Real-World Effectiveness of Single-Inhaler Triple Therapy for COPD: Impact of Diabetes Comorbidity

• Published in: Chronic obstructive pulmonary disease Vol. 21; no. 1; p. 2327345
• Main Authors: Eilat-Tsanani, Sophia, Ernst, Pierre, Suissa, Samy
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Group 01-12-2024
• Subjects: Administration, Inhalation; Adrenergic beta-2 Receptor Agonists - therapeutic use; Bronchodilator Agents; Cohort studies; Comorbidity; COPD exacerbation; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Drug Therapy, Combination; Humans; multimorbidity; Muscarinic Antagonists - therapeutic use; Nebulizers and Vaporizers; Pneumonia; propensity scores; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - epidemiology; real-world evidence; multimorbidity; propensity scores; real-world evidence; COPD exacerbation; Cohort studies
• ISSN: 1541-2555; 1541-2563
• DOI: 10.1080/15412555.2024.2327345

Type 2 diabetes is a frequent comorbidity in chronic obstructive pulmonary disease (COPD) patients, with the GOLD treatment recommendations asserting that the presence of diabetes be disregarded in the choice of treatment.
In a cohort of COPD patients with frequent exacerbations, initiators of single-inhaler triple therapy or dual bronchodilators were compared on the incidence of COPD exacerbation and pneumonia over one year, adjusted by propensity score weighting and stratified by type 2 diabetes.
The COPD cohort included 1,114 initiators of triple inhalers and 4,233 of dual bronchodilators (28% with type 2 diabetes). The adjusted hazard ratio (HR) of exacerbation with triple therapy was 1.04 (95% CI: 0.86-1.25) among COPD patients with type 2 diabetes and 0.74 (0.65-0.85) in those without. The incidence of severe pneumonia was elevated with triple therapy among patients with type 2 diabetes (HR 1.77; 1.14-2.75).
Triple therapy in COPD is effective among those without, but not those with, type 2 diabetes. Future therapeutic trials in COPD should consider diabetes comorbidity.