CHEST Guidelines-Single-Inhaler-Triple-vs Long-Acting-Beta-sub

Single-Inhaler-Triple-vs Long-Acting-Beta-sub

Pdf Summary

Recent guidelines for chronic obstructive pulmonary disease (COPD) treatment have shifted from the combined use of long-acting beta2-agonist and inhaled corticosteroid (LABA-ICS) inhalers to single-inhaler triple therapy that includes a long-acting muscarinic antagonist (LAMA). However, concerns arose about increased cardiovascular adverse events with triple therapy. This study, conducted by Samy Suissa, Sophie Dell'Aniello, and Pierre Ernst, evaluated the real-world cardiovascular safety of single-inhaler triple therapy compared to LABA-ICS.<br /><br />The study involved a cohort from the UK Clinical Practice Research Datalink (CPRD) encompassing 10,255 COPD patients on each treatment type from 2017 to 2021. LAMA-naive patients initiating triple therapy were compared to LABA-ICS users based on time-conditional propensity scores. The primary measure was the incidence of major adverse cardiovascular events (MACE), such as myocardial infarction, stroke, or all-cause mortality, over one year.<br /><br />Results indicated a higher MACE incidence with triple therapy, particularly within the first four months. The adjusted hazard ratio (HR) for MACE was 1.28, driven mainly by an increase in all-cause mortality (HR 1.31). Myocardial infarction and stroke risks showed no significant increase, indicating that mortality risks need cautious interpretation.<br /><br />The study's observational nature may introduce potential confounders despite robust matching methods. Risk variations were noted among specific inhaler formulations, suggesting nuanced differences in safety profiles that can impact clinical decisions. <br /><br />In summary, COPD patients starting single-inhaler triple therapy showed a slight but significant increase in cardiovascular risks compared to LABA-ICS, primarily due to all-cause mortality. These findings call for caution in clinical practice, ideally reserving triple therapy for patients whose profiles align with trial populations. Further research should explore these associations with a focus on prior LAMA use for comprehensive risk assessment.

Keywords

COPD

single-inhaler triple therapy

LABA-ICS

cardiovascular safety

MACE

all-cause mortality

myocardial infarction

stroke

UK CPRD

hazard ratio