Triple Versus Dual Combination Therapy in Chronic Obstructive Pulmonary Disease in Asian Countries: Analysis of the IMPACT Trial

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Introduction

In the IMPACT trial, single-inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) reduced moderate/severe exacerbation rates versus FF/VI or UMEC/VI dual therapy in patients with chronic obstructive pulmonary disease (COPD); however, pneumonia incidence was higher in FF-containing arms. As COPD is a growing problem in Asia, we compared the efficacy and safety of FF/UMEC/VI in Asia versus non-Asia regions.

Methods

IMPACT was a double-blind, 52-week trial in symptomatic COPD patients with ≥ 1 moderate/severe exacerbation in the prior year. This pre-specified analysis evaluated the annual rate of moderate/severe exacerbations, change from baseline in trough forced expiratory volume in 1 s, and St George’s Respiratory Questionnaire total score, mortality, and safety (including pneumonia) in Asia versus non-Asia regions.

Results

The intent-to-treat population comprised 10,355 patients (Asia n = 1644 [16%]). Rate ratios (95% confidence intervals) for moderate/severe exacerbations with FF/UMEC/VI were 0.89 (0.76–1.05) versus FF/VI and 0.86 (0.71–1.04) versus UMEC/VI in Asia, and 0.84 (0.79–0.90) and 0.74 (0.68–0.80) in non-Asia. Efficacy of FF/UMEC/VI on other endpoints was similar in both regions. There was an increased incidence of investigator-reported pneumonia in patients in Asia (FF/UMEC/VI: 13%; FF/VI: 14%; UMEC/VI: 6%) compared with non-Asia (FF/UMEC/VI: 6%; FF/VI: 5%; UMEC/VI: 4%). The increased risk of pneumonia in patients in Asia was most marked in patients with lower body mass index, lower lung function, and taking inhaled corticosteroids. In post hoc analysis of adjudicated on-treatment all-cause mortality, probabilities of death were numerically lower in both regions with FF/UMEC/VI (Asia: 1.16%; non-Asia: 1.35%) and FF/VI (Asia: 1.77%; non-Asia: 1.21%) versus UMEC/VI (Asia: 1.91%; non-Asia: 2.23%).

Conclusions

FF/UMEC/VI provides similar benefits in COPD patients in Asia and non-Asia regions. Clinical benefits of treatment, including reduction in mortality risk, should be weighed against risk of pneumonia, taking account of all known risk factors.

Trial Registration

ClinicalTrials.gov identification, NCT02164513.

Electronic supplementary material

The online version of this article (10.1007/s41030-020-00136-3) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 28

Record: found
Abstract: found
Article: found

Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD

David A. Lipson, Frank Barnhart, Noushin Brealey … (2018)

The benefits of triple therapy for chronic obstructive pulmonary disease (COPD) with an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β2-agonist (LABA), as compared with dual therapy (either inhaled glucocorticoid-LABA or LAMA-LABA), are uncertain.

0 comments Cited 287 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.

Amy Berrington de Gonzalez, Sarah Darby (2004)

Diagnostic X-rays are the largest man-made source of radiation exposure to the general population, contributing about 14% of the total annual exposure worldwide from all sources. Although diagnostic X-rays provide great benefits, that their use involves some small risk of developing cancer is generally accepted. Our aim was to estimate the extent of this risk on the basis of the annual number of diagnostic X-rays undertaken in the UK and in 14 other developed countries. We combined data on the frequency of diagnostic X-ray use, estimated radiation doses from X-rays to individual body organs, and risk models, based mainly on the Japanese atomic bomb survivors, with population-based cancer incidence rates and mortality rates for all causes of death, using life table methods. Our results indicate that in the UK about 0.6% of the cumulative risk of cancer to age 75 years could be attributable to diagnostic X-rays. This percentage is equivalent to about 700 cases of cancer per year. In 13 other developed countries, estimates of the attributable risk ranged from 0.6% to 1.8%, whereas in Japan, which had the highest estimated annual exposure frequency in the world, it was more than 3%. We provide detailed estimates of the cancer risk from diagnostic X-rays. The calculations involved a number of assumptions and so are inevitably subject to considerable uncertainty. The possibility that we have overestimated the risks cannot be ruled out, but that we have underestimated them substantially seems unlikely.

0 comments Cited 270 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Global burden of COPD.

José Luis López-Campos, Pui-Wan Tan, Joan B Soriano (2016)

It is estimated that the world population will reach a record 7.3 billion in 2015, and the high burden of chronic conditions associated with ageing and smoking will increase further. Respiratory diseases in general receive little attention and funding in comparison with other major causes of global morbidity and mortality. In particular, chronic obstructive pulmonary disease (COPD) has been a major public health problem and will remain a challenge for clinicians within the 21st century. Worldwide, COPD is in the spotlight, since its high prevalence, morbidity and mortality create formidable challenges for health-care systems. This review emphasizes the magnitude of the COPD problem from a clinician's standpoint by drawing extensively from the new findings of the Global Burden of Disease study. Updated, distilled information on the population distribution of COPD is useful for the clinician to help provide an appreciation of the relative impact of COPD in daily practice compared with other chronic conditions, and to allocate minimum resources in anticipation of future needs in care. Despite recent trends in reduction of COPD standardized mortality rates and some recent successes in anti-smoking efforts in a number of Western countries, the overarching demographic impact of ageing in an ever-expanding world population, joined with other factors such as high rates of smoking and air pollution in Asia, will ensure that COPD will continue to pose an ever-increasing problem well into the 21st century.

