What is it about?
The recent TRIBUTE and IMPACT trials comparing triple LAMA-LABA-ICS therapy with LAMA-LABA double bronchodilators for the treatment of COPD reveal a peculiar pattern in the timing of exacerbations: The difference in the rate of exacerbation between triple and double therapy is observed exclusively in the first month, where there is a surge in the LAMA-LABA double bronchodilators group, with no differences in the rates between the two groups during the subsequent 11 months.
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Why is it important?
Such a pattern in the timing of COPD exacerbation suggests that there is a subset of patients who could benefit from triple therapy, while the remaining patients benefit equally from LAMA-LABA: These are likely the patients with a history of asthma and those with milder lung function impairment and multiple exacerbations, a group overrepresented in IMPACT.
Perspectives
Precision medicine aiming to identify the right treatment for the right patient rather than one treatment for all is possible in COPD: the presence of asthma, airflow limitation, exacerbation frequency and degree of eosinophilia are known factors that can provide a precision medicine approach to COPD management. Such a modern approach to COPD treatment will permit the identification of the subgroup of patients who could benefit from triple therapy and avoid harms all others for whom bronchodilators are just as effective and safer.
Samy Suissa
McGill University
Read the Original
This page is a summary of: Triple therapy trials in COPD: a precision medicine opportunity, European Respiratory Journal, December 2018, European Respiratory Society (ERS),
DOI: 10.1183/13993003.01848-2018.
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