Journal Article

Benefits of budesonide/glycopyrronium/formoterol fumarate dihydrate on lung function and exacerbations of COPD: a post-hoc analysis of the KRONOS study by blood eosinophil level and exacerbation history

Tomotaka Kawayama, Elizabeth A. Duncan, Karin Bowen, Shigeo Muro, Hisatoshi Sugiura, Ayman Megally, Jonathan Marshall, Munehiro Seki, Mehul Patel

2024

Overview

Background Japanese guidelines recommend triple inhaled corticosteroid (ICS)/long-acting muscarinic antagonist (LAMA)/long-acting β 2 -agonist (LABA) therapy in patients with chronic obstructive pulmonary disease (COPD) and no concurrent asthma diagnosis who experience frequent exacerbations and have blood eosinophil (EOS) count ≥ 300 cells/mm 3 , and in patients with COPD and asthma with continuing/worsening symptoms despite receiving dual ICS/LABA therapy. These post-hoc analyses of the KRONOS study in patients with COPD and without an asthma diagnosis, examine the effects of fixed-dose triple therapy with budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) versus dual therapies on lung function and exacerbations based on blood EOS count – focusing on blood EOS count 100 to < 300 cells/mm 3 – as a function of exacerbation history and COPD severity. Methods In KRONOS, patients were randomized to receive treatments that included BGF 320/14.4/10 µg, glycopyrronium/formoterol fumarate dihydrate (GFF) 14.4/10 µg, or budesonide/formoterol fumarate dihydrate (BFF) 320/10 µg via metered dose inhaler (two inhalations twice-daily for 24 weeks). These post-hoc analyses assessed changes from baseline in morning pre-dose trough forced expiratory volume in 1 s (FEV 1 ) over 12–24 weeks and moderate or severe COPD exacerbations rates over 24 weeks. The KRONOS study was not prospectively powered for these subgroup analyses. Results Among patients with blood EOS count 100 to < 300 cells/mm 3 , least squares mean treatment differences for lung function improvement favored BGF over BFF in patients without an exacerbation history in the past year and in patients with moderate and severe COPD, with observed differences ranging from 62 ml to 73 ml across populations. In this same blood EOS population, moderate or severe exacerbation rates were reduced for BGF relative to GFF by 56% in patients without an exacerbation history in the past year, by 47% in patients with moderate COPD, and by 50% in patients with severe COPD. Conclusions These post-hoc analyses of patients with moderate-to-very severe COPD from the KRONOS study seem to indicate clinicians may want to consider a step-up to triple therapy in patients with persistent/worsening symptoms with blood EOS count > 100 cells/mm 3 , even if disease severity is moderate and there is no recent history of exacerbations. Trial registration ClinicalTrials.gov registry number NCT02497001 (registration date, 13 July 2015).

• Publisher: Springer Science and Business Media LLC,BioMed Central,BioMed Central Ltd,Nature Publishing Group,BMC
• Subject: Acetylcholine receptors (muscarinic) / Administration, Inhalation / Aged / Analysis / Asthma / Blood / Blood eosinophils / Blood levels / Bronchodilator Agents - administration & dosage / Bronchodilators / Budesonide / Budesonide - administration & dosage / Budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) / Chronic obstructive pulmonary disease / Chronic obstructive pulmonary disease (COPD) / Corticosteroids / Diagnosis / Disease Progression / Disease severity / Diseases of the respiratory system / Dosage and administration / Double-Blind Method / Drug therapy / Eosinophils - drug effects / Exacerbation rates / Female / Forced Expiratory Volume - drug effects / Forced Expiratory Volume - physiology / Formoterol / Formoterol Fumarate - administration & dosage / Glycopyrrolate - administration & dosage / Humans / Inhalers / Leukocytes (eosinophilic) / Lung - drug effects / Lung - physiopathology / Lung diseases / Lung diseases, Obstructive / Lung function / Lungs / Male / Medicine / Medicine & Public Health / Middle Aged / Muscarinic Antagonists - administration & dosage / Patient outcomes / Patients / Pneumology/Respiratory System / Pulmonary Disease, Chronic Obstructive - blood / Pulmonary Disease, Chronic Obstructive - diagnosis / Pulmonary Disease, Chronic Obstructive - drug therapy / Pulmonary Disease, Chronic Obstructive - physiopathology / Pulmonary function tests / RC705-779 / Respiratory agents / Respiratory function / Review boards / Signs and symptoms / Steroids / Subgroups / Therapy / Treatment Outcome