A discussion with a study author on promising new findings for the combination inhaler therapy.
Dr. Jennifer K. Quint
New data planned for presentation at the American Thoracic Society (ATS) 2020 International Conference this year showed that tiotropium/olodaterol (Stiolto Respimat) was more beneficial in reducing chronic obstructive pulmonary disease (COPD) patient escalation to triple-therapy inhaler than a combination of inhaled corticosteroid (ICS) and long-acting beta agonist (LABA).
The real-world assessment, led by Dr. Jennifer K. Quint of Imperial College London, also showed the inhaler combination therapy reduced COPD patient risk of adverse outcomes when compared to LABA/ICS.
In an interview with HCPLive® regarding the new ATS 2020 findings, Quint detailed the study makeup, the recent history of COPD research, the current primary goals of COPD treatment, and what may come next in her team’s research.
HCPLive: Why did your team choose to compare tiotropium/olodaterol to LABA/ICS?
Quint: Current evidence-based COPD treatment guidelines recommend to restrict the use of ICS treatments to COPD patients with history of frequent exacerbations or who are symptomatic on dual bronchodilators and to use blood eosinophils as a tool to identify patients likely to respond to ICS; despite these recommendations, LABA/ICS are widely prescribed in COPD, making it the most commonly prescribed first line treatment in COPD. There is a large body of evidence that shows the benefits of ICS in the reduction of exacerbations, but also the risks associated with a long-term exposure to ICS treatments.
Some recent RCTs have shown superiority of LAMA/LABAs over LABA/ICS on lung function improvement and exacerbation reduction; and most recently real-world evidence studies have shown that LAMA/LABAs are at least as effective as LABA/ICS in the reduction of exacerbations, with a lower risk of pneumonia.
Tiotropium/olodaterol has demonstrated to be an efficacious maintenance treatment in COPD; we wanted to assess its effectiveness in a real-world setting, compared to the most commonly initiated treatment combination in COPD, evaluating important patient outcomes.
It is important to evaluate the benefit/risk ratio of treatments in the real world and to help us understand how effectively and safely are patients managed.
HCPLive: What are the most adverse outcomes among treated patients with COPD? For what are they at greater risk?
Quint: COPD is a progressive disease, shortness of breath is hallmark of COPD, as it has a big impact on a patients’ quality of life and their ability to normally perform activities of daily living. A subgroup of COPD patients also experience exacerbations, these are indeed very important events in COPD.
Exacerbations are important as they increase the impact of the disease, may accelerate progression and ultimately increase the risk of death. Fortunately, exacerbations are not experienced by all COPD patients and only a relatively small proportion of COPD patients experience frequent exacerbations.
HCPLive: What were the most impressive findings to come from this analysis?
Quint: We believe that our results highlight the effectiveness of Tiotropium/Olodaterol in the reduction of exacerbations, especially versus LABA/ICS which are commonly prescribed with the aim of reducing the risk of future exacerbation events.
Furthermore, the superior benefit on exacerbation reduction is complemented by a better safety profile as demonstrated with a lower risk of pneumonia and a lower risk of being escalated to triple therapy. Altogether, our results show how tiotropium/olodaterol provides better overall outcomes for COPD patients compared to LABA/ICS.
HCPLive: What is the significance of lowering risk to triple therapy inhaler use among patients with COPD?
Quint: There is evidence showing a large number of patients are prescribed LABA/ICS without a history of exacerbations, so it is possible that there are a large number of COPD patients who are being exposed to the risks associated with long term exposure to ICS without receiving the potential benefits of these treatments.
There is also evidence of the superiority of LAMA/LABAs on lung function improvements, symptom control and exacerbation reduction, representing an effective treatment choice for patients without the risk associated of ICS. Triple therapy is an effective treatment for COPD but it needs to be reserved for the right population, so delaying escalation to triple therapy can have implications for patients by avoiding the potential associated risk of long exposure to ICS; it could also have implications for health systems in relation to costs and resource utilization managing untoward effects.
HCPLive: How do these findings influence COPD symptom management and care?
Quint: We hope these findings will help prescribers in their selection of maintenance treatment for COPD patients, whether their goal is to improve lung function and manage symptoms as demonstrated in previous studies, or in reducing exacerbations as seen in this current study. Most importantly we hope our study can help prescribers keeping in mind the benefit/risk profiles of the treatment options for patients with COPD.
HCPLive: What would come next, in terms of follow-up assessment?
Quint: Well, in this study we looked at somewhat short-term outcomes, it would be important to look at long term outcomes, especially in terms of safety. Moreover, it will also be important to perform cost/benefit assessments and healthcare resource utilization to also explore the economic impact of both treatments.