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Agusti A, Lopez-Campos JL, Miravitlles M, Soler-Cataluña JJ, Marin JM, Cosio BG, Alcázar-Navarrete B, Echave-Sustaeta JM, Casanova C, Peces-Barba G, de-Torres JP, Fernandez-Villar A, Ancochea J, Villar-Alvarez F, Roman-Rodriguez M, Molina J, Garcia-Rivero JL, Gonzalez C, Sobradillo P, Faner R, Peña C, Sharma R, Celli BR. Triple Therapy and Clinical Control in B+ COPD Patients: A Pragmatic, Prospective, Randomized Trial. Arch Bronconeumol 2024:S0300-2896(24)00116-9. [PMID: 38729884 DOI: 10.1016/j.arbres.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Treatment with LABA/LAMA is recommended in GOLD B patients. We hypothesized that triple therapy (LABA/LAMA/ICS) will be superior to LABA/LAMA in achieving and maintaining clinical control (CC), a composite outcome that considers both impact and disease stability in a subgroup of GOLD B patients (here termed GOLD B+ patients) characterized by: (1) remaining symptomatic (CAT≥10) despite regular LABA/LAMA therapy; (2) having suffered one moderate exacerbation in the previous year; and (3) having blood eosinophil counts (BEC) ≥150cells/μL. METHODS The ANTES B+ study is a prospective, multicenter, open label, randomized, pragmatic, controlled trial designed to test this hypothesis. It will randomize 1028 B+ patients to continue with their usual LABA/LAMA combination prescribed by their attending physician or to begin fluticasone furoate (FF) 92μg/umeclidinium (UMEC) 55μg/vilanterol (VI) 22μg in a single inhaler q.d. for 12 months. The primary efficacy outcome will be the level of CC achieved. Secondary outcomes include the clinical important deterioration index (CID), annual rate of exacerbations, and FEV1. Exploratory objectives include the interaction of BEC and smoking status, all-cause mortality and proportion of patients on LABA/LAMA arm that switch therapy arms. Safety analysis include adverse events and incidence of pneumonia. RESULTS The first patient was recruited on February 29, 2024; results are expected in the first quarter of 2026. CONCLUSIONS The ANTES B+ study is the first to: (1) explore the efficacy and safety of triple therapy in a population of B+ COPD patients and (2) use a composite index (CC) as the primary result of a COPD trial.
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Affiliation(s)
- Alvar Agusti
- Cátedra Salud Respiratoria, Universidad Barcelona, Institut Respiratori, Clinic Barcelona, FCRB-IDIBAPS, CIBERES, Spain.
| | - José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Juan Jose Soler-Cataluña
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Valencia, Spain; Departamento de Medicina, Universitat de València, Spain
| | - Jose Maria Marin
- Respiratory Service, Hospital Universitario Miguel Servet, IISAragón, Zaragoza, Spain
| | - Borja G Cosio
- Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa, Universidad de las Islas Baleares, CIBERES, Spain
| | - Bernardino Alcázar-Navarrete
- Servicio de Neumología, Hospital Universitario Virgen de las Nieves, IBS-Granada, Universidad de Granada, CIBERES, Spain
| | | | - Ciro Casanova
- Pulmonary Department - Research Unit, Hospital Universitario Nuestra Señora de La Candelaria, CIBERES, ISCIII, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | - Alberto Fernandez-Villar
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
| | - Julio Ancochea
- Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, CIBER Enfermedades Respiratorias, Madrid, Spain
| | - Felipe Villar-Alvarez
- Pulmonology Department, IIS Fundación Jiménez Díaz, Universidad Autónoma of Madrid, CIBER Enfermedades Respiratorias, Madrid, Spain
| | - Miguel Roman-Rodriguez
- Primary Care Health Service Mallorca, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa) Palma, Universidad de las Islas Baleares, Spain
| | - Jesus Molina
- Centro de Salud Francia, Fuenlabrada, Madrid, Spain; Dirección Asistencial Oeste, Spain
| | | | - Cruz Gonzalez
- Respiratory Department, Hospital Clínico Universitario, Valencia, Spain
| | - Patricia Sobradillo
- Pulmonology Department, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - Rosa Faner
- Biomedicine Department, University of Barcelona, FCRB-IDIBAPS, CIBERES, Barcelona, Spain
