Evaluating the Effects of “Triple Therapy” With Inhaled Corticosteroids, Long-Acting β 2 -Agonists, and Leukotriene Modifiers in Asthma

CHEST Journal ◽  
2006 ◽  
Vol 130 (1) ◽  
pp. 301-302
Author(s):  
Graeme P. Currie ◽  
Daniel K.C. Lee ◽  
Daniel Menzies ◽  
Brian J. Lipworth
Keyword(s):  
Triple Therapy ◽  
Inhaled Corticosteroids ◽  
Long Acting

Utilization Patterns and Trends in The Use of Medications for Asthma Control in a Cohort of Colombian Patients, 2017-2019. v1

2021 ◽  
Author(s):  
Jorge Machado Alba
Keyword(s):  
Retrospective Study ◽  
General Practitioner ◽  
Health System ◽  
Triple Therapy ◽  
Inhaled Corticosteroids ◽  
Prescription Patterns ◽  
Utilization Patterns ◽  
Control Therapy ◽  
Long Acting

Objective:To determine the trend in the use of medications used to treat asthma in a group of patients affiliated to the Colombian health system. Methods:A retrospective study on prescription patterns of medications used to treat asthma in patients over 5 years of age between 2017 and 2019. Sociodemographic variables, medications used and combinations, persistence of use and prescribing physician were considered. Results:10,706 people with a diagnosis of asthma were identified, with predominance in female sex (56.8 %), median age 32.2 ± 26.1 years. At the start of follow-up, 53.2% of patients aged 5-11 years were receiving monotherapy, mean 1.5 ± 0.6 drugs/patient, especially inhaled corticosteroids (ICS; 55.9%) and short-acting β-agonists (SABA; 55.6%). Moreover, in patients older than 12 years, 53.5% were treated in monotherapy, mean 1.6 ± 0.7 drugs/patient, of which 45.9% were on SABA, and 37.1 % on ICS.Between 63.0% and 83.6% of patients were treated by a general practitioner. The proportion of patients on the ICS/ long-acting β-agonists (LABA) combination grew at 24 months follow-up by 411% and 177%, respectively. 12.5% of patients (495) received triple therapy (ICS/LABA+LAMA [long-acting anticholinergics]), particularly with fluticasone/salmeterol+tiotropium. Conclusions:Patients with a diagnosis of asthma older than 5 years in Colombia are mainly receiving control therapy with ICS, alone or combined with SAMA and, to a lesser extent, with LABA.

scholarly journals Cost-utility of triple versus dual inhaler therapy in moderate to severe asthma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jefferson Antonio Buendía ◽  
Diana Guerrero Patiño
Keyword(s):  
Cost Effectiveness ◽  
Triple Therapy ◽  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Dual Therapy ◽  
Lifetime Horizon ◽  
Discounted Cost ◽  
Life Years ◽  
Long Acting ◽  
The Cost

Abstract Background An important proportion of asthma patients remain uncontrolled despite using inhaled corticosteroids and long-acting beta-agonists. Clinical guidelines recommend, in these patients, using add-on long-acting muscarinic antagonists (triple therapy) to treatment with high doses of inhaled corticosteroids-long-acting beta2-agonist (dual therapy). The purpose of this study was to assess the cost-effectiveness of triple therapy versus dual therapy for patients with severe asthma. Methods A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. Total costs and QALYS of dual and triple therapy were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. Results The model suggests a potential gain of 1.55 QALYs per patient per year on triple therapy with respect to dual therapy. We observed a difference of US$304 in discounted cost per person-year on triple therapy with respect to dual therapy. The incremental cost-effectiveness ratio was US$196 in the probabilistic model. In the sensitivity analysis, our base‐case results were robust to variations in all assumptions and parameters. Conclusion In conclusion, triple therapy in patients with moderate-severe asthma was cost-effective. Using triple therapy emerges with our results as an alternative before using oral corticosteroids or biologics, especially in resource-limited settings.

scholarly journals Escalation Time to Open Triple Combination Therapy from the Initiation of LAMA versus ICS/LABA in COPD Management: Findings from Comparing the Incidence of Tiotropium and ICS/LABA in Real-World Use in South Korea (CITRUS) Study

2021 ◽  
Vol 11 (12) ◽  
pp. 1325
Author(s):  
Ye Jin Lee ◽  
Chin Kook Rhee ◽  
Yong Il Hwang ◽  
Kwang Ha Yoo ◽  
So Eun Lee ◽  
...  
Keyword(s):  
Combination Therapy ◽  
South Korea ◽  
Triple Therapy ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Triple Combination ◽  
Obstructive Pulmonary Disease ◽  
Triple Combination Therapy ◽  
Copd Patients ◽  
Long Acting

