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Clinical Usefulness of Once-Daily Triple Therapy, Ciclesonide and Tiotropium Bromide/Olodaterol Combination Inhaler for COPD Patients
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A4770 - Clinical Usefulness of Once-Daily Triple Therapy, Ciclesonide and Tiotropium Bromide/Olodaterol Combination Inhaler for COPD Patients
Author Block: H. Masayuki; Chest Disease Clinical and Research Institute, NTT medical center Tokyo, Tokyo, Japan.
RATIONALE; In GOLD 2017, the positioning of the ICS use for COPD patients declined, still its use for the cases with frequent exacerbations and overlapping with asthma were recommended. The triplet, ICS+LABA+LAMA could be used for GOLD group D, however, three drugs combination agent is not marketed in Japan at present, and there were not yet the findings which combination were the best choice. Ciclesonide Hydrate (CIC) and Tiotropium bromide/Olodaterol Hydrochloride combination inhaler (CIC + TIO/OLO) are both once-daily fine mist preparations which could contribute to better adherence to the inhalation therapy and distribution to peripheral airways. Therefore, we conducted a clinical analysis to compare anti-inflammatory effect and bronchodilator effect especially on peripheral airway between CIC + TIO/OLO and other triple combination therapy.
METHODS; COPD patients, aged from 40 to 85 years old, classified as either group D or ACO and have been treated with triplet more than six months at our hospital are recruited. After obtaining informed consent, the current treatment is switched to once-daily CIC 400 μg/day + TIO/OLO 5 μg/5 μg/day. Then COPD assessment test (CAT) score, Spirometry, fractional exhaled nitric oxide (FeNO), FOT (forced oscillation technique; MostGraph-02) and exacerbation rate per year are examined before and after 6 months treatment with CIC + TIO/OLO.
RESULTS; 24 patients are enrolled. Mean age is 74.6 ± 13.3 years old, and GOLD group D were 16 cases, 8 cases are peripheral blood eosinophil count more than 300/μL suggesting ACO. Triplet used before entry are SFC + TIO 16 cases, FP + GLY/IND 3 case, BUD + GLY/IND 2 cases, while FF/VI + TIO are 3 cases. As a result, more than 2 points increase of CAT score is observed in 19 out of 24 patients and significant improvements are observed not only in CAT score (10.4±5.7 to 5.3±2.4) but also FeNO (40.7±19.7ppb to 30.6±9.5ppb). Although no change are observed in FEV1% (61.8±14.1% to 62.8±12.3%), MMF (0.89±0.62 to 1.11±0.63 L/s) and Fres in MostGraph (13.7±3.12 to 9.1±6.1 Hz) improve significantly, which suggest bronchial dilatation might occur more peripheral airways.
CONCLUSIONS; CIC + TIO/OLO, the combination of once-daily fine mist preparations, could be a favorable option as a triple therapy for COPD and ACO patients.
Author Block: H. Masayuki; Chest Disease Clinical and Research Institute, NTT medical center Tokyo, Tokyo, Japan.
RATIONALE; In GOLD 2017, the positioning of the ICS use for COPD patients declined, still its use for the cases with frequent exacerbations and overlapping with asthma were recommended. The triplet, ICS+LABA+LAMA could be used for GOLD group D, however, three drugs combination agent is not marketed in Japan at present, and there were not yet the findings which combination were the best choice. Ciclesonide Hydrate (CIC) and Tiotropium bromide/Olodaterol Hydrochloride combination inhaler (CIC + TIO/OLO) are both once-daily fine mist preparations which could contribute to better adherence to the inhalation therapy and distribution to peripheral airways. Therefore, we conducted a clinical analysis to compare anti-inflammatory effect and bronchodilator effect especially on peripheral airway between CIC + TIO/OLO and other triple combination therapy.
METHODS; COPD patients, aged from 40 to 85 years old, classified as either group D or ACO and have been treated with triplet more than six months at our hospital are recruited. After obtaining informed consent, the current treatment is switched to once-daily CIC 400 μg/day + TIO/OLO 5 μg/5 μg/day. Then COPD assessment test (CAT) score, Spirometry, fractional exhaled nitric oxide (FeNO), FOT (forced oscillation technique; MostGraph-02) and exacerbation rate per year are examined before and after 6 months treatment with CIC + TIO/OLO.
RESULTS; 24 patients are enrolled. Mean age is 74.6 ± 13.3 years old, and GOLD group D were 16 cases, 8 cases are peripheral blood eosinophil count more than 300/μL suggesting ACO. Triplet used before entry are SFC + TIO 16 cases, FP + GLY/IND 3 case, BUD + GLY/IND 2 cases, while FF/VI + TIO are 3 cases. As a result, more than 2 points increase of CAT score is observed in 19 out of 24 patients and significant improvements are observed not only in CAT score (10.4±5.7 to 5.3±2.4) but also FeNO (40.7±19.7ppb to 30.6±9.5ppb). Although no change are observed in FEV1% (61.8±14.1% to 62.8±12.3%), MMF (0.89±0.62 to 1.11±0.63 L/s) and Fres in MostGraph (13.7±3.12 to 9.1±6.1 Hz) improve significantly, which suggest bronchial dilatation might occur more peripheral airways.
CONCLUSIONS; CIC + TIO/OLO, the combination of once-daily fine mist preparations, could be a favorable option as a triple therapy for COPD and ACO patients.
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