慢性阻塞性肺疾病（COPD）现实生活中的三联疗法：使用单一吸入器还是多个吸入器更好？

Triple Therapy in COPD in Real Life: Is It Better to Use Single or Multiple Inhalers?

作者信息

Sposato Bruno, Ricci Alberto, Lacerenza Leonardo Gianluca, Petrucci Elisa, Cresti Alberto, Baratta Pasquale, Perrella Antonio, Serafini Andrea, Scalese Marco

机构信息

Pneumology Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, 58100 Grosseto, Italy.

Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, 00189 Rome, Italy.

出版信息

J Clin Med. 2024 Oct 17;13(20):6191. doi: 10.3390/jcm13206191.

Today, single-inhaler ICS/LAMA/LABA (SITT) COPD therapies are available. It is unclear whether they are more effective than multiple-device triple therapies (MITT) in improving COPD outcomes. : We retrospectively considered patients on SITT/MITT in 2019/2020 who were prescribed >7 packages of ICS/LABA/LAMA or ICS/LAMA (+LAMA). The two treatments were compared concerning systemic corticosteroids, antibiotics, salbutamol, antifungal prescriptions, and number of emergency room visits/hospitalizations (ERV/Hs). We studied 292 MITT patients (Group A) during 2019, switching to SITT in 2020, and 366 subjects (Group B) who took SITT during 2019, and 206 MITT individuals (Group C) in 2020. ICS/LABA + LAMA (MITT) package use was 8.2 ± 4.2 and 7.85 ± 4 in 2019, switching to 11.2 ± 3.2 when patients shifted to SITT in 2020 ( = 0.0001). Group A MITT package use was lower than in SITT patients in 2019 (9.31 ± 2.71, = 0.0001; Group B). Throughout 2020, Group C (10.3 ± 6.1 packs) adherence to ICS/LABA was similar to SITT adherence in Group A ( = 0.270), whereas LAMA package use (9.1 ± 5) was lower ( = 0.0038). Patients using systemic corticosteroids/antibiotics were fewer in SITT in 2020, compared to the MITT results in 2019. Subjects with fewer ERV/Hs were observed with SITT rather than with MITT. Particularly, 13.8% of patients needed ≥2 ERV/Hs when treated with SITT, whereas 19.2% needed ≥2 ERV/Hs with MITT in 2019 ( = 0.08). Multivariate analysis, adjusted for all confounding factors including treatment adherence, showed that MITT (vs. SITT) can have an increased risk of at least one ERV/H (subjects receiving MITT during 2019 passing to SITT in 2020, OR: 1.718 [1.010-2.924], = 0.046; Group A/MITT/2019 vs. Group B/SITT/2019, OR: 1.650 [0.973-3.153], = 0.056; Group C/MITT/2020 vs. Group B/SITT/2019, OR: 1.908 [1.018-3.577], = 0.044). SITT therapy may promote treatment adherence more effectively, therefore, reducing COPD exacerbations better than MITT. A possible synergistic effect of ICS/LABA/LAMA intake with a single device might be another cause of SITT's greater efficacy.

如今，单吸入器ICS/LAMA/LABA（SITT）慢性阻塞性肺疾病（COPD）治疗方案已经问世。目前尚不清楚在改善COPD治疗效果方面，它们是否比多装置三联疗法（MITT）更有效。我们回顾性研究了2019/2020年接受SITT/MITT治疗的患者，这些患者被开具了超过7包ICS/LABA/LAMA或ICS/LAMA（+LAMA）。比较了两种治疗方案在全身用糖皮质激素、抗生素、沙丁胺醇、抗真菌药物处方以及急诊就诊/住院次数（ERV/Hs）方面的差异。我们研究了292例2019年接受MITT治疗（A组）、2020年转为接受SITT治疗的患者，366例2019年接受SITT治疗的患者（B组），以及206例2020年接受MITT治疗的患者（C组）。2019年，ICS/LABA + LAMA（MITT）的用药包数为8.2±4.2和7.85±4，当患者在2020年转为接受SITT治疗时，用药包数变为11.2±3.2（P = 0.0001）。A组2019年MITT的用药包数低于2019年接受SITT治疗的患者（9.31±2.71，P = 0.0001；B组）。在整个2020年，C组（10.3±6.1包）对ICS/LABA的依从性与A组SITT的依从性相似（P = 0.270），而LAMA的用药包数（9.1±5）较低（P = 0.0038）。与2019年MITT的结果相比，2020年接受SITT治疗的患者使用全身用糖皮质激素/抗生素的人数更少。接受SITT治疗的患者急诊就诊/住院次数较少，而非接受MITT治疗的患者。特别是，13.8%接受SITT治疗的患者需要≥2次急诊就诊/住院，而2019年接受MITT治疗的患者中有19.2%需要≥2次急诊就诊/住院（P = 0.08）。多因素分析对包括治疗依从性在内的所有混杂因素进行了校正，结果显示MITT（与SITT相比）至少有一次急诊就诊/住院的风险可能增加（2019年接受MITT治疗、2020年转为接受SITT治疗的患者，OR：1.718 [1.010 - 2.924]，P = 0.046；A组/MITT/2019年与B组/SITT/2019年相比，OR：1.650 [0.973 - 3.153]，P = 0.056；C组/MITT/2020年与B组/SITT/2019年相比，OR：1.908 [1.018 - 3.577]，P = 0.044）。因此，SITT治疗可能更有效地促进治疗依从性，从而比MITT更好地减少COPD急性加重。使用单一装置吸入ICS/LABA/LAMA可能产生的协同效应可能是SITT疗效更佳的另一个原因。