Antonio Anzueto, MD, on Single-Inhaler Triple Therapy Compared With Monotherapy In COPD

In this video, Antonio Anzueto, MD, gives an overview of his team's study that compared fluticasone furoate/umeclidinium/vilanterol in a single inhaler with tiotropium among patients with symptomatic COPD, who are at risk of exacerbations.

Additional Resource:

  • Anzueto A, Obeid D, Bansal S, et al. Single-inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol compared with tiotropium monotherapy in COPD: a post-hoc analysis by airflow. Paper presented at: CHEST Annual Meeting 2020; October 18-21, 2020; Virtual. 

Antonio R. Anzueto, MD, is a professor of medicine in the Division of Pulmonary Diseases at the University of Texas, San Antonio, and the chief of the Pulmonary Section at the South Texas Veterans Health Care System.


My name is Antonio Anzueto. I’m a professor of medicine at the University of Texas, San Antonio. I'm also the section chief for pulmonary at the South Texas Veterans Health Care System.

The standard treatment therapy in COPD has been long-acting bronchodilators. As a matter of fact, 20 years ago is when we started having medication called tiotropium, the first long-acting anticholinergic that demonstrated that patients with COPD given long-acting bronchodilators will significantly increase lung function. That lung function will stay elevated over time. So, tiotropium has become the gold standard in the management of COPD.

In 20 years, we have a tremendous development of medications with a better understanding of the mechanisms of disease and how the pharmacotherapy can impact the different areas within the lungs. So, we have the development of long-acting anticholinergics, like tiotropium that I mentioned. Others have been [indecipherable 1:17-1:20]. We also have the development of long-acting β-2 agonists, vilanterol in this formulation. But we also have salmeterol, formoterol, and olodaterol. And we have inhaled corticosteroids.

So over the last 10 years, we have been slowly finding a way where medications will fade out and who needs to receive what type of medications. In this particular study, where we tried to look is having a fixed combination of the 3 classes of medications: the long-acting β-2 agonists (vilanterol), long-acting anticholinergics (umeclidinium), and the inhaled corticosteroids (fluticasone furoate).

We wanted to see what will be the efficacy in lung function and its cost compared with the gold standard, tiotropium. The studies show that given the triple therapy, given 2 bronchodilators and inhaled corticosteroid, you will have much higher improvements in lung function over time. We translate in improvement in patients’ quality of life and decreasing exacerbations.

Certainly, this may not be completely fair for tiotropium because it's one medication vs 3 three, knowing that the bronchodilators have some synergism. It was very important to make this comparison for 2 reasons. One is demonstrated the other combinations can hold the improvement in lung function and for safety. We know that tiotropium is a very safe medication. We have extensive studies about the safety of the long-acting anticholinergics.

The safety of the combination of the triple therapy was very similar to tiotropium. The only difference is they have more ICS-related adverse effects; for example, more oral candidiasis that we don't see with anticholinergics and we see with inhaled corticosteroids.

And a slight increase in the number of patients who developed pneumonia in the corticosteroid group. This is something that we know and can be expected. Overall, the efficacy was significantly improved, and the safety was very similar.

I hope I have provided you with useful information to your practice. And, remember, make a diagnosis because if you can treat that condition, you can significant impact the patient's life. Thank you.

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