Why small particle fixed dose triple therapy? An excursus from COPD pathology to pharmacological treatment evolution
Although bronchodilators are the cornerstone in chronic obstructive pulmonary disease (COPD) therapy, the treatment with a single-agent bronchodilator may not provide adequate symptoms control in COPD. The combination of drugs with different mechanisms of action may be more effective in inducing bro...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-01-01
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| Series: | Therapeutic Advances in Respiratory Disease |
| Online Access: | https://doi.org/10.1177/17534666211066063 |
| _version_ | 1798016046076002304 |
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| author | Fulvio Braido Angelo G. Corsico Davide Paleari Alessio Piraino Luca Cavalieri Nicola Scichilone |
| author_facet | Fulvio Braido Angelo G. Corsico Davide Paleari Alessio Piraino Luca Cavalieri Nicola Scichilone |
| author_sort | Fulvio Braido |
| collection | DOAJ |
| description | Although bronchodilators are the cornerstone in chronic obstructive pulmonary disease (COPD) therapy, the treatment with a single-agent bronchodilator may not provide adequate symptoms control in COPD. The combination of drugs with different mechanisms of action may be more effective in inducing bronchodilation and preventing exacerbations, with a lower risk of side-effects in comparison with the increase of the dose of a single molecule. Several studies comparing the triple therapy with the association of long-acting ß 2 agonist (LABA)/inhaled corticosteroid (ICS) or long-acting muscarinic antagonist (LAMA)/LABA reported improvement of lung function and quality of life. A significant reduction in moderate/severe exacerbations has been observed with a fixed triple combination of beclometasone dipropionate (BDP), formoterol fumarate (FF) and glycopyrronium (G) in a single inhaler. The TRILOGY, TRINITY and TRIBUTE studies have provided confirming evidence for a clinical benefit of triple therapy over ICS/LABA combination treatment, LAMA monotherapy and LABA/LAMA combination, with prevention of exacerbations being a key finding. A pooled post hoc analysis of the published clinical studies involving BDP/FF/G fixed combination demonstrated a reduction in fatal events in patients treated with ICS-containing medications, with a trend of statistical significance [hazard ratio = 0.72, 95% confidence interval (CI) 0.50–1.02, p = 0.066], that becomes significant if we consider reduction in fatal events for non-respiratory reasons (hazard ratio = 0.65, 95% CI 0.43–0.97, p = 0.037). In conclusion, a fixed combination of more drugs in a single inhaler can improve long-term adherence to the therapy, reducing the risk of exacerbations and hospital resources utilization. The twice a day administration may provide a better coverage of night, particularly in COPD patients who are highly symptomatic. The inhaled extrafine formulation that allows drug deposition in both large and small – peripheral – airways, is the value added. |
| first_indexed | 2024-04-11T15:43:23Z |
| format | Article |
| id | doaj.art-288faeea132447c79a7264c4c9d7eca2 |
| institution | Directory Open Access Journal |
| issn | 1753-4666 |
| language | English |
| last_indexed | 2024-04-11T15:43:23Z |
| publishDate | 2022-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Respiratory Disease |
| spelling | doaj.art-288faeea132447c79a7264c4c9d7eca22022-12-22T04:15:39ZengSAGE PublishingTherapeutic Advances in Respiratory Disease1753-46662022-01-011610.1177/17534666211066063Why small particle fixed dose triple therapy? An excursus from COPD pathology to pharmacological treatment evolutionFulvio BraidoAngelo G. CorsicoDavide PaleariAlessio PirainoLuca CavalieriNicola ScichiloneAlthough bronchodilators are the cornerstone in chronic obstructive pulmonary disease (COPD) therapy, the treatment with a single-agent bronchodilator may not provide adequate symptoms control in COPD. The combination of drugs with different mechanisms of action may be more effective in inducing bronchodilation and preventing exacerbations, with a lower risk of side-effects in comparison with the increase of the dose of a single molecule. Several studies comparing the triple therapy with the association of long-acting ß 2 agonist (LABA)/inhaled corticosteroid (ICS) or long-acting muscarinic antagonist (LAMA)/LABA reported improvement of lung function and quality of life. A significant reduction in moderate/severe exacerbations has been observed with a fixed triple combination of beclometasone dipropionate (BDP), formoterol fumarate (FF) and glycopyrronium (G) in a single inhaler. The TRILOGY, TRINITY and TRIBUTE studies have provided confirming evidence for a clinical benefit of triple therapy over ICS/LABA combination treatment, LAMA monotherapy and LABA/LAMA combination, with prevention of exacerbations being a key finding. A pooled post hoc analysis of the published clinical studies involving BDP/FF/G fixed combination demonstrated a reduction in fatal events in patients treated with ICS-containing medications, with a trend of statistical significance [hazard ratio = 0.72, 95% confidence interval (CI) 0.50–1.02, p = 0.066], that becomes significant if we consider reduction in fatal events for non-respiratory reasons (hazard ratio = 0.65, 95% CI 0.43–0.97, p = 0.037). In conclusion, a fixed combination of more drugs in a single inhaler can improve long-term adherence to the therapy, reducing the risk of exacerbations and hospital resources utilization. The twice a day administration may provide a better coverage of night, particularly in COPD patients who are highly symptomatic. The inhaled extrafine formulation that allows drug deposition in both large and small – peripheral – airways, is the value added.https://doi.org/10.1177/17534666211066063 |
| spellingShingle | Fulvio Braido Angelo G. Corsico Davide Paleari Alessio Piraino Luca Cavalieri Nicola Scichilone Why small particle fixed dose triple therapy? An excursus from COPD pathology to pharmacological treatment evolution Therapeutic Advances in Respiratory Disease |
| title | Why small particle fixed dose triple therapy? An excursus from COPD pathology to pharmacological treatment evolution |
| title_full | Why small particle fixed dose triple therapy? An excursus from COPD pathology to pharmacological treatment evolution |
| title_fullStr | Why small particle fixed dose triple therapy? An excursus from COPD pathology to pharmacological treatment evolution |
| title_full_unstemmed | Why small particle fixed dose triple therapy? An excursus from COPD pathology to pharmacological treatment evolution |
| title_short | Why small particle fixed dose triple therapy? An excursus from COPD pathology to pharmacological treatment evolution |
| title_sort | why small particle fixed dose triple therapy an excursus from copd pathology to pharmacological treatment evolution |
| url | https://doi.org/10.1177/17534666211066063 |
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