CHEST 2019 — Steroid-free COPD: dual bronchodilator therapy an earlier treatment option


  • Keren Landman, MD
  • Conference Reports
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Takeaway

  • Tiotropium/olodaterol (T/O) increased lung function among steroid-free COPD patients more than tiotropium alone.

Why this matters

  • Symptomatic patients with COPD whose bronchodilation is not optimized may be prematurely started on inhaled steroids. 

Study design

  • Post hoc analysis of pooled data from TONADO 1 and 2 and OTEMTO 1 and 2 phase 3 trials comparing tiotropium/olodaterol (T/O, 5/5 μg) with tiotropium monotherapy (5 μg) in 1581 steroid-free patients with COPD.
  • Outcomes evaluated at 12 weeks included markers of bronchodilation: trough FEV1, FEV1 area under the curve from 0 to 3 hours (FEV1 AUC0-3), St. George's Respiratory Questionnaire (SGRQ) total score, and Transition Dyspnea Index (TDI) score.
  • Funding: Boehringer Ingelheim.

Key results

  • At week 12, patients receiving T/O vs tiotropium had:
    • Increased FEV1 AUC0-3 (0.296 vs 0.193 L, P<.0001>
    • Increased trough FEV1 (0.141 vs 0.086 L, P<.0001>
    • Improved SGRQ score (−6.317 vs −4.399, P=.0005).
    • Improved TDI score (2.154 vs 1.579, P.0001).
  • Subgroup analysis by Global Initiative for Chronic Obstructive Lung Disease stage and baseline symptoms found improvements irrespective of baseline COPD severity and symptoms.

Limitations

  • Exclusion of patients with major comorbidities from study limits generalizability to more medically complicated populations.