A RECENT study examining real-world COPD treatment outcomes has highlighted safety concerns regarding single-inhaler triple therapy compared to the long-acting beta2-agonist (LABA) and inhaled corticosteroid (ICS) combination, particularly in terms of cardiovascular risks.
Researchers analyzed data from over 20,000 patients aged 40 and older, drawn from the UK’s Clinical Practice Research Datalink between 2017 and 2021. This study compared single-inhaler triple therapy, which includes a long-acting muscarinic antagonist (LAMA), long-acting beta2-agonist (LABA), and inhaled corticosteroid (ICS), with the LABA-ICS combination.
The findings revealed an increased incidence of major adverse cardiovascular events (MACEs) among those using triple therapy. The adjusted hazard ratio (HR) for MACEs with triple therapy was 1.28 (95% CI, 1.05–1.55), compared to LABA-ICS users, with the risk most pronounced in the first four months (HR, 1.41; 95% CI, 1.14–1.74).
Notably, the increased MACE rate was driven by a rise in all-cause mortality (HR, 1.31; 95% CI, 1.06–1.62). There were no significant differences in the rates of acute myocardial infarction (HR, 1.00) or stroke hospitalizations (HR, 1.06).
The study underscores the importance of careful patient monitoring, particularly during the early stages of triple therapy initiation. These findings may inform clinicians’ decisions on treatment selection for patients with COPD patients cardiovascular risks.
Reference: Suissa S et al. Single-Inhaler Triple vs LABA-ICS Therapy for COPD. Chest. 2024. doi: 10.1016/j.chest.2024.10.025. [In press].
Anaya Malik | AMJ
