CID at the time-point of interest was defined as a moderate/severe exacerbation, ≥100 mL decrease in trough forced expiratory volume in 1 s or deterioration in health status (increase of ≥4.0 units in St George's Respiratory Questionnaire total score or increase of ≥2.0 units in COPD Assessment Test score) from baseline. A treatment-independent post hoc prognostic analysis compared clinical outcomes up to week 52 in patients with/without a CID by week 28. A prospective analysis evaluated time to first CID with each treatment.Results Patients with a CID by week 28 had significantly increased exacerbation rates after week 28, smaller improvements in lung function and health status at week 52 (all p<0.001), and increased risk of all-cause mortality after week 28 versus patients who were CID-free. FF/UMEC/VI significantly reduced CID risk versus dual therapies (all p<0.001).Conclusions Prevention of short-term disease worsening was associated with better long-term clinical outcomes. FF/UMEC/VI reduced CID risk versus dual therapies; this effect may improve long-term prognosis in this population.Preventing short-term clinically important deterioration (CID) is associated with better long-term clinical outcomes in patients with COPD. FF/UMEC/VI reduces CID risk versus FF/VI and UMEC/VI therapy, and this may improve patients’ long-term prognosis. https://bit.ly/3gP1KJu ER -