Prognostic value of clinically important deterioration in COPD: IMPACT trial analysis
IntroductionClinically important deterioration (CID) is a multicomponent measure for assessing disease worsening in chronic obstructive pulmonary disease (COPD). This analysis investigated the prognostic value of a CID event on future clinical outcomes, and effect of single-inhaler triple versus dual therapy on reducing CID risk in patients in the IMPACT trial.MethodsIMPACT was a Phase III, double-blind, 52-week multicenter trial. Patients with symptomatic COPD and ≥1 moderate/severe exacerbation in the prior year were randomised 2:2:1 to fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 µg, FF/VI 100/25 µg, or UMEC/VI 62.5/25 µg. CID at the timepoint of interest was defined as: a moderate/severe exacerbation, or ≥100 mL decrease in trough forced expiratory volume in 1 s or deterioration in health status (≥4.0 unit increase in St George's Respiratory Questionnaire total score or ≥2.0 unit increase in COPD Assessment Test score) from baseline. A treatment-independent post hoc prognostic analysis compared clinical outcomes up to Week 52 in patients with/without a CID by Week 28. A prospective analysis evaluated time-to-first CID with each treatment.ResultsPatients with a CID by Week 28 had significantly increased exacerbation rates after Week 28, smaller improvements in lung function and health status at Week 52 (all p<0.001), and increased risk of all-cause mortality after Week 28 versus patients who were CID-free. FF/UMEC/VI significantly reduced CID risk versus dual therapies (all p<0.001).ConclusionsPrevention of short-term disease worsening was associated with better long-term clinical outcomes. FF/UMEC/VI reduced CID risk versus dual therapies; this effect may improve long-term prognosis in this population.FundingGSK (CTT116855/NCT02164513).