In which patients is COPD LAMA / LABA sufficient?

Stop ICS

Stop inhaled corticosteroids in COPD – This seems to work well in patients with little Exacerbations and without eosinophilia.

By Dirk Eincke

SAN DIEGO. Patients with COPD undergoing triple inhalation with two bronchodilators and a corticosteroid may experience double bronchodilation without undesirable consequences, unless there are frequent exacerbations and no eosinophils greater than 300 / μl .

According to the guideline, bronchodilators be used. Inhaled corticosteroids (ICS) are used when the patient experiences acute bronchial crisis (exacerbations) under double bronchodilatation. However, many patients with COPD receive CSIs, although they rarely or rarely suffer exacerbations. This raises the question: how and under what circumstances can the ICS be interrupted?

The results of the SUNSET study presented at the annual congress of the American Thoracic ATS Society (Am J Respir Crit Care Med 2018, online May 20). In this study, 1053 patients with moderate to severe COPD had been studied, two-thirds of whom had not had one-third had an exacerbation during the previous year. All patients had been treated for at least six months with long-acting beta-2-mimetic (LABA), long-acting anticholinergic (LAMA), and CSI triple therapy.

All patients were revoked during a four-week preinclusion period. put the same triple therapy: tiotropium, salmeterol, fluticasone. Subsequently, he was randomized and treated for six months or changed directly to indacaterol / glycopyrronium without ICS. The primary endpoint was non-inferiority to the deterioration of Trough-FEV ₁ after half a year. The difference in FEV ₁ between groups was low at 26 ml Due to the confidence interval of +1 to -53 ml, the objective of demonstrating non-inferiority was narrowly missed

interrupted the CSI because of its forced vital capacity and risked exacerbations (0.52 / year for LABA / LABA and 0.48 / year for triple therapy), reported Professor Kenneth Chapman of the Asthma and Airway Center of the University of Toronto. Canada, at an event sponsored by Novartis.

However, with the increase in the number of eosinophils, it has been shown that differences between IBS-containing and non-IBS-regimens increase. Patients with more than 300 / μl of eosinophils lost on average 70 ml of FEV 1 ₁ and almost doubled their risk of exacerbation when they discontinued SCI

] The WISDOM study (N Engl J Med 2014; 1285-1294) had studied the withdrawal effect of IBS in 2,485 patients with COPD, with patients with a history of exacerbation more pronounced in this study and all of which have never been treated consistently with an IBS for an extended period. In this study, the stop ICS was not inferior to the follow-up. But here too, a slight deterioration of VEM ₁ was badociated (43 ml after 12 months). The WISDOM study also revealed that patients with high eosinophil levels were more likely to benefit from continuous ICS therapy.

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