0 comments Cited 248 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

David M. G. Halpin: d.halpin@nhs.net

Journal

Journal ID (nlm-ta): Pulm Ther

Journal ID (iso-abbrev): Pulm Ther

Title: Pulmonary Therapy

Publisher: Springer Healthcare (Cheshire )

ISSN (Print): 2364-1754

ISSN (Electronic): 2364-1746

Publication date (Electronic): 17 November 2020

Publication date PMC-release: 17 November 2020

Publication date Collection: June 2021

Volume: 7

Issue: 1

Pages: 101-118

Affiliations

[1 ]GRID grid.8391.3, ISNI 0000 0004 1936 8024, University of Exeter Medical School, College of Medicine and Health, , University of Exeter, ; Exeter, UK

[2 ]GRID grid.264727.2, ISNI 0000 0001 2248 3398, Lewis Katz School of Medicine at Temple University, ; Philadelphia, PA USA

[3 ]GRID grid.265892.2, ISNI 0000000106344187, Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, , University of Alabama at Birmingham, ; Birmingham, AL USA

[4 ]GRID grid.214458.e, ISNI 0000000086837370, Pulmonary and Critical Care, , University of Michigan, ; Ann Arbor, MI USA

[5 ]Veramed Ltd, Twickenham, UK

[6 ]GRID grid.418236.a, ISNI 0000 0001 2162 0389, GlaxoSmithKline, ; Uxbridge, UK

[7 ]GRID grid.418019.5, ISNI 0000 0004 0393 4335, GlaxoSmithKline, ; Research Triangle Park, NC USA

[8 ]Respiratory Institute, Kamei Hospital, Kishiwada, Osaka Japan

[9 ]GRID grid.5254.6, ISNI 0000 0001 0674 042X, Section of Epidemiology, Department of Public Health, , University of Copenhagen, ; Copenhagen, Denmark

[10 ]GRID grid.411646.0, ISNI 0000 0004 0646 7402, Medical Department, , Herlev and Gentofte Hospital, ; Herlev, Denmark

[11 ]GRID grid.83440.3b, ISNI 0000000121901201, UCL Respiratory, , University College London, ; London, UK

[12 ]GRID grid.413734.6, ISNI 0000 0000 8499 1112, New York-Presbyterian Weill Cornell Medical Center, ; New York, NY USA

[13 ]GRID grid.418236.a, ISNI 0000 0001 2162 0389, GlaxoSmithKline, ; Brentford, UK

[14 ]GRID grid.9918.9, ISNI 0000 0004 1936 8411, University of Leicester, ; Leicester, UK

[15 ]GRID grid.5379.8, ISNI 0000000121662407, Manchester University NHS Foundation Trust, , University of Manchester, ; Manchester, UK

[16 ]GRID grid.469474.c, ISNI 0000 0000 8617 4175, Division of Pulmonary and Critical Care Medicine, , Johns Hopkins Medicine, ; Baltimore, MD USA

[17 ]GRID grid.470124.4, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, , First Affiliated Hospital of Guangzhou Medical University, ; Guangzhou, China

[18 ]GRID grid.418019.5, ISNI 0000 0004 0393 4335, GlaxoSmithKline, ; Collegeville, PA USA

[19 ]GRID grid.25879.31, ISNI 0000 0004 1936 8972, Perelman School of Medicine, , University of Pennsylvania, ; Philadelphia, PA USA

Article

Publisher ID: 136

DOI: 10.1007/s41030-020-00136-3

PMC ID: 8137798

PubMed ID: 33201438

SO-VID: 34ef90dc-943a-42dd-b14b-326313dec551

License:

Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 27 August 2020

Date accepted : 15 October 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100004330, GlaxoSmithKline;

Custom metadata

Keywords: asia,chronic obstructive,drug therapy,mortality,pneumonia,pulmonary disease

Data availability:

Keywords: asia, chronic obstructive, drug therapy, mortality, pneumonia, pulmonary disease

Triple Versus Dual Combination Therapy in Chronic Obstructive Pulmonary Disease in Asian Countries: Analysis of the IMPACT Trial

Read this article at

Abstract

Introduction

Methods

Results

Conclusions

Trial Registration

Electronic supplementary material

Related collections

UCL: UN SDG 03 Good Health and Well-Being

Most cited references 28

Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD

Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.

Global burden of COPD.

Author and article information

Contributors

Journal

Affiliations

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 55

Cited by 5

Most referenced authors 293