Implicaciones clínicas del uso de la triple terapia en combinación de dosis fija en EPOC: del ensayo al paciente / The Clinical Implications of Triple Therapy in Fixed-Dose Combination in COPD: From the Trial to the Patient

La aparición de la denominada triple terapia inhalada mediante la combinación de un agonista ß2 de acción prolongada (LABA), un anticolinérgico de acción prolongada (LAMA) y un corticoide inhalado (ICS) en una combinación a dosis fijas (CDF) en un solo dispositivo de inhalación ha supuesto un cambio en el uso de este tratamiento. A pesar de que los ensayos clínicos nos aportan una idea de la eficacia y la seguridad de estas CDF, su aplicación a la clínica diaria puede presentar retos para el clínico sobre dos escenarios concretos. En pacientes que ya están recibiendo una triple terapia en dispositivos distintos el cambio a una CDF podría suponer beneficios en cuanto a disminución de errores críticos en el manejo de los inhaladores, mayor adherencia al tratamiento y menor coste, manteniendo la misma eficacia clínica. En pacientes que no están recibiendo una triple terapia en dispositivos distintos y que necesiten un cambio en el tratamiento, la CDF de triple terapia presenta beneficios mostrados en los ensayos clínicos. Aunque las diferencias metodológicas entre ensayos desaconsejan comparaciones directas, los resultados clínicos muestran una buena eficacia, pero también una considerable variabilidad y un número de resultados clínicos aún por explorar. En el futuro deberán desarrollarse ensayos que completen los datos de eficacia clínica, estudios en vida real que informen de su efectividad y trabajos encaminados a descubrir el perfil de paciente que presenta una mayor respuesta terapéutica a cada CDF, con el objeto de avanzar en el tratamiento personalizado

The emergence of a fixed-dose combination (FDC) of a long-acting ß2-agonists (LABAS), a long-acting anticholinergic agent (LAMA), and an inhaled corticosteroid (ICS) in a single inhalation device has changed the approach to inhaled therapy. Although clinical trials describe the efficacy and safety of these FDCs, their use in daily clinical practice can present challenges for the clinician in two specific scenarios. In patients who are already receiving triple therapy via different devices, switching to FDCs could confer benefits by reducing critical errors in the management of inhalers, improving therapeutic adherence, and lowering costs, while maintaining the same clinical efficacy. In patients who are not receiving triple therapy in different devices and who require a change in treatment, triple therapy FDC has shown benefits in clinical trials. Although methodological differences among the trials advise against direct comparison, clinical results show good efficacy, but also considerable variability, and a number of clinical outcomes have yet to be explored. In the future, trials must be developed to complete clinical efficacy data. Real-world efficacy trials are needed, and studies must be designed to determine the profile of patients who present a greater therapeutic response to each FDC in order to pave to way towards more personalized treatment

The clinical implications of triple therapy in fixed-dose combination in COPD: from the trial to the patient.

The emergence of a fixed-dose combination (FDC) of a long-acting ß2-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled corticosteroid (ICS) in a single inhalation device has changed the approach to inhaled therapy. Although clinical trials describe the efficacy and safety of these FDCs, their use in daily clinical practice can present challenges for the clinician in two specific scenarios. In patients who are already receiving triple therapy via different devices, switching to FDCs could confer benefits by reducing critical errors in the management of inhalers, improving therapeutic adherence, and lowering costs, while maintaining the same clinical efficacy. In patients who are not receiving triple therapy in different devices and who require a change in treatment, triple therapy FDC has shown benefits in clinical trials. Although methodological differences among the trials advise against direct comparison, clinical results show good efficacy, but also considerable variability, and a number of clinical outcomes have yet to be explored. In the future, trials must be developed to complete clinical efficacy data. Real-world efficacy trials are needed, and studies must be designed to determine the profile of patients who present a greater therapeutic response to each FDC in order to pave the way towards more personalized treatment.