Background: bronchodilators are the key treatment for chronic obstructive pulmonary disease (COPD), however, inhaled corticosteroids (ICSs)/long-acting β2-agonists (LABA) are widely prescribed. We compared the escalation time to open triple combination therapy between long-acting muscarinic receptor antagonists (LAMA) and ICS/LABA in COPD management. Methods: this retrospective study included COPD patients selected from the National Health Insurance Service of South Korea from January 2005 to April 2015. The primary outcome was the escalation time to triple therapy in patients who initially received LAMA or ICS/LABA. Other outcomes included risk factors predisposing escalation to triple combination therapy. Results: a total of 2444 patients were assigned to the LAMA or ICS/LABA groups. The incidences of triple combination therapy in the LAMA and ICS/LABA groups were 81.0 and 139.8 per 1000 person-years, respectively (p < 0.001); the median times to triple therapy escalation were 281 and 207 days, respectively (p = 0.03). Treatment with ICS/LABA showed a higher risk of triple therapy escalation compared to LAMA (hazard ratio (HR), 1.601; 95% confidence interval (CI), 1.402–1.829). The associated risk factor was male sex. (HR, 1.564; 95% CI, 1.352–1.809). Conclusions: the initiation of COPD treatment with LAMA is associated with a reduced escalation time to triple therapy compared with ICS/LABA.

scholarly journals Comparative efficacy of single-inhaler triple therapies for COPD: A protocol for systematic review and network meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255545
Author(s):  
Yixuan Jiang ◽  
Hao Hu ◽  
Siu-wai Leung
Keyword(s):  
Systematic Review ◽  
Triple Therapy ◽  
Assessment Tool ◽  
Inhaled Corticosteroids ◽  
Meta Analysis ◽  
Chronic Obstructive Lung Disease ◽  
Fixed Dose ◽  
Chronic Obstructive ◽  
Bias Analysis ◽  
Long Acting

Introduction 2021 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Reports recommends that patients with clinically significant symptoms and exacerbations of chronic obstructive pulmonary disease (COPD) should escalate to triple therapy, a combined use of inhaled corticosteroids (ICS), long-acting muscarinic antagonists (LAMA) and long-acting b2-agonists (LABA)(ICS/LAMA/LABA). Triple therapy in fixed-dose combinations (FDCs), i.e., combining ICS, LABA with LAMA and administrating by a single inhalation device, has appeared in recent years. This study aims to compare the efficacy of triple therapy in FDCs in treating patients with moderate to severe COPD. Methods and analyses Literature search will be conducted on PubMed, Embase and Web of science, according to pre-specified and corresponding search strategies, for relevant reports published since the inception dates of the databases. Randomised controlled trials (RCT) which compared the triple therapy in FDCs with other pharmacological therapies will be included. The Cochrane risk of bias assessment tool (RoB 2) will be used to assess the RCT quality. The outcomes will be analyzed as rate ratios and mean differences under a random-effects model in a frequentist network meta-analysis (NMA). Additional statistical analyses including subgroup analysis, sensitivity analysis, and publication bias analysis will be performed to assess the evidential heterogeneity and robustness. The strength of evidence from the NMA will be evaluated with the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) methods. Ethics and dissemination No ethics approval is required as this systematic review and network meta-analysis do not collect confidential personal data and do not carry out interventions in treating patients. Protocol registration number CRD42021240823.

scholarly journals Triple Therapy Versus Dual Bronchodilation and Inhaled Corticosteroids/Long-Acting β-Agonists in COPD: Accumulating Evidence from Network Meta-Analyses

2019 ◽  
Vol 5 (2) ◽  
pp. 117-126 ◽  
Author(s):  
Mario Cazzola ◽  
Luigino Calzetta ◽  
Paola Rogliani ◽  
Maria Gabriella Matera
Keyword(s):  
Triple Therapy ◽  
Clinical Benefit ◽  
Inhaled Corticosteroids ◽  
Daily Practice ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Dual Bronchodilation ◽  
Long Acting ◽  
Meta Analyses

Abstract Guidelines are mainly based on evidence of well-designed randomized controlled trials (RCTs), but there are limitations to the transferability of conclusions of RCTs to usual care mainly because the patients enrolled in RCTs are selected and not representative of the population encountered in daily practice; moreover, the research environment is substantially different from that of the real world. Because of the scarcity of data generated in large unselected populations in everyday clinical practice, the possibility of using meta-analyses can be considered. Recently, several meta-analyses have attempted to clarify the role of triple therapy containing a long-acting β-agonist (LABA), a long-acting muscarinic antagonist (LAMA) and an inhaled corticosteroid (ICS) delivered from a single inhaler in chronic obstructive pulmonary disease (COPD), also considering that there is a big difference in the use of triple therapy between what is recommended by COPD guidelines or strategies and the prescriptive behaviour of clinicians. Taking into account the results of the most recent meta-analyses, we believe that triple therapy provides modest clinical benefit in the general COPD population, but in patients on LABA/LAMA combination therapy, who still experience acute exacerbations of COPD (AECOPDs) and have blood eosinophil counts ≥ 300 cells·μl−1, it is of clinical relevance. On the contrary, adding a LAMA to an ICS/LABA combination elicits relevant clinical benefit in the general COPD population, supporting the role of dual bronchodilation therapy for the treatment of COPD. The quantitative synthesis of the currently available clinical evidence seems to suggest that, in patients with COPD already on ICS/LABA combination, the therapy can be improved without an increase of cardiovascular severe adverse events (SAEs) when a LAMA is added to the combination.

Sign in / Sign up

Export Citation Format

Share Document