Therapeutic Response to Single-Inhaler Triple Therapies in Moderate-to-Severe COPD

BACKGROUND: COPD is characterized by progressive and irreversible air flow limitations. Single-inhaler therapies (SITTs) incorporating an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting β₂-agonist have been shown to effectively alleviate symptoms and improve lung function. Fluticasone-furoate/umeclidinium/vilanterol (F/U/V) and budesonide/glycopyrronium/formoterol (B/G/F) are available as SITT in Japan. However, the clinical differences between these 2 combinations and the predictors of their proper use have not been established. This study aimed to identify the subject characteristics that could predict the effectiveness of inhaler therapy.

METHODS: We assessed the pulmonary function test results of subjects with COPD before and one month after using F/U/V and B/G/F as SITT. Subjects with a difference of 100 mL or more in the FEV₁ after treatment with pre-SITT were extracted and divided into the F/U/V effect and no-effect group and B/G/F effect and no-effect group to examine the factors associated with positive outcomes with each inhaler.

RESULTS: F/U/V and B/G/F significantly improved the inspiratory capacity (IC), %IC, FVC, and %FEV₁ when compared to pre-intervention values (P < .001, P = .001, P = .007, P = .009, respectively, for F/U/V; and P = .006, P = .008, P = .038, P = .005, respectively, for B/G/F). Factors associated with FEV₁ improvement in F/U/V included lower %IC (odds ratio 0.97 [95% CI 0.94–0.99], P = .03) and a higher modified Medical Research Council (mMRC) dyspnea score (2.36 [1.27–4.70], P < .01). In addition, a higher %IC (1.03 [1.00–1.06], P = .02) and lower mMRC dyspnea score (0.55 [0.28–0.99], P = .041) were predictors for the effectiveness of B/G/F.

CONCLUSIONS: Our results showed that SITT significantly improved the IC, %IC, FVC, and %FEV₁ when compared to pre-intervention and that F/U/V was more effective in subjects with severe symptoms, whereas B/G/F was more effective in subjects with mild symptoms.