Early versus late escalation to extrafine BDP/FF/GB single-inhaler triple therapy in COPD: a real-world subgroup analysis by disease duration since diagnosis.

BACKGROUND: The optimal timing for escalation to triple therapy in chronic obstructive pulmonary disease (COPD) remains undefined, often resulting in delayed treatment. Consequently, evidence on the effectiveness of early initiation is limited.

METHODS: This subgroup analysis used pooled patient-level data from six observational studies to evaluate the real-world effectiveness of beclomethasone dipropionate/formoterol fumarate/glycopyrronium bromide single-inhaler triple therapy (SITT) in COPD according to disease duration. Patients were stratified into three subgroups: ≤48 months (short), 49-96 months (intermediate), and ≥97 months (long-standing). Outcomes assessed at 3, 6, and 12 months post-SITT initiation included mean number of exacerbations, proportion of patients experiencing ≥1 exacerbation, and proportion achieving disease stability and control.

RESULTS: Mean number of exacerbations decreased from the year prior to SITT initiation at all post-treatment time points across all subgroups, with the largest reductions observed in short disease patients, particularly at 12 months. Similarly, the proportion of patients experiencing ≥1 exacerbation decreased in all subgroups, with the lowest proportions observed in short disease patients. No differences between subgroups were observed at 3 and 6 months in the proportion of patients achieving disease stability and control; conversely, at 12 months the short disease subgroup showed significantly higher rates of disease stability and control compared with longer disease duration subgroups, suggesting that earlier SITT initiation may provide more sustained benefits.

CONCLUSION: Early escalation to SITT in COPD may result in more durable sustained clinical benefits compared with later intervention, reducing exacerbations and maintaining disease stability and control up to 12 months.