Getting patients with COPD to adhere to their medications has long been a challenge for clinicians everywhere. A recent study suggests that nonadherence could be more dangerous than previously thought.
Results from the study, “Disproportionate Increase in COPD Exacerbation Risk for Three Months After Discontinuing LAMA or ICS: Insights From the FLAME Trial,” were published in Thorax.
The researchers performed a post hoc analysis of the 52-week, double-blind Effect of Indacaterol Glycopyrronium Versus Fluticasone Salmeterol on COPD Exacerbations trial. The earlier trial compared combined treatment with a long-acting beta-2 antagonist (LABA) and a long-acting muscarinic antagonist (LAMA) with LABA and inhaled corticosteroids (ICS).
Potential withdrawal effects for continuing either LAMA or ICS were suggested by monthly exacerbation incidence plots during the first quarter of follow-up. Outcomes were compared between the first and subsequent quarters for those who continued versus discontinued each treatment.
The researchers found that discontinuing LAMA was associated with a marked, transient increase in moderate-to-severe exacerbations during the first quarter compared to subsequent quarters. Due to the low number of severe exacerbations, the researchers were unable to confirm the same observation in those cases. However, the ICS withdrawal effects were consistent regardless of baseline blood eosinophil count.
The authors concluded that there are “potent LAMA and ISC treatment withdrawal effects on exacerbations, highlighting the importance of treatment adherence and accounting for withdrawal effects in clinical trials.”
