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Terapia triple con un solo inhalador extrafino versus terapia con antagonistas muscarínicos de acción prolongada para

Jørgen Vestbo¹, Alberto Papi², Massimo Corradi³

¹Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; University Hospital South Manchester NHS Foundation Trust, Manchester, UK; Medicines Evaluation Unit, Manchester, UK.

Lancet (London, England)

|April 8, 2017

Resumen

La terapia triple fija, que combina corticosteroides inhalados y dos broncodilatadores de acción prolongada, redujo las exacerbaciones en pacientes con EPOC en comparación con el tiotropio. Este tratamiento también mejoró la función pulmonar, ofreciendo beneficios clínicos para la enfermedad pulmonar obstructiva crónica sintomática.

Área de la Ciencia:

Pulmonología
Medicina de las vías respiratorias
Ensayos clínicos

Sus antecedentes:

Existen datos limitados sobre la eficacia de la terapia triple en la EPOC.
Este estudio comparó la terapia triple fija (dipropionato de beclometasona, fumarato de formoterol, bromuro de glicopirrónio) con el tiotropio y la terapia triple abierta.

Objetivo del estudio:

Comparar la eficacia de la terapia triple fija frente al tiotropio y la terapia triple abierta en pacientes con EPOC.
Evaluar el impacto en las exacerbaciones de moderadas a severas y en la función pulmonar (FEV1).

Principales métodos:

Un ensayo controlado aleatorizado doble ciego en el que participaron 2691 pacientes con EPOC.
Los pacientes presentaron FEV1 < 50%, al menos una exacerbación en 12 meses y una puntuación CAT >= 10.
Los tratamientos incluyeron triple fijo, tiotropium o triple abierto durante 52 semanas.

Principales resultados:

La terapia triple fija mostró tasas de exacerbación de moderadas a severas significativamente más bajas que el tiotropium (0,46 frente a 0,57).
El tratamiento triple fijo mejoró el FEV1 previo a la dosis a las 52 semanas en comparación con el tiotropium.
El tratamiento triple fijo no fue inferior al tratamiento triple abierto en la mejora de la FEV1.

Conclusiones:

La terapia triple fija con Extrafine demostró beneficios clínicos sobre el tiotropium en pacientes sintomáticos con EPOC con bajo FEV1 y antecedentes de exacerbación.
El estudio TRINITY proporciona evidencia que apoya la terapia triple fija para el tratamiento de poblaciones específicas de pacientes con EPOC.

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