Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University, School of Medicine, Shinagawa-ku, Tokyo, Japan
Novartis Pharma AG, Basel, Switzerland.
BMJ Open Respir Res. 2021 Mar;8(1). doi: 10.1136/bmjresp-2020-000856.
The 52-week IRIDIUM study demonstrated the efficacy of indacaterol acetate/glycopyrronium bromide/mometasone furoate (IND/GLY/MF) versus IND/MF and salmeterol xinafoate/fluticasone propionate (SAL/FLU) in patients with symptomatic asthma, despite long-acting β-agonist/inhaled corticosteroids (LABA/ICS) medium-dose or high-dose, predicted forced expiratory volume in 1 s (FEV) <80% and at least one exacerbation in the previous year. Here, we present data from a post hoc analysis of the IRIDIUM study in the Asian subpopulation.
This post hoc analysis evaluated improvements in lung function, asthma control and reduction in asthma exacerbations with IND/GLY/MF medium- (150/50/80 µg) and high-dose (150/50/160 µg) versus IND/MF medium- (150/160 µg) and high-dose (150/320 µg), all one time per day and SAL/FLU high-dose (50/500 µg) two times per day, in Asian patients from the IRIDIUM study.
In total, 258 patients (IND/GLY/MF medium-dose, 52; IND/GLY/MF high-dose, 52; IND/MF medium-dose, 51; IND/MF high-dose, 51; SAL/FLU high-dose, 52) were included. IND/GLY/MF medium- and high-dose showed greater improvement in trough FEV at week 26 versus respective doses of IND/MF (Δ, 100 mL and 101 mL; both p<0.05, respectively), and SAL/FLU high-dose (Δ, 125 mL; p=0.0189, and 136 mL; p=0.0118, respectively), which were maintained over 52 weeks. Both doses of IND/GLY/MF showed greater improvement in morning and evening peak expiratory flow versus respective doses of IND/MF and SAL/FLU high-dose at week 52. The changes in Asthma Control Questionnaire-7 scores from baseline were comparable in all treatment groups. IND/GLY/MF medium- and high-dose showed greater reductions in severe (34%, 69%), moderate or severe (18%, 54%) and all exacerbations (21%, 34%) compared with SAL/FLU high-dose over 52 weeks.
One time per day, single-inhaler IND/GLY/MF improved lung function, reduced asthma exacerbations and provided comparable asthma control versus IND/MF and SAL/FLU in Asian patients with inadequately controlled asthma despite LABA/ICS. The results of this analysis were consistent with the overall population in the IRIDIUM study.
52 周 IRIDIUM 研究表明,在接受中剂量或高剂量长效β激动剂/吸入性皮质激素(LABA/ICS)治疗后,预测第 1 秒用力呼气量(FEV)<80%且上一年至少有 1 次加重的有症状哮喘患者中,与 IND/MF 和沙美特罗氟替卡松(SAL/FLU)相比,醋酸茚达特罗/格隆溴铵/糠酸莫米松(IND/GLY/MF)具有更好的疗效。在此,我们对 IRIDIUM 研究中的亚洲亚人群进行了事后分析,报告了该研究的数据。
本事后分析评估了中剂量(150/50/80μg)和高剂量(150/50/160μg)IND/GLY/MF 与中剂量(150/160μg)和高剂量(150/320μg)IND/MF 以及高剂量(50/500μg)SAL/FLU 每日 1 次,在 IRIDIUM 研究中的亚洲患者中的肺功能改善、哮喘控制和哮喘加重减少情况。
共有 258 例患者(IND/GLY/MF 中剂量组 52 例,IND/GLY/MF 高剂量组 52 例,IND/MF 中剂量组 51 例,IND/MF 高剂量组 51 例,SAL/FLU 高剂量组 52 例)被纳入分析。与 IND/MF 相应剂量相比,26 周时 IND/GLY/MF 中剂量和高剂量组的谷值 FEV 改善更大(分别为Δ100mL和Δ101mL;均 p<0.05),而 SAL/FLU 高剂量组的谷值 FEV 改善更大(Δ125mL;p=0.0189 和Δ136mL;p=0.0118),并且这种改善在 52 周时得以维持。与 IND/MF 和 SAL/FLU 高剂量组相比,在第 52 周时,IND/GLY/MF 中剂量和高剂量组的晨晚峰值呼气流速改善更大。所有治疗组的哮喘控制问卷-7 评分变化基线相比均无显著差异。与 SAL/FLU 高剂量组相比,52 周时 IND/GLY/MF 中剂量和高剂量组严重(34%,69%)、中度或重度(18%,54%)和所有加重(21%,34%)的减少比例更大。
对于 LABA/ICS 治疗后哮喘控制仍不理想的亚洲哮喘患者,每日 1 次、单吸入器 IND/GLY/MF 可改善肺功能,减少哮喘加重,与 IND/MF 和 SAL/FLU 相比,提供了相当的哮喘控制效果。该分析的结果与 IRIDIUM 研究的总体人群一致。