COPD: Withdrawal of ICS vs Continuation of Triple Therapy (LAMA/LABA/ICS)

Takeaway

• In patients with chronic obstructive pulmonary disease (COPD), composed mostly of infrequent exacerbators, discontinuation of inhaled corticosteroid (ICS) from triple therapy (TT; long-acting muscarinic antagonist [LAMA]+long-acting beta2-agonist [LABA]+ICS) was not associated with an increased risk of exacerbation.

• However, the risk of reinitiating ICS or suffering an exacerbation was significantly increased in subgroup of patients with blood eosinophil count ≥300 cells/μL and having more oral corticosteroid (OCS) prescriptions in the year prior to ICS cessation.

Why this matters

• Discontinuation of ICS from TT is still very infrequent in primary care.

• Findings support the recommendations that ICS withdrawal should be considered in patients without a history of frequent exacerbations and low blood eosinophil counts.

Study design

• This observational comparative effectiveness study included 1046 patients who withdrew ICS matched 1:4 by time on TT to 4184 patients who continued with TT over a period of 1 year of observation from the UK Optimum Patient Care Research Database (OPCRD).

• 76.1% of patients had 0 or 1 exacerbation the previous year.

• Primary outcome: time to first COPD exacerbation.

• Funding: Boehringer Ingelheim.

Key results

• After controlling for confounders, cessation of ICS was not associated with an increased risk of moderate or severe exacerbations (adjusted HR, 1.04; 95% CI, 0.94-1.15; P=.441).

• Rates of exacerbations managed in primary care (incidence rate ratio [IRR], 1.33; 95% CI, 1.10-1.60; P=.003) or in hospital (IRR, 1.72; 95% CI, 1.03-2.86; P=.036) were significantly higher in the ICS withdrawal group.

• The odds of successful ICS withdrawal were significantly reduced with:

  • blood eosinophil count ≥300 cells/μL (aHR, 0.50; 95% CI, 027-0.91; P=.023); and

  • frequent courses of OCS in the year prior to ICS cessation.

    • 2 prescriptions (aHR, 0.23; 95% CI, 0.11-0.44; P<.001).

    • >3 prescriptions (aHR, 0.31; 95% CI, 0.19-0.47; P<.001).

Limitations

• Observational design.

• Risk of bias.

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Sarfaroj Khan. COPD: Withdrawal of ICS vs Continuation of Triple Therapy (LAMA/LABA/ICS) - Medscape - Jan 28, 2021.