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Single-inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol versus dual therapy in current and former smokers with COPD: IMPACT trial post hoc analysis
Bardsley, Samuel Criner, Gerard J. Haplin, David M.G. Han, MeiLan K. Hanania, Nicola A. Hill, David Lange, Peter Lipson, David A. Martinez, Fernando J. Midwinter, Dawn
Bardsley, Samuel
Criner, Gerard J.
Haplin, David M.G.
Han, MeiLan K.
Hanania, Nicola A.
Hill, David
Lange, Peter
Lipson, David A.
Martinez, Fernando J.
Midwinter, Dawn
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Journal article
Date
2022-12-02
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Thoracic Medicine and Surgery
Medicine
Medicine
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http://dx.doi.org/10.1016/j.rmed.2022.107040
Abstract
Background: Smoking is the major risk factor for chronic obstructive pulmonary disease (COPD). In IMPACT, single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy significantly reduced moderate/severe exacerbation rates and improved lung function and health status versus FF/VI or UMEC/VI in COPD patients. This post hoc analysis investigated trial outcomes by smoking status. Methods: IMPACT was a double-blind, 52-week trial. Patients aged ≥40 years with symptomatic COPD and ≥1 moderate/severe exacerbation in the prior year were randomized 2:2:1 to FF/UMEC/VI 100/62.5/25 μg, FF/VI 100/25 μg, or UMEC/VI 62.5/25 μg. Endpoints assessed by smoking status at screening included rate and risk of moderate/severe exacerbations, change from baseline in trough forced expiratory volume in 1 s, and St George's Respiratory Questionnaire total score at Week 52. Safety was also assessed. Results: Of the 10,355 patients in the intent-to-treat population, 3,587 (35%) were current smokers. FF/UMEC/VI significantly reduced on-treatment moderate/severe exacerbation rates versus FF/VI and UMEC/VI in current (rate ratio 0.85 [95% confidence interval: 0.77–0.95]; P = 0.003 and 0.86 [0.76–0.98]; P = 0.021) and former smokers (0.85 [0.78–0.91]; P < 0.001 and 0.70 [0.64–0.77]; P < 0.001). FF/UMEC/VI significantly reduced time-to-first on-treatment moderate/severe exacerbation versus FF/VI and UMEC/VI in former smokers, and versus FF/VI in current smokers. Similar trends were seen for lung function and health status. Former smokers receiving inhaled corticosteroid-containing therapy had higher pneumonia incidence than current smokers. Conclusions: FF/UMEC/VI improved clinical outcomes versus dual therapy regardless of smoking status. Benefits of FF/UMEC/VI versus UMEC/VI were greatest in former smokers, potentially due to relative corticosteroid resistance in current smokers. Clinical trial registration: GSK (CTT116855/NCT02164513).
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Citation
Samuel Bardsley, Gerard J. Criner, David M.G. Halpin, MeiLan K. Han, Nicola A. Hanania, David Hill, Peter Lange, David A. Lipson, Fernando J. Martinez, Dawn Midwinter, Thomas M. Siler, Dave Singh, Robert A. Wise, Richard N. van Zyl-Smit, Neville Berkman, Single-inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol versus dual therapy in current and former smokers with COPD: IMPACT trial post hoc analysis, Respiratory Medicine, Volume 205, 2022, 107040, ISSN 0954-6111, https://doi.org/10.1016/j.rmed.2022.107040.
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Elsevier
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Respiratory Medicine, Vol. 205
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