International Journal of COPD (Aug 2023)

Clinical Concepts for Triple Therapy Use in Patients with COPD: A Delphi Consensus

  • Miravitlles M,
  • Acharya S,
  • Aggarwal B,
  • Fernandes FL,
  • Dreyse J,
  • Jardim JR,
  • Juthong S,
  • Levy G,
  • Sivori M

Journal volume & issue
Vol. Volume 18
pp. 1853 – 1866

Abstract

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Marc Miravitlles,1 Sudeep Acharya,2 Bhumika Aggarwal,2 Frederico LA Fernandes,3 Jorge Dreyse,4 José R Jardim,5 Siwasak Juthong,6 Gur Levy,7 Martin Sivori8 1Pneumology Department, Hospital Universitari Vall d’Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 2Emerging Markets, GlaxoSmithKline, Singapore; 3Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; 4Internal Medicine and Critical Care Center Departments, Clínica Las Condes and School of Medicine, Universidad Finis Terrae, Santiago, Chile; 5Respiratory Division, Escola Paulista de Medicina, Federal University of São Paulo, Sao Paulo, Brazil; 6Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; 7Emerging Markets, GlaxoSmithKline, Panama City, Panama; 8Pneumonology University Center, School of Medicine, University of Buenos Aires, Argentina, Unit of Pneumonology Hospital “Dr.J.M. Ramos Mejia”, Buenos Aires, ArgentinaCorrespondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron 119-129, Barcelona, 08035, Spain, Tel/Fax +34 932746083, Email [email protected]: Role of triple therapy in chronic obstructive pulmonary disease (COPD) management is supported by growing evidence, but consensus is lacking on various aspects. We conducted a Delphi survey in respiratory experts on the effects of triple therapy on exacerbation reduction, early optimization, pneumonia risk, and mortality benefits in COPD management.Methods: The study comprised 2-round online surveys and a participant meeting with 21 respiratory experts from 10 countries. The 31-statement questionnaire was prepared using Decipher software after literature review. Responses were recorded using Likert scale ranging from 1 (disagreement) to 9 (agreement) with a consensus threshold of 75%.Results: All experts participated in both surveys and 14/21 attended participant meeting. Consensus was reached on 13/31 questions in first survey and 4/14 in second survey on: mortality benefits of triple therapy; comparable pneumonia risk between single inhaler triple therapy (SITT) and multiple inhaler triple therapy (81%); preference of SITT for patients with high eosinophil count (95%); exacerbation risk reduction and healthcare cost benefits with early initiation of SITT post exacerbation-related hospitalization (< 30 days) (86%). No consensus was reached on first line SITT use after first exacerbation resulting in COPD diagnosis (62%).Conclusion: This study demonstrated that there is consensus among experts regarding many of the key concepts about appropriate clinical use and benefits of triple therapy in COPD. More evidence is required for evaluating the benefits of early optimisation of triple therapy.Keywords: SITT, MITT, triple inhaled therapy, Delphi procedure, COPD exacerbations, COPD mortality

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