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Prognostic value of clinically important deterioration in COPD: IMPACT trial analysis

Han, MK; Criner, GJ; Dransfield, MT; Halpin, DMG; Jones, CE; Kilbride, S; Lange, P; ... Singh, D; + view all (2021) Prognostic value of clinically important deterioration in COPD: IMPACT trial analysis. ERJ Open Research , 7 (1) , Article 00663-2020. 10.1183/23120541.00663-2020. Green open access

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Abstract

Introduction: Clinically important deterioration (CID) is a multicomponent measure for assessing disease worsening in chronic obstructive pulmonary disease (COPD). This analysis investigated the prognostic value of a CID event on future clinical outcomes and the effect of single-inhaler triple versus dual therapy on reducing CID risk in patients in the IMPACT trial. Methods: IMPACT was a phase III, double-blind, 52-week, multicentre trial. Patients with symptomatic COPD and at least one moderate/severe exacerbation in the prior year were randomised 2:2:1 to fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 µg, FF/VI 100/25 µg or UMEC/VI 62.5/25 µg. CID at the time-point of interest was defined as a moderate/severe exacerbation, ≥100 mL decrease in trough forced expiratory volume in 1 s or deterioration in health status (increase of ≥4.0 units in St George's Respiratory Questionnaire total score or increase of ≥2.0 units in COPD Assessment Test score) from baseline. A treatment-independent post hoc prognostic analysis compared clinical outcomes up to week 52 in patients with/without a CID by week 28. A prospective analysis evaluated time to first CID with each treatment. Results: Patients with a CID by week 28 had significantly increased exacerbation rates after week 28, smaller improvements in lung function and health status at week 52 (all p<0.001), and increased risk of all-cause mortality after week 28 versus patients who were CID-free. FF/UMEC/VI significantly reduced CID risk versus dual therapies (all p<0.001). Conclusions: Prevention of short-term disease worsening was associated with better long-term clinical outcomes. FF/UMEC/VI reduced CID risk versus dual therapies; this effect may improve long-term prognosis in this population.

Type: Article
Title: Prognostic value of clinically important deterioration in COPD: IMPACT trial analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1183/23120541.00663-2020
Publisher version: http://dx.doi.org/10.1183/23120541.00663-2020
Language: English
Additional information: Copyright ©ERS 2021. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > VP: Health
URI: https://discovery.ucl.ac.uk/id/eprint/10125007
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