FULFIL Trial: Once-Daily Triple Therapy for Patients with Chronic Obstructive Pulmonary Disease

Lipson, David A.; Barnacle, Helen; Birk, Ruby; Brealey, Noushin; Locantore, Nicholas; Lomas, David A.; Ludwig-Sengpiel, Andrea; Mohindra, Rajat; Tabberer, Maggie; Zhu, Chang‐Qing; Pascoe, Steven

doi:10.1164/rccm.201703-0449oc

Cited by 280 publications

(362 citation statements)

References 19 publications

(10 reference statements)

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“…Nevertheless, a numerical difference in the CAT responder analysis was seen at week 8, with 47% of UMEC/VI-treated patients compared with 38% of TIO/OLO-treated patients obtaining clinically relevant improvements in symptoms and health-related QoL, with a similar response rate at week 4, in line with the primary study. This magnitude of improvement in symptom burden and QoL is consistent with treatment benefit on CAT and other patientreported outcomes seen on escalating therapy from one to two bronchodilators in patients with more advanced COPD [37,39,40].…”

Section: Discussionsupporting

confidence: 73%

Umeclidinium/Vilanterol Versus Tiotropium/Olodaterol in Maintenance-Naïve Patients with Moderate Symptomatic Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis

Navarrete¹,

Boucot²,

Naya³

et al. 2018

Pulm Ther

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Section: Discussionsupporting

confidence: 73%

Umeclidinium/Vilanterol Versus Tiotropium/Olodaterol in Maintenance-Naïve Patients with Moderate Symptomatic Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis

Navarrete¹,

Boucot²,

Naya³

et al. 2018

Pulm Ther

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“…As such, escalation from LABA-LAMA therapy directly to triple therapy needs to be evaluated. The recently published Lung Function and Quality of Life Assessment in COPD with Closed Triple Therapy (FULFIL) study results support a benefit of single-inhaler triple therapy compared with ICS-LABA for lung function, health status, and exacerbation rate at 24 weeks 82. Moreover, results of the Informing the Pathway of COPD Treatment (IMPACT) study demonstrated that the triple combination of fluticasone furoate–umeclidinium–vilanterol reduced the rate of moderate or severe exacerbations more effectively than both the ICS-LABA (fluticasone furoate–vilanterol, 15% difference, P <0.001) and the LABA-LAMA (umeclidinium–vilanterol, 25% difference, P <0.001) combinations 83.…”

Section: Future Directions: Triple Therapy and Beyondmentioning

confidence: 96%

Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?

Tashkin¹,

Strange²

2018

COPD

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Inhaled corticosteroids (ICSs) are a mainstay of COPD treatment for patients with a history of exacerbations. Initial studies evaluating their use as monotherapy failed to show an effect on rate of pulmonary function decline in COPD, despite improvements in symptoms and reductions in exacerbations. Subsequently, ICS use in combination with long-acting β2-agonists (LABAs) was shown to provide improved reductions in exacerbations, lung function, and health status. ICS-LABA combination therapy is currently recommended for patients with a history of exacerbations despite treatment with long-acting bronchodilators alone. The presence of eosinophilic bronchial inflammation, detected by high blood eosinophil levels or a history of asthma or asthma–COPD overlap, may define a population of patients in whom ICSs may be of particular benefit. Prospective clinical studies to determine an appropriate threshold of eosinophil levels for predicting the beneficial effects of ICSs are needed. Further study is also required in COPD patients who continue to smoke to assess the impact of cell- and tissue-specific changes on ICS responsiveness. The safety profile of ICSs in COPD patients is confounded by comorbidities, age, and prior use of systemic corticosteroids. The risk of pneumonia in patients with COPD is increased, particularly with more advanced age and worse disease severity. ICS-containing therapy also has been shown to increase pneumonia risk; however, differences in study design and the definition of pneumonia events have led to substantial variability in risk estimates, and some data indicate that pneumonia risk may differ by the specific ICS used. In summary, treatment with ICSs has a role in dual and triple therapy for COPD to reduce exacerbations and improve symptoms. Careful assessment of COPD phenotypes related to risk factors, triggers, and comorbidities may assist in individualizing treatment while maximizing the benefit-to-risk ratio of ICS-containing COPD treatment.

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“…This strategy of therapy with aerosols facilitates the education, decreases the risk of mistakes committed by patients and may be a more effective therapy than inhalation with 2-3 different DPI inhalers [42]. The most recent example of the three-drug therapy with a single DPI is a combination of fluticasone furoate with umeclidinium bromide and with vilanterol in the Ellipta ® inhaler [43]. The improvement of the efficacy of inhalation therapy seen from the patient's perspective requires as follows: to define the characteristics of inhaler important to a user, to choose a DPI consistent with preferences and possibilities of the patient and to properly educate the patient.…”

Section: How To Improve the Effectiveness Of Inhalation Therapy -Physmentioning

confidence: 99%

Dry Powder Inhalers—Between the Doctor and the Patient

Emeryk

Pirożyński²,

Emeryk-Maksymiuk³

2018

Advances in Respiratory Medicine

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The article briefly presents currently accessible dry powder inhalers (DPI). Basing on the data from the literature, we discussed the most common mistakes related to the utilisation of DPI as well as their clinical and economic consequences. We also extensively analysed all factors that may influence the efficacy and safety of inhaler therapy of asthma and COPD, mostly with the use of DPI. In addition, we indicated the potential to improve the efficacy of inhaler therapy from the doctor and COPD or asthma patient perspective. We also presented a DPI choice algorithm including the patient's preferences and competences.

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FULFIL Trial: Once-Daily Triple Therapy for Patients with Chronic Obstructive Pulmonary Disease

Cited by 280 publications

References 19 publications

Umeclidinium/Vilanterol Versus Tiotropium/Olodaterol in Maintenance-Naïve Patients with Moderate Symptomatic Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis

Umeclidinium/Vilanterol Versus Tiotropium/Olodaterol in Maintenance-Naïve Patients with Moderate Symptomatic Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis

Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?

Dry Powder Inhalers—Between the Doctor and the Patient

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