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Almagro P, Soler-Cataluña JJ, Huerta A, González-Segura D, Cosío BG. Impact of comorbidities in COPD clinical control criteria. The CLAVE study. BMC Pulm Med 2024; 24:6. [PMID: 38166965 PMCID: PMC10759491 DOI: 10.1186/s12890-023-02758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) frequently coexists with other chronic diseases, namely comorbidities. They negatively impact prognosis, exacerbations and quality of life in COPD patients. However, no studies have been performed to explore the impact of these comorbidities on COPD clinical control criteria. RESEARCH QUESTION Determine the relationship between individualized comorbidities and COPD clinical control criteria. STUDY DESIGN AND METHODS Observational, multicenter, cross-sectional study performed in Spain involving 4801 patients with severe COPD (< 50 predicted forced expiratory volume in the first second [FEV1%]). Clinical control criteria were defined by the combination of COPD assessment test (CAT) scores (≤16 vs ≥17) and exacerbations in the previous three months (none vs ≥1). Binary logistic regression adjusted by age and FEV1% was performed to identify comorbidities potentially associated with the lack of control of COPD. Secondary endpoints were the relationship between individualized comorbidities with COPD assessment test and exacerbations within the last three months. RESULTS Most frequent comorbidities were arterial hypertension (51.2%), dyslipidemia (36.0%), diabetes (24.9%), obstructive sleep apnea-hypopnea syndrome (14.9%), anxiety (14.1%), heart failure (11.6%), depression (11.8%), atrial fibrillation (11.5%), peripheral arterial vascular disease (10.4%) and ischemic heart disease (10.1%). After age and FEV1% adjustment, comorbidities related to lack of clinical control were cardiovascular diseases (heart failure, peripheral vascular disease and atrial fibrillation; p < 0.0001), psychologic disorders (anxiety and depression; all p < 0.0001), metabolic diseases (diabetes, arterial hypertension and abdominal obesity; all p < 0.001), sleep disorders (p < 0.0001), anemia (p = 0.015) and gastroesophageal reflux (p < 0.0001). These comorbidities were also related to previous exacerbations and COPD assessment test scores. INTERPRETATION Comorbidities are frequent in patients with severe COPD, negatively impacting COPD clinical control criteria. They are related to health-related quality of life measured by the COPD assessment test. Our results suggest that comorbidities should be investigated and treated in these patients to improve their clinical control. TAKE-HOME POINTS Study question: What is the impact of comorbidities on COPD clinical control criteria? RESULTS Among 4801 patients with severe COPD (27.5% controlled and 72.5% uncontrolled), after adjustment by age and FEV1%, comorbidities related to lack of clinical control were cardiovascular diseases (heart failure, peripheral vascular disease and atrial fibrillation; p < 0.0001), psychologic disorders (anxiety and depression; p < 0.0001), metabolic diseases (diabetes, arterial hypertension and abdominal obesity; p < 0.001), obstructive sleep apnea-hypopnea syndrome (p < 0.0001), anaemia (p = 0.015) and gastroesophageal reflux (p < 0.0001), which were related to previous exacerbations and COPD assessment test scores. INTERPRETATION Comorbidities are related to health-related quality of life measured by the COPD assessment test scores and history of exacerbations in the previous three months.
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Affiliation(s)
- Pere Almagro
- Multimorbidity Patients Unit. Internal Medicine Department, H. Mutua Terrassa University Hospital, Plaza del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
| | - Juan José Soler-Cataluña
- Department of Pneumology, Hospital Arnau de Vilanova-Lliria, Medicine Department, València University and CIBERES, Valencia, Spain
| | - Arturo Huerta
- Pulmonary and Critical Care Division, Emergency Department, Clínica Sagrada Família, Barcelona, Spain
| | | | - Borja G Cosío
- Department of Pneumology, H. Universitari Son Espases Hospital-IdISBa and CIBERES, Palma de Mallorca, Balearic Islands, Spain
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Figueira-Gonçalves JM, Hernández-Pérez JM, Cabrera-Lopez C, Wangüemert-Pérez AL, García-Talavera I, Ramallo-Fariña Y, Golpe R, González-García LM. Relationship Between the Summation of GesEPOC High-Risk Factors and the Presence of Cardiovascular Disease. Arch Bronconeumol 2023:S0300-2896(23)00010-8. [PMID: 36707328 DOI: 10.1016/j.arbres.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/23/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023]
Affiliation(s)
- Juan Marco Figueira-Gonçalves
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; University Institute of Tropical Disease and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain.
| | - José María Hernández-Pérez
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Ignacio García-Talavera
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Foundation of the Canary Islands Health Research Institute (FIISC), Santa Cruz de Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Rafael Golpe
- Pneumology Service, University Hospital Lucus Augusti, Lugo, Spain
| | - Luis Manuel González-García
- Primary Care Centre of the Canary Islands Public Health Service, Breña Baja, La Palma, Santa Cruz de Tenerife, Spain
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