New Drugs and Formulations for COPD Treatment

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The MD Magazine Peer Exchange “Expanding Treatment Options: The Latest Developments in COPD Therapy” features a panel of physician experts discussing key topics in COPD therapy, including risk factors, personalized treatment, preventive measures, new combination therapies, and more.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Byron Thomashow, MD, professor of medicine at Columbia University Medical Center, medical director at the Jo-Ann LeBuhn Center for Chest Disease at New York-Presbyterian Hospital, and chairman of the board of the COPD Foundation
• Neil R. MacIntyre, MD, clinical chief of the Pulmonary/Critical Care Division, medical director of Respiratory Care Services, and professor of medicine at Duke University School of Medicine
• Barry J. Make, MD, director of Pulmonary and Respiratory Care for National Jewish Health and professor of medicine at the University of Colorado School of Medicine
• Nicola A. Hanania, MD, MS, associate professor of medicine and director of the Asthma and COPD Clinical Research Center at Baylor College of Medicine

While triple therapy has been the mainstay of COPD regimens in pulmonologist practices, where the sickest patients are treated, Thomashow acknowledged that they have made a difference to many patients, but that he has made an effort to move away from triple therapy and toward combination LAMA/LABA therapy.

According to MacIntyre, the results from the TORCH trial are really driving this.

He said that “revolutionized” the notion of triple therapy because showed a reduction in exacerbations in patients treated with three therapies compared to either alone or the combination of an inhaled corticosteroid and a LABA, you clearly had a better outcome. “I think that’s driven a lot of these decisions to go with inhaled corticosteroids in ‘frequent flier’ patients,” he said.

Hanania pointed out there is some data from the Canadian OPTIMAL trial suggesting that triple therapy may reduce hospital admission compared to tiotropium alone. “But when you look at just exacerbation, in that study there was no major difference,” he said.

In the study, triple therapy reduced hospital admission, which was a secondary endpoint. “I think there are patients definitely who would benefit from triple therapy, and actually a triple combination now is being studied in a large Phase III trial. So we are getting there hopefully in the future. I also want to underline the fact that inhaled steroids, just like any of these drugs, may have their own potential side effects, and pneumonia is definitely at the higher incidence in COPD than in patients on inhaled steroids. So you have to weigh the risks and benefits,” he said.