A randomized trial of symptom-based management in Japanese patients with COPD
Received 27 September 2017
Accepted for publication 28 June 2018
Published 13 August 2018 Volume 2018:13 Pages 2409—2423
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Tomoko Betsuyaku,1 Motokazu Kato,2 Keisaku Fujimoto,3 Akihiro Kobayashi,4 Tomoyuki Hayamizu,4 Hideki Hitosugi,4 Gerald Hagan,5 Mark H James,6 Paul W Jones6
1Division of Pulmonary Medicine, Department of Medicine, Keio University, Tokyo, Japan; 2Chest Disease Clinical and Research Institute, Kishiwada City Hospital, Kishiwada, Japan; 3Department of Clinical Laboratory Sciences, Shinshu University, Matsumoto, Japan; 4GSK K.K., MA, Respiratory, Tokyo, Japan; 5Respiratory Science Consultant, Marbella, Spain; 6GSK, Respiratory Franchise Medical, GSK House, Brentford, Middlesex, UK
Background: The Global initiative for chronic Obstructive Lung Disease strategy document for COPD recommends treatment changes according to the persistence of symptoms or exacerbations. This study assessed the feasibility and outcomes of a structured step-up/step-down treatment approach in a randomized controlled clinical trial setting.
Methods: Japanese patients with moderate-to-severe COPD were randomized to blinded, double-dummy treatment with twice-daily fluticasone propionate/salmeterol (FP/SAL) 250/50 µg or once-daily tiotropium bromide (TIO) 18 µg for 24 weeks (dual bronchodilator was not available). At 4-weekly intervals, patients remaining symptomatic (COPD Assessment Test score >10) or experiencing an exacerbation were offered the option to use triple therapy. Primary endpoint was the proportion of patients remaining on randomized therapy.
Results: In total, 406 patients participated (mean FEV1 59%±13% predicted; COPD Assessment Test 12±6). Of these, 204 and 201 patients were included in the FP/SAL and TIO groups, respectively, of whom 67% and 63% continued treatment throughout the study; this difference was not statistically significant. Time to first therapy switch was longer with FP/SAL, but not significantly (P=0.21). More patients in Global initiative for chronic Obstructive Lung Disease (2011 criteria) groups C/D switched (FP/SAL 55%, TIO 63%) than in groups A/B (FP/SAL 27%, TIO 27%).
Conclusion: Given the choice, patients with more symptoms or those experiencing an exacerbation will agree to step-up therapy. Effectiveness of disease management pathways can be tested using double-blind studies.
Keywords: COPD management, fluticasone propionate/salmeterol, tiotropium
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